Who Chooses? American Reproductive History since 1830

Citation preview

M . C«roiA/

J fh o Chooses

Who Chooses?

U N IV E R S IT Y P R E SS OF F LO R ID A

Florida A &M University, Tallahassee Florida Atlantic University, Boca Raton Florida Gulf Coast University, Ft. Myers Florida International University, Miami Florida State University, Tallahassee New College of Florida, Sarasota University of Central Florida, Orlando University of Florida, Gainesville University of North Florida, Jacksonville University of South Florida, Tampa University of West Florida, Pensacola

Who Chooses? American Reproductive History since 1830

Simone M. Caron

U n iv e r s it y P r e s s o f F lo r id a G a in e s v ille / T a lla h a s s e e / T a m p a / B o c a R a to n P e n s a c o la / O r la n d o / M ia m i/ Ja c k s o n v ille / F t . M y e r s / S a r a s o t a

Copyright 2008 by Simone M. Caron Printed in the United States of America on recycled, acid-free paper All rights reserved 12

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Library of Congress Cataloging-in-Publication Data Caron, Simone M. Who chooses? : American reproductive history since 1830 / Simone M. Caron. p. cm. Includes bibliographical references and index. ISBN 978-0-8130-3199-6 (alk. paper); ISBN 978-0-8130-3922-0 (e-book) 1. Contraception—United States—History—19th century. 2. Contraception—Gov­ ernment policy—United States—History—19th century. 3. Birth control—United States—History—19th century. 4. Birth control—Government policy—United States—History—19th century. 5. Abortion—United States—History—19th cen­ tury. 6. Abortion—Government policy—United States—History—19th century. 7. Human reproduction—Government policy—United States—History—19th century. I. Title. HQ766.5.U5C37 2008 363.4609739-dc22 2007038091 The University Press of Florida is the scholarly publishing agency for the State University System of Florida, comprising Florida A&M University, Florida Atlantic University, Florida Gulf Coast University, Florida International University, Florida State University, New College of Florida, University of Central Florida, University of Florida, University of North Florida, University of South Florida, and University of West Florida. University Press of Florida 15 Northwest 15th Street Gainesville, FL 32611-2079 www.upf.com

To my children, Quaid and Alden, for bringing joy and purpose to my life. In memory of my father Leo O. Caron Jr. 1936-2007

Contents

List of Tables ix Abbreviations xi Preface xiii Acknowledgments xv 1. A Brief Overview of American Reproductive History 1 2. Abortion and Contraception in the Nineteenth Century 14 3. Race Suicide, Eugenics, and Contraception, 1900-1930 44 4. Population Control and the Great Depression, 1930-1939 81 5. World War II, the Baby Boom, and the Population Explosion, 1939-1963 119 6. Who Pays? Contraceptive Services and the Welfare State, 1963-1975 149 7. Who Pays for What? Abortion and Sterilization, 1960-1975 187 8. Backlash, 1973-2000 221 9. Conclusion 251 Appendix A. Henry Miller, “Letter to the President and Councilors of the State Medical Society" 1860 257 Appendix B. Henry Miller, “Memorial to the Governor and Legislature of the State of Rhode Island" 1860 259 Appendix C. Recommended State Statute by Horatio R. Storer 261 Appendix D. 1861 Rhode Island Abortion Statute 263 Appendix E. 1867 Rhode Island Abortion Statute 265 Notes 267 Bibliography 323 Index 357

Tables

Table 4.1. Ethnicity of RIBCL Clients and State Residents 102 Table 4.2. Referral of Women to RIBCL, 1935-1939 104 Table 6.1. Estimated Number of Illegitimate Births and Illegitimacy Ratios, United States, 1920-1968 159 Table 6.2. Percent Pregnant, 1968, by Age and Race 161 Table 6.3. Legitimate, Illegitimate, and Total Out-of-Wedlock Conceived Birthrates per 1,000 Unmarried Women by Color and Age, U.S. 1964- 1966 Annual Average 162 Table 7.1. Percent of Wives Who Approve Different Reasons for Abortion, 19 6 5- 1970 191 Table 7.2. Characteristics of Women Having Abortions, New York City, 1970-1971 196

Abbreviations

ABA ABCL ACLU ACOG ADC AFDC AID ALI AMA ANA ARAL ASCA AVS BAL BCCRB BCFA BSH BVCAP CAP CMH

American Breeders Association American Birth Control League American Civil Liberties Union American College of Obstetricians and Gynecologists Aid to Dependent Children Aid for Families with Dependent Children Agency for International Development American Law Institute American Medical Association American Neurological Association Association for the Repeal of Abortion Laws Anglo Saxon Clubs of America Association for Voluntary Sterilization Black Americans for Life Birth Control Clinical Research Bureau Birth Control Federation of America Bureau of Social Hygiene Blackstone Valley Community Action Program Community Action Pittsburgh Committee on Maternal Health

CMJ&R

Charleston Medical Journal & Review

CORE DHEW DNS DP FDA FSA HBF ICMCA IHS MBL MSRB NAAC NAACP

Congress of Racial Equality Department of Health, Education and Welfare Division of Negro Service Depo Provera United States Food and Drug Administration Farm Security Administration Human Betterment Foundation Illinois Citizens for the Medical Control of Abortion Indian Health Service Massachusetts Blacks for Life Margaret Sanger Research Bureau National Abortion Action Committee National Association for the Advancement of Colored People

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Abbreviations

NARAL NBWHP NCFL NIH NOW NWHN NWPC NWSA NYCCSA OEO PPCP PPFA PPRI RIBCL RIMHA RIMS SCMS TFR ULRI VPL WAC WHO

National Abortion Rights Action League National Black Women’s Health Project National Committee on Federal Legislation National Institutes of Health National Organization for Women National Women’s Health Network National Women’s Political Caucus National Women’s Suffrage Association New York Clergy Consultation Service on Abortion Office of Economic Opportunity Planned Parenthood Center of Pittsburgh Planned Parenthood Federation of America Planned Parenthood of Rhode Island Rhode Island Birth Control League Rhode Island Maternal Health Association Rhode Island Medical Society South Carolina Medical Society total fertility rate Urban League of Rhode Island Voluntary Parenthood League Women’s Army Corps World Health Organization

Preface

The intent of this book is to analyze national policies on reproductive issues and their connection to population concerns since the nineteenth century. An inherent conflict has existed between a population-control agenda that permeated the national discourse on sexual politics and individuals’ desires to be in command of their reproduction. Elite white officials, influenced by genetic and eugenic theories as well as by race, class, and gender biases, used abortion, birth control, and sterilization to control the fertility of the indi­ gent, many of whom were women of color. In sum, political, moral, and eco­ nomic forces shaped reproductive policies that impacted women’s ability to choose how to control their bodies. This book contributes to understanding reproductive history by synthe­ sizing secondary material that treats abortion, birth control, and steriliza­ tion as separate entities and placing these three areas of reproductive control into a cohesive framework. As such, this work is intended to suit the needs of undergraduate and graduate students while also being accessible to the public. Over the past two centuries, restrictive reproductive policies have served as barriers to women’s equality. The impact of these policies has been felt most poignantly at the local level by women endeavoring to control their daily lives. This work examines the national context while simultaneously analyzing developments at the state and local level, with particular attention to Rhode Island. This microanalysis demonstrates that the national consen­ sus on sexual politics had variants at the state level. Rhode Island restricted abortion yet was one of only two states to exempt women from prosecution. When most states adopted laws modeled on Comstock and eugenic steriliza­ tion legislation, Rhode Island did not. It allowed the only birth control clinic in New England to operate from 1931 to 1965. While immigrant or female doctors worked at many freestanding clinics, “respectable” white male phy­ sicians staffed the Rhode Island clinic. The clinic prioritized clients’ health and choices rather than following population control advocates, including Planned Parenthood Federation of America.

Acknowledgments

This book would not have been possible without the help of many people along the way. David Culver mesmerized me during my undergraduate years with his ability to bring history to life in his classroom. I strive to emulate his example in my own classes today. David also supported my dream of attend­ ing graduate school; I will always be grateful for his friendship and support over the years. In graduate school Ballard Campbell insisted that I write in concise, jargon-free prose; appreciative of the results, I now insist on the same for my own students. Paul Ropp helped me negotiate the politics of academia. Ronald Formisano has been a mentor and a friend. I am grateful to Allan Brandt for his insights and willingness to read drafts of this work. I thank Sarah Bradford Campbell and David Epperson for sharing their in­ sights in interviews with me. This book has been read by many people. Sections of it have been com­ mented on at conferences and seminars. I appreciate the thoughtful con­ tributions from Gail Bederman, MariJo Buhle, Janet Golden, Ellen Good­ man, Michael Hughes, Ester Katz, Carol McCann, James Patterson, Johanna Schoen, and Lauri Umansky. For medical advice I thank Dr. Gregory Cherr. Julie Edelson read the entire manuscript and helped me cut it to a more man­ ageable size. Michael Sinclair’s assistance with computer technology was in­ dispensable; I owe him enormous gratitude for helping me whenever I called upon him. I have also benefited from comments by participants in the Social Science Research Seminar at Wake Forest University, in particular Michael Lawlor and Ian Taplin. I thank them not only for their critiques but also for the intellectual atmosphere they help perpetuate on campus. Funding and librarians make research possible. I thank the Griffin Fund in the History Department of Wake Forest University for financing research trips to the archives. The librarians at the Z. Smith Reynolds Library at WFU are the most supportive colleagues one could hope to encounter. Rick Statler at the Rhode Island Historical Society has been a great asset to my research projects, and I thank him for his sense of professionalism and his great ef­ ficiency. I must also thank Planned Parenthood of Rhode Island for allowing me to conduct research on-site at their facility, where the records of the or­ ganization have been kept since its opening in the 1930s. Spending countless days there made me realize the stress the staff must experience, from crossing

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picket lines to listening for ticking bombs. To these staff members and others similar to them women across the country owe a debt of gratitude that can never be repaid. Personally, I have many people to thank. My parents, Leo and Eva Caron, taught me the value of hard work. My sister, Therese Caron, and brother, Robert Caron, have supported my academic pursuits from day one. Mike, Jan, Emma, and Moria Lawlor have been our substitute family in WinstonSalem, North Carolina. My son, Quaid, and daughter, Alden, have been the pride and joy of my life. Their laughter and tears have kept me going, and their soccer games and swim meets have given me needed time away from the manuscript. Finally, my husband, Christopher O’Neill, has provided editorial comments, love and emotional support, and gourmet meals these many years.

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A Brief Overview of American Reproductive History

A m e rican s have struggled to define th e g o v e rn m en t’s relatio n sh ip to th e ir private lives, and few co n tests have b e e n m o re ra n co ro u s th a n g ov ern m en t attem p ts to co n tro l sexuality. The pu blic realm p asses rep ro d u ctiv e legisla­ tio n , bu t th e se laws a ffe ct th e m o st in tim ate and private a sp e cts o f citiz e n s’ lives.1 In Buck v. Bell 2 7 4 U.S. 2 0 0 (1 9 2 7 ), fo r exam ple, S u p rem e C o u rt Ju stice O liver W en d ell H olm es upheld a 1 9 2 4 V irginia state law th a t allow ed state officials to sterilize th e “u n fit”; th e law w as p rim arily a cost-savin g m easu re in th e face o f rapid co n g estio n at state in stitu tio n s fo r th e “feeblem ind ed .” C arrie B u ck , th e d aughter o f a supposed “feeb lem in d ed ” single m other, gave b irth out o f w ed lock to a d aughter d eem ed an “im b e c ile ” Dr. A lb ert Priddy, su p erin ten d en t o f th e V irginia C olon y for th e E p ilep tic and F eeblem ind ed , ch aracte rized th e B u ck s as belon g in g “to th e shiftless, ig n o ran t, and w o rth ­ less class o f a n ti-s o c ia l w h ites o f th e S o u th ” H olm es agreed, arguing th a t th e p re ce d e n t set in co m p u lsory v a ccin a tio n w as “bro ad enou gh to cover cu ttin g th e Fallopian tu bes.” In his now in fam o u s co n clu sio n H o lm es d eclared th a t “th re e g en eratio n s o f im b ecile s are enough.” W h a t th e state and th e C ou rt failed to u n co v er w as th a t C a rrie B u c k ’s m o th e r w as n o t “feeb lem in d ed ”; h e r adoptive fam ily had in stitu tio n alized h e r ag ainst h e r w ill a fter th e fa m ­ ily’s n ep h ew raped her. C a rrie also w as n o t a n “im b e c ile ”; she had earn ed a sp o t o n h e r sc h o o l’s h o n o r roll. This tragedy, fo r w h ich V irg in ia g ov ern o r M a rk W ag n e r apolog ized in 2 0 0 3 , h appened as a resu lt o f th e sta te’s pow er to en fo rce legally eu gen ic d esires to , as H o lm es stated , “p rev en t our b ein g sw am ped w ith in c o m p e te n c e ”2 This b o o k exam in es p o licy ch an g es co n c ern in g rep ro d u ctiv e righ ts. P ol­ icy tran sfo rm atio n s have resu lted in p art fro m a n x ieties over h ig h b irth ra tes am o n g w o m en d eem ed u nd esirable by th e w hite elite esta b lish m en t, in clu d ­ ing, during th e n in e te e n th centu ry, ce rta in groups o f im m ig ran ts (nam ely, th e Irish , so u th ea stern E u rop ean s, and A sians) and, during th e tw e n tieth centu ry, n o n n o rth w e ste rn E u rop ea n im m ig ra n ts as w ell as th e poor, th e u n ed u cated , racia l m in o rities, th e “u n fit” (a te rm used to d en o te th e m e n ­ tally o r physically hand icap p ed ), and sexual “deviants,” su ch as C a rrie B u ck and h e r m other. S ta te m en ts d eem in g th e high fertility am o n g th e se groups a

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“threat” to the “racial purity” and intelligence level of the country dominated the national discourse on the “problem of population.” By the 1960s popula­ tion controllers—advocates of policies to control the socioeconomic and/or racial composition of the population—and fiscal conservatives blamed these groups for burgeoning welfare expenditures. Population concerns, therefore, governed national discussions of reproductive policy. In local communities many women ignored or were unaware of the invidious arguments employed by population controllers to shape policy. Whether reproductive policies became more restrictive or more lenient, many women consistently sought means—legal or illegal—to control their fertility and therefore their lives, and they received help in their endeavors from some sympathetic health officials, clergy, and feminists.3 This book examines the reproductive choices available to individuals since the mid-nineteenth century. It seeks to determine who chooses for whom and on what grounds. It traces the emergence of contraception and abortion as social, medical, and legal issues in the nineteenth century to the contem­ porary policy of publicly supported fertility control. The driving force for legislation dealing with abortion, contraception, and sterilization was the high fertility rate among the “wrong” type of people, but the agenda of popu­ lation controllers did not represent reality for most Americans. The history of reproductive control is a complex tale reflecting the interests of two dis­ tinct factions: those pushing to control the reproductive capacity of others and those determined to control their own reproductive choices. The former have attempted to control the choices available to women, presuming the latter cannot intelligently and rationally choose for themselves. This book is unique in that it examines the three main fields of reproduc­ tion over a period of nearly two hundred years. Many historians analyze ei­ ther abortion, contraception, or sterilization in a focused study of one aspect of fertility control. This book synthesizes these topically and temporally fo­ cused secondary works to provide a broad overview of national trends in pol­ icy developments and the impact they have had on people’s private choices. While variations in federal and state laws existed in the nineteenth century, a national consensus did emerge to control women’s abilities to procreate. The twentieth century witnessed a liberalization of policies, but these changes were not a reaction or response to organized feminist demands for reproduc­ tive control. Legislators did not care at all what women wanted—that is, con­ trol over their bodies. Instead, public expenditures dominated the discourse that shaped policies in a way that wrested control of reproductive matters from indigent women and placed it in the hands of white elites concerned with the composition of the population.

A Brief Overview of American Reproductive History

Historical Overview

From the colonial period through the early nineteenth century control of reproduction, similar to other family matters, remained a private concern. Legislators did not obstruct the use or dispersal of contraceptives.4 The ma­ jority of Americans did not consider abortion legally or morally wrong as long as it occurred before quickening, the mother’s first perception of fetal movement. In 1873, however, the Comstock Law forbade the importation, mailing, and interstate transportation of articles and literature concerning both contraception and abortion. By the end of the century every state in the Union except Kentucky had outlawed abortion.5 What brought about this change in policy? While many factors played a role, nativism constituted the most publicly employed justification for the repressive changes in reproductive policies during the nineteenth century. Earlier, Thomas Jefferson had expressed such fears: “The circumstances of superior beauty is thought worthy of attention in the propagation of our horses, dogs, and other domestic animals; why not in that of man?” He con­ tended that children born of mixed-race unions produced “a degradation to which no lover of this country, no lover of excellence in the human character can innocently consent” The fate of the white race in his home state of Vir­ ginia weighed heavily on his mind: “Under the mild treatment our slaves ex­ perience, and their wholesome, though coarse, food, this blot in our country increases as fast, or faster, than whites”6 Racial concerns mounted as the fertility rate of white American women steadily declined in the late eighteenth century and plummeted between 1830 and 1870, the same period during which immigrants began to flood the United States. These anxieties continued in the early twentieth century as many population controllers agonized over the disparity between the fer­ tility of the “best”—defined as wealthy, educated, white Protestants—and the “inferior”—variously defined as poor, uneducated, immigrant, Catholic, Jewish, mentally or physically impaired, sexually deviant, or criminal. Race suicide theorists espoused racial doom propaganda to convince the “best” that their incessant use of contraceptives would eventually lead to their ex­ tinction. When these arguments failed to alter the reproductive patterns of the elite, tactics changed during the 1910s and 1920s. Rather than ban birth control (a term first used in 1914 by Otto Bobsein) to coerce the “best,” these theorists attempted to liberalize legislation to make contraceptives available to the “inferior”7 By this point, birth control and abortion became two distinct issues. While few called for the relegalization of abortion, a vocal movement for the liberalization of contraceptive restrictions was well under way. The notion

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of population control gained increased public support during the economic devastation of the Great Depression. Reports concerning the high fertility rates of families on government relief helped ignite widespread indignation against “dole babies" Such propaganda fueled a push for contraceptive dis­ persal among the poor through welfare organizations. During World War II the national discourse shifted to view contraception as a means to utilize most effectively man- and womanpower. The military’s campaign to rid its ranks of debilitating venereal diseases promoted the use of condoms. The war years saw contraceptives touted for their contribution to soldiers’ fitness, national health, and women’s ability to undertake war work. The conclusion of the war brought a baby boom that affected women of all races and socioeconomic classes. The first significant increase in white middle-class fertility rates during the late 1940s and 1950s allayed the anxi­ eties of many population controllers on the domestic scene, but they soon turned their attention to the “population explosion” in the Third World. Not until the 1960s did the issue of reproductive policy again become significant in domestic policy discussions. Liberalizing Contraception

By the 1960s the judicial system had handed down a number of decisions that had gradually loosened restrictions on contraceptives. Two cases in the appellate courts abrogated many federal limitations. Bours v. United States, 229 F. 950 (7th Cir. 1915) and United States v. One Package, 85 F. 2d 737 (2d Cir. 1935) exempted physicians from the contraceptive restrictions of the Comstock Law. The first successful challenge to a state statute came with Griswold v. Connecticut, 381 U.S. 471 (1965). The Supreme Court declared unconstitutional a Connecticut statute that made the use of contraceptives by both married and single persons a criminal offense. For the first time the Court identified a “zone of privacy” guaranteed by the Constitution: the First Amendment ensures the right of association, while the Fourth Amendment affirms citizens’ immunity from unreasonable search and seizure in their homes. Since this case the Court has interpreted the “zone of privacy” as a Fourteenth Amendment right under the equal protection clause. Although Griswold invalidated an outdated law that regulated sexual morality, the Su­ preme Court supported contraceptive aids for married women only. Seven years later Eisenstadt v. Baird , 405 U.S. 440 (1972), declared unconstitutional a statute that imposed a five-year jail term for distributing contraceptives. In­ voking the equal protection clause of the Fourteenth Amendment, the Court found no reason to restrict contraceptive privileges to married women: “If the right of privacy means anything, it is the right of the individual, married

A Brief Overview of American Reproductive History

or single, to b e free fro m u nw arranted g ov ern m en tal in tru sio n in to m atters so fu n d am en tally affectin g a p e rso n as th e d ecisio n w h eth er to b e a r or beg et a ch ild " This d ecisio n finally rem ov ed th e in stitu tio n a liz a tio n o f pu nitive sex stand ard s regard ing p rem a rita l in terco u rse. Sev eral fa cto rs led to th is tra n sfo rm a tio n in co n tra cep tiv e policy. In th e late n in e te e n th and early tw e n tieth cen tu ries m any so cia l a ctiv ists, religious groups, and physicians actively op p osed b irth c o n tro l b eca u se th e y believed it th reate n ed th e values and m orals o f society. O f th e se th re e groups, d o c­ to rs exerted th e m o st in flu en ce.8 D escrip tio n s o f available co n tracep tiv es ap­ peared in m e d ica l jo u rn a ls a fter 1 8 6 5 , y et m any d o ctors opp osed d ispersal fo r a n u m b er o f reason s: th e la ck o f g ov ern m en t reg u latio n led to d e fe c­ tive and in effectiv e p ro d u cts in m any in sta n ce s, and m an y d o cto rs re je c te d co n tracep tiv es fo r th e ir m o ra l im p licatio n s b eca u se th e y allow ed in terco u rse w ith o u t co n se q u e n ce s. B y th e 1 9 3 0 s th e A m e ric a n M e d ica l A sso c ia tio n (A M A , estab lish ed in 1 8 4 7 ) held a m o re co n serv ativ e view o f co n tra c e p ­ tio n th a n m o st m id d le-class A m e rica n s. As lay groups p ressured fo r change, th e m e d ica l p ro fessio n cau tiously en d o rsed co n tra cep tiv es b u t in sisted on a m o n o p o ly over delivery. M an y p o o r and w o rk in g -class w o m en could n o t afford a private d o c to r’s fees; th e se w o m en fou nd co n tra cep tiv e care on th e b la ck m ark et or a t freesta n d in g clin ics generally staffed by o u tca st p hy si­ cian s su ch as foreig n ers and w om en. Th ese d o cto rs ten d ed to apply stric te r stand ard s fo r d isp ersal th a n private phy sicians b e c a u se th e fo rm e r feared th e ir co lleagu es’ disapproval. B eca u se clin ics provided th e largest p e rce n t o f legal co n tracep tiv e care, w om en, esp ecially single w om en, co n tin u ed to face b arriers in th e ir attem p ts to p ro cu re co n tra ce p tiv es.9 Even afte r th e A M A en d orsed co n tracep tiv es in th e 1 9 3 0 s , acco rd in g to E lizab eth Sieg el W a tk in s, so m e d o cto rs m a in ta in e d th e ir o p p o sitio n , and o th e rs ex p erien ced “lin g erin g am b iv a le n ce” regard ing th e m e d ica l ro le o f co n trace p tio n . M o st d o cto rs, a cco rd in g to W a tk in s, “gained little by o ffer­ ing b irth co n tro l serv ices to th e ir p atients: th e w ork w as n o t fin an cially re ­ w arding, m ed ically ch allen gin g, or p ro fession ally acknow ledged.” W ith th e m ark etin g in 1 9 6 0 o f E n ovid -10, co m m o n ly know n as th e pill, d o cto rs b eg an to see co n tra ce p tio n as a leg itim ate m e d ica l serv ice b eca u se o f its p lace in p rescrip tiv e p harm acology. The pill, u nlike earlier fo rm s o f co n tra ce p tio n , w as lu crative for physicians: w o m en had to re tu rn fo r regu lar ch eck u p s and p re scrip tio n ren ew a ls.10 The d ev elop m en t o f th e pill alon g w ith th e 1 9 6 5

Griswold d ecisio n h elp ed brin g th e issue o f rep ro d u ctiv e rig h ts to th e pu blic eye. D u rin g th e 1 9 6 0 s th e fed eral g ov ern m en t finally p o sitio n ed its e lf beh in d th e lib eralizatio n o f rep rod u ctive legislation. D on ald T. C ritch lo w asserts th a t m u ch o f th is chang e w as th e resu lt o f th e “p o p u lation lo b b y ” th a t em erged

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in the 1950s to argue that contraceptives could help ameliorate “an array of social problems, including poverty, welfare, crime, urban decay, and pollu­ tion" This lobby shared racial, religious, and socioeconomic characteristics and had access to policy makers not only in Congress and the White House but at social clubs and private dinners. Interest groups were able to influence policy developments by the 1960s because most Americans accepted the no­ tion of family planning. The Catholic Church was another matter. No matter how much the church supported the social welfare programs of the Great Society and the War on Poverty, desired to be accepted in American society, endeavored to be seen as progressive rather than regressive, and realized that Protestant and Jewish leaders supported birth control, church leaders could not in good faith participate in federal programs that involved family plan­ ning because church policy deemed birth control immoral. American church leaders agreed not to oppose federal funding of birth control as long as all programs were voluntary and offered instruction in the rhythm method.11 The population lobby’s advocacy of subsidized family-planning services for the medically indigent gained support at the same time as national concern over poverty intensified. Many political and social critics favored the removal of contraceptive restrictions as a means to decrease the cost of Aid to Fami­ lies with Dependent Children and to curb the high fertility of the poor. Some promoted sterilization as a permanent solution to large families among welfare recipients. This proposal was not new to the 1960s. It had entered the public debate during the depressed 1930s. Many eugenicists promoted the sterilization of genetically “defective” dependents in publicly funded institutions. Periodicals reported mounting resentment against taxes spent on the mentally impaired, imbeciles, idiots, the insane, epileptics, and, in some states, criminals, drug addicts, and prostitutes and argued that only sterilization could save American society from the continued breeding of these “unfit.” The connection between sterilization and economics slackened but did not disappear when the Great Depression ended and when during World War II it was associated with Nazi Germany. By the 1960s the national debate over increasing government expenditures influenced federal and state decisions not only to legalize sterilization but also to fund it. This method of birth control became increasingly popular during the 1970s and constituted the single most used form of contraception by the end of the century. While sterilization was liberating for people who chose it on their own initiative, of­ ficials and physicians sometimes used it to control the reproduction of poor and minority women without their consent.

A Brief Overview of American Reproductive History

Abortion

Such manipulation occurred with abortion as well. The antiabortion crusade in the nineteenth century resulted in part from publicized vexation over the perceived imbalance in fertility rates between the “best” and “inferior” stock. Abortion among the middle and upper classes was supposedly to blame for the imminent downfall of the race. Banning abortion, crusaders argued, was one way to force the “best” women to fulfill their duty to the nation in bring­ ing forth “proper” children, that is, white, Protestant, and financially secure citizens. Other factors influenced this antiabortion campaign. By the mid-nine­ teenth century, doctors were attempting to monopolize the medical profes­ sion. As Faye D. Ginsburg argues, in order for this campaign to succeed, doctors had to redefine abortion from a common practice women learned from their mothers, other relatives, or midwives to a practice that under­ mined family stability.12 New state laws that permitted physicians to perform abortions only to preserve the health and/or life of the mother effectively allowed male doctors rather than women to control procreation. Because almost all medical schools excluded women, access to a legal abortion rested in the hands of male physicians who took the Hippocratic oath, which en­ joins against abortion. Moreover, state license requirements usually excluded quacks and “irregulars,” a term used to denote practitioners without formal training from a recognized medical school, from the lucrative abortion mar­ ket. Safety may have also influenced some antiabortion crusaders’ attitudes. Abortion, similar to other surgeries at that time, often endangered the health of the mother. Some irregulars and quacks performed abortions badly, often killing or seriously injuring patients.13 Scientific advancements by midcen­ tury undermined earlier notions of quickening, beginning a concern for fetal life that began at the moment of conception. Despite the organized move­ ment by physicians to regulate abortion, doctors were not a monolithic bloc. Some remained sympathetic to the plight of women facing unwanted preg­ nancies; some were more concerned with the life and health of the mother; and some were more interested in the life and health of the fetus. Physicians opposed to abortion carried the day. Doctors gained allies in their cause. Nicola Beisel argues that advocates of social purity supported banning abortion as part of a larger antivice move­ ment that “endangered elite children because moral corruption threatened to topple them from the peak of the social hierarchy, rendering them unfit for respectable society.” The shared resentment of immigrants by many doc­ tors and Social Purity advocates helped cement their alliance.14 Feminists also joined the effort to ban abortions. Doctors and feminists, according to

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Ginsburg, “each held the opposite sex responsible for what they saw as the decay of the culture and especially, in their view, the pernicious increase in abortion.”15 Together these groups succeeded in banning abortion and, in most states, the dispersal of birth control. Abortion, similar to gambling, prostitution, and drinking, did not disap­ pear when the state decreed it illegal. Women continued to resort to abortion in steady numbers. Leslie J. Reagan argues that while many historians have viewed illegal abortion as “static,” it was in fact “dynamic.” State laws allowed an abortion if it saved the life of the mother. The definition of lifesaving varied over time and among individual physicians; this leeway made the doctor’s role “complex” While doctors gained control over women’s reproductive choices through antiabortion legislation, the state increased its control over doctors by forcing them to “police the practices of . . . members”16 Neverthe­ less, numerous doctors continued to provide abortions, as did midwives and irregulars in states across the nation through the 1950s. Historians generally agree on the reasons for the reemergence of the abortion controversy in the mid-twentieth century. Some of the incentives included the concern about population growth and environmental issues; openness about sex, marital problems, and contraception; and the introduc­ tion of relatively simple and safe abortion procedures.17 Many doctors real­ ized that one hundred years of criminalization had not put an end to the practice: illegal abortions continued at a steady rate throughout the twentieth century.18 New restrictive policies passed in the 1940s and 1950s that tight­ ened the loopholes allowing for lifesaving abortions coincided with increased demand for the procedure, resulting in an increased death rate and health risk from illegal abortions.19 The horrible aftermath of incompetent and untrained abortionists finally led some professionals to argue for a reconstruction of abortion policies. The first group to question restrictive abortion laws in the early 1950s was psychiatrists who had close contact with individual women facing unwanted pregnancies. Some medical doctors joined because they resented laws that interfered with their best medical judgment. They signed a statement in 1955 advocating statutes that would allow doctors to decide conditions for abor­ tion. In 1958 Planned Parenthood Federation of America (PPFA) requested that the American Law Institute (ALI) draft a new, model abortion law. The ALI complied because lawyers could sympathize with physicians constrained in their practice by law. The resulting ALI recommendation allowed for le­ gal abortions in three instances: if the pregnancy would likely cause serious physical or mental damage to the mother; if the birth would result in a physi­ cally or mentally handicapped baby; and if the pregnancy resulted from rape or incest.20

A Brief Overview of American Reproductive History

S h o rtly afte r th e A L I p ro p o sal tw o events help ed trig g er su p p ort fo r rev i­ sions in a b o rtio n p o licies. F irst, re sea rch ers fou nd th a t th e n ew tran q u ilizer T halid om id e cau sed b irth d efects. S e co n d , an ep id em ic o f G e rm a n m easles sw ept th e U n ited S ta tes b etw een 1 9 6 2 and 1 9 6 5 . B e c a u se in fecte d m o th ers face a 5 0 p e rce n t risk o f b earin g a d eform ed child, m any w o m en sought a b o r­ tio n s. A fter su b stan tial lobbying th e C alifo rn ia legislature passed a b ill th a t legalized a b o rtio n in th e case o f a severely d eform ed fetu s and to p ro te ct th e m e n tal h ealth o f th e w o m an ; ironically, th e n -g o v e rn o r R on ald R eag an, later a zealous a b o rtio n op p o n en t, signed th e m easu re in 1 9 6 7 .21 T hat sam e year C olorad o b e c a m e th e first state to ad opt a n ew a b o rtio n law m od eled on th e exam ple p ro p o sed by th e A LI. B etw een 1 9 6 7 and 1 9 7 0 tw elve states en acted n ew bills th a t exten d ed th e ground s for th e legal te rm in a tio n o f pregnancy. W h ile still sp ecify in g ce rta in co n d itio n s u nd er w h ich w o m en could o b tain ab o rtio n s, th e se statu tes w ere su bstantially less re strictiv e th a n laws th e y re ­ placed. In 1 9 7 0 fou r states ad op ted legislation th a t p laced n o co n d itio n s on th e te rm in a tio n o f p reg n an cy : A laska, H aw aii, N ew York, and W ash in g to n in effect legalized a b o rtio n on re q u e st.22 By 1 9 7 3 sixtee n states had passed legislation th a t lib eralized a b o rtio n p olicies. A lth ou g h fem in ist a ctio n s fo r a b o rtio n re fo rm w ere im p o rta n t, th e y w ere n o t pivotal. S o m e fem in ists attem p ted to expand th e rig h t o f m a rita l privacy secu red in Griswold to inclu d e th e right to safe, legal a b o rtio n s fo r all w om en, m arried or single. M a n y w o m en and so m e sy m p ath etic m e n p ick eted m e e t­ ings o f th e A M A , dem anding su pport fo r change. They also staged p ro tests to in flu en ce state legislators and to raise p u blic aw areness o f th e issue. N o tio n s o f w o m en ’s righ ts in th is aren a, how ever, had little im p a ct on d ecisions to re ­ fo rm a b o rtio n legislation. F em inists acknow led ged th a t th e y dow nplayed th is angle b ecau se it o ften alien ated p ow erful groups w illing to su p p ort changes in a b o rtio n laws fo r n o n fe m in ist re a so n s, su ch as p op u latio n co n tro l, w elfare savings, en v iro n m en tal c o n c e rn s, and free d o m to p ra ctice m e d icin e w ithou t g o v ern m en t in terferen ce. B e c a u se legal a b o rtio n s did n o t em erg e b ased on fem in ist reaso n in g , th e rig h t to a b o rtio n in th e tw e n ty -first ce n tu ry is on p recario u s ground.

Judicial Review The volum e o f cases b ro u g h t b efo re state co u rts in th e late 1 9 6 0 s and early 1 9 7 0 s in flu en ced th e d ecisio n o f th e Su p rem e C o u rt to co n sid er th e a b o r­ tio n issue. In United States v. Vuitch, 4 0 2 U.S. 6 2 (1971), th e C o u rt d ecid ed th a t a b o rtio n w as a su rgical p ro ced u re; phy sicians should d eterm in e if it was n ecessary to p ro te ct th e m o th e r’s health . Tw o years la ter Roe v. Wade, 410 U .S. 113 (1973), co n firm ed th is m e d ica l ju risd ictio n : th e C o u rt stru ck dow n

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Chapter 1

a Texas statu te th a t con sid ered an attem p t “to p ro cu re an a b o rtio n ” a c rim i­ n al a ct u nless “p ro cu red or attem p ted by m e d ica l advice for th e pu rp ose o f saving th e life o f th e m o th e r” This statu te in terfered w ith a d o c to r’s m ed ical ju d g m en t to p u rsue th e o p tim u m m e d ica l care fo r individual p a tie n ts. A s Ju stice H arry B la ck m u n argued, th e ex cep tio n fo r th e m o th e r’s life w as “in ­ su fficiently in form ativ e to th e p hy sician to w h om it p u rp o rts to afford a m e a ­ sure o f p ro fessio n al p ro te c tio n bu t w ho m u st m easu re its in d efin ite m eanin g at th e risk o f his liberty,” a lib erty d enied only to th e d octor, n o t th e w om an, involved.23 W h ile m e d ica l au to n o m y w as p a ram o u n t, B la ck m u n added an im p o rta n t p riv acy p ro te c tio n in Roe, draw ing o n p re ce d e n ts in Griswold, Loving v. Virginia, and Eisenstadt: “This rig h t o f privacy, w h eth er it b e found in th e F o u rte en th A m e n d m en t’s co n c ep t o f p erso n a l lib erty and re strictio n s u p on state a ctio n , as w e feel it is, or, as th e D istric t C o u rts d eterm in ed , in th e N in th A m e n d m en t’s reserv a tio n o f righ ts to th e p eop le, is broad enou gh to en co m p ass a w om an’s d ecisio n w h eth er or n o t to te rm in a te h e r p regnancy ”24 B lack m u n stated th a t th e availability o f a b o rtio n in th e early n in e te e n th c e n ­ tu ry co n firm ed th e Su p rem e C o u rt’s co n clu sio n th a t a fetu s is n o t a p erso n u nd er th e C o n stitu tio n . A lth ou g h Roe legalized a b o rtio n , it did n o t rem ove all re strictio n s. A fte r th e first trim e s te r a state m ay reg u late a b o rtio n s to p reserv e th e m o th e r’s health . B ec a u se th e end o f th e seco n d trim e ste r u su ­ ally co n stitu tes th e p o in t o f viability (the fetu s’s cap acity to live outsid e th e w om b ), th e state m ay p ro h ib it a b o rtio n s at th a t tim e u nless th e m o th e r’s h ealth or life is endangered. B la ck m u n in tro d u c ed th is trim e s te r a p p ro a ch — a n “a rb itra ry ” on e, as B lack m u n h im s e lf ad m itted . H is ra tio n a le w as “to leave th e states free to draw th e ir ow n m e d ica l co n clu sio n s w ith re sp e c t to th e p erio d a fter th ree m o n th s and u n til viability”25 N e ith er side arguing th e case to th e C o u rt had developed a ratio n ale b ased on a d ivision o f pregnancy. This ap p roach has p laced re strictio n s on th e right to an a b o rtio n and has led to state efforts to lim it access th rou g h m an d ated te stin g o f feta l viability b efo re p erfo rm in g th e p roced u re.

Doe v. Bolton, 4 1 0 U .S. 179 (1 9 7 3 ), th e co m p an io n case to Roe, d eclared G eo rg ia’s a b o rtio n statu te u n co n stitu tion al. The C o u rt stru ck dow n re q u ire ­ m e n ts fo r p rio r approval by a h o sp ita l sta ff co m m ittee and tw o con su ltin g physicians. The ju stic e s co n clu d ed th a t th e ju d g m en t o f th e atten d in g physi­ cian w as su fficient. Doe also rem ov ed th e resid en cy re q u irem e n t to prevent p atien ts fro m en terin g states solely fo r th e m ed ica l a ssista n ce available th ere. N o o th er m ed ical pro ced u re had resid en cy re q u irem e n ts fo r p atients seeking m e d ical care. Together, Roe and Doe invalidated th e sta te ’s tra d itio n a l pow er to crim in alize ab o rtio n .

A Brief Overview of American Reproductive History

Prochoice or Prolife? A b o rtio n has galvanized activ ists o n b o th sides o f th e issue sin ce Roe. P rio r to Roe p ro ch o ice activ ists w orked alm o st exclusively to legalize a b o rtio n ; since Roe th e y have b e e n fighting to keep a b o rtio n legal and, m o re recently, have resp on d ed to pressu re fro m w o m en o f co lo r to ensu re full a ccess to all re p ro ­ ductive ch o ice s, inclu d ing co n tra cep tiv es, b irth in g health y b ab ies, and rais­ ing ch ild ren in h ou seh old s above th e p overty lin e.26 This expanded agenda can b e seen in th e tra n sfo rm a tio n o f th e N a tio n a l A b o rtio n R ig h ts A c tio n L eagu e to th e N a tio n a l A b o rtio n and R ep ro d u ctiv e R ig h ts A c tio n L eag u e in 1994. W h ile th e issu es o f b irth and adult a ccess to c o n tra ce p tio n m ay serve as a brid ge b etw ee n p ro c h o ice and p rolife cam p s, m a jo r d ifferences exist. P ro ch o icers en d orse g ov ern m en t prog ram s th a t em p ow er w o m en to m ake th e rep ro d u ctiv e ch o ice th a t is rig h t fo r th e m , be it a b o rtio n , co n tra ce p tio n , or child b irth . P rolifers in sist th a t th e g o v ern m en t b an a b o rtio n , sex ed u ca ­ tio n in sch o o ls, and a ccess to co n tra cep tiv es fo r te e n s. T he largest divide is over ab o rtio n . G insbu rg argues th a t prolifers co n sid er a b o rtio n a “con d en sed sym bol fo r th e devaluation o f m o th e rh o o d " W o m e n in b o th cam p s re co g ­ n ize existin g sexu al in eq u ality b u t d isagree over its basis. P ro ch o ic e a ctiv ­ ists, acco rd in g to G insbu rg, “criticiz e th o se stru ctu res th a t co n fin e w om en to n u rtu ran ce in th e d o m estic d om ain and suggest it b e expand ed to b e c o m e a m o re co llectiv e responsibility. P rolife ad vocates critiq u e a cu ltu ral and so cial system th a t assigns n u rtu ra n ce to w o m en y et d egrades it as a v o c a tio n "27 S o m e p ro lifers, su ch as th e S o u th e rn B a p tist C on v en tion , believe w o m en are in ferio r and are d estined to fulfill th e ir n atu ral role as m o th ers. The p rolife cam p has re m a in e d v ery v isible, w ell org anized , and w ell funded. A co alitio n o f fo rces, it inclu d es th e C ath o lic C hu rch , th e N ew R ight, and th e R ep u b lican P arty along w ith a h o st o f nationw id e and lo c a l org ani­ zatio n s. This co a litio n has b e e n jo in e d by a rad ical frin g e th a t has b eco m e in creasin gly v iolen t and o ften u ses “sh o ck tactics," su ch as b o m b in g s, m u r­ ders, sh o o ting s, o b stru ctin g en tra n ces to clin ics, th rea ts and h a ra ssm en t, and b ro ad castin g graphic d ep ictio n s o f fetu ses, inclu d ing th e highly sen sa tio n a l­ ized and fraud u lent film The Silent Scream .28 A lthou gh th e ir co m b in ed efforts have n o t resulted in th e recrim in a liz a tio n o f ab o rtio n , th e ir propagand a and th e ir p o litica l and e c o n o m ic pow er have in flu en ced state legislators to pass laws re strictin g a ccess to th is p roced u re. In th e im m ed iate w ake o f Roe, fo r exam ple, a co st-sav in g s ra tio n a le in flu ­ en ced th e d ecisio n o f fed eral and state g ov ern m en ts to fund a b o rtio n s. Fiscal co n serv ativ es argued th a t an a b o rtio n w as m u ch m o re co st-e ffec tiv e th a n paying th e exp en ses o f ch ild b earin g and ch ild rearin g fo r w elfare re cip ien ts.

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Chapter1

This argu m en t fell out o f favor quickly due to th e p olitically charged natu re o f th e a b o rtio n d ebate by th e late 1 9 7 0 s. The prolife co a litio n cam p aig ned to elim in ate fund ing fo r virtu ally all a b o rtio n s w ith th e Hyde A m en d m en t. W ith a b o rtio n n o lo n g er a feasib le o p tio n fo r m o st ind igent w o m en , pop u la­ tio n co n tro llers sought p e rm a n en t m eans to co n tro l th e se w o m en ’s ability to p ro create. T h eir answ er w as sterilization . M ed ica id funds 9 0 p e rce n t o f th e co st o f sterilizatio n , a fa il-sa fe p ro ced u re fro m th e p ersp ectiv e o f p op u la­ tio n co n tro llers. This d iscrim in a tio n in fund ing sends a m essage to ind igent w o m en th a t th e g ov ern m en t prefers to sev er th e ir rep ro d u ctiv e cap acities ra th er th a n allow th e m to c o n tro l th e ir fertility. T h ese reg u latio n s a c t c o e r­ cively and d etrim en tally in th e lives o f m any w om en , esp ecially th e young and th e ind igent.

The Case o f Rhode Island A m icroan aly sis o f R h od e Island d em o n strates th a t th e n a tio n a l con sen su s on sexu al p o litics had v arian ts at th e state level. R h od e Island follow ed th e n atio n al d ebate and p o licy d evelop m ents b u t in m any ways pursued a diver­ gen t path, esp ecially fro m o th e r N ew England states. In th e n in e te e n th c e n ­ tu ry th e state legislature re stricte d ab o rtio n , apparently persuaded by nativist argu m en ts em ployed by th e R h od e Island M ed ica l S o c ie ty (R IM S , fou nd ed in 1821), yet th e law w as one o f only tw o in th e n a tio n to exem pt w o m en from p ro secu tio n . W h e n m o st states ad op ted a versio n o f th e C o m sto ck Law in th e late n in e te e n th centu ry, R h o d e Island did n o t. It w as th e only state in N ew England th a t did n o t b an th e d istrib u tio n o f co n tra cep tiv es, and it al­ low ed th e first and only fully o p eratin g b irth c o n tro l clin ic in N ew E ngland fro m 1931 to 1 9 6 5 , alternatively called th e R h od e Island B irth C o n tro l C lin ic, th e R h od e Island M a te rn a l H ea lth A sso cia tio n , and finally P lan n ed P a ren t­ h o o d o f R h od e Island (P P R I), a n am e u nd er w h ich it co n tin u es to op erate in th e tw en ty -first century. U nlik e m o st clin ics, w h ich did n o t re co rd p erso n al ch a ra cte ristics o f clien ts, th e R h od e Island clin ic offers insights in to th e ra ­ cial, eth n ic, and religiou s a sp e cts o f patrons. W h ile im m ig ran t or fem ale d o c­ to rs w orked at m any freestan d in g b irth co n tro l clin ics, “re sp e c ta b le ” w hite m ale physicians staffed th e R h od e Island clin ic. D u rin g th e 1 9 2 0 s and 1 9 3 0 s m o st states passed eu gen ic steriliz a tio n legislation. R h od e Island legislators tw ice d ebated th e issue b u t defeated th e p rop osals. T he legislators d eem ed sterilizatio n a private m e d ica l issue to b e d ecid ed b etw ee n p h y sician and p atient, a stan ce la ter v o calized by B la ck m u n w ith regard to a b o rtio n in Roe. This privacy stand allow ed P P R I to o p en th e first v a secto m y clin ic in N ew England in 1 9 7 0 . T h rou gh ou t its h isto ry th e clin ic has p rio ritized th e h ealth and individual ch o ice s o f clien ts ra th er th a n follow ing th e agend a o f pop u la­

A Brief Overview of American Reproductive History

tion control advocates, including PPFA. Women and men of different races, ethnicities, religions, and classes were bound by the shared desire to allow individual choice in reproduction. This book focuses on the conflict inherent between a population control agenda that permeated the national discourse on sexual politics for well over a century and a half and a desire by individuals to be in command of their reproduction. It synthesizes secondary material that treats abortion, birth control, and sterilization as separate entities and places these three areas of reproductive control into a cohesive framework. While various factors influ­ enced policy in each of these three areas, the thread that ties them together is population control. Elite white officials, influenced by genetic and eugenic theories as well as by race, class, and gender biases, used all three-abor­ tion, birth control, and sterilization—to control the fertility of the indigent, many of whom were women of color. In sum, political, moral, and economic forces together shaped reproductive policies that impacted women’s ability to choose how to control their bodies. Doctors, nurses, and social workers also influenced this choice: not a monolithic bloc, some supported women’s right to choose; some employed the rhetoric of the population control agenda to secure services for their clients; and some endorsed the notion of population control. The conflict between population controllers and individual choice in reproductive matters continues today, albeit with less overtly racist and classist rhetoric than that used in the nineteenth and twentieth centuries. The covert nature of the campaign, however, does not diminish its impact on policy development that controls who chooses for whom in reproductive matters.

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Abortion and Contraception in the Nineteenth Century

In th e 1 8 4 0 s a flo o d o f p red om in an tly Irish im m ig ra n ts jo in e d th e am algam th a t w as A m e rica n so ciety and released a nativ ist backlash. N o t only w ere th e se im m ig ran ts generally poor, u n ed u cated , and C a th o lic, bu t th e ir fe rtil­ ity rate w as m u ch h ig h er th a n th a t o f P ro te sta n t citiz en s, w hose to ta l fertility rate (T F R , th e p red icted n u m b er o f ch ild ren a w om an w ill have b etw een th e ages o f fifte en and forty -fo u r) had steadily d eclin ed since th e late eig h teen th cen tu ry and plunged betw een 1 8 3 0 and 18 7 0 . M an y physicians attrib u ted this slum p to a rapid rise in th e n u m b er o f ab o rtio n s am o n g w hite m id d le- and u p p er-class m arried P ro te sta n t w om en. Dr. H o ra tio R. Storer, a B o s to n gy­ n eco lo g ist, a su rgeon at th e N ew England H o sp ita l fo r W o m en , as w ell as an assistan t in o b ste trics at H arvard U n iversity and a p ro fesso r o f o b ste trics at B erk sh ire M e d ica l C ollege, persuad ed th e A M A in 1 8 6 0 to lau n ch a c a m ­ paign to co n v in ce state leg islators to p ro h ib it a b o rtio n s. The m a in arg u m ent driving th e cam p aig n w as n ativ ism ; lead ers o f th e a n tia b o rtio n m o v em en t harp ed o n escala tin g x e n o p h o b ic fears am on g th e w h ite P ro te sta n t b o u r­ geoisie. The cam p aig n also played o n m ale in d ig n ation at th e grow ing e m ­ p ow erm en t o f w o m en .1 The assu m p tio n o f w o m en as th e sole pow er b ro k er w ith regard to a b o rtio n d ecisio n s d iscou n ted th e ro le o f husbands and lovers, as seen in th e C orn ell/A v ery ca se in R h od e Island. W h ile n o t all physicians co n d o n ed th e a n tia b o rtio n cam p aig n , th e A M A cru sad e w as legislatively su ccessful, esp ecially am on g states su ch as R h od e Island w here nativ ism was stron g. This ch a p ter su m m arizes th e n a tio n a l d isco u rse on co n tra ce p tio n and th e n exam in es th e ch an g in g co n te x t fo r a b o rtio n and b irth c o n tro l in R h od e Island fro m th e 1 8 3 0 s to th e tu rn o f th e tw e n tieth century. N ativism in flu en ced th e a b o rtio n statu tes passed in th a t state, bu t legislators pursued th e ir ow n co u rse w ith regard to co n tra cep tio n .

The State o f Knowledge in the Mid-Nineteenth Century The d eclin e in T F R signaled individual steps to lim it progeny. S o m e w o m en p ro lon g ed b re a st-fe ed in g and re fra in ed fro m sex w hile n u rsin g , b u t th is m eth o d w as sh o rt-te rm .2 As on e p hy sician w arned , “T he in flu en ce o f la c ta -

Abortion and Contraception in the Nineteenth Century

tio n in averting m e n stru a tio n o r co n c ep tio n , ca n n o t fo r th e m o st p a rt be kept up lo n g er th a n tw elve m o n th s "3 S o m e “very p o o r” u rb an ites co n tin u ed to p ra ctice in fan ticid e, w hile o th ers trie d folk rem ed ies to p revent c o n c e p ­ tio n . The v u lcan iz a tio n o f ru b b er in 1 8 4 4 b rou gh t m ass p ro d u ctio n o f c o n ­ dom s, alth ou g h th is d evelopm ent did n o t tra n sla te in to an in sta n t m ark et, as co n d o m s co n tin u ed to b e co n n e cte d to p ro stitu tio n and ven ereal disease. Still, m any cou ples did use th em . T h ree o th er co n tracep tiv e m eth o d s w ere far m o re co m m o n : co itu s in terru p tu s, or w ithdraw al; d ou ching syringes, m ade o f ru b b er by th e 1 8 5 0 s; and th e rh y th m m eth o d , in tro d u ced in th e 1 8 4 0 s as a n on in tru siv e m ean s o f co n tra ce p tio n .4 By m id cen tu ry in tra u terin e devices (IU D s) cou ld b e m ad e by th o se w ith know led ge ab o u t and a ccess to su b ­ stan ces su ch as w ood, ru bber, and m etal; and p h a rm a ceu tica l p ro d u cts su ch as sp onges, su p p o sito ries, and ch em ically co ated ta m p o n s w ere available.5 P u blic le ctu re s and tra c ts on sexu ality in crea sed th e circ u la tio n o f k now l­ edge regard ing co n tra ce p tio n . Moral Physiology (1831) by th e u to p ian so cia l­ ist R o b e rt D ale O w en re co m m en d e d w ithdraw al, th e vaginal sponge, and th e co n d o m (m ade fro m an im a l skin or m e m b ra n e o r fro m oiled silk b efo re 1 8 4 4 ). H is w ork in flu en ced C harles K n ow lton , a u th o r o f Fruits of Philosophy (1 8 3 2 ).6 H e alth guru Sy lvester G ra h a m and P resb y te ria n m in iste r and r e ­ fo rm er H en ry C. W rig h t argued fo r m ale self-co n tro l, w hile th e tr a c t Repro­

ductive Control re je c te d variou s drugs, co n d o m s, exercise, co itu s in terru p ­ tu s, and th e sponge as eith e r in effectiv e or to o in h ib itin g o f sexu al pleasu re; it ad vocated d ou ch in g w ith a syringe, available at any lo c a l d ru g store for “tw en ty five cents,” filled w ith cold w ater.7 The ju stifica tio n fo r em ploying co n tracep tiv es varied. W rig h t and oth ers em ployed early fem in ist arg u m ents: w o m en had a rig h t to decid e w h en and if to b e a r ch ild ren . S o m e u sed E n lig h ten m e n t ra tio n a lism , attrib u tin g th e “silly p re ju d ice” ag ainst b irth co n tro l “to religiou s ed u ca tio n . . . and n o t to any d ictate o f reason.” C o n tra ce p tiv es w ould allow p eop le to co n tro l th e ir destiny, p e rm it th e p o o r to ad vance econom ically , m ak e m arriag es happier and sexually fulfilling, and stop p ro stitu tes fro m b ea rin g ch ild ren d o om ed to “v ice s " The sexu al double standard, esp ecially m e n ’s ability to avoid “any ju s t re trib u tio n ” fo r in terco u rse , and su p erficial p ru d ery w ere also attack ed : th e “p reten d ed sq u eam ish n ess o f th e A m e rica n peop le o n th is s u b je c t” c o n tra ­ d icted th e fa ct th a t “n o class o f b o o k s finds a read ier sale, o r is m o re eagerly sought a fter in p riv a te "8 W h ile m o stly m id d le-class read ers had a ccess to su ch b o o k s, n ew sp ap er ad vertisem en ts rea ch ed a large au d ien ce.9 A fte r 1 8 4 0 a b o rtio n cam e in to p u blic view as a free -m a rk et service. M id ­ w ives, d ruggists, and so m e physicians co m p eted fo r clien ts w ith ad v ertise­ m e n ts in new sp ap ers, m ag azin es, and religiou s jo u rn a ls. O b serv ers claim ed th a t th e overall in cid e n ce o f a b o rtio n b eg an to rise sharply a fter 1 8 4 0 and

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rem ain ed high th ro u g h th e 1 8 7 0 s. M ad am e R este ll (A nn L oh m an ) op erated a lu crativ e a b o rtio n service during th is p erio d th a t ca tered p rim arily to w hite elite w o m en attem p tin g to c o n tro l th e ir b o d ie s.10 V ariou s a b o rtio n m e th o d s w ere available. M an y w o m en used h o m e re m ­ edies passed o n fro m previou s g en era tio n s co m p o sed of ord in ary b o ta n i­ cal in g red ien ts. M an y a b o rtifa cie n ts inclu d ed “aloes or b la ck h elle b o re”; al­ th o u g h effective, th e y p osed con sid erable h ea lth hazards. S o m e b la ck w om en relied on a blend o f m ercu ro u s ch lorid e and tu rp e n tin e or o n indigo p la n ts.11 The Charleston Medical Journal and Review (CMJ&R) claim ed th a t th e “N e ­ g ro” p o p u latio n d iscovered th e b en efits o f “B la c k R o o t” and “m istleto e . . . to in d u ce abortion ,” w hile on e p hy sician in fo rm ed th e S o u th C a ro lin a M ed ica l S o cie ty (S C M S ) th a t “a neg ress had p ro cu red a b o rtio n by th e use o f T ob acco . Leaves o f th e p lant w ere found a d h eren t to th e placenta.”12 T he ro o t o f th e co tto n p lant w as “on e o f th e b est em m en ag og u es . . . su p erio r to . . . ergot,” “handy to all, and free o f expense.” S o m e hailed th e Jap an ese rem ed y “K eytse-Sin g ,” “In d ian hem p,” “U va U rsi,” o r “e x tra ct o f b ellad o n n a” over ergot. C h lo ro fo rm o in tm en t w as useful; o th ers sw ore by th e “Purgative P ro p ertie s o f th e A rg em o n e M exican a.” Q u in in e w as effective and a ccessib le b eca u se “it co n stitu ted th e base o f . . . p re scrip tio n s o f physicians p ractisin g in th e S o u th and W est.” P hysicians also to u te d d ouching. The “Tepid d o u ch e” fro m V i­ en n a req u ired th a t w ater b e p laced tw elve feet above a seated w om an w ith a vaginal tu b e so th a t th e w ater w as “p ro je c te d ag ainst th e os u te ri” tw ice daily fo r on e w eek. The “K iw isch P lan” involved “k eep in g up a co n tin u ou s stream o f w ater against th e os u teri by m eans o f a syphon tube.” “D ry cu p p in g ” was also su ccessfu l: “A pplied to th e low est p art o f th e sacru m , d ilation o f th e os

uteri is prod u ced ; and applied h ig h er up, c o n tra ctio n o f th e u teru s follow s.” S o m e believed th a t “m easu res w h ich a c t d irectly and p rim arily u p o n th e b reast, su ch as w arm clo th in g to th e bu st, and th e ap p lication o f stim ulant,” inclu d ing th e “cupping glass” and esp ecially “suckling,” b ro u g h t ab o u t a b o r­ tio n s. C a rb o n ic acid gas “co n d u cted in to th e vagina by m ean s o f an elastic tu b e ” w as also effectiv e.13 Finally, th e use o f a p ro b e by a d octor, m idw ife, or th e w om an h e rse lf usually a b o rte d th e fetus. T h ere w ere few legal re strictio n s o n a b o rtio n s. A lthou g h L ord E llen b o rough’s A ct o f 1 8 0 3 expand ed B ritish c o m m o n law by p ro h ib itin g a b o rtio n p rio r to q u icken in g , th e legal co d es o f th e U n ite d S ta te s did n o t ad op t th is in te rp re ta tio n , and a b o rtio n re m a in e d u nreg u lated p rio r to q u ick en in g .14 D u rin g th is p erio d “a b o rtio n ” d en oted m isca rria g e, o r th e b o d y ’s “natu ral expu lsion o f th e fetus.”15 P hysicians and th e pu blic alike generally did n o t b e ­ lieve p regn an cy cou ld b e co n firm ed during th e first trim ester. M an y w o m en and th e ir d o cto rs assu m ed th e ab ey an ce o f th e m e n stru a l cy cle could result fro m a blockag e as m u ch as fro m pregnancy. As Dr. J. G a sto n o f C olu m bia,

Abortion and Contraception in the Nineteenth Century

S o u th C arolin a, argued, “W e m ay em p h atically p ro n o u n ce th a t th e h ea lth o f w om an depends on th e s e c re tio n o f th e w om b, and it is co n seq u en tly o f g reat im p o rta n ce th a t th is should be c o rre cte d w henever any d eran g em en t as to qu an tity o r quality m ay occur.”16 Thus, th e u se o f drugs and p o tio n s to resu m e m en ses w as co m m o n . “C rim in a l abortion ,” o n th e o th e r hand, sign i­ fied actio n s tak en to end a n u nw anted p reg n an cy a fte r qu ickening . In 1839 H ugh L. H od ge o f th e U n iversity o f P ennsylvania M e d ica l S c h o o l alerted his stud ents to th e freq u en t dem ands fo r a b o rtio n th e y w ould e n c o u n ter in th e ir p ra ctice .17 H isto ria n C o rn e lia H ughes D ay ton argues th a t “a b o rtio n a t­ te m p ts w ere far fro m ra re ” and th a t “ou trage over th e d estru c tio n o f th e fetus or d en u n ciation s o f th o se w ho w ould a rre st ‘n a tu re’s p ro p er co u rse ’” w ere “strikingly absent.”18 Yet som e au th ors did express m o ra l ou trage regard ing a b o rtio n . In a tra c t p u blished in th e U n ited S ta te s in 1 7 9 6 B ritish physician H ugh S m ith c r iti­ cized cou ples w ho re so rte d to th e “dreaded evil” as “selfish and u n so cia l . . . ; th o se p erso n s, w ho th in k and a c t th u s narrow ly, ca n n e ith e r b e acco u n ted good ch a ra cte rs in th em selv es, n o r w orth y m e m b ers w ith re sp e c t to s o c iety.”19 In 1810 Dr. Jo se p h B re v itt atta ck ed th e “h o rrid depravity o f h um an w eakness, in w retch es lo st to every sense o f religion, m orality, and th a t m u ­ tu al atta ch m e n t fro m a m o th e r to h er offspring, and every te n d er tie in n a ­ tu re, [that] seek th e m eans to p ro cu re abortion .” A lthou g h m e n w ere guilty o f su ch depraved behavior, B rev itt saw w om en as m o re d eg enerate b ecau se th e y eschew ed th e ir natu ral ro le as m o th ers. M en w ere cu lp able, b u t only as acco m p lices to in d ep en d ent w o m en .20 Conversely, W illia m B u ch an , a B ritish w riter w hose w orks w ere pop u lar in th e U n ited S ta te s, co n sid ered a w om an seeking an a b o rtio n a “v ictim o f sed u ctio n ” try in g to avoid “p u blic sham e or private scorn,” bu t even th is re a so n w as “no excu se for murder.”21 W h ile th e

CMJ&R to u te d th e n ew and safer m ean s to p ro cu re a b o rtio n s in th e 1 8 5 0 s, th e y w ere only a ccep ta b le to save th e life or h ea lth o f th e m o th er.22

Nativism and the Decline in TFR The in creasin g visibility o f a b o rtio n co m b in ed w ith d em og rap h ic tren d s to stim u late co n cern . The em phasis o n a b o rtio n resu lted in p art fro m p erceived changes in w ho sought th is p ro ced u re by th e m id -n in e te e n th century. P rio r to 1 8 4 0 , acco rd in g to phy sicians, a b o rtio n w as th e re co u rse o f d esp erate sin ­ gle w om en. B y m id cen tu ry nu m ero u s physicians a ccu sed a grow ing n u m b er o f m arried w hite m id d le- and u p p er-class w om en o f re so rtin g to a b o rtio n .23 This p e rce p tio n m ay have b e e n false. M a rried b ou rg eois w o m en m ay have sought a b o rtio n s all along b u t fro m m idw ives, n o t physicians. W ith th e p ro ­ fession alizatio n o f m e d icin e by m id centu ry , d o cto rs defined th em selv es as

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ex p erts in all fields, inclu d ing gynecology, and w ealthy m arried w o m en m ay have forgone m idw ives in favor o f physicians. In ten tio n a l ab o rtio n , accord ing to th e se d o cto rs, explained th e d ram atic d ecrea se in th e T F R am on g w hites fro m 7 .0 4 in 1 8 0 0 to 3 .5 6 in 1 9 0 0 , w ith th e m o st sign ifican t d eclin e betw een 1 8 3 0 and 1 8 7 0 (from 6 .5 5 to 4 .5 5 ).24 W h ile th e T F R am o n g w hite citiz en s d eclin ed , m o re th a n th re e m illio n im m ig ran ts settled in th e U n ited S ta tes b etw een 1 8 4 6 and 1 8 5 5 alone. The g reat m ajo rity w ere C a th o lic, and, a cco rd in g to m any ph y sician s, th e y did n o t a b o rt th e ir p reg n an cies. T h eir large fam ilies n o t only sy m bolized a lack o f sexual se lf-co n tro l bu t also th rea te n ed P ro te sta n t hegem ony. M id cen tu ry b o o k s and tra c ts as w ell as a cco u n ts o f foreig n travelers a ttest to th e in c re a s ­ ing v exation over w hite m id d le- and u p p er-class P ro te sta n t w o m en seeking a b o rtio n s and th e resu ltan t d ecrease in th e T F R in th e face o f waves o f C a th o ­ lic im m ig ran ts.25 N u m erou s fa cto rs in flu en ced th e fertility decline. It b eg an in th e in d u s­ trialized N o rth am o n g th e m iddle class and gradually affected o th e r groups and region s, alth ou g h fertility rates rem ain ed h ig h er in fro n tie r areas and in th e S o u th , w h ere ag ricu ltu re co n tin u ed to d om inate. E c o n o m ic fa cto rs in th e d eclin e inclu d ed th e tra n sfo rm a tio n fro m an ag ricu ltu ral to an in d u strial society. C hild ren w ho had previou sly co n trib u te d to fin an cial stability o n th e farm now drained u rb an fa cto ry w o rk ers’ bu dgets, esp ecially w ith th e in tro ­ d u ctio n o f com p u lsory ed u ca tio n to th e age o f 16. L and also had an im p act: th e less land a m id d le- or u p p er-class fam ily had to pass on, th e m o re likely th e p aren ts w ere to lim it th e ir offspring. F ew er ch ild ren m e a n t e c o n o m ic so l­ v en cy fo r th e m iddle class and p ossibly even upw ard m o b ility fo r heirs. C u l­ turally, th e d ecrea se ca n b e seen as a n attem p t by w hite m id d le-class fam ilies to su stain th e ir stand ing in th e com m u nity. The d im inishing b e lie f th a t all events w ere th e w ill o f G o d in flu en ced so m e cou ples: rep ro d u ctiv e co n tro l re flected th e ir d esire to c o n tro l th e ir future, inclu d ing th e size o f th e ir fa m ­ ily.26 The d eclin e in th e T F R also re flec ted in c rea sed au to n o m y fo r w om en. W o m e n used a b o rtio n to d ecrea se th e ir ch a n ces o f dying in ch ild b irth and to free th em selv es fro m th e c o n sta n t bu rd en o f child ren. F ew er ch ild ren c o ­ in cid ed w ith th e m o d ern em phasis on ch ild rearin g over child b earin g . W ith sm aller fam ilies, w hite m id d le- and u p p er-class m o th e rs could in ten sify th e ir m atern al “d u ties” to raise pious child ren. Few er ch ild ren also allow ed th ese w o m en to b e co m e activ e in so cia l and m o ra l cau ses su ch as ab o litio n ism , te m p e ran ce , h ea lth and fash io n refo rm , and th e w om an’s rig h ts m ovem en t. A lth ou g h relatively few w o m en w ere activ ists, m any elite w hite m e n co n sid ­ ered th e m th rea te n in g b eca u se o f th e exam ple th e y s e t.27 M oreov er, th e se refo rm s called fo r chang es in m ale behavior.

Abortion and Contraception in the Nineteenth Century

The fertility d eclin e a m o n g th e se w o m en raised n ativ ist co n c e rn s. The K n o w -N o th in g Party, an a n tifo reig n and a n ti-C a th o lic org anizatio n , b u rst in to th e p o litica l aren a during th e 1 8 5 0 s and in 1 8 5 4 carried M a ssa ch u setts, D elaw are, and, w ith a W h ig co a litio n , P ennsylvania. T he party also sen t sev­ enty-five m e m b ers to C on g ress. The follow ing y ear it sw ept R h od e Island, M assach u setts, C o n n e c tic u t, M arylan d , and K entucky, and m o st state offi­ cers in N ew York, Pennsylvania, and C alifo rn ia d escrib ed th em selv es as party affiliates. In th e S o u th th e K n o w -N o th ing s n early carried V irginia, G eo rg ia, A labam a, M ississip pi, and L o u isian a.28 N ativist co m m e n ta ry a ttra cted m any d o ctors. M o st physicians in th e A M A w ere w hite A m e ric a n -b o rn P ro te sta n ts, and x en o p h o b ic sen tim e n t ran high am o n g th em . This group in sisted th a t th e m a jo rity o f w o m en seekin g a b o r­ tio n s w ere w hite, m arried , A m e ric a n -b o rn , P ro testa n t, “ed u cated and refined ladies.” M e d ica l jo u rn a ls and p h y sicia n s’ sp e ech e s w arn ed th a t th e “ig n o ­ ran t, th e low lived and th e alien ” w ould co n tro l th e n a tio n by o u tbreed in g “our ow n population.” Dr. M a rtin L u th er H o lb ro o k claim ed th a t A m e rica n w o m en w ere “ad d icted ” to th e “w ick ed ” p ra ctice. Dr. N ath an A llen, an o b ste ­ tric ia n in Low ell, M a ssa ch u setts, found th a t in Low ell w hite P ro te sta n t fam ily size had d eclin ed by a b o u t o n e -h a lf since th e end o f th e eig h tee n th cen tu ry due to in creased a b o rtio n and co n tra ce p tio n . Im m ig ra n ts, he w arned , w ere quickly outm ultiplying A m e ric a n s.29 W ritin g o n th e ap p roach in g U .S. c e n ­ te n n ia l celeb ratio n , on e M ich ig a n d o cto r claim ed th a t “th e an n u al d estru c­ tio n o f fetu ses” had b e c o m e so “tru ly appalling” th a t “th e P u rita n ic b loo d o f ’7 6 [would] b e bu t sparingly rep resen ted in th e ap p roach in g centenary.”30

The Antiabortion Campaign The c o n n e ctio n b etw ee n a b o rtio n , th e d eclin in g w hite T F R , and grow ing fem ale au ton om y a ttra c ted th e a tten tio n o f d o ctors. W h ile n o t speaking in a u nited voice, m any physicians cited a b o rtio n as a key fa cto r in th e d iscrep an cy b etw een im m ig ran t and w hite P ro te sta n t m id d le- and u p p er-class b irth rates. The legal status o f a b o rtio n b e c a m e a ce n tra l c o n c e rn o f th e A M A , w h ich in 1 8 6 0 in itiated a sta te-b y -sta te cam p aig n to outlaw th e p ractice. A s Jam es M o h r argues, cam paig n lead ers p o in ted to ad vances in s c ie n c e .31 B y m id cen tu ry m o st “reg u lars” o r allopaths w ere aw are th a t qu icken in g was n o t a m agic m o m en t at w h ich th e fetu s ca m e to life; it developed gradually. A s early as 1 8 0 8 Dr. Jo h n B u rn s stated th a t “m any p eop le at least p reten d to view attem p ts to ex cite a b o rtio n as different fro m m urder, u p o n th e p rin cip le th a t th e em bryo is n o t p o ssessed o f life. . . . It u nd ou bted ly ca n n e ith e r th in k n o r a ct; bu t, u pon th e sam e reason in g , w e should co n clu d e it to b e in n o c e n t to kill th e ch ild in birth.” Dr. H od ge in fo rm ed stu d ents th a t th e “e m b ry o ”

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w as “endow ed, at o n ce, w ith th e p rin cip les o f vitality,” and th u s a b o rtio n w as “m u rd er" Dr. S to re r w ro te th a t ph y sician s had “arrived at th e u nan im o u s op in ion , th a t th e foetu s in u tero is alive fro m th e m o m e n t o f co n cep tio n .” Thus, crim in a l a b o rtio n s w ere “a crim e ag ainst life, th e child bein g always alive” A n u m b er o f phy sicians re fe rred to th e fetu s as “th e little b e in g ” A p hysician and th e an on ym ou s au th o r o f Satan in Society criticiz ed “m o d ern so p h ists” w ho used P lato and A risto tle to ju stify ab o rtio n . W h ile th e latter “ad v o cated ” a b o rtio n to preven t “excessive population,” th e y “tau g ht th a t th e child only acq u ires a soul at th e m o m e n t o f m atu re b irth ” M o d e rn m ed ical scien ce had disproved th em : life b eg an at co n cep tio n , n o t q u ick en in g .32 C ircu m stan ce s w ith in th e m ed ical p rofession also im p acted th e cam paign. M an y young m e n a p p ren ticed only o n e o r tw o years b efo re han gin g out a shingle. M id d le- and u p p er-class d o ctors tra in ed in th e tra d itio n a l E u rop ean fash io n faced co m p e titio n fro m th e m and fro m h o m eo p a th s, hyd ropaths, b o ta n ica l ph ysician s, and e c le c tic s , w ho o ften offered reliab le alternativ es to tre a tm e n ts by “re g u la rs” Th ese re fo rm e rs en co u rag ed m e n and w o m en to cu re th em selv es and m ad e m e d ica l in fo rm a tio n available to th e pu blic th rou g h p am p h lets, th e reb y u nd erm in in g th e social, gender, and in tellectu a l order. R egulars also co m p eted w ith a b o rtio n ists, w h om m any w o m en c o n ­ sulted o n o th e r m ed ica l m a tters, th u s draining regu lars’ e c o n o m ic and p ro ­ fession al security. B e c a u se regu lars had ta k en th e H ip p o cra tic o a th opposing co n tracep tiv es and a b o rtio n , th e y cou ld n o t b en e fit fro m th is grow ing, lu cra ­ tive trade. I f n o th in g else, laws re strictin g a b o rtio n to licen sed physicians to save a w om an’s life w ould strip irreg ulars o f p a tie n ts.33 R egulars o ften co u ch e d th is e c o n o m ic c o n c e rn in rh e to ric a ccu sin g ir­ regu lars o f b o tch in g a b o rtio n s, leading to d eath or serious injury. Dr. Storer, fo r exam ple, claim ed th a t “a very large p ro p o rtio n o f w o m en b e c o m e c o n ­ firm ed invalids, perhaps for life,” o r died follow ing an a b o rtio n . Dr. J. R. M c Fadden claim ed th a t th e “v iolen t p rod u cin g ca u se” o f a b o rtio n p o sed a seri­ ous danger; “th e m o st seriou s o f all is an a b o rtio n b rou gh t on by m ed icin es ad m in istered in tern ally or by m anip ulations.” The fatalities due to a b o rtio n s re p o rte d in th e New York Times verify su ch a sse rtio n s.34 T h ese deaths and in ju ries m o st likely resu lted fro m im p ro p er train in g , ig n o ra n ce o f im proved m e th o d s o f ab o rtio n , o r la ck o f san itary care: th e drive to outlaw a b o rtio n o ccu rred w h en m e d ica l know ledge in crea sed its safety. In 1 8 5 6 th e CMJ&R, fo r exam ple, co n clu d ed th a t “our know ledge o f th e n atu re o f th e co n d itio n o f p regn an cy has vastly in crea sed w ith in a few years; and th e m eans by w hich its p rogress m ay b e in terru p ted , w ith ou t end ang ering life, have b e e n m o re co rre ctly and d efinitely a sc e rta in e d ”35 N ev erth eless, safety arg u m en ts p ro b ­ ably in flu en ced so m e states to regu late ab o rtio n . S o cia l p u rists, w hite m id d le- and u p p er-class P ro te sta n t m e n and w om en,

Abortion and Contraception in the Nineteenth Century

jo in e d p hy sician s’ efforts. A b o rtio n and o th e r m ean s o f fertility c o n tro l al­ low ed sexu al g ra tifica tio n w ith o u t a ccep tin g p a re n ta l responsibility . S o m e cru sad ers argued th a t a b o rtio n in crea sed divorce and ru in ed th e A m e rica n family. S u ch arg u m en ts in flu en ced legislators, w ho designed laws to in h ib it sexu al co n d u ct and to p ro te c t p ren atal life.36 A n th on y C o m sto ck , a lead er in th e N ew Y ork S o c ie ty fo r th e S u p p ression o f V ice, la tch ed o n to a b o rtio n in his an tio b sce n ity cam p aig n b eca u se he believed a b o rtio n re flected sexual p ro m iscu ity am on g th e young in flu en ced by “lasciviou s re a d in g " C o m sto ck ’s m ain co n c e rn was n o t to co n tro l w o m en as m u ch as to p ro te c t ch ild ren .37 He and o th e r cru sad ers also shared p hy sician s’ c o n c e rn s over im m ig ran t in flu ­ en ce in society. Im m ig ra n ts th rea te n ed n o t only th e ra cia l sto c k b u t also th e p o litica l and p ro fessio n al d o m in an ce o f elite w hite m e n in so m e u rb an areas. H isto rian N ico la B eisel argues th a t th e legislative cam p aig n was su ccessfu l in p art b ecau se its lead ers appealed to th e in se cu ritie s o f m e n in pow er at th e state and fed eral lev els.38 P art o f th e se in se cu ritie s stem m ed fro m gend ered ex p ecta tio n s. Tw o p ri­ m ary roles for upper- and m id d le-class w o m en w ere to serve as a “R ep u b ­ lican M other,” raisin g virtu ou s citiz en s to lead th e n atio n , and to fulfill th e cu lt o f d om esticity. A b o rtin g w om en shirked th e ir rep u b lica n duties. P ious, su bm issive, d ep en d en t, and d o m estic w o m en w ould n o t tak e in d ep en d ent a ctio n to a b o rt th e n ex t g en eratio n . Y et th e very w om en w hom lead ers m o st ex p ected to fulfill th e se tw o roles seem ed m o st p ro n e to a b o rtio n , th ereb y u n d erm in in g th e cu ltu ral and so cia l g end ered order. In stea d o f serving as th e civilizing agent to p ro te c t th e n a tio n fro m ch aos and im m orality, th e se w o m en w ere traveling a p ath o f debauchery. C rim in alizin g a b o rtio n could re in stitu te a gend ered order. Dr. S to re r m o u n ted th is a n tia b o rtio n cru sad e in th e 1 8 5 0 s. H is father, Dr. D. H u m phreys Storer, a p ro fesso r o f m idw ifery at H arvard U niversity, had earlier “ap p reciated th e freq u en cy o f crim in a l a b o rtio n s, p o in ted out th e ir tru e ch aracter, and d en o u nced th e m ” In 1857 th e y ou nger S to re r persuad ed th e A M A to le t h im ch air a co m m ittee , “O n C rim in a l A b o rtio n , w ith a V iew to Its G en e ral Suppression,” to investigate th e an n u al n u m b er o f a b o rtio n s in th e U n ited S ta te s.39 W h y w as S to re r so in ten t on leading th is cam paign? In his h o m e state th e M a ssa ch u setts S u p rem e C o u rt had tw ice upheld th e righ t o f w o m en to o b ta in an a b o rtio n p rio r to qu ickening . G u aran teein g th e righ t to a b o rtio n w as n o t ta n ta m o u n t to approval. C h ie f Ju stice L em u el Shaw con clu d ed th e co u rt’s ru ling w ith a d am ning sta tem e n t: “T he co u rt are all o f th e op in io n th a t, alth ou g h th e a cts set fo rth are, in a h ig h d egree, offensive to good m o rals and in ju rio u s to society, y et th e y are n o t p u nishable at c o m ­ m o n law”40 S to re r re je c te d th is legal rig h t to a b o rtio n , esp ecially b eca u se th e w rong w o m en w ere tak in g advantage o f th is prerogative: “In th e state o f M a s ­

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sach u setts at larg e" he w rote, “ . . . th e in c rea se o f th e p o p u lation . . . has b ee n w holly o f th o se o f re c e n t foreig n origin; th is in 18 5 0 . In 1 8 5 3 " he con tin u ed , “ . . . b irth s w ith in th e C om m o n w ealth . . . resu lted in favor o f foreig n p aren ts in an in creased ra tio " S to re r argued th a t th e im b a la n ce b etw een b irth ra tes resu lted fro m d ifferences in a b o rtio n p ra c tice s.41 B etw een 1857 and 1 8 5 9 S to re r w ro te to d o cto rs, w arn in g th e m o f in ­ creasin g n u m b ers o f w o m en seekin g a b o rtio n s. T he w orst offen d ers w ere m id d le- and u p p er-class m a rried w om en: th e y p referred “to devastate w ith p o iso n and w ith steel th e ir w om bs ra th er th a n . . . foreg o th e g aieties o f a w in te r’s ball, p arties or plays, o r th e pleasu res o f a su m m er’s trip s and am u se­ m ents." S to re r re sen te d fo rth rig h t w o m en w ho a b o rte d , co m m e n tin g th a t “ladies b o a st to ea ch o th e r o f th e im punity w ith w h ich th e y have ab o rted , as th e y do o f th e ir exp en d itu res, o f th e ir dress, o f th e ir su ccess in society. T here is a fash io n in this." By p o rtrayin g a b o rtin g w o m en as h ed o n ists, S to re r ig­ n o red th e angu ish m any w o m en faced w hen d ecid ing to a b o rt. H is flippant d ep ictio n m ad e o th ers w illing to co n d em n th e se w o m en and helped silen ce ab o rtin g w o m en and th e ir su pporters. In a n o th e r p u b licatio n he claim ed th a t “th e se w retch e d w o m en , th e se m a rried law ful m o th e rs . . . are th u s m u r­ dering th e ir ch ild ren by th o u sa n d s"42 S to re r believed th a t m a rried w o m en above all had n o rig h t to te rm in a te p reg n an cies b eca u se a “m arriage w here co n ce p tio n or th e b irth o f ch ild ren is in ten tio n ally p rev en ted ” is n o th in g “bu t legalized p ro stitu tio n , a sensu al ra th er th a n a spiritual u n io n "43 B y 1859 S to re r had w on su p p ort fro m so m e physicians and a stron g ally in Dr. H en ry M iller, new ly ap p oin ted A M A p resid en t and p ro fesso r o f o b ste t­ ric m e d icin e at th e U niversity o f Louisville. A t th e A M A ’s n a tio n a l co n v en ­ tio n th a t year th e S to re r co m m itte e p resen ted a “m ass o f ev id en ce" on th e freq u en cy o f ab o rtio n and p ro p o sed m easu res, “chiefly o f a legislative ch a r­ acter,’’ to suppress it. The A M A “u nanim ously in d o rsed " th e se su ggestions, req u ested th a t co m m itte e m e m b ers “co n tin u e th e ir labors," and ad opted an a n tia b o rtio n re so lu tio n th a t allow ed th e p ro ced u re only to save th e m o th e r’s life.44 W h ile in ag reem en t w ith th e a n tia b o rtio n resolu tio n , th e S C M S to o k issue w ith S to r e r’s findings. M em b e rs criticiz ed his m ere “th re e pages" o f “g en er­ alizatio n s" w ith little su bstantive arg u m en t. The S C M S co n clu d ed th a t “th e co m m ittee appear to have trea te d th e A sso cia tio n w ith a d isco u rtesy scarcely sh o rt o f c o n te m p t" They re je c te d S to r e r ’s a sse rtio n th a t crim in a l a b o rtio n w as p rev alen t am o n g “all classes o f society," at le a st “as regards o u r section." Dr. M cF ad d en argued th a t in S o u th C a ro lin a a b o rtio n o cc u rred in tw o sc e ­ n arios: by “th e p hy sician, fo r a lau d able p u rp o se, or by th e p atien t or h er

friends fo r th e p u rp o se o f co n cea lin g a n illicit in te rc o u rse " W h ile th e S C M S co n sid ered a b o rtio n a sign o f “so cia l dem oralization," th e evid en ce p o in ted

Abortion and Contraception in the Nineteenth Century

to its p ra ctice p rim arily in “our N o rth e rn S ta te s " n o t in th e So u th . G row ing sectio n a l ten sio n s w ere im p licit in th e reco rd s: m a rried m id d le- and upperclass S o u th e rn w hite w o m en w ould n o t shirk th e ir duty to b e a r ch ild ren ; only N o rth e rn w o m en w ould behave so im m orally. T he S C M S believed th a t “every in telligen t o r h o n est p hy sician” should p e rfo rm a b o rtio n “on ly ” u nd er “really d esp erate circ u m sta n ce s” to save th e m o th e r’s life.45 N o t only did S o u th e rn physicians refu se to ad m it th a t a b o rtio n w as c o m ­ m o n am ong p ro p er m arried w om en, bu t so m e argued th a t even slave w om en did n o t stoop to th is p ra ctice. This defense co n flicted w ith p la n ters’ a sse r­ tio n s. Dr. E. M . P en d leto n o f S p a rta , G eo rg ia , ch allen g ed th e belief, c o m ­ m o n am o n g slave ow ners, th a t slaves p ra ctice d a b o rtio n m o re th a n w hites. “Every p ra ctitio n e r o f m e d icin e in th e S o u th " he co n ten d ed , “is aw are th a t an op in io n generally prevails am o n g th e p lan ters, th a t th e b lack s have a secre t u nknow n to th e w hites, by w h ich th e y eith e r prod u ce an in ca p a city to b ea r child ren, or d estroy th e foetu s in em b ry o " The first qu estio n asked o f a physi­ cian ten d in g a slave w om an w as, “D o n ’t you th in k th e w o m an has b e e n ta k ­ ing so m eth in g to keep h e r fro m having ch ild ren ?” and “very o ften his reply is in th e affirm ative, w ith ou t any ju s t data u p o n w h ich to fou nd any opinion, bu t ju s t to p lease th e p reju d ices o f th e in q u irer" The p lan ters d esired “to o b ­ ta in a m o re rapid in c re a s e ” am o n g slaves. P en d leto n argued th a t physicians should n o lo n g er “m a in ta in th e h yp oth esis th a t our n eg ro fem ales are forever d ren ch in g th em selv es w ith n o stru m s, in ju rio u s to th e ir h ealth , and fatal to th e ir offspring.” M isca rria g e , n o t crim in a l ab o rtio n , as plan ters assu m ed , was m o re prevalent am on g slaves due to “o v er-ex ertio n at th e w ash -tu b , scou rin g m op and plough.” I f planters w anted to b re ed slaves, th e y should “pay m o re a tte n tio n ” to th e w orkload th e y im p o sed u p on w om en. P en d leto n argued th a t slaves w ere w om en first: “It w ould req u ire a co n sid erab le stre tch o f o n e ’s cred u lity to believe th a t th e neg ress is a n ex cep tio n to th o se g en eral laws o f n atu re . . . w h ich lead th e m to d esire offspring, and to p ro te c t th e m fro m harm .”46 C ertainly, so m e slave w o m en did re so rt to a b o rtio n .47 Y et perhaps slave ow ners exaggerated its ex ten t b eca u se blam in g slaves fo r self-in d u ced ab o rtio n s w as ea sier th a n ad m ittin g th a t overw ork foiled th e m a ste rs’ b re e d ­ ing plans. S to re r and his follow ers gave n o a tten tio n to th is S o u th e rn c o n tro ­ versy. Follow ing th e A M A co n v en tion , M ille r co n ta cted ea ch state m e d ica l so ­ ciety req u estin g its “zealous co o p e ra tio n . . . in pressing th is su b je ct u p on th e legislatures o f th e ir resp ectiv e S ta te s” (see append ixes A and B ).48 The d e c i­ sions re ach ed at th is co n v en tion form ally lau n ch ed an a n tia b o rtio n crusad e th a t has lasted in term itten tly for nearly 1 5 0 years. Even p rio r to th e p hy sician cam p aig n so m e states had reg u lated a b o r­ tio n . C o n n e cticu t passed th e first a n tia b o rtio n bill in 1821, follow ed by M is ­

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sou ri in 1825, Illin ois in 18 2 7 , and N ew Y ork in 1828. T en m o re states had in co rp o ra te d sim ilar laws by 1 8 4 0 . M o st reg u latio n s m ad e a b o rtio n a crim e only after qu icken in g and p u nished only th o se p erfo rm in g th e a b o rtio n , n o t th o se seeking it. The im m u n ity o f w o m en suggests th a t laws w ere in ten d ed to regu late in co m p e te n t p ra c titio n e rs, n o t p ro sc rib e a b o rtio n . Ind eed , m o st laws ban n ed only ab o rtio n s in ju rio u s to th e m oth er, usually th o se em ploying n oxiou s drugs and p o iso n s.49 S to re r and th e A M A co n sid ered th e se laws “a dead le tte r” and dem and ed a u nified ap p roach to th e “p ro b lem ” A s o f 1 8 6 0 , fo r exam ple, only N ew York, N ew H am p sh ire, and W is c o n sin had elim in ated w o m en ’s im m u n ity fro m p ro secu tio n . M ain e, N ew H am p shire, M a ssa ch u setts, N ew Y ork, O h io , In d i­ ana, M ich ig an , M isso u ri, A labam a, M ississip p i, A rk ansas, T exas, M in n e so ta , C alifo rn ia, O reg o n , and th e te rrito rie s o f K an sas and W a sh in g to n allow ed ab o rtio n s to save th e w om an’s life. C o n n e c tic u t, M ississip p i, A rk ansas, M in ­ n eso ta, and O reg o n reco g n ized a b o rtio n as a crim e only if it o ccu rred a fter qu ickening. M ain e, N ew H am p shire, N ew York, O h io , M ich ig an , and W a sh ­ in g to n T e rrito ry ack now led g ed a b o rtio n as a crim e th ro u g h o u t pregnancy, b u t th e p en alty varied w ith th e stage o f th e p regnancy. V erm o n t, Illin ois, W is co n sin , V irg inia, M isso u ri, A lab am a, L ou isian a, T exas, C a lifo rn ia , and K ansas T e rrito ry co n sid ered a b o rtio n a crim e th ro u g h o u t th e p reg n a n cy but req u ired p ro o f o f p reg n an cy to p ro se cu te — p ro o f virtu ally im p ossible to o b ­ ta in after th e fact. O nly Ind iana req u ired no p ro o f o f p regn an cy and punished an attem p ted a b o rtio n even if p reg n a n cy did n o t exist. R h od e Island , N ew Jersey, Pennsylvania, D elaw are, M aryland , N o rth C arolin a, G eo rg ia, F lorid a, K entu cky, T e n n essee, Iow a, th e D is tric t o f C o lu m b ia, and S o u th C arolin a had no a n tia b o rtio n sta tu tes.50 A lth ou g h So u th C arolin a had n o law, d o ctors th e re did n o t h eed S to r e r’s call. P hysicians d ifferentiated n o n eth ele ss b etw een “a b o rtio n ” (m iscarriag e) and “crim in a l a b o rtio n ”51 Dr. M yd d leton M ic h e l o f C h a rle sto n w rote an a r­ ticle fo r th e CMJ&R en titled “P oiso n in g by E rg ot in A ttem p tin g C rim in a l A bortion,” ad m ittin g th a t in fo rm a tio n on how to p ro cu re su ch an a b o rtio n w as w id espread .52 Still, th e S C M S did n o t p e titio n th e state legislature to b an ab o rtio n . S ev era l fa cto rs m ay explain th is in a ctio n . First, a dispute b e ­ tw een S to re r and th e ed ito rs o f th e CMJ&R in th e early 1 8 5 0 s m ay have m ade m any S C M S m e m b ers re lu cta n t to su p p ort him . The co n tro v ersy cen tered on S to r e r’s address to th e M a ssa ch u setts M e d ica l S o c ie ty in w h ich h e argued th a t physicians m u st divulge any illegal or im m o ra l a ctio n s ta k en by patients. The CMJ&R reg retted b ein g “fo rced to tak e ex cep tio n to , and en ter a p ro test against, th e view s expressed by Dr. Storer, in re fe ren ce to th e alleged obliga­ tio n o f th e p hysician to reveal se c re ts th a t are en tru sted to his p rofession al safeguard” P atien t co n fid en tiality m u st rem ain p a ra m o u n t.53 S e co n d , S C M S

Abortion and Contraception in the Nineteenth Century

m e m b ers rem ain ed u n co n v in ced by his arg u m en t th a t m id d le- and upperclass w hite m arried w o m en re so rted to ab o rtio n . Third, th e nativist rh e to ric S to re r em ployed w as n o t p articu larly applicable to th e So u th . L ast and m o re salient to S C M S ab ey an ce w as th e o u tb rea k o f th e C ivil W a r and R e c o n stru c ­ tio n during th e h eight o f S to r e r’s cam paign. B ec a u se th e w ar and its a fter­ m ath b ro u gh t less d isru p tion to th e N o rth , S to re r and o th er phy sicians w ere able to co n tin u e th e ir legal cam p aig n .54 To fu rth e r th is cam p aig n Storer, w ith A M A su p p ort, d rafted an “id eal” law fo r states to adopt. In Criminal Abortion in America (1 8 6 0 ) he re c o m ­ m end ed th a t laws elim in ate w o m en ’s im m u n ity : “T he p a rt played by th e m oth er, h e rse lf so o ften a v ictim , is alm o st always th a t o f a p rin cip al, y et as th e law n ow stand s, she ca n scarcely ever b e reach ed . . . . I f th e m o th e r does n o t h e rse lf in d u ce th e a b o rtio n , she seeks it, o r aids it, or cou n sels to it, and is th e refo re . . . fully accou ntable.” A b o rtio n to save th e w om an’s life should o ccu r only if tw o physicians co n cu rre d o n its u rgency ; th is stip u lation w ould d eter w o m en fro m co n v in cin g a friendly d o cto r to p e rfo rm an u n n ecessa ry ab o rtio n . S to r e r ’s law rem ov ed qu ickening , establish ed eq u al guilt fo r a b o r­ tio n s p erfo rm ed at any tim e and by any m eans, and im p osed stiff sen ten ces.55 S to re r h op ed phy sicians w ould co n v in ce states to en a c t his m easu re (see ap­ p en d ix C). In 1 8 6 4 he co n v in ced th e A M A to offer a p rize for th e b est essay by a phy­ sician to ed u cate A m e rica n w o m en on th e evils o f a b o rtio n .56 N o t su rp ris­ ingly, Why Not? A Book fo r Every Woman by S to re r w on in 1 8 6 5 . T he A M A circu lated cop ies o f th is tr a c t to th e p u b lic.57 N ativist a n x ieties pervad e Why

Not. R eferrin g to th e loss o f A m e rica n lives fro m th e C ivil W ar, S to re r asked, “Sh all th e y b e filled by o u r ow n ch ild ren o r by th o se o f a lien s?” “T his is a q u estio n th a t o u r ow n w o m en m u st answ er; u p on th e ir loin s d epends th e fu tu re d estiny o f th e n a tio n ”58 The perceived th re a t to P ro te sta n t heg em on y w eighed heavily on th e m ind s o f cru sad ers, esp ecially in light o f th e differ­ en tial fertility rates betw een im m ig ran ts, m o st o f w hom w ere C a th o lic, and w hite P ro te sta n ts.59 M o st co n tem p o ra ry o b serv ers claim ed th a t th e vast m a jo rity o f w om en w ho sought a b o rtio n s w ere P ro te sta n t.60 Perhaps th e se critics ov erestim ated th e in cid e n ce o f th is p ra c tice , esp ecially b eca u se m an y ph y sician s at th is tim e designed th e ir re p o rts to in flu en ce state legislatures and p u blic opinion. M oreover, b eca u se th e m a jo rity o f C a th o lic im m ig ran ts w ere probably to o p o o r to co n su lt allop ath s, th e se d o cto rs w ould have had little know ledge o f C ath o lic a b o rtio n p ra ctices. P hysicians’ fears o f P ro te sta n t rep rod u ctive rates falling beh in d th o se o f C a th o lics u nd ou btedly fueled th e cam paign, w h ich in ­ cluded a vested in tere st in th e co n tin u ed P ro te sta n t d o m in atio n o f society. D esp ite th e religiou s d im en sio n o f a b o rtio n , religiou s lead ers generally r e ­

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m ained silent. O n e an on ym ou s m in iste r w ho w as also a physician criticiz ed a b o rtio n in an 1 8 5 5 tr a c t: “A B O R T IO N : th e w riter regard s th a t p ra ctice as essentially im m o ra l"61 Few o th e rs jo in e d his co n d em n atio n . In 1 8 6 0 S to re r d eclared: “W e are com p elled to ad m it th a t C h ristia n ity itself, o r at least P ro t­ estan tism , has failed to c h e c k th e in c rea se o f crim in a l a b o r tio n "62 S ev eral fa cto rs m ay explain th is silence: so m e religiou s lead ers avoided ad dressing sexuality, so m e ad hered to th e qu icken in g d o ctrin e , so m e refu sed to believe th e ir follow ers te rm in a ted p reg n an cies, and o th ers realized th e ex iste n ce o f th e p ra ctice am on g th e ir m e m b ers and avoided ad opting a n u np op u lar p o si­ tio n . O rgan ized religion offered lim ited su p p ort to th e a n tia b o rtio n m o v e­ m e n t, esp ecially co m p ared to th e active ro le assu m ed by som e religiou s lead ­ ers in th e tw e n tieth century. Ironically, th e first religiou s en d o rse m en t ca m e fro m a C a th o lic leader. U n til th e m id -n in e te e n th ce n tu ry th e C a th o lic C h u rch a ccep ted a b o rtio n p rio r to qu ickening , th e p o in t at w h ich ch u rch lead ers believed “en so u lm en t" o ccu rred . The ch u rch also a ccep ted a b o rtio n to save th e m o th e r’s life. S o m e individual ch u rch lead ers p e rm itte d a b o rtio n in rap e cases or o th e r “ex ten u ­ ating circu m stan ces,” b u t th is stand w as n o t official policy. A chang e b eg an in 1 8 5 4 , w h en P ope Pius IX affirm ed th e im m acu late co n c e p tio n o f M a ry and em phasized th e sacred n ess o f m o th e rh o o d .63 B ish op Jo h n B. F itzp atrick o f B o sto n sen t a le tte r to S to re r in 1 8 5 8 praising th e crusad e: “It affords m e g reat p leasu re to le a rn th a t th e A m e ric a n M e d ica l A sso c ia tio n has tu rn ed its a tten tio n to th e p rev en tio n o f crim in a l a b o rtio n ” S to re r p rin ted th e le tter in his a n tia b o rtio n tr a c t Criminal Abortion in America.64 In view o f S to r e r’s a n ti-C a th o lic sen tim e n t, his d ecisio n to d up licate th e le tte r is in terestin g . It cou ld re p rese n t his d esire to d em o n stra te C a th o lic aversion to a b o rtio n versus P ro te sta n t p ra ctice s and th u s co n firm his alleg ation s to his audience. A lternatively, it could suggest his n ee d fo r leg itim a cy am o n g religiou s lead ­ ers. N o fu rth er b acking follow ed fo r alm ost a decade. The C on g reg atio n alists b ro k e th ro u g h P ro te sta n t re ticen c e. T he R everend Jo h n Todd o f M a ssa ch u setts d en o u nced a b o rtio n in “F ash ion able M urder,” w h ich ap p eared in th e jo u rn a l Congregationalist and Boston Recorder in 1 8 6 7 . Todd, w ho k new S to re r fro m th e B erk sh ire M e d ica l In stitu tio n , shared S to r e r’s nativist sen tim en ts. In resp o n se to in crea sin g im m ig ra tio n he w rote th a t “G o d has given th is co n tin e n t to th e stron g est race o n earth , and to th e free st and b est ed u cated p art o f th a t race, and I do n o t b elieve h e is going to le t it drop out o f hands th a t ca n han d le th e globe, and pu t it in to hands th a t are hand s w ith ou t ed u cated b ra in s "65 Sev eral o th e r C on g reg atio n alists c ru ­ saded at th e state level. The R everend E. F ran k H ow e ad d ressed his ch u rch in T erre H au te, Ind iana: “It is w ith ex trem e re lu cta n c e th a t I to u c h th e su b je ct, n o t sim ply b eca u se o f its d elicate natu re, bu t b eca u se I ca n n o t doubt th a t an

Abortion and Contraception in the Nineteenth Century

evil so w id e-spread , has invaded m y ow n ch u rch and con g reg atio n . . . . The sacred gift o f h u m an life is ta k e n . . . and th is c o n stitu tes . . . m u rd er" H e called for th e “p re a ch e r [to] jo in hands w ith th e h o n est p hy sician” to end th is h o rrib le “c r im e "66 Satan in Society called on religiou s lead ers to add th e ir “p ow erfu l v o ice ” to th e cam p aig n .67 In 1 8 6 9 P resb y terian s pledged to help erad icate ab o rtio n . The sam e year th e O ld S c h o o l P resb y terian A ssem bly, a sp lin ter group, re je c te d a sim ilar resolu tio n . Thus, by no m eans w ere P ro te s­ ta n ts u nited in o p p osition . In fa ct, on e d o cto r w as aston ish ed to receiv e a le t­ te r fro m a “clergy m an o f g reat in flu en ce in th e co m m u n ity ” w ho w as seeking advice o n how to o b tain an a b o rtio n for his w ife, d em on stratin g th a t a b o rtio n w as n o t solely a w om an’s c o n c e rn .68 C a th o lic arch b ish o p M a rtin Jo h n Sp ald ­ ing o f B altim o re , on th e o th er hand, co n firm ed C a th o lic unity, d en ou ncin g a b o rtio n in th e w ake o f a b ish op s’ m eetin g . In 1 8 6 9 ch u rch d o ctrin e stated th a t anyone p erfo rm in g an a b o rtio n w ould b e ex co m m u n ica te d fro m th e ch u rch .69 The a n tia b o rtio n cru sad e in flu en ced so m e states, esp ecially th o se w ith large im m ig ran t p o p u lation s, to m o d ify statu tes. In 1 8 4 5 - 4 6 N ew Y ork b e ­ cam e th e first state to ab o lish th e m o th e r’s im m u n ity ; th e law also d eem ed th e a b o rtio n o f a qu ick child as m an slau g h ter in th e seco n d degree. This law passed at th e sam e tim e th a t large n u m b ers o f Irish land ed in N ew Y ork and on th e h eels o f th e m u ch -p u b liciz ed d eath o f M a ry R og ers fro m an “a b o rtio n gone aw ry" N ew Y ork rem ov ed th e q u icken in g d o ctrin e in 1 8 6 9 .70 M a ssa ch u ­ setts passed its first a n tia b o rtio n statu te in 1 8 4 5 . Tw o years la ter it en acted th e first law in th e n a tio n th a t p ro h ib ited th e ad v ertisem en t or d istrib u tio n o f a b o rtio n -re la ted m aterials. In 1 8 6 9 legislators co n fo rm ed to S to r e r’s r e c ­ o m m en d atio n to elim in ate p ro o f o f p re g n a n cy to p ro se cu te. V irg inia p ro ­ scrib e d a b o rtio n in 1 8 4 8 and en fo rced a five-year ja il te rm if it o cc u rred a fter qu icken in g bu t only on e to tw elve m o n th s if b efo re. The state ab o lish ed th is d istin ctio n in 18 7 3 . C alifo rn ia outlaw ed all m e th o d s o f a b o rtio n at any stage o f th e p reg n an cy in 1 8 4 9 - 5 0 and elim in ated th e m o th e r’s im m u n ity in 1872. L o u isian a regu lated a b o rtio n s p rod u ced by drugs and p o tio n s in 1 8 5 6 ; in 1 8 7 0 it p ro h ib ited all m e th o d s.71 C o n n e c tic u t follow ed A M A guidelines in 1 8 6 0 , rem ov ing th e qu icken in g d istin ctio n , b an n in g ad v ertisem en ts, d eem ­ ing th e p ra ctice a felony, and elim in atin g w o m en ’s im m unity. Pennsylvania’s 1 8 6 0 statu te also ad h ered to A M A guidelines: req u irin g n o p ro o f o f p reg ­ nancy, it outlaw ed a b o rtio n by any m eans at any stage o f g esta tio n and held m o th e rs liable fo r p ro secu tio n . Ten years la ter Pennsylvania p ro h ib ited th e ad v ertisem en t or d istrib u tio n o f all m aterials related to th is “c r im e " In 1 8 6 8 M arylan d b an n ed a b o rtio n at any p e rio d o f th e p reg n a n cy and sen ten ced offend ers to th re e -y e a r ja il te rm s .72 S o u th C a ro lin a b an n ed th e p ro ced u re in 1 8 8 3 , apparently w ith ou t th e a ssista n ce o f th e state m ed ical society. The

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Medical Society Minutes o f th e S C M S fro m 1 8 8 0 to 1 8 8 4 m ake n o m e n tio n at all o f a b o rtio n .73 D elaw are in 1 8 8 3 d eem ed th e o p era tio n a felony, co n sid ­ ered th e attem p t ground s to p ro secu te, and p ro h ib ited th e a d v ertisem en t and d istrib u tio n o f m a teria ls.74 O th e r states, p rim arily in th e S o u th , ad o p ted less strin g en t m easu res. A labam a’s first a b o rtio n statu te (1 8 4 0 ) m ad e it illegal only if p erfo rm ed a fter qu icken in g. In 1 8 6 6 th e legislatu re stiffened th e p en alty fro m th re e to six m o n th s to th re e to tw elve m o n th s, hardly a d rastic alteratio n . M ississip p i’s 1 8 4 8 law d eem ed a b o rtio n o f a n “u n b o rn qu ick ch ild ” m an slau g h ter in th e first degree and attem p ted a b o rtio n o f a qu ick child m an slau g h ter in th e se c ­ ond degree. This law rem ain ed u naltered in to th e tw e n tieth century. W h ile G eo rg ia p ro scrib e d a b o rtio n in 1 8 7 6 , it d isting uished betw een p u n ish m en ts assigned fo r qu ick and u n q u ick op eratio n s. The state co n sid ered th e fo rm er a felony p u nishable by d eath or life im p riso n m e n t and th e la tte r an assault w ith in te n t to m u rd er.75 N o rth C a ro lin a ’s 1881 law d ifferentiated betw een qu ick and u n q u ick as well, w ith th e fo rm er a felony pu nishable by on e to te n y ears’ im p riso n m e n t and th e la tte r a m isd e m ea n o r w ith a sen ten ce o f on e to five y ears.76 K en tu ck y rem ain ed th e only state w ith n o a b o rtio n law in th e n in e te e n th cen tu ry and did n o t ad opt on e u n til 1910.77 A lth ou g h th e p h y sician s’ cru sad e did n o t su cceed in all sta tes, in g e n ­ eral it in flu en ced th e a ctio n s o f m any legislatures th a t had also exp erien ced K n o w -N o th in g su ccess in th e 1 8 5 0 s. B o th cam p aig ns drew on nativist fears o f im m ig ran ts d estroying P ro te sta n t hegem ony, an an x iety n o t as relev ant to S o u th e rn as to N o rth ern states. B etw een 1 8 6 0 and 1 8 8 0 fo rty a n tia b o rtio n statu tes passed legislatures: th irte e n states o r te rrito rie s outlaw ed it fo r th e first tim e, w hile tw en ty -sev en b road en ed existing m easu res. B y th e end o f th e cen tu ry th e U n ited S ta tes had evolved fro m a so ciety th a t p laced few re s tric ­ tio n s on a b o rtio n to on e th a t strictly regu lated th e p roced u re.

Feminist Reaction M o st fem in ists did n o t oppose new regu lations th a t re stricte d w o m en ’s ability to co n tro l rep ro d u ctio n . F em inists did n o t view a b o rtio n as a sy m bol o f au ­ tonom y. In fa ct, th e y d en o u nced it as v eh em en tly as S to re r and his follow ers bu t co n sid ered m en, n o t w om en, th e th re a t to th e so cia l o rd er b eca u se m ale dem ands for sex led to u nd esired re p ro d u ctio n for w om en. F em inist p ro tests w ere less co n cern e d w ith a b o rtio n p er se th a n w ith th e circu m sta n ces th a t com p elled so m e w o m en to re so rt to a b o rtio n .78 H en ry C. W rig h t in The Unwelcomed Child (1858) en u n ciated th e earliest fem in ist p o sitio n . H e b elieved w o m en re so rte d to a b o rtio n b eca u se o f th e

Abortion and Contraception in the Nineteenth Century

o v erbearing selfish sexu al dem and s o f husbands. B ec a u se w o m en refu sed “to b e a r th e cross and end u re th e cru cifixion ,” a b o rtio n w as an u nd esirable n e ­ cessity. T o avoid a b o rtio n w o m en m u st have full a ccess to co n tracep tiv es b e­ cau se “w om an, alon e, has a right to say w hen, and u nd er w hat circu m sta n ces, she shall assu m e th e office o f m atern ity ” H e co n ten d ed th a t husbands kept in fo rm atio n fro m w ives ab o u t h ow th e y b e c a m e p reg n a n t as a way to k eep th e m in slavery.79 F em inists in th e N atio n al W o m en ’s Suffrage A sso cia tio n (N W S A ) agreed. In th e N W S A new spaper, Revolution, E liz a b eth Cady S ta n ­ to n argued th a t th e grow ing in cid e n ce o f a b o rtio n did n o t re flec t th e in c re a s ­ ing in d ep en d en ce o f w o m en bu t th e “d eg rad ation o f w om an” at th e hands o f ty ran n ical husbands. A lth ou g h she and o th er fem in ists could u nd erstand a w o m an w ho re so rte d to a b o rtio n u n d er ce rta in circ u m sta n ce s , th e y did n o t co n d o n e it. They h op ed th e p ra ctice w ould d isappear if m arriage re fo rm b ro u gh t eg alitarian re sp e c t and sexu al d isc re tio n a m o n g cou p les. W o m en w ere n o t th e cu lp rits, M a th ild a E. J. G age argued; rather, “th is crim e o f ‘child murder,’ ‘abortion ,’ ‘infanticid e,’ lies at th e d o or o f th e m ale sex ”80 Even free love ad vocates refu sed to en d o rse a b o rtio n . F ree-lov e p hilosophy dem and ed th e righ t o f b o th m e n and w o m en to ch o o se sexu al p a rtn ers b ased on m u tu al love w ith ou t ch u rch or state in terferen ce. They con sid ered a b o rtio n a rep u l­ sive end to w h ich w o m en re so rte d b eca u se o f th e rep ressive n atu re o f th e m arriage in stitu tio n .81 Free lovers and fem in ists re je c te d n o t only a b o rtio n bu t also c o n tra ce p ­ tives. C o n tra ce p tio n was a rtificia l and allow ed m e n th e privilege o f sex on de­ m an d b o th insid e and outsid e m arriage. In stead , th e y ad vocated a b stin en ce and “V olu ntary M o th erh oo d ,” a la te -n in e te e n th -ce n tu ry fem in ist slogan th a t em phasized rep ro d u ctiv e au ton om y fo r w o m en w hile at th e sam e tim e ex­ alted th e ir ro le as m o th e rs. D arw in ’s ideas p e rm ea ted V olu n tarism : p reg ­ n an cies resu lting fro m m utually w illing in terco u rse w ould p ro d u ce healthy, stable ch ild ren and th u s ad vance th e race; th o se con ceiv ed during in v olu n ­ ta ry sex w ere at risk o f b ec o m in g crim in als, id iots, o r paupers. The reality o f a b o rtio n w as p ro b lem atic for w o m en re fo rm e rs w ho assu m ed th e high m o ra l grou nd in co n d em n in g m ale sexu al tra n sg re ssio n s th ro u g h th e V olu ntary M o th e rh o o d cam paig n, w h ich a ccep ted th e n o tio n th a t w o m en engaged in sex p rim arily fo r child b earin g p u rp o ses.82 Fam ily lim ita tio n — e ith e r by v o lu n tary m o th e rh o o d , co n tra ce p tiv es, or a b o rtio n — did affect fertility by th e end o f th e century, w ith th e w hite T F R dropping fro m 7 .0 4 in 1 8 0 0 to 3 .5 6 in 1 9 0 0 . In 1 9 0 0 5 0 p e rce n t o f ed u cated b lack w ives and 2 5 p e rce n t o f all b la ck w om en w ere child less, d espite re s tric ­ tio n s on a b o rtio n and co n tra ce p tiv es.83 The lack o f org anized fem in ist o p p o ­ sitio n to state re strictio n s o n a b o rtio n eased th e ta sk o f d o cto rs in p ressu r­

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ing legislatures to crim in alize th is p ra c tice and in keep in g th e se laws on th e b o o k s, alth ou g h even a v o cal fem in ist o u tcry w ould have had little in flu en ce on m ale legislators in th e p o litica l cu ltu re o f th e tim e. W h a t im p act did th is chang e in p o licy have on w om en? It b a n n ed a b o r­ tio n and attem p ted to re in fo rce tra d itio n a l m a rita l relatio n s and obligations. It also re flected p rog ressive p hilo so p h y by en a ctin g le g isla tio n to “solve” perceived so cieta l p ro b lem s, inclu d ing issues previou sly co n sid ered private. Y et th e cam p aig n did n o t elim in ate a b o rtio n . In stead , it re stric te d a ccess to w o m en w ith m o n ey and c o n n e ctio n s or to w o m en d esp erate enou gh to ch an ce b ack-alley p ro ced u res. W h ile legislative exem p tion s to save a w o m ­ an’s life allow ed private d o cto rs o f m id d le- and u p p er-class w o m en to p ro ­ vide safer ab o rtio n s, lo w er-in co m e w om en lacked th is reco u rse. Law s also b rou gh t th e possib ility o f in crim in a tio n , im p riso n m e n t, and so cia l o stra cism fo r b o th w o m en and physicians w ho b re a ch ed new ly a ccep ted cod es o f c o n ­ d uct. The p o p u lar press avoided any o v ert m a teria l o n a b o rtio n , alth ou g h veiled ad vertising co n tin u ed in m ag azines and new spap ers. U ltim ately, th e late n in e te e n th cen tu ry w itn essed a d eclin e in th e ca lib e r o f a ccessib le c o n ­ tracep tiv e in fo rm a tio n , bu t a co m p etitiv e b la ck m ark et in d evices co n tin u ed to th riv e.84

The Case o f Rhode Island M an y o f th e chang es th a t o ccu rred on th e n a tio n a l level fro m th e 1 8 3 0 s to th e end o f th e ce n tu ry ca n b e seen in a m icro an aly sis o f R h od e Island. In th e early p erio d a b o rtio n and co n tra cep tiv es w ere relatively co m m o n p lace. By m id cen tu ry th e K n o w -N o th in g P arty d o m in ated th e sta te and h eed ed th e R IM S ’s call to b an a b o rtio n . C o n tra ce p tiv es, o n th e o th e r hand , rem ain ed legal in to th e tw e n tieth century. The g eo p o litica l situ atio n o f R h od e Island helps explain th e p ath legislators ch o se regard ing rep ro d u ctiv e legislation. The C orn ell/A v ery case in th e 1 8 3 0 s w as on e o f th e first in th e state to deal w ith ab o rtio n . S a ra h C o rn e ll first en co u n tered th e R everen d E p hraim K. Avery w h en he w as p a sto r o f a M eth o d ist ch u rch in Low ell, M a ssa ch u setts, w here Sarah w as a m ill operative. Avery charged h e r w ith lying and fo rn ic a ­ tio n ; she w ro te letters o f co n fessio n to Avery, w h ich he kept, and he ex c o m ­ m u n icated h e r in 1 8 3 0 . H e la ter assu m ed th e p astorsh ip o f th e M eth o d ist C h u rch in B risto l, R h od e Island; she re lo ca ted to Fall River. C o rn e ll and Av­ ery, a m arried m an w ith child ren, m e t again at a cam p m e etin g in T hom p son , C o n n e cticu t, in A ugust 1832. W h e n she asked h im to re co m m en d h er for m em b ersh ip in th e M eth o d ist ch u rch o f Fall R iver u nd er th e p astorsh ip o f th e R everend Ira Biddle, Avery in fo rm ed h er th a t th e re w as “on e co n d itio n on w h ich ” he w ould “b u rn ” th e le tters o f co n fessio n and “settle th e difficulty.” He

Abortion and Contraception in the Nineteenth Century

p ro ceed ed to p lace his hand on h e r b o so m and “th e n had a co n n e x io n w ith her.” In o th er w ords, he w ould n o t alert Bid d le to h e r previous e x co m m u n ica ­ tio n if she had sex w ith him . Sed u ced “u nd er th e m ask o f relig ion ” C o rn ell “finally su rren d ered h e rs e lf” and b e c a m e a m e m b e r o f B id d le’s ch u rch .85 In O c to b e r C o rn e ll visited Dr. T h o m as W ilb u r o f Fall River, w ho told h er she w as p regn an t. S h e in fo rm ed W ilb u r th a t Avery w as th e fa th er bu t th a t she w ould n o t p u b licize h e r p reg n an cy b eca u se she did n o t w ant to ru in his re p u tatio n o r em b arrass his family. C o rn e ll sought th e aid o f a law yer to co m p el Avery to su p p ort h er and th e child in a clan d estin e fashion. Avery attem p ted to co n v in ce C o rn e ll to tak e a “m e d icin e ” called “oil o f ta n sy ” th a t w ould “at o n ce o b litera te th e effects o f th e ir c o n n e x io n ” B e fo re ing esting th e p o tio n C o rn e ll re tu rn ed to W ilb u r’s office, w here h e a lerted h e r to its life-th re aten in g p oten tial. W h ile tan sy w ater, tan sy te a , and essen ce o f tan sy w ere used for ab o rtio n , he in d icated th a t oil o f tan sy should “n ev e r” b e used b ecau se it cau sed d eath or seriou s lifelong h ea lth p roblem s. S h e resp ond ed , “T hen I w on’t tak e it; fo r I w ould ra th er have m y child and do th e b est I can w ith it th a n end anger m y life” (7, 4 4 , 4 5 ) .86 S h e w as n o t opp osed to a b o rtio n p er se, ju s t to a life-th re a ten in g proced ure. H er resolve led Avery to m e e t h e r in D ecem b er, at w h ich tim e he b e a t h er ab o u t th e belly and low er b a ck , h op in g to in d u ce a m iscarriag e b u t instead killing her. A lth ou g h co u n sel for th e state did n o t believe th a t Avery arranged th e m e etin g w ith th e express in ten t o f m urder, he “m ig h t have b e e n suddenly ind u ced to tak e h e r life by th e dreadful state in w hich his cru el a ttem p ts at p ro d u cin g a b o rtio n by v iolen ce m ay have left her” H e trie d to co n c e a l th e m u rd er by h anging h e r fro m th e ra fters, im plying th a t she had co m m itted su icid e (5 0 ). H is plan failed: a n o te in h er tru n k said, “I f I am m issing inq u ire o f Rev. M r. Avery o f B risto l, he w ill k now w here I am g o n e” (16). A pparently, C o rn e ll m e t Avery u nd er th e assu m p tio n th a t he had m ad e arran g em en ts for h e r seclu sio n fo r th e rem ain d er o f h e r pregnancy.87 P olice arrested Avery but released h im u ntil trial. H e fled to N ew H am p shire and disguised h im self, but he w as found and b rou gh t b a ck to R h od e Island .88 The resu lting tria l in M ay 1833 received n a tio n a l a tten tio n and “created ex citem en t u n p reced en ted in th e h isto ry o f our S ta te ” T h ree m illio n m e m ­ bers o f M e th o d ist ch u rch es aw aited “anxiously to k now w h eth er a m in iste r w ho sto o d h igh am o n g th e m b e g uilty o f th e crim e o f m u rd er” (4 ).89 The co m m u n ity w as outraged th a t Avery m ig h t have used his in flu en tial religious p o sitio n to sed u ce a w om an, fo rce h e r to a b o rt h e r fetu s, and u ltim ately m u r­ der her. The tra n scrip ts o f th e tr ia l do n o t ask w h eth er C o rn e ll ag reed to th is last a b o rtio n a ttem p t. The co n sen su s w as th a t Avery fo rced it u p on h er to save his m arriag e and h is rep u tation . The state p ortray ed h e r as a p o o r fa cto ry girl, black m ailed in to a sexu al liaiso n by a p ow erful m an w illing to

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tak e any actio n , inclu d ing a b o rtio n and m urder, to save him self. O n e state w itn ess re m em b e red th a t sh ortly b efo re C o rn e ll’s d eath she asked if “a girl in n o ce n tly ” cou ld “b e led away by a m an in w h om she puts m u ch co n fid en ce, and ra th er look s up to ; . . . w hat ca n a p o o r in n o c e n t girl do in th e hand s o f a stron g m an , and he, to o , using all kinds o f a rg u m en ts?”90 The m ain ta c tic o f th e defense, on e still co m m o n ly em ployed, w as to d e­ fam e C o rn e ll’s c h a ra cte r and p o rtray h e r as a vengefu l w om an. The defense also end eavored to d ep ict C o rn e ll as a d isrep u table w om an , and an u n d e ­ serving v ictim . A very’s law yers co n ten d ed th a t she w as su icid al and hanged herself, w h ich th e state proved w as im p ossible. As W . M . R. Stap les, cou n sel fo r th e state, su rm ised , A very’s law yers asked th a t th e ir clie n t b e dism issed b eca u se o f “h is g ood ch aracter. B ad c h a ra c te r o f d eceased.”91 T h eir o p en ­ ing statem e n t claim ed th a t fro m “h er strange co n d u ct and co n v ersatio n , th e ap p earan ce o f h e r eyes, and fro m o th e r circ u m sta n ce s , she w as generally co n sid ered to b e deranged. W e w ill lay b efo re you th e h isto ry o f th is g irl’s lew d ness and m isco n d u c t fo r fo u rteen years.” D o c to rs testified to trea tin g C o rn e ll fo r th e “m o st lo a th so m e d iso rd e r” o f “v en erial d isea se” (17). O n e w itn ess claim ed th a t C o rn e ll had black m ailed a m an in to believing th a t she w as p regn an t and buying h e r silence. O th ers te stified th a t C o rn e ll had b ee n “to a tav ern w ith a g en tlem an on [the] S a b b a th ” (2 3 ), th a t she had stolen a “p iece o f ca m b ric ” (2 4 ), th a t she had engaged in “im p ro p er c o n d u ct” w hen she “p atted ” a young m an on th e sh ou ld er (2 5 ), and th a t she had displayed “very u n b e co m in g ” b eh av ior w h en she o n ce “put h er arm s ro u n d ” th e n eck o f a “re sp ecta b le m an ” (27). S till oth ers testified th a t she w as a “lo o se w om an” and th a t “h e r ch a ra cte r w as generally b ad ” (31). A s co u n sel fo r th e state c o n ­ cluded, I ca n n o t fo rb ea r rem ark in g o n th a t large p o rtio n o f th e te stim o n y and argu m en t fo r th e d efense w h ich has b e e n d irected ag ainst th e ch a ra cte r o f th e u n fo rtu n a te d eceased . The efforts m ad e fo r th is p u rp o se are I believe u nexam p led in th e reco rd s o f any cap ital trial. For th e last te n years o f h e r life every lew d o r im p ro p er a c t w h ich she eith er did or c o n ­ fessed to have done; and every p assio n ate, re m o rsefu l or in d iscre et ex­ p ressio n w h ich she u ttered , have b e e n co lle cted , co llated and brou ght forw ard fo r th e pu rp ose o f endow ing h e r w ith m otives fo r su icid e and revenge. (49) The defense d ep icted C o rn e ll as u nw orthy o f sym pathy and cred en ce. Avery p articip a ted in th is sm ear cam paign. Follow ing C o rn e ll’s death, he in stru cte d a m an n am ed S tep h e n B a rtle tt to go to Low ell and “o b ta in in fo r­ m atio n re sp ectin g th e bad c h a ra cte r o f th e girl.” B a rtle tt te stified th a t Avery d esp erately n eed ed “evid ence to reb u t th e charges w h ich m ig h t be brou ght

Abortion and Contraception in the Nineteenth Century

against him . H e said she had a reveng e ag ain st h im fo r expelling h er fro m th e ch u rch at Low ell, and had laid th is trap fo r h im ” (12). As so o n as Avery realized th a t his staged su icid e had b e e n exposed, he defend ed h im s e lf by defam ing C o rn e ll’s c h a ra cte r and u n d erm in in g h e r credibility. The defense also argued th a t C o rn e ll w as alread y p regn an t by th e tim e o f th e cam p m e etin g , im plying th a t Avery could n o t have b e e n th e father. M u ch o f th e tria l w as devoted to d eterm in in g th e age o f th e fetu s, an eig h t-in ch , fiv e-o u n ce fem ale. H ad C o rn e ll b e c o m e p reg n an t at th e cam p m e etin g , th e fetu s w ould have b e e n th re e m o n th s and tw en ty days old. T he defense in tro ­ duced d o ctors to te stify th a t a fetu s th is size m u st b e at least five m o n th s old. C ro ss-e xam in atio n , how ever, led th e d o cto rs to ad m it u n certa in ty and th a t th e p regn an cy could have o ccu rred at th e cam p m e etin g , as C o rn e ll said (6, 19). The d efense a sserted th a t C o rn e ll’s “lew d ness” affected feta l grow th: “I th in k w e shall satisfy you th a t th e ch ild ren o f w o m en o f bad fam e, o f diseased w o m en , and o f th o se w ho ind u lge in p ro m iscu o u s in terc o u rse are sm aller th a n th e ch ild ren o f o th e r w om en; th a t th e d eceased a t th e p erio d o f h er d eath m u st have b e e n p regn an t five m o n th s o r m o re ” (17). This strategy failed w h en C o rn e ll’s sister and ro o m m a te te stified th a t C o rn e ll had had h er p e ­ riod on e w eek p rio r to th e m e etin g (13). The d efense resp on d ed w ith d o ctors claim in g th a t so m e w o m en did have period s a fter p reg n a n cy and w ith w it­ n esses claim in g C o rn e ll w as visibly p regn an t at th e m eetin g . T he R everend H en ry M ayo sw ore she w as p reg n an t even th o u g h he “did n o t see h e r fro n t” (19). Sev eral w o m en agreed: C o rn e ll’s “co u n te n a n ce w as pale and sickly,” and h e r “b o so m w as ra th er full” (2 0 ). The state d iscred ited th em . A t fou r to six w eeks p regn an t “h er p reg n an cy could n o t . . . have b e e n perceived or su s­ p e cte d . . . fro m ex tern a l a p p earan ces” (3 0 ). M ay o ’s w ife te stified th a t “I saw n o th in g in th e ap p earan ce o f M iss C o rn ell at T h om p son , th a t w arran ted th e rem ark by m y hu sband ” (5 0 ). A lthou g h th e d efense u nd erm in ed its ow n case, th e ju ry found Avery n o t guilty. The C orn ell/A v ery case is in terestin g fo r several reason s. First, th e reco rd s a ttest to th e rigo ro u s p ressu res th a t forced w o m en to co n fo rm to a ccep ted cod es o f co n d u ct. N u m erou s peop le w ho had en co u n tered C o rn e ll over th e years to o k steps to shape h e r b eh av io r and p u n ish h e r fo r h e r tra n sg re s­ sions. B ro o k s Sh ad d o ck , m an ag er o f a Low ell factory , fired C o rn e ll b ecau se he “w as satisfied she w as n o t a g ood character.” H e to ld h e r she m u st con fess to Avery ab o u t h er “in terco u rse w ith different individuals,” bu t w hen “she did n o t go . . . I w ent and told h im m y self” (2 3 ). N ath an H ow ard o f N orth w ich , M assach u setts, believed C o rn e ll’s c h a ra cte r to b e g ood u n til he heard ru m ors “o f h e r having illicit in terco u rse w ith different m e n ” (2 3 ). H e in fo rm ed Avery and pu shed fo r charges ag ainst h e r in th e M e th o d ist ch u rch. Dr. W illiam G raves o f Low ell trea te d C o rn e ll fo r ven ereal disease in 1 8 3 0 and, d isregard ­

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ing p atien t confid entiality, in fo rm ed Avery (2 2 ). This betray al dism ayed C o r­ nell: Dr. N o ah M a rtin o f G rea t Falls testified th a t w h en C o rn e ll ca m e to h im (G raves had n o t cu red h er), she b em o a n e d th e fa ct th a t G raves had b ro k en h e r confidentiality. A n o th e r w itn ess te stified th a t C o rn e ll had “com p lain ed o f [Graves] having violated his p ro fessio n al co n fid en ce in speaking as h e had o f h e r disease.” G raves m ay have ta k en th is step to fo rce C o rn e ll to leave th e co m m u n ity to save his ow n rep u tation . C o rn e ll told on e p e rso n th a t G raves “had attem p ted to tak e im p ro p er lib e rtie s w ith h er” S h e to ld a n o th e r th a t G raves “had closed th e door, and insu lted her, th rea te n in g to re p o rt th a t she had th e fou l d isease, u nless she co m p lied w ith his im p o rtu n ities.” A th ird w itn ess said G raves “lo ck ed th e door, put his hand rou nd h e r w aist, and told h e r she w as a p retty g irl” W h e n C o rn ell re je c te d his ad vances, he “th rea ten ed if she did n o t com p ly w ith his w ishes to in fo rm M r. Avery th a t she had th e bad d iso rd e r” (2 2 , 2 6 , 2 7 ). This in fo rm a tio n led Avery to charge h e r w ith fo rn ica tio n and expel h er fro m th e ch u rch .92 H e th e n w ro te to th e R everend Jo h n D ow o f S o m ersw o rth , G rea t Falls, w here C o rn e ll had m oved , conveying th e in fo rm atio n ab o u t h e r “fo rn ica tio n and ly ing ” charges and h e r v en ereal d isease and calling h er a “c o m m o n stru m p e t” H er a ctio n s so offended D ow th a t he ig n ored tra d itio n a l ch u rch ru les o f re a d m itta n ce follow ing p ro o f o f “co n tritio n and re p e n ta n ce ” and refu sed to a cc ep t C o rn e ll in his ch u rch even on a tria l basis (2 6 ). A t th e cam p m e etin g Avery and o th e rs “ag reed th a t it w as o u r duty to in fo rm th e peop le at th e te n t w here she b oard ed o f h er ch a ra cte r” (29). Th ese m e n co n tro lled w o m en ’s b eh av ior and a cc e p ta n ce in a given co m m u n ity th rou g h e c o n o m ic rep risals, sexu al exp lo itatio n , and re li­ gious ostracism . S e co n d , th e ca se exem p lifies so m e o f th e d angers single young w o m en faced in n in e te e n th -c e n tu ry A m e rica n cities. R h od e Island cities w ere in a sea o f change b rou gh t by in d u strializatio n and u rb an grow th, w h ich stim ­ u lated e c o n o m ic tra n sfo rm a tio n s, cu ltu ral diversity, and te n sio n s over a c­ cep ted gen d er roles. C o rn e ll’s life and d eath in m any ways w ere sim ilar to th o se o f M a ry R og ers and H elen Jew ett, tw o young w o m en w ho died violent deaths in N ew Y ork City. A ll th re e w ere single, sexually active w o m en w ho enjoyed th e ex citem en t and p eril o f a n teb ellu m u rb an cu lture. As such, th ey w ere a th re a t to th e g end ered so cia l n o rm s o f th e p eriod : engaging in sex as a single m an w as a rite o f passage; th e sam e b eh av ior fo r a single w om an d efined h e r as an im m o ra l tram p and ru in ed h e r and h e r fa m ily ’s re p u ta ­ tio n . B o th R ogers and C o rn e ll died fro m an “a b o rtio n gone awry” Jew ett and C o rn e ll had b o th left fam ily beh in d in ru ra l areas as th e y set o ff for th e city; b o th w ere sed u ced and aban d on ed , Jew ett by a b u sin essm an ra th er th a n a m inister. B o th m e n w ield ed pow er and in flu en ce over single u n p ro tecte d young w om en. Jew ett, w ho tu rn ed to p ro stitu tio n , w as bru tally m u rdered.

Abortion and Contraception in the Nineteenth Century

Jew ett and C o rn ell shared enou gh sim ilarities th a t th e ir w ax figures appeared to g e th e r in a traveling E ast C o a st exh ib it o f fam ou s m u rd er cases. In all th ree cases n o m an w as held legally resp o n sib le for th e d eath s.93 Third, th e case d em o n strates h ow th e M eth o d ist C h u rch closed ran k s in su p p ort o f Avery (n ot unlike th e C a th o lic C h u rch p rio r to th e sex scand als o f 2 0 0 2 ) . M em b e rs o f th e N ew England C o n fere n ce o f th e M eth o d ist E piscopal C h u rch fou nd Avery n o t guilty. They co n clu d ed th a t h e w as n o t th e fa th er o f C o rn e ll’s child b eca u se th e y a ccep ted th e co n c e rte d sm ear cam p aig n against C orn ell. B eca u se h e w as n o t th e father, h e cou ld n o t have b e e n involved in th e a b o rtio n attem p ts. They ig n ored th e evid ence ag ainst Avery, a ccep ted th e testim o n y o f defense d o cto rs, and resolved th a t Avery should co n tin u e in his ecclesia stica l privileges and m in iste ria l office.94 Fou rth , th is ca se sheds light o n d o cto rs’ know ledge ab o u t p reg n an cy and b irth co n tro l in th e 1 8 3 0 s. B a sed o n th e testim on y, n o m ed ica l co n sen su s on p regn an cy existed. Dr. U sh er P arso n s, le ctu re r o n o b ste trics in P rovid ence and P hiladelp hia, argued th a t w o m en could su sp ect th e ir c o n d itio n in six to eight w eeks, b u t th e re w as n o definitive p ro o f u n til qu ick en in g , w hich o ccu rred at th re e to fou r m o n th s. M isog yn y w as ram p an t in his testim ony. “The foetu ses o f w o m en o f very lew d ch a ra cte rs are generally supposed to b e sm aller th a n th o se o f virtu ou s w o m e n " H e co n clu d ed th a t “p ro m iscu ­ ous in terco u rse is certa in ly a w ell know n preventive o f im p reg n atio n ” (2 0 ). O n ly virtu ou s w o m en could b e b lessed w ith m o th erh o od . H is colleagu es did n o t agree: p ro m iscu ity had n o b earin g o n co n cep tio n . Dr. N ath an iel M iller o f Fran klin , M a ssa ch u se tts, displayed k now led ge o f th e rh y th m m eth o d : w o m en w ere m o st likely to g et p reg n an t w ith in th e “first w eek or fortn ig h t a fter m en stru a tio n th a n at a la ter p erio d in th e m o n th " The first sign o f p reg ­ n an cy w as th e “cessa tio n o f th e m en stru a l discharge,” w h ich cou ld th e n be used to ju d g e th e tim e o f im p reg n atio n . H e did n o t m e n tio n qu ickening . Dr. W illiam T u rn er o f N ew p ort argued th a t th e early sign o f p reg n an cy was “eq u ivocal qu ickening , w h ich generally tak es p lace at th e m iddle o f th e fifth m onth,” m u ch la ter th a n P arsons believed (1 9 -2 1 ). D esp ite a n active m ed ical so ciety in R h od e Island , th e se d o cto rs did n o t ag ree on th e b asic facts. Finally, re p o rts o f th e tria l paid little a tten tio n to ab o rtio n . A b o rtio n w as n o t illegal in R h od e Island at th e tim e, and W ilb u r’s te stim o n y co n firm ed th a t know ledge ab o u t ce rta in a b o rtifa cie n ts w as co m m o n . C o rn e ll did n o t m e n tio n to W ilb u r any o b je c tio n to a b o rtio n , n o r did he try to co n v in ce h er th a t she m u st ca rry th e p reg n a n cy to te rm . H e sim ply w arned h e r a b o u t th e dangers o f A very’s p ro p o sed m eth od . The re co rd s do n o t d isclose w h eth er th e y d iscu ssed safer m eth o d s. The state, how ever, co n clu d ed th a t Avery, n o t C orn ell, d ecid ed to a b o rt th e fetu s to avoid a ccep tin g resp o n sib ility for his actio n s. This b e lie f in m ale pow er over d ecisions to a b o rt foreshad ow ed

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later p o licy d evelop m ents in R h od e Island. W h ile h isto ria n C a rro ll S m ith R o sen b erg co n clu d es th a t d o cto rs, m in isters, and o th ers p o in ted to a b o rtin g w o m en as in d ep en d en t, strong -w illed , selfish, “u nn atu ral and m o n stro u s . . . , leth al to m e n and b abies a lik e " w o m en in R h od e Island w ere g enerally c o n ­ sidered victim s o f m ale m an ip u lation s.95 M en , n o t w om en, w ere held re sp o n ­ sible for ab o rtio n . S u ch attitu d es w ere p rev alen t in th e 1 8 3 0 s reco rd s o f th e Lad ies M o ra l R efo rm A sso cia tio n o f R h od e Island. They co n d em n ed a b o rtio n b eca u se it allow ed m e n to “clo ak th e ir sins” and b eca u se it “invaded th e san ctu ary o f th e h o m e " The h ig h in c id e n ce o f a b o rtio n in R h od e Island appalled th e se w om en: “A w are, as w e all m u st be,” th e y w rote, o f th e “in crea sin g facilities fo r begu iling th e w ary and th e u np rotected ," th e se w o m en co m m itted th e m ­ selves “to stay th is risin g and sw elling tid e o f a b o m in a tio n "96 This th e m e o f w o m en as v ictim s o f m ale sed u cers p ervad ed p opu lar tr a c ts and w orks o f fictio n in th e 1 8 4 0 s . As h isto ria n A m y G ilm an S re b n ic k argues, fo r so m e o f th e se au thors a b o rtio n sy m bolized “th e end o f in n o c e n c e fo r th e virtu ou s re ­ p u b lic"97 B u t su ch w orks as well as th e endeavors o f th e Lad ies M o ra l R eform A sso cia tio n had n o im p a ct on state policy. O n e re aso n fo r th e lack o f legislative chang e m ay have b e e n th e state tr a ­ d ition o f n o t regu lating m e d ica l m atters. D u rin g th e co lo n ia l p erio d M a ssa ­ ch u setts, C o n n e cticu t, and N ew York, am o n g o th ers, en acted nu m ero u s laws suppressing qu ack s, regu lating in o cu la tio n s, and q u aran tin in g ships. R h od e Island , how ever, passed only a 1743 law to p rev en t th e spread o f in fectio u s d iseases.98 L eg islato rs th e re fo re grew up in an atm o sp h ere w h ere m ed ical d ecisio n s, p resu m ably in clu d in g a b o rtio n , re m a in e d a m a tte r co n sid ered outsid e legislative ju risd ictio n . Th rou gh th e 1 8 4 0 s and early 1 8 5 0 s few p eop le in R h od e Island openly opp osed ab o rtio n . A d v ertisem en ts fo r a b o rtio n rem ed ies appeared regularly in n ew spap ers and jo u rn a ls. The Rhode Island Medical Reformer: A Family

Journalfo r the Promotion o f Health and Longevity ad vertised “fem ale re sto r­ ativ es” (a co m m o n n in e te e n th -c e n tu ry te rm fo r a b o rtifa cie n ts) a m o n g th e list o f m e d icatio n s a fam ily m ig h t n eed . The D avol M a n u fa ctu rin g C om p any o f P rovid en ce co m p ete d n ationally in th e field o f au to ab o rtiv e in stru m en ts. The bylaws o f th e P rovid en ce M e d ica l A sso c ia tio n fo r 1855 listed a b o rtio n as a co m m o n p ro ced u re d one fo r tw en ty d ollars.99 Yet a fter receivin g th e le tter fro m A M A P resid en t M ille r as w ell as a copy o f S to r e r ’s Criminal Abortion

in America in 1 8 6 0 , th e R IM S p ressu red th e state legislatu re to ad opt an a n tia b o rtio n statu te in 1861. W h y did m o st R h od e Island physicians m o d ify th e ir attitu d e tow ard a b o r­ tio n ? A lth ou g h p ressured to co n fo rm to new A M A guidelines, nativist a s ­ sertion s seem to b e key. R h od e Island ex p erien ced rapid e c o n o m ic grow th

Abortion and Contraception in the Nineteenth Century

b etw ee n 1 8 3 0 and 1 8 6 0 . In d u stria l exp an sio n re q u ired cheap labor, a d e­ m an d satisfied p rim arily by im m ig ran ts. M an y co m m u n ities re sen te d th e ir in tru sio n . The 1 8 5 0 census provides evid ence o f a sign ifican t ch an g e in th e sta te’s eth n ic co m p ositio n . In 1 8 2 8 only 2 3 7 foreig n ers lived in R h od e Island. O v er th e n ex t fifte en years th e in flu x rem ain ed very low. B y 1 8 5 0 , how ever, th e alien p op u latio n had rea ch ed 2 3 ,9 0 2 , or 16 p e rce n t o f th e to ta l resid en ts. D u rin g th e n e x t decad e im m ig ra tio n a cco u n ted for h a lf o f th e to ta l pop u la­ tio n in crease. The state cen su s o f 1 8 6 5 re p o rte d th a t foreig n ers a cco rd in g to nativity n u m b ered 3 9 ,7 0 3 (2 1 .4 6 p e rce n t o f th e to ta l popu lation) bu t a c ­ cord ing to parentag e n u m b ered 6 7 ,6 4 9 (3 6 .5 7 p ercen t). T he g reat m a jo rity w ere Irish C ath o lics. F ew er th a n on e th o u san d C a th o lics, b o th native and foreign, lived in R h od e Island in 18 3 5 . B y 1 8 5 4 n early te n th o u san d lived in P ro v id en ce alo n e, and C a th o licism had em erg ed as a m a jo r d en o m in a tio n in u rb an are as.100 Th ese circu m sta n ces co n trib u te d to th e popu larity o f th e K n o w -N o th in g Party in th e m id -1 8 5 0 s. M ak in g its first show ing in th e 1 8 5 4 electio n , it sw ept state electio n s in 1855 and 1 8 5 6 . F ro m 1857 to 1861 a co a li­ tio n o f K n o w -N o th in g s and th e new ly form ed R ep u b lican P arty d om inated th e G en e ral A ssem bly and state o ffices.101 The p re sen ce o f th e K n o w -N o th in g P arty in th e G en e ra l A ssem b ly in 1 8 6 0 - 6 1 in flu en ced th e first a n tia b o rtio n law. S to r e r ’s n ativ ist arg u m en ts p rom p ted th e R IM S to d raft a b ill and lobby fo r its passage. Dr. Edw in Snow o f th e R IM S u nd erlin ed every passage in S to r e r’s gift copy o f Criminal Abor­

tion in America dealing w ith d eclin in g w hite P ro te sta n t fertility rates due to a b o rtio n and all sta tem en ts d iscussing foreig n inu nd ation. W h e n S to r e r’s b o o k w ent in to p rin t, R h od e Island had n o statu te on a b o rtio n , a fa ct m e n ­ tio n ed in his essay. S n o w n o te d o n its b a ck cover: “R .I. has g ood S ta tu te now. L aw in R .I. o b ta in ed th ro u g h in flu en ce and a c tio n o f S ta te M e d ica l S o c i­ ety "102 The co n sen su s am o n g d o cto rs by th e 1 8 5 0 s th a t th e fetu s w as alive fro m co n ce p tio n versus qu icken in g m ay have also in flu en ced its passage, al­ th o u g h Sn o w m ad e n o m e n tio n o f th is a sp e ct in his n o tes. N ativism w as th e d ecid ing fa cto r fo r him . Yet relative to A M A guidelines, th e 1861 statu te set fairly lib eral stand ard s (see ap p en d ix D ). A lthou g h it excluded re fe ren ces to qu icken in g and b an n ed all m e th o d s o f ab o rtio n , it im p osed only on e y ear in ja il o r a o n e-th o u sa n d dollar fine. W h ile ad hering to S to r e r’s reco m m en d a tio n to allow a b o rtio n s to p reserv e th e m o th e r’s life, th e m easu re failed to b an ad vertisem en ts fo r ab o r­ tio n s or fo r a b o rtifa cie n ts, p robably a resu lt o f lobby ing by th e D avol M a n u ­ factu rin g C om pany. The law also re je c te d S to r e r ’s w ish to elim in ate w o m en ’s im m unity.103 This exem p tio n cou ld b e th e resu lt o f tw o fa cto rs. F irst, legisla­ to rs m ay have believed erad icatin g a b o rtio n w ould be easier if w o m en could b e co m p elled to te stify ag ain st a b o rtio n ists. Im m u n ity d enied w o m en th e

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righ t to invoke th e F ifth A m e n d m en t privilege ag ainst self-in crim in a tio n . S e co n d , m ale legislators m ay have d isagreed w ith S to r e r ’s co n clu sio n th a t w o m en w ere to blam e fo r a b o rtio n . M o st m e n in th e legislature in th e 1 8 6 0 s w ould have b e e n teen a g ers or young m e n during th e C orn ell/A v ery scandal. That case could have b iased th e m to believe th a t m e n w ere th e m o re re sp o n ­ sible party.104 O n 14 M a rch 1 8 6 7 th e legislatu re rev ised th e 1861 statu te in line w ith A M A guidelines (see ap p en d ix E). It in crea sed th e p en alty to five to tw enty years if th e w om an died and on e to seven years if she did n o t. It also p ro ­ h ib ited ad v ertisem en ts and p u b licatio n s as w ell as any verbal co m m u n ic a ­ tio n regard ing a b o rtio n m e th o d s o r lo ca tin g a b o rtio n ists. Yet it m ain tain ed w o m en ’s im m u n ity fro m p ro se cu tio n — an im m u n ity th e y reta in ed in to th e tw e n tieth centu ry.105 S to re r w as u nable to persuad e legislators th a t w om en w ere th e cu lp rits in th e eth n ic and religiou s fertility im b alan ce. In light o f th e A M A ’s d esire to elim in ate th is “u n n e ce ssa ry ” and “invalid ” p ro te ctio n R h od e Island w as excep tion al, on e o f only tw o states th a t reta in ed th is clause. The w ording o f th e a c t seem s to co n firm m ale leg islato rs’ b e lie f th a t w o m en did n o t w illingly und ergo a b o rtio n b u t w ere co e rce d by m en. T he law con v icted anyone “advising or p rescrib in g fo r su ch w om an or cau sing to b e ta k en by h e r . . . o r [of] cou n sellin g and p ro c u rin g ” an a b o rtio n . It also stated th a t “th e w om an w hose m isca rria g e shall have b e e n cau sed or attem p ted shall n o t be liable to th e p e n a lties” o f th e a c t.106 The im p o rta n t em phasis h ere is causing and caused, again im plying th a t so m e ou tsid e fo rce w as resp onsible. This stand co n flicts w ith w hat S m ith -R o se n b e rg and o th e rs co n clu d e regard ing th e p h y sician s’ a n tia b o rtio n cam paig n. S m ith -R o se n b e rg argues th a t physicians persuad ed th e w hite m ale pow er stru ctu re th a t a b o rtio n u n ­ d erm in ed p a tria rc h a l co n tro l. They p o rtray ed w hite m id d le-cla ss fem ales w ho sought a b o rtio n s as unnaturally in d ep en d ent and argued th a t, th rou g h ab o rtio n , w o m en repud iated th e ro le o f m o th e rh o o d th a t m e n ex p ected o f th em . Physicians p articip ated in th e a n tia b o rtio n m o v em en t in p a rt to retu rn w o m en to th e h o m e, reversing th e ir grow ing te n d e n cy to en roll in college or p articip ate in re fo rm m o v em en ts. W h ite b ou rgeois d o cto rs co rrela ted a b o r­ tio n and co n tra ce p tio n w ith fem ale p ro m iscu ity and re c a lc itra n c e .107 R h od e Island legislators, how ever, appeared u n co n v in ced by su ch rh e to ­ ric, if, in fa ct, it w as em ployed in th e state cam paign. U nfortu nately, R h od e Island h as n ev er k ep t re co rd s o f legislative sessio n s; th e only ev id en ce re ­ garding th e d o cto rs’ cru sad e are tra c ts at th e R IM S th a t co n firm th e n atio n al cru sad e’s nativism bu t do n o t re flec t th e m isog y n istic to n e th a t S m ith -R o se n berg fin d s.108 The w ord ing o f th e 1 8 6 7 law also does n o t re flec t su ch m iso g ­ yny, alth ou g h th e law could b e in terp reted as p atern alistic: legislators did n o t seem to believe th a t w o m en w ould r e je c t m o th e rh o o d w ith ou t bein g forced

Abortion and Contraception in the Nineteenth Century

to do so by m en. W o m en w ere u nem p ow ered v ictim s in n eed o f legislative p ro tectio n . The 1 8 6 7 a ct w as also sig n ifican t b eca u se o f a u niqu e se c tio n dealing w ith th e m u rd er o f p regn an t w o m en and in fan t child ren. A ny p e rso n charged w ith th e m u rd er o f a p reg n an t w om an cou ld also b e charged w ith ab o rtio n . I f a ju ry acq u itted on m urder, th e state cou ld still p ro se cu te fo r a b o rtio n .109 P er­ haps th is stip u lation w as a resu lt o f th e C orn ell/A v ery case. U n d er th e new law th e state could have g one a fter Avery fo r a b o rtio n d espite th e no t-g u ilty v erd ict on th e m u rd er charge. The stip u latio n dealing w ith th e “m u rd er o f any in fan t ch ild ” allow ed th e state to charge fo r m u rd er and a b o rtio n . I f th e ju ry found a d efend ant n o t guilty o f m urder, th e y could still co n v ict “h im ” o f ab o rtio n . This stip u latio n co n firm ed le g isla to rs’ ad h ere n ce to th e w o m an cen te red n o tio n o f p re g n a n cy versus th e feta l rig h ts o b sessio n o f th e late tw e n tieth century. Even a fter b irth an in fa n t w as n o t always en titled to th e full righ ts o f citizen sh ip . The a c t im plied th a t an in fa n t w as as d ep en d en t on its m o th e r fo r survival outsid e as insid e th e w om b. A gain, su ch attitu d es c o n flict w ith th o se u nco v ered by o th e r h isto ria n s analyzing b o u rg eo is n o tio n s o f pregnancy. They find th a t a d esire to c o n ­ tr o l fem ale b eh av io r d o m in ated a n tia b o rtio n tra c ts . M iso g y n istic w ritin g s asserted th a t th e u teru s w as th e re to serve th e fetu s, th e m o th e r b ec o m in g a vehicle. Sh e had n o m o re co n tro l over h e r fetu s th a n th e father. In fact, som e tra c ts claim ed th a t b eca u se th e m a le ’s sp erm w as m o re p ow erfu l th a n th e egg, h e had a m o re p ro n o u n ced im p a ct on th e fetu s th a n th e m other. M o re ­ over, physicians co n ten d ed th a t th e w om b cau sed w o m en to m ake illog ical d ecisio ns; S to re r and o th e rs believed th a t h y sterecto m ies solved all w o m en ’s m e n tal d isorders. The a n tifem in ist rh e to ric used by cru sad ers d em o n strated th e ir h o stility tow ard w o m en ’s rep ro d u ctiv e p ow ers.110 Yet in R h od e Island legislators do n o t appear to have b e e n swayed by su ch propaganda. Thus, th e m isogyny stressed by o th e r h isto ria n s is n o t as universal as som e m igh t suppose. S im ila r to tren d s in R h od e Island , th e reco rd s and m inu tes o f th e S C M S do n o t re flec t m isogyny. Physicians in S o u th C arolin a seem ed genuinely co n cern e d w ith w o m en ’s health . S o m e phy sicians co n ten d ed th a t th e fetu s should b e con sid ered th e “enem y o f th e m o th e r” if it end angered h er life: “P laced in th e cru el alternativ e o f ch o o sin g b etw een th e life o f h e r in fan t and h er ow n p reserv atio n , th e w om an has, by th e law o f n atu re, th e rig h t to d ecid e u p on th e m u tila tio n o f th e foetus.” Dr. M ic h e l criticiz ed p ra ctitio n e rs w ho “ig n o ran tly . . . a d m in istered ” su b stan ces to p ro cu re an a b o rtio n th a t “to o o ften . . . d estroyed ” th e m o th e r w hen h e r “only d esire w as to sh elter h er[se lf] fro m h a rm and secu re h er[se lf] fro m sham e.” H is sta tem e n t clearly sym pathizes w ith w o m en facin g to u g h ch o ices. O th e r m e m b ers o f th e S C M S ad vocated a b o rtio n to p reserv e w o m en ’s health : it w as th e ir “duty to re so rt

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to th e m easu res u nd er co n sid era tio n ” to en su re th e “rapid and co m p le te ” re co v ery o f th e ir fem ale p atients. The ed ito rs o f th e CMJ&R lam b asted d o c­ to rs w ho allow ed a p reg n a n t C h a rlo tte B ro n te to suffer “m o rb id ly sev ere” sym ptom s and eventu ally die in 1 8 5 5 ra th e r th a n p e rfo rm an a b o rtio n : “It w as th e duty o f th e p hy sician to rem ov e th e cau se, viz: to remove the fetus from the womb” The CMJ&R su b seq u en tly argued th a t a b o rtio n should be used m o re freq u en tly to p reserv e th e m o th e r’s h ea lth and criticiz ed d o ctors w ho regard ed th e ch ild ’s life above th a t o f th e m oth er, esp ecially w hen “th e life o f th e child is so m u ch regard ed ” th a t “w o m en are exposed to m o re risk fo r its preservation.”111 Thus, th e m isog y n istic a n tia b o rtio n tra c ts did n o t lead to a m ed ical co n sen su s on th is issue. M an y d o cto rs p rio ritized th e ir p a tie n ts’ h ealth , n o t fetal p ro te c tio n at all costs. The alliance am ong b ou rgeois m e n to w hich S m ith -R o se n b erg refers m u st have b e e n o n shaky ground .112 W h ile co n firm a tio n o f m isogyny d oes exist, it is co u n tered by evid en ce o f m e n — d o cto rs, m in iste rs, and o th e rs— w ho w ere sy m p ath etic to w om en, w illing to a tta ck m ale colleagu es, and co n c ern e d w ith w o m en ’s h ealth and rights. This la tte r re co g n itio n ca n b e seen in R h od e Is ­ land legislatio n regard ing re p ro d u ctio n as w ell as in o th er progressive laws in th a t state. M a rried w o m en had rig h ts to divorce, to estab lish life in su ran ce fo r th e ir ow n b en efit, and to sign co n tra c ts as early as th e 1 8 4 0 s . R h od e Island w as also on e o f only a few states th a t did n o t p ro h ib it c o n ­ tracep tiv es. W h e n th e fed eral g o v ern m en t passed th e C o m sto ck A ct in 18 7 3 , b an n in g th e d istrib u tio n and m ailing o f any in fo rm a tio n c o n c e rn in g b irth co n tro l o r ab o rtio n , m o st states follow ed suit w ith laws passed w ith in th e co n te x t o f a n tio b sce n ity and so cia l p u rity cru sad es. R h o d e Islan d passed an a n tio b sce n ity law o n 14 M ay 1 8 9 7 , b u t it did n o t m e n tio n co n tra c e p ­ tiv es.113 The state n ev er re stricte d a ccess to or in fo rm a tio n on b irth con trol. This lib eral stan ce rem ain ed in fo rce th ro u g h o u t th e tw e n tieth century, de­ spite th e sta te’s large C a th o lic p resen ce. The passage o f th e a b o rtio n bills in R h od e Island ca n n o t be a ttrib u ted to C a th o lic p ressure, b eca u se th e ch u rch cou ld have ex erted its in flu en ce to p ro h ib it all b irth co n tro l. Its failu re to do so cou ld re fle c t eth n ic d ivisions am o n g state C a th o lics th a t preven ted th e ch u rch fro m speaking in on e v o ice a n d /o r th e P ro te sta n t d o m in atio n o f th e state legislatu re.114 The passage o f th e se bills rep resen ted larger fo rces at w ork in state p o litics. A n exp lan ation fo r b o th th e im m u n ity o f w o m en and th e lack o f c o n tra ­ ceptive re strictio n s m ay b e th e u niq u e lo c a tio n and size o f R h od e Island. N o t only w as it th e sm allest state, b u t large p o rts d om in ated P rovid ence, N ew p ort, B risto l, and N arrag an sett Bay.115 R h od e Island had a co n cen tra te d naval p resen ce: th e U n ited S ta tes N aval A cad em y m oved fro m B a ltim o re to N ew p ort during th e C ivil W a r b eca u se o f secu rity c o n c e rn s, and th e N aval

Abortion and Contraception in the Nineteenth Century

C ollege lo ca te d th e re in th e 1 8 8 0 s. L eg islators m ay have b e e n apprehensive th a t th e lo o se sexuality am o n g sailors as w ell as foreig n trad ers cou ld lead to liaisons w ith lo c a l w om en. The la ck o f co n tra cep tiv e reg u latio n cou ld have b e e n an effort to h alt th e spread o f ven ereal d isease— a grow ing an x iety w hen R h od e Island passed its o b sce n ity law a b sen t any b an on b irth c o n tro l— and to p rev en t p re g n a n cy a m o n g sed u ced and ab an d o n ed w om en. Im m u n ity fro m p ro se cu tio n for a b o rtio n could have b e e n a resu lt o f leg islato rs’ co n c e rn th a t tra n sie n t m e n w ould co e rce w om en to und ergo ab o rtio n .

How Successful Was the Antiabortion Campaign? D esp ite attem p ts to elim in ate a b o rtio n , th e p ra ctice rem ain ed prevalent and co n tin u ed to draw a tten tio n fro m critics co n c e rn e d w ith th e co n stitu tio n o f th e A m e rican p op u latio n .116 D o c to rs su rm ised th a t tw o m illion p roced u res o ccu rred annually.117 A d m ittin g to th e se sta tistics m u st have b e e n d isco m ­ forting: th e y im plied th a t th e A M A cam p aig n w as n o t as su ccessfu l as th ey had hoped. This sense o f failure led som e d o ctors to lau n ch a seco n d a n tia b o rtio n ca m ­ paign in 1895. L eslie R eagan argues th a t th e y im p lem en ted a th ree-p ro n g ed approach: co n v in cin g w o m en o f th e ir w rongd oing, revok ing th e licen ses o f physicians w ho p e rfo rm e d illegal a b o rtio n s, and w orking w ith officials to e n ­ fo rce existing statu tes and use “dying d ecla ra tio n s” to ro o t o u t a b o rtio n ists. S o m e d o ctors refu sed tre a tm e n t u n til th e w om an divulged th e a b o rtio n ist’s nam e. The cen su rin g o f p h y sician s’ b eh av io r to o k p lace b eh in d th e closed d oors o f m e d ica l so cietie s, w hile critic ism o f m idw ives’ a b o rtio n p ra ctices to o k p u blic stage. D esp ite efforts, a b o rtio n co n tin u ed . B etw een 1 8 7 6 and 1 9 2 0 th e P rovid ence C ou n ty C o ro n e r’s O ffice investigated n in e te e n deaths cau sed by ab o rtio n s; 8 w ere m a rried and 11 w ere single w o m en .118 P resu m ­ ably, m any m o re w ere done safely. A lthou g h th is cam p aig n failed, th e C a th o ­ lic C h u rch en d o rsed it. In 1 8 9 5 ch u rch p o licy n o lo n g er a ccep ted a b o rtio n s to save th e m o th e r’s life, elevating th e fetu s over th e w om an. P ro te sta n ts and Jew s, on th e o th e r hand , co n tin u ed to co n d o n e life-saving a b o rtio n s, in line w ith A M A guidelines and m a in stre a m se n tim e n t.119 The tu rn o f th e cen tu ry saw ab o rtio n debated in m e d ica l jo u rn a ls. A s w ith earlier d isco u rses, n o co n sen su s existed. S im ila r to R h od e Island legislators, Dr. D en slo w L ew is o f C o o k C ou n ty H o sp ital in C h icag o b lam ed m en , n o t w om en, fo r ab o rtio n . W o m e n re so rted to th is p ro ced u re b eca u se cap italists exp loited th e m w ith su ch m ea g er w ages th a t th e y had to seek su p p lem ental food , clo th in g, and e n terta in m e n t fro m m ale co m p an io n s, leading to u n in ­ ten d ed pregnancy. S u b seq u en t m ale d ese rtio n cau sed w o m en to tra n sfo rm th e ir “usual sen tim e n t o f a ffe ctio n and o f jo y ” regard ing m o th e rh o o d in to a

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“feelin g o f aversion.” H e criticiz e d C h ristia n h y p ocrisy fo r sh u nn in g th e se w o m en ra th er th a n a ssisting th e m w ith “em o tio n a l su p p o rt” S u ch sy m p a­ th y w as n o t p resen t am o n g th e ed itors o f th e Medical Age: A Semi-Monthly Journal o f Medicine and Surgery: a b o rtio n w as m u rd er b e c a u se life b eg an at co n cep tio n ; a b o rtin g w o m en w ere crim in als d eserving p u n ish m en t. Dr. Th om as G. A tkin son d isputed th is co n clu sio n as w ell as th e n o tio n th a t legal p ro te ctio n should b e exten d ed to th e fetu s in u tero fro m co n cep tio n : th e fe ­ tu s had n o in d ep en d en t life u n til it left th e m o th e r’s bod y; th u s, th e m o th e r’s, n o t th e fetu s’s, in tere st w as p aram o u n t. O th ers disagreed, a ssertin g th a t “th e child m u st be saved at alm ost all costs,” in p art due to “th e sh arp en in g o f th e m o ral sen se” bu t also to race suicide: “The in s tin c t fo r self-p reserv a tio n — in a so ciety w ith a d eclin in g b irth rate . . . is at th e ro o t o f th is n ew ten d ern ess fo r th e lives o f our children.”120 In o th e r w ords, w hile a grow ing a p p reciatio n fo r in fan t and even feta l life in flu en ced so m e a n tia b o rtio n ists, p o p u latio n co n ce rn s co n tin u ed to play a role in shaping attitu d es on a b o rtio n am o n g w hite elites. P h ysicians, as p art o f th is elite, did n o t speak in on e voice. M a jo r tr a c ts , th e New York Times, and R h od e Island cases p o in t to a b o r­ tio n as a con tin u in g p ro b lem in th e N o rth .121 The S o u th drew little atten tio n . A b o rtio n laws in m any So u th e rn states w ere generally m o re le n ie n t and c o n ­ tin u ed th e ir a d h eren ce to qu ickening . As such, S o u th e rn w o m en ostensibly could o b tain legal, safe a b o rtio n s early in th e ir pregnancy. D a ta fro m W in ­ sto n -Salem , N o rth C arolin a, d em o n stra te th a t a b o rtio n rem ain ed a re so rt o f m any w hite m arried w o m en .122 S C M S physicians, how ever, rarely m en tio n ed a b o rtio n in th e p o st-R e c o n stru c tio n era. W h e n th e y did, th e y d iscussed it as a p ra ctice to w h ich so m e b la ck w o m en resorted . B u t even h ere th e re w as no co n sen su s. Dr. P rioleau in fo rm ed th e S C M S o f his b e lie f “as to th e g reater te n d en cy o f m u latto s to a b o rt th a n show n by w hites.” Dr. K in lo ch , how ever, resp on d ed th a t in his op in io n “b lack s seld om abort.”123 C en te rin g d iscu ssion o f th is “im m o ra l” bu siness on ra ce fit w ell w ith in th e la te -n in e te e n th -ce n tu ry S o u th e rn co n tex t. S o u th e rn elites attem p ted to sep arate th e races physically and m orally. B y p o in tin g to b lack s as th e m ain cu lp rits in a b o rtio n , th e y fu r­ th e r d istan ced w hite w o m en fro m th e ir b la ck co u n terp a rts.

Conclusion The p hy sician s’ cam p aig n su cceed ed in alterin g a b o rtio n law s, bu t it failed to suppress th e p ra ctice for sev eral reason s. M an y state laws reta in ed p ro o f o f pregnancy. P ro cu rin g su ch p ro o f in th e n in e te e n th cen tu ry m ad e in d ict­ m e n ts fo r a b o rtio n virtu ally im p ossible. A cco rd in g to Dr. W h iteh e a d , “th e only p ositive p ro o fs . . . o f p reg n an cy [were] th o s e afford ed by th e m o v e­ m e n ts o f th e foetu s in u tero, bein g co m m u n ica te d to th e sen se o f tou ch .”

Abortion and Contraception in the Nineteenth Century

R elian ce on su ch a n o n scie n tific m e th o d cau sed p ro b lem s fo r p ro secu to rs. The latte r also rarely fou nd anyone w illing to te stify th a t an a b o rtio n had o c ­ cu rred . T h o se p erfo rm in g th e o p era tio n o ften sw ore th a t th e y did n o t realize th e w o m an w as p reg n an t and had trea te d h er fo r irreg u larity or blockag e. W o m e n usually ad m itted th a t an a b o rtio n had b e e n p erfo rm ed only if th ey fou nd th em selv es in an em erg en cy situ a tio n and b elieved th e y w ere n ea r d eath.124 B o th ab o rtio n -se e k in g w o m en and a b o rtio n providers had a stake in foiling p ro se cu to rs’ attem p ts to en fo rce th e law. A lth ou g h th e p hy sician s’ cam p aign tran sfo rm e d a b o rtio n sta tu tes, lo o p h o les allow ed m o st p eop le to escap e p ro secu tion . R egard less o f th e legislative su ccess o f th e cam paign, a b o rtio n co n tin u ed as a m ean s o f b irth co n tro l. W o m e n a cro ss th e n a tio n , b o th m a rried and single, re so rted to th is fo rm o f fertility co n tro l. A lth o u g h th e A M A w as th e driving fo rce b eh in d th e crusad e, d o cto rs did n o t speak in on e voice: som e believed a b o rtio n to b e m u rd er u nd er any circ u m sta n ces; oth ers argued for a b o rtio n to save th e m o th e r’s life and p ro te ct h e r h ealth ; and a m in o rity ex ­ p ressed sym pathy fo r w o m en seeking a b o rtio n s due to e c o n o m ic ex p lo ita­ tio n , sed u ctio n , o r a b an d o n m en t. W h ile m isogyny in flu en ced b o th d o cto rs’ and le g islato rs’ attitu d es, th is sen tim e n t m ay n o t b e q u ite as p rev alen t as so m e h isto rian s have n oted . A grow ing in tere st late in th e cen tu ry to p ro te ct ch ild ren exten d ed to th e fetu s in so m e m ind s, and m e d ica l ad vances th a t suggested life b eg an at co n c e p tio n ra th er th a n qu ick en in g also en tered th e d iscou rse on ab o rtio n . B y th e tu rn o f th e cen tu ry th e d ebate over a b o rtio n and in tere st in pu rsu ­ ing ab o rtio n ists died down. The Reader’s Guide to Periodical Literature fro m 1 8 9 0 to 1 9 3 0 lists only fou r a rticles dealing w ith ab o rtio n , w hile th e New York

Times in d ex fo r 1 8 9 7 to 1917 lists tw o. Yet th e p re o ccu p a tio n w ith fertility im b alan ce b etw een “b e s t” and “in fe rio r” sto c k did n o t disappear. T he early tw e n tieth cen tu ry w itn essed a stron g , v o ca l m o v em en t to co n v in ce W A SP w o m en to aban d on fertility c o n tro l to p reserv e A m e rica n A n g lo -S a x on cu l­ tu re. R ace su icid e th e o rists shifted a tten tio n fro m a b o rtio n to b irth co n tro l as a p rim ary cau se o f ra cia l decay.

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Race Suicide, Eugenics, and Contraception, 1900-1930

The rh e to ric o f ra cia l su icid e em erged in th e m id -n in e te e n th cen tu ry in re ­ a c tio n to d ifferential b irth ra te s b etw ee n w h ite P ro te sta n t A m e rica n s and C ath o lic im m ig ran t w om en. It expanded by th e tu rn o f th e cen tu ry to differ­ en tiate b etw een th e “fit” o r “b e s t” and th e “u n fit” or “u n d esira b le" The fo rm er inclu d ed w hite, w ealthy, ed u cated P ro te sta n ts, w hile th e la tte r re ferred to th e poor, u n ed u cated , crim in a ls, d iseased , m e n ta l and phy sical “defectives,” and eth n ic, racial, and religiou s m in o rities. A rth u r W . C alh ou n , an early -tw en tieth -ce n tu ry h isto ria n , claim ed th a t th e “d esire to p revent co n c e p tio n [was] gen eral am o n g th e p eop le o f th e asp irin g m idd le class,” b u t th e co n d itio n w as “m o st ex trem e am o n g native A m e rica n s o f th e u p p er classes.” H isto ria n A rth u r S ch le sin g er Sr., n o ted th a t th e use o f co n tracep tiv e d evices p rod u ced “a rev ersal o f th e p rin cip le o f n atu ral selectio n , fo r th e progeny o f p o o r and u nd ern o u rish ed p aren ts m u ltiplied w hile th e b e tte r-n u rtu re d classes barely held th e ir own.”1 This naive u nd erstan d in g o f n atu ral selec tio n and so cia l D a rw in ism was co m m o n am o n g tw e n tie th -ce n tu ry ad vocates o f p o p u lation co n tro l— a te rm n o t synonym ous w ith b irth co n tro l. G roups a sso cia te d w ith th e fo rm er w ere co n ce rn e d m o stly w ith th e class, eth n ic, and ra c ia l im p lica tio n s o f p o p u ­ latio n grow th, esp ecially th e possib ility th a t th e low er classes w ould ov er­ p opu late and d estroy th e A m e rica n “race.” B irth co n tro l, o n th e o th e r hand, d en otes individual co n tro l over rep ro d u ctio n . The co n tin u ed d eclin e in fer­ tility am o n g m id d le- and u p p er-class w hite w o m en persisted desp ite d o cto rs’ su ccess in crim in alizin g a b o rtio n , th e fed eral g o v e rn m en t’s b an o n circ u la t­ ing b irth co n tro l in fo rm a tio n th rou g h th e m ails, and cen so rsh ip elim inating co n tracep tiv e d iscu ssion fro m m a rita l guides. R a ce su icid e th e o rists, th e re ­ fore, lau n ch ed a cam p aig n to red u ce th e fertility o f th e “u n fit” and “u nd esir­ a b le” and to in c re a s e th e n u m b er o f ch ild ren b o rn to th e ed u cated w hite P ro te stan t m iddle and u p p er classes. W ith th e ex cep tio n o f new legislation to sterilize “defectives,” how ever, th e laws rem ain ed u nchanged . W o m e n p er­ sisted in th e ir q u est to c o n tro l th e ir ow n fertility w ith b o th b irth c o n tro l and ab o rtio n , w hile p op u latio n co n tro llers in flu en ced by race, class, and gend er

Race Suicide, Eugenics, and Contraception, 1900—1930

biases p ersisted in th e ir q u est to shape th e p o p u latio n along lin es su itab le to th e w hite elite estab lish m en t.

Race Suicide Arguments The sp e cte r o f ra ce d eg en eratio n hau nted th e w ritin g s o f m any p ro m in en t officials and so cia l critic s acro ss th e p o litica l sp e ctru m . The te rm race as em ployed by n in e te e n th - and ea rly -tw e n tie th -c e n tu ry sc ien tists and race su icid e th e o rists w as vague. It cou ld p e rta in to th e color, class, religion, or geo grap h ic origin o f ce rta in g roups.2 W h e n race su icid e th e o rists referred to th e A m e rican race, th e y usually m e a n t w hite, ed u cated , fin an cially secu re, P ro te stan t citizen s. In th e 1 8 8 0 s S am u el W . D ike, a P ro te sta n t m inister, r e ­ form er, and so cio lo g ist, exp ressed fea r over th e d eclin in g b irth ra te am ong th e “native s to c k " H e fou nd th a t in M a ssa ch u setts foreig n w o m en averaged 5 0 p e rce n t m o re ch ild ren th a n native w om en. In an 1891 a rticle in th e Nation W illiam P otts, a lib eral and co fo u n d er o f th e Free R eligious A sso c ia tio n w ith R alph W ald o E m erson , w ro te th a t in financially secu re fam ilies “th e n u m b ers b e co m e stationary , th e n d ecline, and finally th e fam ilies th em selv es . . . b e ­ co m e e x tin c t" 3 C ensu s d ire cto r F ran cis A. W alker, w ho co n sid ered h im s e lf a “so cial sc ie n tist” in ten t on co n tro llin g d em o g rap h ic tren d s th ro u g h c o n ­ ce rte d planning, fou nd im m ig ra tio n partially resp o n sib le for th e an n ih ilatio n o f native sto ck . The “excess o f foreig n arrivals" in th e n in e te e n th cen tu ry “co n stitu ted a sh o ck ” to th e native elem e n t.4 S o m e rad icals to o k up th e banner. In a 1 9 0 5 in v estig atio n o f N ew E n g ­ land, R o b e rt H unter, a m e m b er o f th e S o cia list Party, found th a t th e annual in cre a s e o f ch ild ren to foreig n p a ren ts w as te n tim e s g rea ter th a n th a t to native p aren ts; th e an n u al d eath rate o f natives ex ceed ed th e b irth ra te by 1.5 p er 1 ,0 0 0 , w hile th e an n u al b irth ra te o f im m ig ra n ts exceed ed th e death rate by 4 4 .5 p er 1 ,0 0 0 . H e d ed u ced th a t “th e a n n ih ila tio n o f th e native ele­ m e n t is only a m a tter o f tim e ” and w arned th a t “th e d ire ct d escen d an ts o f th e p eop le w ho fou ght fo r and fou nd ed th e R ep u b lic [were] bein g disp laced by th e Slavic, B alkan, and M ed iterra n ea n p e o p le s" The h ig h fertility o f groups w ith “alien ” religion s d irectly th rea te n ed A n g lo -S a x o n h eritag e in th e U n ited S ta te s.5 H u n ter exem plified th e n ew tw e n tie th -ce n tu ry ra ce su icid e th e o ris t in th a t he added a class p ersp ectiv e to a form erly cu ltu ral co n cern . In ad d ition to high im m ig ra n t fertility, ra ce su icid e th e o ris ts feared th e ex trao rd in ary b irth ra te am o n g th e p o o r and u n ed u cated classes. H u n te r p re d icted th a t th e “p o o re st cla sses” w ere th e “g rea test p o p u latio n -p ro d u cin g cla sses” and w ould eventu ally cau se th e “a n n ih ila tio n ” o f th e “w ealth iest class.”6

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Chapter3

S u ch arg u m en ts in flu en ced p ro m in en t figures, inclu d ing T h eod o re R o o s ­ evelt. H e believed th a t th e Y ankee u p p er class should provide th e ec o n o m ic and p o litica l lead ership o f th e co u n try and w as d istressed th a t w ealthy w hite P ro te stan ts had th e low est b irth ra te in th e n ation . R oo sev elt set o u t to c o n ­ vince th e u p p er classes o f th e ir duty to in c rea se ch ild birth . In an early sta te­ m e n t (1895) he argued th a t Y ankee w o m en w ho refu sed to p ro liferate w ere “cold and selfish.” The only w ay to p reserv e th e ra ce w as to “su b ord in ate th e in tere sts o f th e individual to th e in tere sts o f th e co m m u n ity ” a n in terestin g co m m e n t in ligh t o f its so cia list im p licatio n s. Tw o years later he co m m en ted on his a b h o rre n c e o f th e “p ro n o u n ced te n d en cy am o n g . . . th e m o st highly civilized p o rtio n s o f all races, to lose th e pow er o f m u ltiplying”7 As p resid ent, R oo sev elt used his p o sitio n to sway p u blic opinion. A d dressing th e N a tio n a l C on g ress o f M o th e rs in 1 9 0 5 , he co n d em n e d th e “v icio u sn ess, co ld n ess, [and] sh allo w -h ea rted n ess” o f w o m en w ho sought to avoid th e ir “duty” He d en o u nced th e se w om en as d ecad en t and bran d ed th e m “crim in a l ag ainst th e ra c e ”8 W h ile th e te n d en cy tow ard sm all fam ilies prevailed a m o n g th e wealthy, jo u rn a list Lydia K in g sm ill C o m m a n d e r fou nd in 1 9 0 7 th a t only “th e m o st ig n o ran t and irresp onsible,” p articu larly im m ig ran ts, m ad e n o effort to lim it th e ir child ren. O n e d o cto r she in terv iew ed stated , “The Irish , th e G e rm a n s, and th e Italian s go ahead and have child ren. W e are depend ing on ou r p o o r fo reig n elem e n t fo r o u r popu lation.” P o v erty -strick en G e rm a n and Irish im m ig ran ts, d ep en d en t u pon p u blic and private a ssista n ce , had th e larg­ est fam ilies. C o m m e n tin g on “d istressingly p ro lific” foreign p a tien ts, a d o c­ to r argued th a t A m e rica n lead ers should have b a rred im m ig ran ts b eca u se th e y co n stitu ted th e “p o o re st im ag in ab le m a teria l fo r m ak in g A m e ric a n s” bu t w ould so o n co n stitu te th e m ajo rity .9 By 1 9 0 0 m o re th a n te n m illio n fo r­ eig n -b o rn lived in th e U n ite d S ta te s, and on e or b o th p aren ts o f m o re th an fifte en m illio n w ere b o rn outsid e th e country. B etw een 1 9 0 0 and 1 9 0 7 ap­ p roxim ately fou r m illio n foreig n ers, m any o f th e m p o o r Jew s, C a th o lics, or E a ste rn O rth o d o x , ca m e to th e U n ited S ta te s, p rom p tin g W illia m Z . R ipley to ask, “Is it any w ond er th a t seriou s stud ents con tem p late th e ra cia l fu tu re o f A n g lo -Sax on A m e rica w ith so m e co n cern ? They have seen th e passing o f th e A m e rican In d ian and buffalo, and n o w th e y q u ery as to h ow lo n g th e A nglo S ax o n m ay b e able to survive”10 P u b lication o f th e 1910 cen su s added fuel to th e fire. It show ed th a t im ­ m igran t w o m en ’s fertility w as sig n ifican tly h ig h er th a n th a t o f n a tiv e-b o rn w om en. W ith in th e im m ig ran t popu lation, th e b irth ra te o f sou th ern and ea st­ ern E u rop ean im m ig ran ts, th e least “d esirable” o f th a t co n tin e n t, exceed ed th a t o f n o rth e rn and w estern E u rop ean s.11 In R h od e Island a 1912 head line

Race Suicide, Eugenics, and Contraception, 1900—1930

claim ed : “P ro v id en ce A p p ro ach in g R a ce S u icid e C o n d itio n : D E C R E A S E C A U SE S C O N C E R N " O f 5 ,6 6 2 b irth s in P rovid en ce th e previous year, only 1,521 (2 6 .8 p ercen t) had tw o “A m e rica n ” p aren ts; 145 (2.5 p ercen t) had tw o b lack p aren ts; 2 ,9 4 4 (51.9 p ercen t) had tw o “foreig n ” p aren ts; th e rem ain d er had m ixed “A m e ric a n ” and foreig n parentag e. Italian s alon e a cco u n ted for 1 ,5 2 0 , ju s t on e shy o f “A m e rica n ” b irth s. The a rticle lam en ted th e d eclin e in native A m e rican b irth s, in clu d in g th o se to b la ck p aren ts, in th e face o f fo r­ eign in u n d ation .12 N o ra cism tow ard b lack s w as ap p aren t; su ch h o stility was reserv ed fo r im m ig ran ts. This attitu d e w as apparent in R o o se v elt’s sp e ech at th e P acific T h eolo g ical Se m in ary in th e spring o f 1911. H e a sserted th a t “tw o -th ird s o f ou r in crea se now co m e s fro m th e im m ig ra n ts . . . n o t fro m young A m e rica n s w ho are to p erp etu ate th e b loo d and tra d itio n s o f th e old s to c k " B y 1911 R oo sev elt no lo n g er attrib u ted ra ce su icid e to im m ig ran ts alone. R ather, h e b lam ed th e “w rong ty p e” o f p eop le (aliens, th e poor, th e u ned u cated , crim in a ls), w ho rep ro d u ced at alarm in g speed s, w hile th e “p ro p e r” sto c k su stained an a rtifi­ cially low b irth rate. In an a rtic le in Outlook th e sam e y ear h e w rote: C rim in als should n o t have ch ild ren . S h iftless and w o rth less peop le should n o t m a rry and have fam ilies w h ich th e y are u nable to brin g up properly. . . . In our civ ilizatio n today, th e g reat danger is th a t th e re w ill b e failure to have enou gh ch ild ren o f th e m arriages th a t ought to tak e place. W h a t w e m o st n eed is in siste n ce u p o n th e duty o f d ecen t peop le to have enou gh ch ild ren , and th e stern est co n d em n a tio n o f th e p ra c­ tice s co m m o n ly re so rted to in o rd er to secu re sterility.13 W h e re a s b efo re he had urged n a tiv e-b o rn w o m en in gen eral to in c rea se th e ir fam ily size, now h e en cou rag ed only th e “p ro p e r” natives to “save” th e race. R o o se v elt w as n o t alo n e in h is anxiety. R o b e rt R eed R en to u l, a B ritish eu gen icist w ho su p p orted in fan ticid e fo r d efectives and co n tro lled fertility am o n g th e ind igent, gained an au d ience am o n g so m e A m e ric a n s.14 In Race

Culture or Race Suicide? (1 9 0 6 ) he asked, “I f . . . a n a tio n has its p o p u lation re cru ited , n o t fro m th o se w ho are physically, m entally, fin an cially able to have and to brin g up th e b est sto ck , b u t fro m th e p o o re r classes, w hat can b e ex p ected o f th e co m in g ra c e ?” H e answ ered, “N o th in g b u t evil___ N o n a ­ tio n can survive if its p op u latio n b e re cru ite d fro m slum dom .” The R everend Jo h n Scu d d er o f Jersey C ity ad vocated th e forced lim ita tio n o f p o o r fam ilies and o th e r “u n d esirab les” in so ciety : “In v eterate paupers, hop eless drunkards, in co rrig ib le crim in a ls, in san e and id io tic p eop le . . . should b e d enied th e privilege o f rep ro d u cin g th e ir kind. A b irth forbid d en by law should b e c o n ­ sidered as a crim in a l o ffense and th e p aren ts should b e p u nished by fine or

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im p riso n m en t.”15 A d v ocacy o f su ch h arsh p en alties w as unusual, bu t m any urged serious m easu res b e ta k en to slow th e grow th o f th e p o o r and “u nd esir­ a b le” and to in crea se th e “fit” Yet m any u p p er-class w h ites, th e “fit,” did n o t co n sid er th e ir sm all fa m i­ lies a n a tio n a l m en a ce. C o m m a n d e r fou nd th e y re stricte d fam ily size b e ­ cau se th e y believed th e “sec re t o f su cce ss” w as “ed u catio n and tra in in g ” W ith few er d ep en d en ts, p aren ts cou ld g u a ra n tee fin a n cia l secu rity fo r child ren. W ealth y and highly ed u cated p aren ts generally had th e in crea sin g ly c o m ­ m o n tw o -ch ild n o rm am o n g th is class.16 C ollege w o m en m a rried la ter and less often , and th e y had few er ch ild ren th a n n o n -c o lleg e -ed u c a te d w om en, a tren d developing sin ce R eco n stru c tio n . The B o sto n A sso c ia tio n o f C ollegiate A lu m nae in d icated th a t ju s t 2 5 p e rce n t o f stud ents fro m tw e n ty -th ree area colleges had m arried . O n ly 16.5 p e rce n t o f R ad cliffe’s 1 9 0 0 class had m arried by 1 9 0 9 .17 M an y o f th e se w o m en presu m ably ch o se a ca re e r over m arriage and ch ild re n — a ch o ice race suicide th e o rists cond em ned . That d eclin in g b irth ra tes am o n g th e ed u cated and w ealthy resu lted fro m volu n tary re s tric tio n w as o f little doubt. C harles F. E m erick , a p ro fesso r o f biology, co n clu d ed th a t th e “d im in ish in g b irth -ra te [was] p rim arily v o li­ tional.” Dr. C harles H arrin g to n , an A m e rica n san itarian, also found th a t th e d eclin e w as due to “artificia l and p u rp osefu l and n o t natu ral causes.” O c ta ­ vius C harles B ea le, a u th o r o f Racial Decay (1911), co m p ared th e situ ation in th e U n ited States to th a t o f th e G ree k and R o m a n em p ires, w h ich fell n o t by co n q u est bu t “fro m an in ten tio n a l d eclin e in th e ir fertility ” th a t red u ced th e ir pop u lations. In th e Journal o f the American Medical Association (1 9 0 7 ) Dr. J. N ew to n H u n sb erg er ag reed and, sim ilar to R oo sev elt, believed w o m en ’s “cu rse o f selfish n ess” w ould d estroy th e n a tio n a l ch aracter.18 The d istress over race suicide w as a re a c tio n to so cia l tra n sfo rm a tio n s in fam ily size and g en d er relatio n s. E co n om ically, ch ild ren in u rb a n areas no lo n g er fulfilled th e role th e y had played in an ag ricu ltu ral society. In fa ct, th ey co n stitu ted an e c o n o m ic d rain in light o f grow ing ex p e cta tio n s fo r h ig h er ed u catio n . Fem in ism played a role as well: th e V ic to ria n w o m an gave way to th e G ib so n girl and th e “M o d e rn W om an,” m an y o f w h om w ere m o re in ­ te rested in pu rsuing h ig h er ed u catio n , careers, and re fo rm activ ities th a n in m arriage and fam ilies. R ace su icid e th e o rists view ed th is shirking o f m o th e r­ h o o d as “u n n atu ral” and d etrim e n ta l to th e ra ce.19 M an y m e n felt th rea te n ed by rapid ch an ges affectin g th e ir daily lives. T em p eran ce and a n tip ro stitu tio n cam p aigns criticiz ed m ale behavior. Suffrage and w o m en in th e w o rkforce u nd erm in ed th e m ale cu ltu re o f p o litics and office w ork. B u sin ess co n so li­ d ations fo rced th e clo sin g o f m any sm all firm s, leaving m id d le-class m e n d ep end ent on large firm s fo r em p lo y m en t.20 Pushing w hite m id d le- and u p­ p er-class w o m en in to th e h o m e as m o th e rs p reserved m ale h eg em o n y over

Race Suicide, Eugenics, and Contraception, 1900—1930

h ig h er ed u catio n al and p ro fessio n al op p o rtu n ities. W o m e n w ith young ch il­ d ren could n o t rea listica lly co m p e te w ith m e n fo r re sp ecte d ca re e r o p en ­ ings.

Eugenics in the United States R ace su icid e arg u m en ts cap tu red a d h eren ts o f eu g en ics, a so cia l p h ilo so ­ phy th a t b e c a m e p opu larized a fter th e w orks o f G reg o r M en d el, an A u strian m o n k and b o ta n ist, and A ugust W eism a n n , a G e rm a n b iolo g ist, o n g en etic m u tatio n and g erm in al continu ity. T h eir h y p oth eses a sserted th a t g erm in al p lasm a tra n sm itted h ered ita ry b u t n o t acq u ired ch a ra cte ristic s. F ran cis G alto n , a B ritis h sta tisticia n , lead er o f th e eu genics m o v em en t in h is country, and co u sin o f C harles D arw in , o rig in ated th e te rm eugenics fro m th e G reek w ord “eugenes,” m ean in g “g ood in birth,” and d efined it as th e “sc ien c e o f im proving s to c k ” G a lto n also in flu en ced eu g e n ics’ in c o rp o ra tio n o f so cial D arw in ist th e o rie s, w h ich held th a t p eop le w ere lo ck ed in a so cio cu ltu ra l struggle in w h ich th o se w ho had w ealth and pow er p o ssessed th e b io lo g i­ cal su p erio rity to survive. E u g en icists p ro p o sed a so lu tio n to th e p roblem s o f race d egen eration: en cou rag e breed in g am o n g th o se w ith “d esirab le” and d iscourage it am on g th o se w ith “u n d esirab le” tra its .21 R e ce n t h isto ria n s have d ispelled th e n o tio n th a t g en eticists frow ned u pon eu genics. L ab elin g eu genics a p se u d o scien ce su p p orted by naive follow ers and g en etics a tru e scien ce su p p orted by re sp ecte d scien tists, acco rd in g to M a ro u f A rif H asian, Jr., tre a ts eu g en ics “as a te m p o ra ry a b erra tio n , an ir­ ratio n al p o litica l ap p rop riatio n o f g e n e tic s” B u t as D ian e B. Paul h as found, “every m e m b e r” o f th e ed ito ria l b o a rd o f Genetics (fou nd ed in 1916 in th e U n ited S tate s) su p p orted eu genics. C harles D av en p o rt, a ch am p io n o f eu ­ gen ics in flu en ced by G a lto n and o th ers, fou nd ed th e E u g enics R eco rd O ffice in C old Sp rin g H arbor, L ong Island. A t th e sam e tim e, he p rod u ced signifi­ can t g en etic w ork o n H u n tin g to n ’s ch o re a and on tra its su ch as skin and eye color. H asian argues th a t g en etics did n o t m ove “u nilin early out o f th e dark ages o f ig n o ran ce and tow ard th e ligh t o f scien tific progress.” It rem ain ed in tertw in ed w ith eu genics w ell in to th e p o s t-W o rld W a r II period . It w as n o t a b e lie f held only by a few elites bu t on e in w h ich a “su b stan tial p ercen tag e o f th e A n g lo -A m erica n p u blic believed.”22 In th e early tw e n tieth ce n tu ry eu genics gained a diverse au dience, in part due to its am bigu ou s nature. E u g enicists agreed on h ered ity b u t n o t on w hich tra its w ere in h eritab le. They ag reed on th e n eed to im prove th e race bu t n o t on th e m e th o d s to ach ieve th is goal o r w ho should ch o o se th em . H ard -lin e eu g en icists, heavily in flu en ced by W e ism a n n ’s th e o ry th a t g erm plasm a is u nm alleab le, called fo r co n tro lled re p ro d u c tio n or co e rce d steriliz a tio n as

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a “final solution.” A s b io lo g ica l d eterm in ists, h a rd -lin ers re je c te d en v iro n ­ m ental, ed u catio n al, or p aren tal in flu en ce o n ch ild ren ’s d evelopm ent. They inu nd ated th e p u blic w ith claim s th a t th e g ood o f so ciety su persed ed any in ­ dividual righ t to rep rod u ce. S o m e en d orsed in fan ticid e fo r d efective b abies, w hile o th ers ad vocated th e killing o f old er “im b e c ile s ” M o d e ra te o r re fo rm eu gen icists and m illio n s o f A m e rica n s believed in th e n ee d to im prove th e race bu t n o t n ecessarily th ro u g h th e co e rce d steriliz a tio n o f th o se d eem ed unfit. R efo rm eu genics a ccep ted th e in flu en ce o f ed u catio n and o th e r so cial p rogram s as w ell as p aren tal behavior. As H asian argues, th e “very la ck o f u niv ocality m e a n t th a t its goals could b e co n stru e d in m an y ways. . . . Eu­ gen ics w as p art o f d ozens o f lo c a l p ro je c ts , inclu d ing b ette r-b a b y co n tests, im p roved p are n th o o d p ro g ram s, c o n tro l o f ra ce p o iso n s, co n se rv a tio n o f re so u rces, w o m en ’s te m p e ra n ce m o v em en ts, and even m ilita ry p rep aratio n fo r w ar” C hild ren lea rn ed o f re fo rm eu genics in sch o o l, ch u rch, and scou ts. A dults and ch ild ren en co u n tere d it at state fairs and exh ib its th ro u g h o u t th e early d ecad es o f th e tw e n tieth centu ry.23 W h ile physical tra its w ere im p o rta n t, eu genicists w ere prim arily co n cern ed w ith no n p h ysical tra its: in tellig en ce, ch aracter, and m orality. In th e m id - to late n in e te e n th cen tu ry th e d egenerative th e o ry stated th a t th e feeb lem in d ed and m entally ill po sed n o sig n ifican t th re a t to th e race b eca u se th e y generally disap peared w ith in fou r g en eratio n s. B y th e tu rn o f th e ce n tu ry h ard -lin e eu gen icists had re je c te d th is th e o ry : in h e rited d efectiv e g en es p re sen ted a m e n ace to th e race. B o th h ard -lin e and re fo rm eu g en icists believed th e p ro b ­ lem could b e hand led b eca u se ex p erts cou ld d iscern m e n ta l d efects th rou g h physical a ttrib u tes su ch as a low brow , a sm all head, or grossly p rotru d in g ears. P sych ologists had d ispelled su ch n o tio n s by th e 1910s, w hen th e y de­ te rm in e d th a t attractiv e, “n o rm a l”-lo o k in g h u m ans cou ld also be m entally d eficien t, a co n d itio n d efined by th e n ew te rm moron. M o ro n s w ere m o re th reate n in g to th e race th a n “groveling id io ts” b eca u se th e fo rm er w ere quite liable to p ro crea te.24 The eu gen ics m o v em en t receiv ed a b o o s t fro m fam ily stud ies. R ich ard D ugdale, an execu tiv e c o m m itte e m e m b e r o f th e P riso n A sso cia tio n o f N ew York, assessed th e in m a tes o f th e state p riso n system . H e tra ce d th e Juke fam ily th ro u g h five g en eratio n s, co n clu d in g in his 1 8 7 7 re p o rt th a t th e y had a startlin g in clin a tio n fo r poverty and crim e and th a t th e p u blic had sp en t $1.3 m illio n to su p p ort th e m . D ugdale w as a re fo rm eu gen icist: w hile crim in ality could b e in h erited , th e en v iro n m en t also shaped behavior. Thus, he ad vocated p u blic h ealth p rog ram s and in crea sed ed u catio n fo r child ren. E arly -tw en tieth -ce n tu ry h ard -lin e reev alu atio n s o f th e Juke family, how ever, con clu d ed th a t th is fam ily d em o n strated th e n eed fo r steriliz a tio n or sexu al seg regation,

Race Suicide, Eugenics, and Contraception, 1900—1930

n o t so cial pro g ram s.25 S im ila r re p o rts o f fam ily depravity am on g p o o r “w hite tra sh ” ad vocated th e ir steriliz a tio n .26 The eu gen ic n o tio n o f ra c ia l im p ro v em en t th ro u g h p o p u latio n c o n tro l gained an au d ien ce a m o n g p ro fessio n als, p a rticu la rly in telle ctu a ls, sc ie n ­ tis ts , and physicians. T h ese m o stly elite w hite m e n believed , a cco rd in g to h isto rian M a rk H aller, th a t “co lleg e-ed u cated , native, w hite P ro te sta n ts (like th em selv es) w ere th e b earers o f th e valuable g enes o f so ciety ”27 W en d y K line argues th a t eu genics a ttra c ted p rofession als b eca u se it could h alt th e “m o ral and racial d ecay ” th e y d ecried . It also im plied a n ew tw ist o n m o th erh o od : only w ealthy w hite w om en had an in h e ren t rig h t to p ro crea te. “W o m a n h o o d w as d ouble-edged,” argues K lin e, b eca u se w o m en cou ld b e th e “m o th e r o f to m o rro w ” o r th e “m o ro n ” w ho “sy m bolized th e danger o f fem ale sexuality u n leash ed ” As such, w o m en could b e “resp o n sib le n o t only for ra cia l p ro g ­ ress bu t also fo r ra cia l d e stru c tio n ”28 In 1 9 0 3 university b iolo g ists co o p e r­ ated w ith agricu ltu ral breed ers to fo rm th e A m e rica n B ree d ers A sso cia tio n C o m m itte e to Stud y and to R ep o rt on th e B e st P ra ctica l M ea n s o f C u ttin g o ff th e D efectiv e G e rm P lasm in th e A m e rica n P op u lation (A BA ). T h ree years later th e A B A establish ed a co m m itte e on eu genics “to investigate and re p o rt on h ered ity in th e h u m an race [and] to em phasize th e value o f su p erior b lood and th e m e n ace to so ciety o f in ferio r b lo o d ” D a v en p o rt’s E u g enics R eco rd O ffice b e ca m e th e A BA ’s m a in p ropagand a agency, and h u m an breed in g was its m ain focu s. In 1913 th e A B A b e c a m e th e A m e ric a n G e n e tic s A sso cia tio n and co n cen trate d on th e study o f g en etics and eu genics. M an y eu gen icists r e ­ ceived fin an cial backing fro m fou n d ation s, and th e y affected state and fed eral p o licy co n cern in g a h o st o f issues, fro m im m ig ra tio n to steriliz a tio n .29 Sev eral reason s a cco u n t fo r th e a cc e p ta n ce o f eu genics by so m e A m e ri­ cans. First, its em phasis o n th e p e rm a n en ce o f h u m an in eq u alities sustained asse rtio n s o f A n g lo -S a x o n su periority. S e co n d , eu g en ics su p p o rted a tw o p art program : positive eu genics en cou rag ed th e “b est sto c k ” to rep rod u ce; n egative eu gen ics d iscou rag ed re p ro d u c tio n am o n g u nd esirab les. C o n tra ­ ceptives should b e d istrib u ted to th e la tte r bu t avoided by th e form er. E u g en ­ ics w arned th a t excessive breed in g o f th e “unfit” and avoid ance o f c o n c e p ­ tio n by th e “b est sto c k ” w ould lead to ra ce d eg eneration. E u g enics, th erefo re, converged w ith p o p u lar n o tio n s o f race suicide. Third, it suited progressive re fo rm e rs’ b e lie f in sc ie n tific p rin cip les and g o v ern m en t in te rv e n tio n to c o rr e c t th e w orst abu ses in th e social, e c o n o m ic, and p o litica l realm s. E ug en icists ad vocated g ov ern m en t in terv e n tio n based on scien tific philosophy eith er to sterilize or seg regate “undesirables.” E u g en icists offered sim ple a n ­ sw ers to so m e o f th e p ro b lem s w ith w h ich progressives w ere struggling, in ­ cluding poverty, crim e, and th e m entally or physically hand icapped . Eugenic

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attem p ts to raise ro b u st, in tellig en t offspring m esh ed w ell w ith progressive attem p ts to elim in ate tu b ercu lo sis, d ip h th eria, and v en ereal disease and to red u ce m a tern a l and in fa n t m ortality. E u g en icists and progressives alike b e ­ lieved th e race w ould b en efit fro m th e p rop ag ation o f th e “fit” and d ecreased fertility am o n g u n d esirab les.30 E u g en ics a ttra c te d o th e r groups as well. W h ite m id d le-class ed u cated w o m en believed in state in terv e n tio n to p ro te ct th e fam ily fro m p ro stitu tio n , p o llu tio n , ig n o ra n ce , p o o r n u tritio n , and “m o ro n s ” T hou sand s o f w o m en served as field w orkers co lle ctin g d ata fo r fam ily studies th a t h ard -lin ers used to ju stify seg regation and sterilizatio n . O th e r w o m en hailed eu genics fo r its em phasis o n im proving th e ra ce and its im p o rta n ce in ch o o sin g m ates and b eco m in g good p aren ts. Yet so m e fem in ists, w hile en ticed by re fo rm -eu g en ic em phasis on th e h ea lth and fitness o f m o th e rs and ch ild ren , b ristled at ta lk o f saving th e race at th e exp en se o f w o m en ’s individual liberty. C a th o lic lead ­ ers opp osed steriliz a tio n and b irth co n tro l bu t su p p orted sexu al seg regation and “race b e tte rm e n t” p rogram s: b eca u se th e en v iro n m en t shaped heredity, p rogram s should help th e p o o r and w orking class. H a rd -lin ers d isagreed, believing su ch p rog ram s w asted tim e and m oney. F or b lack s eu g en ics was “a sw ord th a t cu t tw o w ays”: th ro u g h ed u ca tio n and o th e r so cia l program s b lacks could im prove th em selv es and th e ir ch ild ren ; bu t h ard -lin e eu genics provided am m u n itio n for ra cists to deny b lack s a ccess to ed u catio n al and p o ­ litica l power. P sy ch iatrists su p p orted eu genics fo r “p ro fessio n al reasons,” n o t race p reju d ice. W ith m o st p sy ch iatrists w orking in asylum s, eu genics offered th e m co m fo rt: th e ir p atien ts failed to im prove b eca u se o f d efective g enes, n o t in ad eq u ate tre a tm e n t. E u g enics also exten d ed p sy ch ia trists’ role outsid e th e asylum , allow ing th e m to b e p art o f progressive and scien tific refo rm s and th e refo re gain leg itim a cy fo r th e ir sp ecialty w ith in th e m e d ica l p rofession. M an y w orking in asylum s b e c a m e h ard -lin ers u n til W o rld W a r I.31 Eugenics attracted follow ers across th e p olitical sp ectru m . It appealed to conservatives in terested in class and race. M any M a rx ists, accord ing to D i­ ane Paul, supported “th e im provem ent o f th e g en etic stock o f th e h um an race throu gh selective breed in g ” E ugenics re je c te d laissez-faire and called for state in terv en tio n in rep ro d u ctio n . The righ t o f every m an and w om an to b e a r c h il­ d ren w as to o ind ivid u alistic; th e g ood o f society, inclu d ing race p reserv atio n , m u st b e p ro tected . M a rx ists su p p orted eu genics as long as it stressed h ered ­ ity, n o t class or race b ia ses.32 Yet su ch biases rem ain ed , evid en ced by calls for re stricte d im m ig ratio n. Foreig ners flood ed n o rth e rn u rb an alm sh ou ses. This p ro b lem paled in co m p a riso n to th e a n im o sity am o n g n a tiv e-b o rn w orkers w ho faced jo b co m p etitio n fro m im m ig ran ts w illing to w ork fo r su b sisten ce w ages. The K n igh ts o f L a b o r called for im m ig ra tio n re strictio n s in 1 8 9 2 , as did th e A m e rica n F ed eratio n o f L a b o r in 1 8 9 4 . X e n o p h o b ic groups backed

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th e se dem and s. E u g en icists jo in e d th e cam p aig n , arguing th a t im m ig ran ts d isp ro p o rtio n ately ca m e fro m “d efectiv e” sto ck . T h ese co m b in ed efforts b rou gh t re strictiv e legislation b efo re C on g ress b etw een 1 8 9 0 and 1 9 2 4 .33 In cre a sin g sta te m a rria g e re s tric tio n s also re flec ted ra c ia l purity. A l­ th o u g h m isceg en a tio n had ta k en p lace th ro u g h o u t A m e ric a n history, m any believed it w as risin g d angerously in th e p o s t-C iv il W a r p eriod . N u m erou s states p ro h ib ited w hites fro m m arry in g anyone w ith “o n e -six te e n th or m o re o f N egro b lo o d ” S o m e w estern states p ro h ib ited m arriage b etw een w hites and A sians. E u g en icists expand ed re stric tio n s to inclu d e ep ilep tics, im b e ­ ciles, and th e feeb lem in d ed u nless th e w o m an w as forty -five o r older. C o n ­ n e c tic u t passed th e first su ch law in 1 8 9 5 ; by 1913 tw en ty -fo u r sta tes, th e D istric t o f C olu m b ia, and P u erto R ico had follow ed. M an y eu g en icists, how ­ ever, co n sid ered th e laws in effectiv e b eca u se th e y believed th e feeb lem in d ed lacked th e m o ra lity to w ait fo r m a rria g e to p ro c re a te .34 The In te rn a tio n a l C on g ress fo r E u g enics, held in L o n d o n in 1912, discussed solu tion s to th e “d i­ le m m a ” M o re th a n th re e hu nd red peop le, m o stly E u rop ean s and A m e rica n s, attend ed. A m e rica n s inclu d ed D av en p o rt; A lexan d er G rah am B ell; C harles E lio t, p resid en t em eritu s o f H arvard; and D avid S ta rr-Jo rd o n , p resid en t o f Stanford . The final session o f th e co n fere n ce dealt w ith m eans to ad vocate th e m u ltip licatio n o f th e “fit” th rou g h eu genic ed u catio n and to obviate “u nfit” p rop agation th rou g h steriliz a tio n and sex seg reg atio n .35 N u m ero u s w orks in th e 1910s called fo r lifetim e seg reg atio n o f “d efec­ tives.” S o m e argued th a t th e ir high p ro lificity p o sed a fin an cial, in stitu tio n al, and so cie ta l strain. B uild ing on an teb ellu m state m e n ta l h o sp itals, eu g en icists called fo r “cu sto d ial co lo n ies” to seg regate th e “village idiot.” E ug enic dem ands tran sfo rm e d state in stitu tio n s’ ratio n ale fro m safeguarding th e af­ flicte d to shield ing so ciety fro m “defectives,” esp ecially th e ir p o te n tia l off­ spring. This new g oal g en erated funds fo r th e co n stru c tio n o r exp an sion o f in stitu tio n s. H. H. G od d ard ’s 1 9 0 8 “in tellig en ce qu otient,” or IQ , te st m ade sp ecifyin g in m ates easier. The u se o f th is te s t in sch o o ls, p riso n s, th e m ilitary, and p o o rh o u ses as w ell as on Ellis Island led so ciety to perceive feeb lem in d ­ ed ness as a b u rg eon in g p ro b lem th a t seg reg atio n alo n e cou ld n o t handle. The d ifficulty w ith seg reg atio n w as tw ofold: m an y p aren ts spu rned it, due eith er to d evotion o r to th e desire to em ploy m ildly retard ed ch ild ren ; and eu g en icists id en tified fa r m o re p eop le w ho should n o t b re ed th a n in stitu ­ tio n s cou ld a cco m m o d a te. B y th e 1910s th e y estim a ted th a t 10 p e rce n t o f th e p o p u latio n carried th e recessiv e tra it fo r feeb lem in d ed n ess. T hese “n o rm al”-lo o kin g p eop le w ere a real d anger if th e y m arried a n o th e r p erso n w ith th e recessive tra it and th e n co n ceiv ed a feeb lem in d ed child. T he exp en se to d etain individuals solely to preven t th e ir p ro p ag atio n b e c a m e prohibitive. A cheaper, p e rm an en t so lu tio n w as to elim in ate th e ir ability to re p ro d u ce.36

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Sterilization W h ile b o th g e n e tic ists and e u g e n icists b eliev ed in sterilizin g th e fe e b le ­ m ind ed , th e fo rm e r re sen te d th e la tte r’s claim s th a t th is p ro ced u re w ould solve th e p o p u lation p roblem . A t b est, it could red u ce feeb lem in d ed n ess by 10 p e rce n t. B u t it did d em o n stra te th e ability to re s tric t p aren th o o d . The earliest re co rd ed cases in th e U n ited S ta tes date to th e late 1 8 9 0 s . In 1 8 9 8 th e tru stees at th e K ansas S ta te In stitu tio n fo r F eeb le-M in d ed C hild ren approved th e w ork o f Dr. F. H oy t P ilcher, w ho ca stra ted fo rty -fo u r boys and s te ril­ ized fo u rteen girls b eca u se th e bo ard co n sid ered th e m “unfit.” W h e n lo ca l new spap ers carried th e story, pu blic ou trage over ca stra tio n fo rced P ilch er to resign. C astra tio n , how ever, laid th e basis fo r m o re a ccep ta b le m e th o d s o f sterilizatio n .37 D u rin g th e late n in e te e n th cen tu ry E u rop ean d o ctors developed n ew ster­ ilizatio n te ch n iq u e s. The v a se cto m y elim in ated m ale rep ro d u ctiv e pow ers w hile p reservin g pleasu re, ju s t as th e salp in g ectom y did fo r w om en, althou g h th e la tte r p ro ced u re w as m o re risky. Dr. A . J. O ch sn er, c h ie f su rgeon at St. M a ry ’s H o sp ital in C hicag o, p erfo rm ed th e first v a secto m y in 1 8 9 7 . H e b e ­ lieved th e v ase cto m y provided a civil m ean s by w h ich to elim in ate “h ered i­ ta ry crim in als,” a lc o h o lic s, “im b e cile s, p e rv erts, and paupers.” D esp ite th e lack o f scien tific p ro o f th a t th e se tra its w ere g en etically co n tro lled , O c h s n e r’s lo g ic to o k hold am o n g eu g e n icists.38 B etw een 1 8 9 9 and 1912, fo r exam ple, Dr. H arry Sh arp o f th e P u rity S o ciety o f In d ian a and m e d ica l officer at Jefferso n R efo rm a to ry ca rrie d out on his ow n initiative at le a st 2 3 6 co m p u lsory v a secto m ies. W ritin g to th e Eugenics

Review in 1912, he stated th a t h e had “o p erated on m an y ag ainst th e ir w ill and over th e ir vigorous p ro te st” and “w ith ou t a d m in isterin g an a n esth etic eith er g en eral or local.” H e a cted w ith ou t legal sa n ctio n . Sh arp encou rag ed his colleagu es to p e titio n legislatures to allow m ale steriliz a tio n in p rison s, re fo rm ato rie s, and in stitu tio n s fo r th e feeb lem in d ed , resu lting in m any p ro s­ teriliz a tio n m e d ica l tr a c ts .39 N o t all d o cto rs su p p orted steriliz a tio n fo r eu genic p u rp oses. In a study o f S to c k to n S ta te H o sp ital in C alifo rn ia, Jo e l T. B raslow found th a t d o ctors sterilized p atie n ts b eca u se th e y “saw steriliz a tio n , n o t as an in stru m e n t o f th e state to preven t th e p ro c re a tio n o f th e in san e, b u t as a th e ra p e u tic in ­ te rv e n tio n to alleviate individual suffering.” D o c to rs believed th e p roced u re had g reat “p sy ch o lo g ical b en e fits” in p ro te ctin g m entally im p aired w om en fro m th e strain o f child b earin g and ch ild rearin g , “a goal w o m en o ften shared w ith th e ir physicians.” D o c to rs m ain tain ed th a t sterilizatio n had “a d ire ct and p ositive b io lo g ica l e ffe c t” on m en: it d im in ish ed m a n ifesta tio n s o f m a n ic -d e ­

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pressive p sychosis and d em en tia p raeco x. Th ese d o cto rs co n su lted p atients and acted in th e ir in tere sts; eu g en icists ig n ored individual w ill.40 Individual w ill w as ea sier to ig n ore on ce states passed steriliz a tio n laws. In 1 8 9 7 M ich ig a n p ro p o sed bu t failed to pass th e first su ch law .41 In 1 9 0 7 In d iana en acted th e first statu te, w h ich allow ed a b o ard o f exp erts to ord er th e sterilizatio n o f sta te-in stitu tio n a liz ed id iots, im b ecile s, co n v icts, and ra p ­ is ts.42 B etw een 1 9 0 7 and 1913 sixtee n states passed laws: g overn ors v etoed four, and tw elve b e c a m e law. The resp o n sib ility fo r th e se laws lay w ith som e zealous d o cto rs w ho in fo rm ed state legislators a b o u t vasectom y. L eg islators h op in g to d im in ish crim in a l activ ity and co sts em b ra ced th e se e x p e rts’ ad­ v o cacy o f a m e th o d less b ru ta l th a n ca stra tio n . E u g en ic steriliz a tio n n ever b e ca m e a g rassro o ts m o v em en t b u t rem ain ed an elitist answ er to perceived so cial and e co n o m ic p roblem s. Even so m e eu g en icists re je c te d sterilizatio n excep t as a last re so rt. In th e 1910s D av en p o rt and Paul P op en oe, au th o r o f

Applied Eugenics (1918), believed sterilizatio n w as u n -C h ristia n b eca u se it al­ low ed officials to sterilize th e feeb lem in d ed and th e n d ischarge th e m to fend fo r th em selv es, w h ich m an y cou ld n o t do. They believed seg reg atio n w as m o re h u m an e.43 Fam ily m e m b e rs’ re a ctio n varied. S o m e spou ses sa n ctio n ed it as a m eans o f p e rm a n en t co n tra ce p tio n . O th e r fam ily m e m b ers a ccep ted it b ecau se th e y believed in th e th e ra p e u tic im p act. S o m e su p p orted it b ecau se in stitu tio n alized p atien ts could b e d ischarged and re jo in th e ir fam ilies. O th ­ ers refu sed to co n se n t b eca u se th e y w ere unw illing to a cc ep t th e re sp o n sib il­ ity. S o m e repud iated steriliz a tio n b eca u se it im plied a g en etic d efect in th e ir fam ily lin e.44 M an y steriliz a tio n laws faced legal ch allen ges. W h ile eu g en ic th e o rie s in flu en ced m any state legislators, far few er ju d g es and scien tists w ere c o n ­ vinced . B etw een 1913 and 1918 state co u rts d eclared seven o f th e tw elve laws invalid b ecau se th e y in stitu ted cru el and u nu su al p u n ish m en t, violated due p ro cess, or co n stitu ted p u n ish m en t w ith ou t a trial. Judges req u ired evid ence th a t th e p ro ced u re w ould b en efit th e individual, n o t society. S o m e scien tists also challenged th e laws, attack in g th e naive view o f in h e rita n ce prom u lgated by eu g en icists, esp ecially th e n o tio n o f in h e rited crim inality . T h ese o b je c ­ tio n s w ere only a m in o r setb a ck fo r eu genic p ro p o n en ts. A seco n d wave o f legislation passed in th e 1 9 2 0 s. E u g en icists ben efited fro m risin g xen o p h o b ia in th e face o f in crea sin g so u th ea stern E u rop ean im m ig ra tio n and m o u n tin g a n x ieties regard ing th e m ig ra tio n o f b lack s to n o rth e rn c itie s.45 P erhaps th e m o st sig n ifican t im p etu s fo r n ew state laws ca m e fro m th e Su p rem e C o u rt’s en d o rse m en t o f sterilizin g th e “u n fit” w ith Buck v. Bell (1927). W ritin g fo r th e m ajority, Ju stice H o lm es a ccep ted th e b a sic te n e ts o f th e eu gen icists: m e n ta l d efects and crim in a lity w ere in h e rited ; th e fe r­

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tility o f m en tal d efectives could o verru n so ciety w ith in co m p eten ce. C arrie B u ck , he argued, w as a p o te n tia l p a ren t o f “socially in ad eq u ate offspring,” and, as such, she cou ld b e “sexually sterilized w ith ou t d etrim en t to h e r g en ­ eral h ea lth and . . . h er w elfare and th a t o f so ciety [w ou ld ] b e p ro m o ted by h e r sterilization .” H o lm es believed th a t so ciety had th e rig h t to “ca ll u pon th o se w ho already sap th e stren g th o f th e S ta te . . . in ord er to p revent our b ein g sw am ped w ith in co m p eten ce.” H e argued th a t so ciety should “prevent th o se w ho are m an ifestly u nfit fro m co n tin u in g th e ir k in d ”46 A ny co n c e rn over w h eth er th e p ro ced u re ben efited th e individual ra th er th a n so ciety was n o tice ab ly ab sen t fro m th is decision.

Buck v. Bell in crea sed sterilizatio n s. N u m erou s ju d g es b ased th e ir in te r­ p re ta tio n o f state laws o n H o lm e s’s find ings. W ith th is d ecisio n , H arry H. Laughlin, a fo rm er high sch o o l b iology te a c h e r fro m M isso u ri and now d ire c­ to r o f th e C old Spring H arb or L a b o ra to ries, gained th e leg itim acy h e lacked in th e early 1 9 2 0 s w h en he d rafted a steriliz a tio n law th a t drew op p o sitio n fro m p ro m in en t physicians. H e had ap p roach ed th e M e n ta l H ygiene A sso ciatio n , th e A m e rican S o c ia l H ygiene A sso cia tio n , and th e B u reau o f S o c ia l H ygiene req u estin g su p p ort fo r th e p u b licatio n o f his w o rk Eugenical Sterilization in

the United States. W h ile Dr. Th om as W . S alm o n , Dr. W illiam F. Snow , and Dr. K ath erin e D avis o f th e th re e org anization s, respectively, found valuable m a ­ te ria l on state laws and co u rt d ecisions o n sterilizatio n , n o n e w ould help fund th e b o o k ’s p u b licatio n b eca u se n o n e w anted to b e “resp o n sib le fo r th a t part o f th e b o o k w h ich had to do w ith d ire ct prop ag and a favoring steriliz a tio n legislation.” S a lm o n believed th a t Laughlin’s law rep resen ted “th e view p o in t o f only a relatively sm all group o f p erso n s in th e U n ited S ta te s ” Follow ing

Buck v. Bell, L au g hlin’s m o d el b ill cap tu red in crea sed a tten tio n . Laughlin de­ fined “a socially in ad eq u ate p erso n ” as so m eo n e w ho “fails ch ron ica lly . . . as a u sefu l m e m b e r o f th e org anized so cia l life o f th e sta te” The “socially in ad ­ eq u ate classes,” w h ich en co m p assed th e feeb lem in d ed , d elinqu ent, ep ilep tic, blind o r deaf, d eform ed , and “d ep end ent (includ ing orp h an s, n e ’er-d o-w ells, th e h o m eless, tra m p s and paupers),” ce rta in ly a broad ly defined category, w ere su b je cts fo r state sterilization . This p ro ced u re, a cco rd in g to Laughlin, w ould save so ciety fro m o verbreed ing th e w rong p eop le.47 B y th e late 1 9 2 0 s tw e n ty -th ree states had law s.48 R h od e Island did n o t ju m p on th e bandw agon. D a n iel F. M cL a u g h lin (R) u nsu ccessfu lly in tro d u ced H 1 0 5 0 in 1 9 2 5 . The b ill defined a “m en tally de­ fectiv e p e rso n ” as “eith e r a n id io t, a n im b e cile , a feeb lem in d ed p erso n , an ep ilep tic, an in san e p erson , o r a p e rso n co n v icted o f th e crim e o f rape,” p ro ­ cre a tio n by w h om w ould n o t b e d esirable or b e n e ficia l to th e com m unity. The b ill w ould have em p ow ered th e s e c re ta ry o f th e S ta te P u b lic W elfare C o m m issio n to re co m m en d to th e co u rt fo r steriliz a tio n anyone “m entally

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defective.” T h ree phy sicians w ould exam in e th e cand id ate and te stify to th e ir findings. I f th e co u rt d eterm in ed th e can d id ate d efective, th e state w ould pay fo r “su ch p e rso n to b e eu genically steriliz ed ”49 W h ile m any state bills d ealt w ith b o th eu genic and e c o n o m ic im p licatio n s o f steriliz a tio n (i.e., sav­ ing state m o n ey by red u cin g d ep en d en t offspring o r by d ischarging sterilized in m ates fro m in stitu tio n s), M cL au g h lin ’s b ill p e rta in ed only to eu genics. H is in tere st w as to save th e co m m u n ity fro m th e b reed in g o f th e unfit. The failure o f th is b ill ca n n o t b e a ttrib u ted to th e in flu en ce o f th e C ath o lic C hu rch . A lthou g h ch u rch officials re je c te d sterilizatio n , th e y m o re strongly op p osed b irth c o n tro l and y et w ere n o t able to m ak e th a t p ra c tice illegal in R h od e Island d esp ite th e ir stron g p resen ce. O th e r fa cto rs played a role. M cL au g h lin ’s law w ould have applied to anyone d eem ed u nfit, in stitu tio n ­ alized or n o t. This a sp e ct m ay have b e e n to o h a rsh fo r m an y legislators. It w ould have applied to affluent p a tie n ts in private h o m es o r san itariu m s ra th er th a n only to in m a tes o f p u blic in stitu tio n s, as in so m e o th e r states. S o m e legislators m ay have b e e n le ery o f su p p ortin g a b ill to b en e fit so ciety at th e expense o f individual rig h ts, a hallm ark o f R h od e Island leg islatio n .50 R h od e Islan d w as in th e m in o rity o f states re je c tin g sterilizatio n . S u ch rep u d iation did n o t d istress m o st eu g en icists; steriliz a tio n w as only p art o f th e solu tion. R ace su icid e th e o rists and negative eu g en icists co n clu d ed th a t co n tracep tiv e know ledge m u st b e m ad e available to th e “unfit.” The p ro b lem w ith th is strategy w as th e co n tin u ed ex iste n ce o f th e C o m sto ck Law.

The Contraceptive Campaign The fed eral g ov ern m en t p laced n o re strictio n s on co n tra cep tiv e d evices and literatu re u n til 1 8 7 3 , w h en th e lobby in g efforts o f A n th on y C o m sto ck cu l­ m in ated in th e C o m sto ck A ct. C o m sto ck ja m m e d th ro u g h at th e end o f a bu sy co n g ressio n a l sessio n leg islatio n th a t d ealt w ith obscenity, vice, and crim e. C on g ress passed th e bill, and P resid en t U lysses G ra n t signed it o n 4 M a rch 1873. The a c t’s language w as vague and ram blin g , yet C on g ress passed it swiftly, w ith ou t d iscu ssion and w ith ou t a ro ll-ca ll vote. M an y re p rese n ta ­ tives did n o t realize th a t th e a c t b a n n ed th e d istrib u tio n and m ailing o f any in fo rm atio n co n c ern in g b irth co n tro l or ab o rtio n . In 1 8 7 6 th e N atio n al L ib ­ eral League organized betw een forty and seventy th o u san d citizen s to p ro test th e C o m sto ck L aw as u n -A m e rica n , u nju st, unw ise, and u n co n stitu tio n a l b e ­ cau se it en fo rced p a rticu la r m oral, religiou s, and m e d ica l o pinions. C ong ress failed to rep eal th e law.51 The law forbade th e d istrib u tio n o f in fo rm a tio n ab o u t, n o t th e a ctu a l p rac­ tice of, b irth co n tro l. M oreover, it w as rarely en forced , w ith few arre sts and even few er co n v ictio n s. M a n y w o m en co n tin u ed to o b ta in b o ra x , ca rb o lic

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acid , and o th e r su b sta n ces w ith w h ich to m ake h o m em a d e su p p ositories. A b o o tleg trad e flo u rish ed am o n g sm all en trep ren eu rs and large c o rp o ra ­ tio n s th a t em ployed ad vertisin g language th e p u b lic u n d e rsto o d b u t th a t still shield ed bu sin esses fro m p ro se cu tio n . W h ile n u m ero u s co n tra ce p tiv e op tio n s w ere available, n o g ov ern m en t ag en cy regu lated or in sp ected th ese p ro d u cts, leaving th e buyer to bew are. W ea lth y w o m en o b tain ed c o n tra ce p ­ tiv es fro m th is b la ck m a rk et b u t also fro m ph y sician s w ho tru ste d th em . C atalo g s ad vertised IU D s and o th e r form s o f b irth c o n tro l w ith in a m e d i­ cal co n tex t to avoid th e ban. IU D s, fo r exam ple, w ere to c o rre c t prolapsed u teri.52 P oo r w om en, w ho could rarely afford to see d o cto rs, cou ld n o t avail th em selv es o f th e se op tion s and relied on b o o tleg g ers and th e ir o ften u n reli­ able co n trace p tiv es. T h ose w ho n eed ed co n tra ce p tiv es m o st in th e eyes o f race su icid e th e o rists and p ro p o n e n ts o f negative eu genics had little access to affordable, effective m eth o d s. The so lu tio n , a cco rd in g to th e se tw o grou p s, w as to m o d ify re strictiv e legislation. In 1916 M a u rice P arm elee p u blished Poverty and Social Progress. C laim in g th a t th e crie s o f ra c ia l su icid e had g on e u n h eed ed by th e u pper classes, P arm elee re co m m en d e d a cam p aig n w hereby th e poor, “ord inarily to o ig n o ran t and to o c a re le ss" w ould b e tau g ht how to regu late fam ily size. Law s w ould have to be repealed : “W h ile th e a b o litio n o f th is re stric tio n w ill n o t in crea se th e b irth rate o f th e u p p er classes, it w ill d oubtless low er th e b irth rate o f th e low er classes som ew hat. The resu lt w ill th e n b e to in crea se th e p ro p o rtio n o f th o se w ho are alleged to b e eu genically m o re d esira b le "53 S im ilar arg u m en ts p erm eated m ag azines during th e 1910s.54 T h eod o re R o o se v elt claim ed th a t th e survival o f th e n a tio n d epended u p on “en cou ragin g th e fit and d iscouraging th e u n fit” to breed. T hese eu genic te rm s w ere m issing in his early w ritin g s on ra ce suicide. In an a rtic le in Out­

look (1914) he con ten d ed : “I w ish very m u ch th a t th e w rong peop le could be prevented entirely fro m breeding," y et he refu sed to en d orse co n tra cep tio n . H e believed th a t if co n tra cep tiv es w ere m o re easily available, th e “b est sto c k ” w ould red u ce th e ir b irth ra te even m o re, w hile th e “p o o r sto ck " w ould c o n ­ tin u e o n th e ir p resen t p ath .55 R oo sev elt, how ever, w as in th e m in o rity am ong race su icid e th e o rists, w ho p ressed for lib eralized laws to b a la n ce b irth ra tes b etw een “fit" and “unfit." Iron ically, n a tio n a l fem in ist o rg a n iz a tio n s avoided in v olv em en t in th e m o v em e n t to ease re stric tio n s. F em in ists w ere co g n iz a n t o f th e p o p u lar c o n n e ctio n b etw ee n c o n tra ce p tio n and sexu al lew d ness. M oreover, m any fem in ists b o u g h t in to th e ra c ist and classist d o ctrin e s o f ra ce suicide th e o ris ts .56 The N atio n al A m e rica n W o m a n Suffrage A sso cia tio n , th e N ation al W o m a n ’s Party, and th e W o m e n ’s T rad e U n io n League assu m ed no role in

Race Suicide, Eugenics, and Contraception, 1900—1930

th e co n tro v ersy and esp ecially d istan ced th em selv es fro m any d iscu ssio n o f a b o rtio n .57 W h ile n o m o v em en t em erged to lo o se n a b o rtio n re strictio n s, tw o m ain groups lo b b ied fo r co n tracep tiv e lib era liz a tio n in th e 1910s. E u g en icists p ro ­ m o te d it to p ro te ct th e A n g lo -S a x o n c h a ra cte r o f th e n a tio n , w hile som e le ft­ ists su p p orted it as p art o f th e class struggle.58 T he p rim ary p ro p o n en ts on th e left w ere E m m a G o ld m a n and M a rg a ret Sanger. G o ld m an , an a n a rch ist, saw co n tra ce p tio n in e c o n o m ic ra th er th a n fem in ist te rm s ; she w an ted to help raise w o rkin g-class w ages and expand w o rk ers’ p o litica l power. U nlike th e m ale-d o m in a te d S o c ia list P arty, w h ich re m a in e d silen t b e c a u se it a c­ cep ted w om an’s ro le as h ousew ife and m oth er, G o ld m an actively su pported co n tracep tiv es. H er w riting s display c o n c e rn fo r th e plight o f w orkers. Few er ch ild ren w ould a m elio ra te th e ir living co n d itio n s and allow p aren ts to de­ vote m o re tim e to th e class struggle. In th e inau gu ral issue o f th e Woman

Rebel G o ld m an argued th a t “th e d efend ers o f au th o rity dread th e advent o f a freed m o th e rh o o d le st it ro b th e m o f th e ir prey. W h o w ould fight w ars? W h o w ould create w ealth? W h o w ould m ake th e p o licem an , th e jailer, if w o m en w ere to refu se th e in d iscrim in ate b reed in g o f ch ild ren ?” G o ld m an co n ten d ed th a t “w om an n o lo n g er w ants to b e a p arty to th e p ro d u ctio n o f a ra ce o f sickly, feeb le, d ecrep it, w retch e d h u m an b e in g s___ In stead she desires few er and b e tte r ch ild ren , b e g o tte n and reared in love and th rou g h free ch o ic e ”59 D esp ite h e r ad v ocacy o f co n tra ce p tio n , G o ld m an had little im p a ct due to h er re p u tatio n as a le ftist agitator. Sanger, on th e o th e r hand , had b e c o m e a n in flu en tial lead er fo r co n tra ce p ­ tive d isp ersal by th e late 1910s. S a n g er re sen te d h e r ro le as a ran k -an d -file o rg anizer w ith in th e S o cia list Party. H er biog rap h ers as w ell as a n u m b er o f h isto rian s have n o te d h e r stron g ego and d esire fo r atten tio n . H er son G ran t agreed: “T h e re’s n o q u estio n a b o u t m o th e r’s ego. S h e always th o u g h t th a t h e r w o rk was th e g reatest w ork in th e w orld, and any o th e r w o rk w as purely secon d ary ”60 This h an k erin g for th e lim elig ht led S a n g er to b ra n ch o ff fro m th e S o cia list P arty in th e m id -1910s and pu rsue full tim e th e re fo rm o f law s.61 Early on she em ployed fem in ist ideology: every w o m an had th e right to de­ cid e w ith ou t gov ern m en t in terferen ce w h eth er to have a child. H er co n c e rn w as fo r w o m en w ho cou ld n o t afford large fam ilies b u t had n o a ccess to c o n ­ tracep tiv es. T rad ition al h isto ric a l a cco u n ts a sserted th a t h e r c o n c e rn fo r th e p o o r m ad e h er h o stile to th e eu genics m o v em en t and th a t she m ain tain ed co n ta ct w ith its lead ers only to gain th e ir su p p ort fo r th e re fo rm o f fed eral co n tracep tiv e leg islatio n .62 R e ce n t histo rio g rap h y su ggests, how ever, th a t San g er did a ccep t eu genic ideas by th e 1 9 2 0 s . H avelock E llis, B ritish p sy ch o lo g ist, so cia l rad ical, and

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p ro p o n e n t o f free love, in flu en ced h er; acco rd in g to G ra n t Sanger, she “was te rrib ly in love w ith H avelock E llis" and he served as h er tu to r fo r th e year she sp en t in E ngland .63 S a n g e r’s biographer, E llen C hesler, co n clu d es th a t San g er “d eliberately co u rted th e pow er o f eu genically in clin ed acad em ics and scien tists to b lu n t th e a tta ck s o f religiou s con serv ativ es ag ainst h e r . . . ; th e re is n o denying th a t she allow ed h e rse lf to b e c o m e cau ght up in th e eu genic zeal o f th e day"64 Sim ilarly, A ngela Franks argues th a t S a n g er “had a g enuine co m m itm e n t to th e eu genic id eology . . . ; at n o tim e did h e r b e lie f in eu gen ­ ics la g "65 M an y ad vocates o f co n tra cep tiv e lib eralizatio n , inclu d ing Sanger, accep ted eu gen ic te n e ts and w anted to jo in forces. S an g er cen tered a tten tio n on legislation by d eliberately defying th e C o m ­ sto c k Law. In 1915 h e r d istrib u tio n o f co n tra ce p tiv e in fo rm a tio n to w ork ­ in g -class w o m en earn ed h e r an official w arning. T he follow ing year she ag i­ tated nationw id e to am end th e fed eral law. S h e and h e r sister E th el B yrne, b o th n u rses, op ened th e first ed u catio n al ce n te r in th e B row nsville sec tio n o f B ro o klyn th a t d istrib u ted co n tracep tiv e in fo rm atio n , n o t d evices, to w ork­ in g -class w o m en .66 T en days la ter th e p o lice a rrested S a n g er and B y rn e for v iolating N ew Y ork ’s versio n o f C o m sto ck . San g er used h e r tria l and im p ris­ o n m en t to cap tu re a tten tio n fo r reform . W h ile in p riso n she g arn ered sy m ­ pathy fro m th e p u blic as a m a rty r severed fro m h er ch ild ren .67 B y 1917 a variety o f lo c a l and n a tio n a l o rg anization s ru n alm o st entirely by w o m en had fou ght fo r th e legalization o f co n tracep tiv es. M a ry W a re D en n ett establish ed th e N atio n al B irth C o n tro l League in 1915, bu t it did n o t re a ch bey on d N ew Y ork C ity and had d isin tegrated by 1919. M an y o th e r re fo rm groups w ere affiliated w ith th e S o cia list P arty o r w ith lo c a l so cia list so cietie s, d espite th e p a rty ’s o p p o sitio n to co n tra ce p tio n . In ad d ition, th e N ew York W o m a n ’s P ublishing C om p any b eg an to d istribu te th e Birth Control Review in 1917, w ith M a rg a ret S a n g er as editor. S a n g er p u blished th is p erio d ical, w h ich had over eight th o u san d su b scrib ers, th ro u g h o u t W o rld W a r I.68 S ev eral even ts and tren d s show th e g row ing a cc e p ta n ce o f co n tra c e p ­ tives in th e 1910s. First, in 1916 tw o ju d g es, on e in N ew Y ork C ity and on e in C leveland , released w o m en a ccu sed o f th e ft b eca u se th e y stole to feed th e ir child ren; b o th jud ges spoke o f th e n eed to d isperse co n tracep tiv es to th e p o o r to p revent su ch situ ation s. S e co n d , th e m o re lib eral sexu al clim ate eased th e d isco m fo rt o f req u estin g co n tra ce p tiv e advice. B y th e early tw e n tie th c e n ­ tu ry a grow ing n u m b er o f w o m en co n sid ered p rem a rita l in terco u rse a cc ep t­ able in so m e situ atio n s, and a m id d le-class n o rm b eg an to em erge w hereby cou p les sp en t th e ir early m a rried years a tta in in g fin a n cia l and em o tio n a l stability p rio r to having ch ild ren . A n u nd ergrou n d co n tra ce p tiv e n etw ork con tin u ed , circu m v en tin g b o th state and fed eral law s.69 Third, th e a n tip ro s­ titu tio n cru sad e p rio r to and during W o rld W a r I in crea sed th e pressu re for

Race Suicide, Eugenics, and Contraception, 1900—1930

co n trace p tiv e lib eralizatio n . A s sex gradually evolved fro m a d anger to be co n tro lled to a natu ral o u tlet fo r m ale and fem ale passion, sexually active single w o m en n eed ed safeguards. F ou rth , th e p rev alen ce o f ven ereal disease in creased th e acc e p ta n ce o f co n d o m s b eca u se o f th e ir dual ro le in preventing p regn an cy and disease. V en ereal d isease affected n o t only m e n engaging in u n p ro tecte d sex bu t also “in n o c e n t w om en,” w ho co n tra cted it th ro u g h th e ir h u sban d s.70 In July 1918 C on g ress created th e D iv ision o f V en ereal D isease in th e U.S. P u blic H ealth S e rv ice w ith a fo u r-m illio n -d o lla r budget. That sam e year Judge F red erick C ra n e o f th e N ew Y ork C o u rt o f A ppeals ru led c o n tra ­ ceptives legal as a pu blic h ea lth m easu re if p re scrib ed by a doctor. D ru g sto res ig n ored th e la tte r a sp e ct, and th e co n d o m b u sin ess b o o m ed u nd er th e guise o f preventive h ea lth and m e d ica l necessity. C ra n e ’s d ecisio n o p en ed th e way fo r clin ics to p re scrib e fem ale co n tra ce p tiv es.71 These d evelop m ents did n o t lead to w holesale approval o f b irth con trol. The grow ing acc e p ta n ce o f a fem ale sex drive u nd erm in ed so m e m e n ’s sense o f m arital security, and co n tra cep tiv es w ere a con v en ien t ta rg e t fo r th is a n x i­ ety.72 O p p o sitio n also derived fro m co n tra ce p tio n ’s u n o rth o d o x a n teced en ts. R eco g n izin g th a t th e m o v em e n t’s early ties w ith le ftist and so cia list groups im p aired its ch a n ce o f su ccess, S a n g er sev ered th e m and a ltered ta c tic s .73 Sh e ab an d o n ed fem in ism and ad opted eu genics in h er drive for reform . D u rin g th e 1 9 2 0 s S a n g e r’s o b jectiv es inclu d ed lobbying th e fed eral g ov ern ­ m e n t to am end C o m sto ck and fo rm in g ed u catio n al b od ies th a t did n o t defy it. In N o v em b er 1921 she organized th e First N atio n al C o n fere n ce on B irth C o n tro l in N ew Y ork C ity at w hich a ctiv ists laid plans fo r th e estab lish m en t o f th e A m e rican B irth C o n tro l L eag u e (A B C L ). T he A B C L w as to organize state leagu es and lo c a l co m m ittee s to m ake co n tracep tiv es a ccessib le and to ed u cate th e p u blic on th e ir so cia l and “eu g e n ic” im p o rta n c e .74 The average A B C L su p p o rter w as a w hite, P ro te sta n t, n a tiv e-b o rn , u p p er-m id d le-class, th irty -fiv e-y ear-old housew ife. M o re th a n h a lf th e m e m b ers w ere R ep u b li­ can s; 17 p e rce n t w ere p ro fessio n al m e n .75 S a n g er in c o rp o ra te d th e A B C L as an e d u catio n a l b od y u n d er N ew Y ork S ta te law in A pril 1 9 2 2 w ith th e

Birth Control Review as its official organ. In its first tw en ty m o n th s th e A B C L received 11,525 calls and 1 3 2 ,0 0 0 letters req u estin g co n tra cep tiv e in fo rm a ­ tio n , drew 1 7 5 ,0 0 0 atten d ees to le ctu re s acro ss th e cou ntry, and pu blished 6 0 0 ,0 0 0 cop ies o f th e Birth Control Review. B e c a u se th e A B C L cou ld n o t d istribu te co n tracep tiv e in fo rm atio n , it answ ered in q u iries by explaining fed ­ eral and state re strictio n s and en cou rag in g p eop le to w rite th e ir legislators to in sist on rep eal.76 The A B C L lau n ch ed its ow n cam p aig n w ith a le tte r strong in nativist and eu gen ic rh e to ric to th e fed eral g ov ern m en t. It dem and ed th e crea tio n o f a fed eral b irth ra te co m m issio n co m p osed o f scien tists to study th e p ro b lem s “m e n a cin g th e ra cia l h ea lth ” o f th e n atio n : “T he sto c k w h ich

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has m ad e A m e ric a a g reat n a tio n (the sturdy old native sto c k w ith its vision, cou rage and high ideals) is bein g sw am ped by a d ifferent ord er o f hum anity, o f w h ich a huge p ro p o rtio n is b iolo g ically u nd esirab le and w ill inevitably, th rou g h u n restra in ed b reed in g , w ork a vast ch an g e in th e c h a ra cte r o f th e p o p u la tio n "77 The im m ig ra tio n re s tric tio n o f 1917 w ould n o t elim in ate th e th re a t to th e race.78 O n ly co n tra cep tiv e d istrib u tio n to u nd esirables w ould solve th e problem . A n x ieties co n c ern in g im m ig ra tio n in crea sed in th e early 1 9 2 0 s . A lthough W o rld W a r I tem p o ra rily h alted th e flow, a fte r th e w ar th e n u m b ers surged: 1 1 1 ,0 0 0 in 1919, 4 3 0 ,0 0 0 in 1 9 2 0 , and 8 0 5 ,0 0 0 in 1921. M an y w ere o f th e “in fe rio r” and “d ark er” pop u lations o f so u th ea stern E u rop ean co u n tries. The Ku K lu x K lan reem erged , and C on g ress passed im m ig ra tio n re strictio n s in 1921 and 1 9 2 4 .79 M an y A m e rica n s jo in e d nativist groups. Tw o slogans spoke fo r m illio n s— "A m erica for A m e ric a n s” and “O n e H u nd red P ercen t A m e ri­ ca n is m "80 The u nderlying factor, a cco rd in g to d em o g rap h er Louis D u blin, w as d istru st o f th e n ew com er, esp ecially “th e fear eng end ered by his g reater fertility and rapid in crea se in nu m b ers a fte r his a rriv a l" T he 1 9 2 0 census c o n ­ firm ed th e con tin u in g d isparity b etw een w hite n a tiv e-b o rn and im m ig ran t fertility rates, a fa ct b em o a n e d by W illia m S. R ossiter, sta tisticia n and ch ie f clerk o f th e cen su s.81 The 1 9 2 0 s also w itn essed a re ca p itu la tio n o f sta tem e n ts co n c ern in g th e b irth differential betw een th e “ig n o ra n t” p o o r and th e ed u cated rich . W illiam L. P oteat, p resid en t o f th e N o rth C a ro lin a S o c ie ty fo r M e n ta l H ygiene, o f th e S o u th e rn B ap tist E d u cation A sso cia tio n , and o f W ak e F orest C ollege, argued th a t “th e alarm in g th in g is th a t th e u p p er grades o f in tellig en ce are n o t re p ro ­ d ucing th em selv es, w hile th e low er grades show a n am azing fertility. . . . N ow th e en em ies o f so ciety are re cru ited fro m th is rapidly in crea sin g low er se c ­ tio n o f th e pop u lation, and it is n o t u n reaso n ab le th a t it w ill a cco m p lish th e ov erth row o f civilized so cie ty "82 O th ers argued sim ilarly. T hese d oom sayers ad vocated p op u lation c o n tro l— a co n c e rte d effort to m anip u late p o p u lation grow th by d istrib u tin g co n tra cep tiv es am on g th e “u ndesirable,” w h ich n e c e s ­ sitated a rep eal o f th e C o m sto ck Law.83 Yet th e fed eral gov ern m en t failed to am end th e law. W h y? For som e, pru d ­ ery prevailed. A ttem p tin g to u phold th e outd ated V icto ria n sex cod e, m o r­ alists b elieved th a t lib eralized leg islatio n w ould lead to in crea sed p re- and ex tram arital sex. S o m e sch o lars co n ten d th a t a lib eralized law w ould have lo o se n ed th e tra d itio n a l b on d s m e n had o n w o m en .84 W ith o u t c o n sta n t ch ild b earin g and ch ild rearin g b u rd en s, w o m en cou ld co m p ete w ith m en in th e p u blic realm . Perhaps p ro n atalist attitu d es played a role. In 1921 th e Sh ep p ard -T o w n er A ct b e c a m e th e first fed eral legislative foray in to w elfare as w ell as p regn an cy and ch ild b irth , en cou rag in g states to develop prog ram s

Race Suicide, Eugenics, and Contraception, 1900—1930

to b en efit in fan ts and m o th e rs th rou g h g ra n ts-in -a id .85 P op u lation c o n tro l ad vocates expressed co n c e rn over leg islatio n th a t u n d erw ro te ch ild b irth but did n o th in g to d iscou rag e it: th e clin ics estab lish ed u nd er th is a c t did n o t provide co n tracep tiv e in fo rm atio n . The B u reau o f S o c ia l H ygiene (B S H ), in particu lar, called fo r linking co n tra ce p tiv e clin ics w ith pren atal, natal, and p o stn atal clin ics, bu t th e fed eral g o v ern m en t refu sed .86 T he g reatest b a rrier cam e fro m th e C a th o lic C hu rch , th e A M A ’s failure to en d orse a new bill, and th e p u b lic’s fear th a t easy a ccess to co n tracep tiv es w ould w orsen th e differ­ en ce in b irth ra tes b etw een th e desirable and und esirable. The C a th o lic C h u rch ’s o p p o sitio n to b irth co n tro l rem a in ed firm .87 In 1 9 0 2 th e ch u rch b a n n ed a b o rtio n s even fo r e c to p ic p reg n an cies, and in 1917 a n ew po licy ex com m u n ica ted w o m en w ho sought a b o rtio n s. A m e rica n ca r­ dinal Jam es G ib b o n s reitera ted th e d o ctrin e on b irth co n tro l: “To d efeat N a ­ tu re in m arriage is as crim in a l as to co m m it murder,” he stated . “N o excu se is p o ssib le— n e ith e r fin an cial reason s n o r any other. The qu estio n o f ec o n o m ics has n o p lace, should have n o n e, in regu lating th e size o f fam ilies. That C a th o ­ lics are tau g h t th is explains why, as a rule, th e y have large fa m ilie s”88 F ather W ard , execu tiv e d ire cto r o f O rgan ized W o rk A g ainst B irth C on tro l, stated th a t alth o u g h “B irth C o n tro l has every ap p earan ce o f bein g a re a l rem ed y fo r m u ch p overty and disease, [it] is to o m a teria l and sinfu l a rem ed y to be ad opted by th e C h u rc h ” In an in terv iew w ith A n n e K ennedy, execu tiv e se c ­ re ta ry o f th e A B C L , W ard asserted: The o p p o sitio n o f th e R o m a n C a th o lic C h u rch ag ainst B irth C o n tro l is based on th e fa ct th a t th e re is only on e tru e C h u rch reco g n ized by G od. This is th e R om an C a th o lic C hu rch . . . . T hey are resp o n sib le for th e m o rals o f th e en tire h u m an race; th e refo re it is th e ir duty to in te r­ fere and b lo ck all legislation th a t w ill a ffe ct th e m o rals o f C a th o lics and n o n C ath o lics. . . . The R o m a n C a th o lic C h u rch never loses th e h ope th a t n o n C ath o lics w ill be so m e day co u n ted in th e fold. T h erefore, it is n ecessary to supervise all so cia l and m o ra l legislation .89 To en fo rce C ath o lic m o rality on A m e rica n society, W ard and o th e r p riests n o t only used th e pulpit b u t also d eveloped a p ow erful lobby to defeat liberal bills th a t cam e b efo re C ong ress. U nlike th e C a th o lic C hu rch , th e A M A did n o t a ttem p t to b lo c k legislative refo rm s, yet its failure to en d orse bills h in d ered th e lib era liz a tio n cam paigns. W h y did it h esita te to ratify a new bill? W h e n nativ ist fears o f th e high im ­ m igran t fertility ra te peaked in th e 1 8 5 0 s and 1 8 6 0 s , th e A M A resp on d ed w ith a cam p aig n to outlaw a b o rtio n am o n g w ealthy A n g lo -S a x o n w om en; m o st state laws also b a n n ed th e sale and d istrib u tio n o f co n tra ce p tiv e d e­ vices. O n ce th e A M A had h elp ed co n d em n th e se m eans o f lim itatio n , it w as

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slow to reverse its p o sitio n .90 A t Yale M e d ica l S c h o o l, fo r exam ple, facu lty tau g ht th a t d o cto rs should n o t d isp erse co n tra cep tiv e in fo rm atio n , even if a p regn an cy w ould k ill th e ir p atien t. A re p o rt by th e C o m m ittee o n M a te rn a l H ealth , organized by R o b e rt L. D ick in so n in M a rc h 1 9 2 3 in N ew Y ork City, o b serv ed th a t th e co n serv ativ e stand o f th e m e d ica l p ro fessio n o n co n tra ­ ce p tio n w as n o t u niqu e; it paralleled th e p ro fessio n ’s in itia l attitu d e tow ard tu b ercu lo sis, v en ereal disease, ind u strial hygiene, and h ea lth exam in ation s. P h ysician s’ re tice n c e in to th e 1 9 2 0 s , acco rd in g to Dr. A lice C. B o u g h to n , ex­ ecu tive secre ta ry o f th e C o m m itte e on M a te rn a l H ea lth o f th e A cad em y o f M ed icin e , resu lted fro m several fa cto rs: in e rtia , an in tere st in d isease ra th er th a n h ealth , th e p o te n tia l loss o f lu crative retu rn s fro m o b ste tric serv ices, and a lack o f relev ant tra in in g in m e d ica l sc h o o ls.91 The A M A ’s failure to en d o rse co n tra ce p tio n w ielded co n sid erab le in flu en ce b eca u se d o cto rs in ­ creasingly d om in ated rep ro d u ctiv e m a tters.92 This failu re left so m e d o ctors in a C a tch -2 2 : th e y op p osed lay m ark etin g o f co n tra cep tiv es, bu t th e A M A ’s refu sal to alter its p o sitio n left w o m en reliant on th is b o o tleg tra d e .93 The final m a jo r o p p o sitio n to lib era liz a tio n co n c e rn e d ra ce suicide. Dr. Jo h n Fulton, se c re ta ry o f th e M arylan d S ta te H ealth D ep a rtm en t, o b jected b ecau se he believed lib era liz a tio n w ould qu icken th e “ra ce su icid e o f . . . th e in telle ctu al and leisu re c la sse s " C a ro lin e H adley R o b in so n fro m C olu m b ia U niversity fou nd th a t m any peop le opp osed it b eca u se th e y b elieved it w ould have a “trem en d o u s effect in low ering th e quality o r q u an tity o f th e pop u la­ tio n " A s on e p e rso n told R ob in so n : “The fear hau nts m an y th a t th e c o n tra ­ ceptive teach in g s w ill b e p ra ctice d p rin cip ally by th e w ell endow ed, so th a t th e p ercen tag e o f w ell endow ed ch ild ren w ill fall in su b seq u en t g en era tio n s" The p resu m p tion th a t relaxed re strictio n s w ould “d ecrea se th e ch ild ren o f th e cau tio u s, ‘w ell-en d ow ed ’ m an . . . w hile th o se o f th e wild, ‘ill-en d o w ed ’ m e n w ould still flou rish ” led m any to opp ose re fo rm .94 T h ose in favor o f change set out to co u n te r ad versaries’ arg u m en ts. R ealiz­ ing th e y had little ch a n ce o f alterin g th e C a th o lic p o sitio n , th e y co n cen tra te d on physicians. Sa n g er and th e A B C L attem p ted to secu re th e su p p ort o f th e p ro fessio n by offering a m e d ica l m o n o p o ly over serv ices.95 In th e early 1 9 2 0 s th e A B C L released a p u b licity p ack et co n firm in g th e “co m m o n know ledge" th a t th e “w ell to do and ed u cated p eop le o f A m e rica ” p ra ctice d b irth con trol. B eca u se m any m e th o d s w ere “in ju rio u s and unsafe," co n tra ce p tio n m u st be p laced o n a “h ig h er plane o f scien tific k now led ge" A n n e K en n ed y d eclared: “W e feel th a t th e m e d ica l p ro fessio n is th e natu ral ch a n n e l th ro u g h w hich co n tracep tiv e in fo rm a tio n should b e given, and in chang ing th e U n ited States law s, w e em p hasize th is p o in t as th e d istin ct p rin cip le o f th e A B C L " 96 The A B C L co m m issio n e d Dr. Jam es F. C o o p e r in 1 9 2 4 to le ctu re m e d ica l s o c i­

Race Suicide, Eugenics, and Contraception, 1900—1930

eties. C oop er, a clin ica l o b ste tric in s tru c to r at B o s to n U n iversity M e d ica l S ch o o l, b e c a m e co n v in ced o f th e n ee d fo r regu lated fertility during his visits to th e B o s to n slum s. D u rin g his tw o -y ea r le ctu re to u r d o cto rs show ed “great in te re s t" and he gained th e ir a tten tio n as no fem ale activ ist could. A lthough so m e physicians feared th a t co n tra ce p tiv es w ould low er w o m en ’s m o rals, m o st d o cto rs su p p orted th e id ea.97 The m a jo r o b sta cle C o o p e r en co u n tered w as th e re lu cta n ce o f so cietie s to en d orse A B C L a ctio n s u n til th e A M A to o k a stand. In 1 9 2 5 th e A M A co n sid ered b u t split over th e issue. The s c ie n ­ tific se ctio n on o b ste trics and g yn ecolog y called fo r a law to allow physicians to give co n trace p tiv e in fo rm a tio n . B u t th e p o litica l co m m itte e re je c te d it, S an g er claim ed , b eca u se m o st m e m b ers w ere g en eral p ra ctitio n e rs w ho did n o t face w o m en ’s p roblem s o n a daily basis. O n e b o ard m e m b e r conclu d ed th a t th e A M A w as “co m p osed o f a h etero g en e o u s group o f m e n and w e have to go conservatively, bu t it does n o t m e a n th a t th e physicians in th e org aniza­ tio n are n o t fo r i t " 98 A s a body, th e A M A rem a in ed silen t on th e issue in th e m id -1 9 2 0 s. The A M A w as n o t th e only re sp ecta b le elem en t th a t th e A B C L cou rted . B y th e 1 9 2 0 s th e eu genics m o v em en t had gained stren g th , and a n u m b er o f university scie n c e d ep artm en ts studied eu genics. W ith som e o f th e se w hite m ale p rofession als o n board , th e n a tio n a l m o v em en t in th e 1 9 2 0 s sought to shape th e pop u lace in th e likeness o f th e elite.99 S o m e eu gen icists applied th is attitu d e specifically to w h ite-b la ck relation s, esp ecially in th e So u th . E a rn est S ev ier C ox, a ra cia l pu rity zealot and advo­ cate o f eu genics, and Jo h n Pow ell, a co m p o se r and m u sicia n fro m a n a risto ­ cra tic so u th ern fam ily, fou nd ed th e A n g lo -S a x o n C lu bs o f A m e ric a (A SC A ) in 1922. T h eir p rim ary goal w as to p reserv e A n g lo -S a x on civilization in th e U n ited Sta te s by stren g th en in g th e “orig in al A m e rica n sto c k ”; selectin g and excluding im m ig ran ts; and d iscovering th e so lu tio n fo r “our ra cia l problem s,” defined as th e in term in g lin g o f b lack s w ith w hites. C o x expanded o n his id e­ ology in White America (1 9 2 3 ): b lack s “in sa n ely ” o b sessed w ith cou pling w ith w hite w o m en to b irth “w h iter” offspring w ould ru in th e w hite race. To avoid race m ixin g th e A S C A su p p orted a tw ofold plan. F irst, it d rafted a m o d el b ill th a t w ould req u ire states to in stitu te a re g istra tio n system using b irth ce rtificates to show individ u als’ ra cia l co m p ositio n . N o m arriage could tak e p lace w ith ou t p resen tin g th is ce rtifica te, and w hites could only m arry o th ers w ith pure C au casian blood . H isto ria n L isa L in d q u ist D o rr argues th a t an an cillary m otive beh in d su ch m arriage laws w as to preven t in d ep en d ent w hite w o m en fro m engaging in sexu al liaisons w ith b la ck m en. S e co n d , th ese groups su p p o rted M a rcu s G arvey, w ho ad vocated b la ck sep aratism and a “B a ck to A frica” m o v em en t in th e 1 9 2 0 s . G arvey argued th a t th e key to race

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p rogress w as stron g w om en, virtu ou s m o th e rs, stable h o m es, and ra cia l pu ­ rity. C ox, Pow ell, and th e K K K b elieved G a rv ey ’s m o v em e n t w as th e b est safeguard against th e co n ta m in a tio n o f th e w hite ra ce.100 The in flu en ce o f th e A S C A w as ap p aren t in V irginia, w here a m arriag e law b ased on th e A S C A m o d el passed in 1 9 2 4 . The follow ing year th e V irginia S ta te B o ard o f H ealth d istrib u ted a p am p h let to p lace “b efo re th e b e tte r class o f young peop le in V irginia know ledge as to th e tw o g reat dangers th re a te n ­ ing th e in teg rity and su p rem acy o f th e native w hite A m e rica n race.” The first w as th e “d ecrease in th e b irth ra te o f th e u p p er and m iddle classes o f w hites as a resu lt o f th e ‘R ace S u icid e’ m ovem ent,” and th e seco n d w as th e “u ltim ate co m p lete in term ix tu re o f th e w hite and co lo red races if th e y co n tin u e to live to g eth er” The “re m e d ie s” to th e se dangers w ere “self-e v id en t”: th e “b e tte r class o f w h ites” m u st stop th e “in terferen ce w ith th e n o rm a l in c rea se in th e grow th o f th e family,” w hile th e low er classes m u st stop th e “m ixtu re o f th e b loo d w ith th a t o f a n o th e r ra c e ” Th ese ra cia l co n c ern s w ere p articu larly re l­ evant to V irginia and N o rth C arolin a b eca u se “fo rty p er ce n t o f our ch o ice st young m a n h o o d ” left th e ir h o m es during th e C ivil W a r “n ev er to re tu rn ” This situ atio n fo rced “splendid young w o m en ” to secu re m ates fro m th e “low er circ le ” or fro m th o se w ho, “b eca u se o f th e ir very u n fitn ess, escap ed th e d an­ gers o f th e b attle lin e” The pam p h let co n d em n ed w hite affluent cou ples w ho in terfered w ith “th e laws o f natu re, establish ed by o u r M aker,” to b e “fru itfu l and multiply.”101 Sim ilar an x ieties over ra cia l purity w ere obvious in th e A m e rica n E ugenics So ciety, fou nd ed in 1921 at th e S e co n d In tern a tio n a l C o n fere n ce on E u g en ­ ics in N ew York. G eo rg e E astm an , Irving Fisher, and o th e r p ro m in en t eu g en icists jo in ed . R a cist attitu d es prevailed, esp ecially u nd er th e lead ership o f F red erick O sb o rn , sec re ta ry fro m 1 9 2 8 to 1 9 7 2 , and E xecu tiv e D ire c to r L eo n W h itn ey . Its C o m m itte e on S e le ctiv e Im m ig ra tio n urged w h ite-o n ly im m i­ gration. S im ilar to th e A S C A , th e A m e ric a n E ugenics S o c ie ty sa n ctio n e d a n ­ tim isceg en a tio n laws. W h ite su p rem acists exp loited th e popu larity o f eu gen ­ ics to p erp etu ate racial d iscrim in a tio n .102 The S e co n d In tern a tio n a l C ongress also led to th e esta b lish m en t o f th e E ugenics C o m m itte e o f th e U n ited States. Irving Fish er chaired , and o th e r m e m b ers inclu d ed C harles D av en p o rt and H en ry Fairfield O sb o rn , p resid en t o f th e A m e rica n M u seu m o f N atu ral H is­ to ry and a zo ology p ro fesso r at C olu m b ia University. The co n g ress appointed th is co m m itte e b eca u se th e tim e w as “rip e for a stron g p u blic m o v em en t to stem th e tid e o f th rea ten ed racial degeneracy.” T he U n ited States in particular, acco rd in g to Fisher, m u st b e p ro te cte d ag ainst “in d iscrim in a te im m ig ratio n, crim in a l d egenerates and th e ra ce su icid e d eplored by P resid en t R oosevelt.” The co m m itte e elected Dr. K a th erin e D avis to serve on th e ad visory cou n cil;

Race Suicide, Eugenics, and Contraception, 1900—1930

she accep ted th is p o st as a n individual, n o t as rep resen tativ e o f th e B SH , b e ­ cau se its bo ard o f tru ste e s did n o t au th o rize involvem ent in eu g en ics.103 The B S H did provide fin a n cia l b ack in g to tw o o th e r o rg anization s esta b ­ lished in 1923. The C o m m ittee o n M a te rn a l H ea lth (C M H ), a v olu n tary org a­ n izatio n o f d o cto rs, laym en, so cia l w orkers, and nu rses, plan n ed to prod uce a scien tific ev alu ation o f co n tra ce p tiv e effectiv en ess and safety. W h ile Dr. Sam u el W . L a m b e rt ch aired and M rs. G ertru d e M in tu rn P in c h o t, fo rm er p resid en t o f th e N atio n al B irth C o n tro l L eague, provided th e o rg anization al stren g th , D ick in so n , as se c re ta ry o f th e execu tiv e co m m itte e , set th e co n ­ servative to n e and d ire ctio n o f th e C M H .104 H e d isasso ciated co n tra ce p tio n fro m a b o rtio n in th e sam e way S a n g er later did to gain th e b ack in g o f p ro fes­ sionals. H e b elieved co n tra ce p tiv es should b e d istrib u ted only to m arried w o m en w ho had alread y had all th e ch ild ren “called u p o n [them ] to b e a r” or “w here progeny w ould b e reason ably ce rta in to co n stitu te a so cia l m e n a c e ”105 The B S H th e n provided Dr. F. A . E. C rew , a p hy sician and d ire cto r o f th e A n im al B reed in g R e se a rch D e p a rtm e n t, w ith a te n -th o u sa n d -d o lla r gran t to u n d ertak e th e C rew study, w h ich th e C M H h op ed w ould find “a co n tracep tiv e sim ple enou gh to b e p ra ctica b le fo r th e m o st ig n o ran t and dull p e rso n and cheap enou gh to b e w ith in re a ch o f th e p o o re s t”106 The study’s five-year re p o rt stressed th a t “attem p ts to im prove ra cia l sto c k d epend u pon co n tro l o f fertility, negative and p o sitiv e”107 The sam e year D ick in so n establish ed th e C M H , San g er fou nd ed th e B irth C o n tro l C lin ical R esea rch B u reau (B C C R B ) in N ew Y ork C ity as a d ep art­ m e n t o f th e A B C L . Its p u rp ose w as to give co n tracep tiv es to m arried w o m en w ho m e t legal provisions th a t p e rm itte d phy sicians to o ffer co n tra cep tiv e ad­ vice fo r th e cu re or p rev en tio n o f disease and to study “som e o f th e m ed ical, eu genic, eco n o m ic, and so cia l im p licatio n s o f b irth c o n tro l” The B C C R B also served as an ed u catio n ce n te r in co n tra cep tiv e te ch n iq u e s fo r physicians, a service to w h ich th e B S H co n trib u te d fin an cially to fill th e void in m ed ica l sch o o l cu rricu lu m . In its first tw o years Dr. D o ro th y B o c k e r served as m e d i­ cal d irector, rep laced by Dr. H an n ah S to n e in 1 9 2 5 . B y th e end o f th e decade th e B C C R B had received m o re th a n fifte en th o u san d p a tie n ts.108 Sanger, th e A B C L , and th e B C C R B sought th e su p p ort o f eu g en icists and th e m e d ical p ro fessio n to am end th e N ew Y ork statu te in 1 9 2 3 . S a n g er ad­ v o cated a b ill th a t w ould allow “d o cto rs only” to d isp erse co n tracep tiv es for fertility lim itatio n as w ell as disease p rev en tio n , a ta c tic to a ttra c t physicians w ho cou ld b en e fit eco n o m ica lly fro m su ch co n tro l. To g arn er th e sa n ctio n o f eu gen icists, she w ro te to H arry H. Laughlin, d ire cto r o f th e E u g enics R eco rd O ffice in L o n g Island . H e en co u rag ed h e r to in teg rate eu g en icists in to h er m o v em en t and su ggested fu rth e r steps to gain th e ir full en d o rsem en t:

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L et m e tak e th is o p p o rtu n ity to say th a t in ord er to a ttra c t to th e p re s­ en t b irth co n tro l m o v em en t . . . th e su p p ort o f p erson s w hose p rim ary in tere st is eu genics, it w ould b e n ecessa ry to m ake it m u ch clea rer in fu tu re p o licy and propagand a th a t th e p u rp o se o f b irth co n tro l is eu g en ical— th a t is to say, its activ ities m u st b e d irected tow ard a differ­ en tial b irth rate in re fe ren ce n o t only to m a tern a l h ea lth and ec o n o m ic co n d itio n , bu t also should dem and a h ig h er b irth ra te am on g p erson s b est endow ed by n atu re w ith fine m ental, physical, and m o ra l q u alities, and, at th e sam e tim e, to forbid and positively p rev en t re p ro d u ctio n by th e d efective and d eg enerate fam ily stock s. W ould it n o t b e possible in th e fu tu re to em p hasize m o re strong ly th is possible eu g en ical featu re o f b irth co n tro l?109 S an g er and th e A B C L w illingly obliged, evid enced by th e stron g eu genic to n e o f th e ir p ropagand a in th e w ake o f L aughlin’s letter.110 The A B C L p u b licity pack et in 1 9 2 3 first p e titio n e d th e m e d ica l p rofession fo r re co g n itio n o f th e m o v em en t and th e n co u rted eu g en icists. “The m ain o b jectiv e in co n d u ctin g [this] cam p aig n is th a t th e know ledge n ow con fin ed to ‘th e b est fam ilies’ should b e exten d ed to th e poor, th e ig n o ran t, th e im ­ m ig ran t, and th e crow d s o f slum dw ellers w ho are p o p u latin g th e U n ited S ta te s " The A B C L lau n ch ed a le ctu re to u r o f w o m en ’s clubs to g ath er fin an ­ cial su p p ort bu t o ften could address th e m only if th e A B C L ag reed to p resen t eu genic o r e c o n o m ic, n o t fem in ist, sides o f co n tra ce p tio n .111 C lu b m em b ers w ere m o st co n cern e d w ith hig h fertility am on g “in ferio rs” and th e ta x m o n ey spent on th em . In late O c to b e r 1 9 2 3 th e A B C L sp o n so red a co n fere n ce in C h icag o w ith fou r goals: to d ecrea se d elin q u en ts; to red u ce th e b u rd en o n ch a rities and ta x a tio n fro m th e d ep end ent and “d efectiv e” classes; to aw aken so cia l w ork ­ ers, p hysicians, and th e p u blic to th e n o tio n o f “ra cia l re sp o n sib ility ”; and to secu re th e co o p e ra tio n o f so cia l w elfare groups, w h ich had th e m o st co n ta ct w ith th e p o o r and “unfit.” P rogress could b e ach ieved if so cia l w orkers so rted out th e “least fit” and pu rsued th e m w ith “p e rsisten t co n tra cep tiv e in stru ction.”112 A b sen t fro m th e se goals w as any m e n tio n o f fem in ist righ ts to re p ro ­ ductive co n tro l, an arg u m en t th a t w ould have alien ated th e very eu gen icists to w h om S an g er appealed fo r su p p o rt and legitim acy. In stead , th e A B C L exh ib ited d ata to d em o n stra te th e co st to th e state o f on e m arriag e b etw een a “feeb le-m in d ed m an and w o m an ” and th e ir five ch ild ren , w ho should “n ever have b e e n born.” N ew Y ork S ta te sta tistics fo r 1921 show ed th a t th e D ep a rt­ m e n t o f Public W elfare had spent $ 2 0 ,6 7 6 ,6 2 4 .4 0 , w hile private ch arities had d isp ensed $ 7 ,4 8 3 ,7 5 4 .3 5 , to ta lin g $ 2 8 ,1 6 0 ,3 7 8 .7 5 by on e state in on e year to su p p ort p eop le defined as diseased , d efective, d elinqu ent, or d ep en d en t.113

Race Suicide, Eugenics, and Contraception, 1900—1930

The session s held at th e co n fere n ce su b stan tiate its eu gen ic agenda. P ro fe s­ so r E. M . E ast spoke o f th e “p erils facin g civilizatio n ” if th e “reck less b reed in g o f th e u n fit” co n tin u ed . The lu n ch e o n d iscu ssio n delved in to “S u p er R a ce and th e G e n iu s” O n e sessio n review ed th e so cia l co st o f th e “w ro n g ” peop le m ultiplying; th e “D e te rio ra tio n o f th e R a c e ”; and state co st o f providing for th e “u n fit” d elinqu ent, and feeb lem ind ed . The final d isco u rse con clu d ed th a t th e “evils” d iscussed during th e co n fere n ce could only b e am elio rated by a “p ra ctica l ap p lication o f b irth c o n tro l”114 The A B C L ’s c o rre sp o n d e n c e follow in g th is co n fe re n c e illu stra tes its co n tin u in g d rift tow ard eu genics. W ritin g to P ro fe sso r T h o m as D. E lio t o f N o rth w e ste rn U niversity, S a n g er a sserted th a t th e peop le w h om th e A B C L had th e “m o st d esire to h elp ” w ere th o se “w hose m u ltip licatio n [was] ca u s­ ing dysgenic effect to th e ra c e ” Dr. W . J. H ick so n , head o f th e p sy ch op ath ic lab o rato ry o f th e m u n icip al co u rt o f C hicag o, w ro te th a t his w ork am o n g c e r­ ta in “u n fit” groups provided “con clu sive and co n v in cin g evid ence o f th e need o f th e ap p lication o f th e p rin cip les o f B irth C o n tro l am o n g ce rta in d efinite types o f p e o p le” A t a m e etin g o f th e Tiog a C ou n ty M ed ica l S o c ie ty in P en n ­ sylvania Dr. Jam es C o o p e r re p o rte d th a t “p ra ctica lly all o f th e se m e n w ere very favorable to th e . . . steriliz a tio n o f th e u nfit and B irth C o n tro l fo r th e u nd esirable elem en ts o f so ciety ” A cco rd in g to his sta tistics, th e “u n fit” w ere in creasin g th re e tim e s fa ste r th a n th e “b est sto c k ” and tw o tim e s fa ste r th a n th e “average stock.” Th ese data, a cco rd in g to C ooper, provided th e biolo g ical ju stifica tio n fo r co n tracep tiv e d ispersal am o n g th e “u nd esirab le”115 S an g er sp o n so red a n o th e r co n fere n ce , th e S ix th In te rn a tio n a l N e o -M a l­ th u sian C o n fere n ce in N ew Y ork City, in 19 2 5 . In th e o p en in g address San g er attack ed th e fed eral g ov ern m en t fo r its in effectiv e p o p u lation co n tro l p o li­ cies. A lth o u g h laws allow ed th e co u n try to “shu t its g a tes” to “u nd esirable foreig n ers” n o attem p t had b e e n m ade to “discourage th e rapid m u ltip licatio n o f u nd esirable alien s” w ith in th e n ation . O n th e contrary , S a n g er claim ed th e U.S. g ov ern m en t “d eliberately encourage[d] and even [made] n ecessa ry by its laws th e b reed in g — w ith a b re a k n e ck rapidity— o f id io ts, d efectives, diseased, feeb le m ind ed and crim in a l cla sses” G o v ern m e n ts as w ell as private ch a ri­ ties squ and ered m o n ey fo r “th e care, th e m a in ten a n ce, and th e p e rp etu a tio n o f th e se cla sse s” A s a resu lt, th e A m e rica n p u blic w as “heavily tax ed . . . to m ain tain an in crea sin g race o f m o ro n s w h ich th r e a te n e d ] th e very fou n d a­ tio n s o f our civilization.” S h e called o n C on g ress to “d ecrea se or to re stric t th e in cessan t and u n in terru p ted advent o f th e h ord es o f th e u n fit”116 M issin g fro m th is sp e ech is any o f h er earlier fem in ist n o tio n s o f b irth co n tro l. W h e n fem in ist arg u m en ts failed, San g er grasped eu g en ics.117 The m o st p e rsisten t arg u m en ts offered at th e co n fere n ce w ere race suicide and race im p ro v em en t. O w en R. Lovejoy, execu tiv e sec re ta ry o f th e N ation al

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C hild L a b o r C o m m ittee , claim ed th a t th e “ig n o ran t, self-in d u lg en t, [and] v i­ cio u s” as w ell as th e “m entally in fe rio r and th e physically u n fit” co n tin u ed “to p ropagate th e ir kind and th u s m o re and m o re tip th e b alan ce in favor o f th e v icto ry o f in ferio rity and race d epreciation.” O th e rs m ain tain ed th a t as long as th e “cu ltu red cla sses” lim ited fertility w hile th e “p o o r in ou r slu m s” did n o t, fu tu re g en eratio n s w ould spring p red om in an tly fro m th e “p o o rest stocks.” P ro fe sso r R aym ond Pearl, head o f th e D e p a rtm e n t o f B io m e try at Joh n s H opkins U niversity, su m m ed up: “The w rong kind o f peop le have to o m any ch ild ren , and th e rig h t kind to o few. . . . [I]f it is n o t p ossible to m ake desirable p eop le have m o re b ab ies, w hy n o t try te a ch in g o th e r p eop le h ow to have few er?”118 O sw ald G a rriso n V illard, ed ito r o f th e Nation, su pported c o n ­ tra ce p tio n aim ed at th e “gradual im p ro v em en t o f th e race.” H u d son M a x im , n o te d in v en to r and an tip acifist, believed th a t so ciety had a duty “to im prove and p ro te ct . . . th e h u m an b loo d stream .” P ro te c tio n inclu d ed th e sep aration o f b lack and w hite b lood , n o t only in co n c e p tio n bu t also in tran sfu sio n s. The b loo d o f “u n d esirab les” should b e “in so m e way led to sew ers and n o t allow ed to flow in to th e strea m o f life.” M aj. H ald ane M a cF a ll w ro te th a t “th e only way to b reed a fin e ra ce is by B irth C ontrol.” A u th o r M . P. W illc o ck s regarded “scien tific b irth c o n tro l” as th e “fo u n d a tio n -sto n e ” u p on w hich th e n ew so ­ cial ord er m u st be bu ilt. N o u to p ian ideals could b e achieved u nless so ciety allow ed only th o se b irth s th a t co n trib u te d to th e pop u lace as a w h ole.119 B y th e end o f th e co n fere n ce S a n g er had co n clu d ed th a t a tten d ees ap­ proved h e r goal to in c re a s e “p e rso n s o f su p erio r s to c k ” and to c h e c k th e “p o o r and ign oran t.”120 Yet h isto ria n Jam es R eed a sse rts th a t S a n g er only relu ctan tly to le ra te d eu g en icists. A lth o u g h she d esired th e “re sp e c ta b ility ” and o rg an izatio n a l b ack in g th e y offered , R eed argues th a t she repud iated any plans fo r “p o sitiv e” eu genics. In regard to lau n ch in g a cam p aig n to fo ster large fam ilies am o n g co lleg e-ed u ca ted w om en, R eed claim s th a t San g er was “u n eq u iv o cal in h e r re je c tio n o f th a t stran ge argum ent.” Yet th e papers o f th e A B C L as w ell as p u b licatio n s by S a n g er d o cu m en t th e eu genic to n e o f b o th S an g er and th e A B C L in g en eral during th e 1 9 2 0 s .121

The Struggle for Legislative Change The A B C L lau n ch ed a cru sad e to co n v in ce fed eral legislators to m anip ulate p op u latio n grow th to p reserv e th e race. It w as n o t th e first su ch endeavor. M a ry W are D e n n e tt and th e V olu n tary P a ren th o o d L eag u e (V P L ) in 1 9 2 3 had in tro d u ced th e C u m m in e-V aile B ill, w h ich called fo r th e rep eal o f th e C o m sto ck Law .122 This “o p en b ill” sought to rem ov e re strictio n s on c o n tra ­ ceptive dispersal. The A B C L refu sed to su p p ort it b eca u se it w ould allow m ail d istrib u tio n o f co n tra cep tiv e in fo rm a tio n w ith ou t regard to safety standards.

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D e n n e tt saw co n tra ce p tio n as a fre e -s p e e c h and free -p ress issue w ell in to th e 1 9 2 0 s and re je cte d th e n ee d fo r a “m e d ica l m onopoly.” Sanger, on th e o th e r hand , b elieved only p ro fessio n als cou ld p re d ict th e co n se q u e n ce s o f som e d evices.123 W h ile c o n c e rn fo r safety and effectiv en ess w as legitim ate, fed eral regu latio n o f d evices could have ad d ressed th is p ro b lem w ith ou t a m ed ical m onopoly. S a n g e r’s in siste n ce on su ch a m o n o p o ly w as a ploy to gain A M A su p p ort and th e refo re leg itim acy fo r h e r cau se, w hich by th is p o in t had little to do w ith D e n n e tt’s fre e -sp e e c h approach. C o e rcio n , n o t freed o m , w as n e c ­ essary to save th e race. R e a ctio n to th e C u m m in e-V aile B ill w as m ixed. In R h od e Island M rs. Isa ­ belle A h earn O ’N eill in tro d u ced H 6 6 5 in 1 9 2 3 to b e s e e c h R h od e Island rep ­ resen tatives in C on g ress to opp ose C u m m in e-V aile “and any o th er legislation w h ich p e rm its th e p ra c tice o f b irth c o n tro l” The G en e ra l A ssem b ly failed to pass it.124 A t th is tim e th e state had n o re strictio n s on co n tra cep tiv es. L eg islato rs believed eith e r th a t b irth c o n tro l w as a m a tte r outsid e g ov ern ­ m e n t ju ris d ic tio n o r th a t cou ples had th e rig h t to lim it th e ir fam ilies. The state cou ld have passed a law lim itin g co n tracep tiv es to disease preven tion , as o th e r states had. N o o n e in tro d u ced su ch a m ea su re o n th e state level. A t th e n atio n al level C u m m in e-V aile failed by a large m argin. B ec a u se m o st p o litician s criticiz ed th e lack o f regu lation , D e n n e tt rein tro d u ced th e b ill a year later, stipu lating th a t all co n tra cep tiv e literatu re m u st b e certified by five physicians as “n o t in ju rio u s to life o r h e a lth ” This im p ra ctica l sp e cifica tio n led to th e b ill’s d eath in co m m ittee . D e n n e tt retired fro m th e V P L th e follow ­ ing year, and it d isbanded in 19 2 5 . S a n g er and th e A B C L th e n b eg an a push fo r th e ir ow n bill.125 In Jan u ary 1 9 2 6 S a n g er and A n n e K en n ed y trav eled to W a sh in g to n , D .C ., to o p en cam p aig n h ead q u arters. T h eir m easu re p ro p o sed th e m ailing o f co n trace p tiv e in fo rm a tio n only to th e m e d ica l p ro fessio n and scien tists and th e reb y p laced c o n tra ce p tio n in th e field o f preventive m e d icin e and scien tific re se a rc h .126 A s G ra n t S a n g er recalled , his m o th e r saw th e value in in tro d u cin g scie n c e and m ed icin e to h e r m o v em en t: she w anted “big n a m e s” to help legitim ize co n tracep tiv es am o n g th e p u b lic.127 This m easu re receiv ed m ixed re a ctio n s in R h o d e Island . O ’N eill again op p osed it b eca u se it w as “p reju d icial to th e m o rals o f th e A m e rica n people,” bu t again, th e state failed to pass h e r bill. In fa ct, U.S. S e n a to r Jesse H. M e tc a lf (RI) favored th e A B C L m easu re “as a p ro te c tio n to fu tu re generations.” H e told K enned y he w ould have en d orsed a stron g er m easu re providing fo r th e steriliz a tio n o f th e “u n ­ fit,” an attitu d e n o t reflectiv e o f th a t o f his state p e e rs.128 The A B C L re ceiv ed sim ilar e n d o rse m en ts fro m p o liticia n s w ho felt strongly ab o u t eu genics o r ra ce d eg en eration. S e n a to r E lliso n D. S m ith (SC ) favored co n tra ce p tio n and steriliz a tio n o f th e “unfit,” as did C on g ressm an

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C h arles A . E a to n (N J), w ho to ld A B C L E xecu tiv e S e c re ta ry M rs. R. H use th a t th e “p ro d u ctio n o f m o ro n s and u nfit in th is co u n try m u st cease, if we are to m a in ta in ourselves as a nation.” R ep resen tativ e T h eod o re E. B u rto n (O H ) ad m itted th a t h e w as “m u ch im p ressed w ith th e id ea o f elim in atin g th e u n fit” and th a t h e b elieved in “selection.” C om p arin g an im al and h um an b reed in g , S e n a to r L aw ren ce D. T y so n (T N ) argued th a t b e c a u se C on g ress regu lated th e b re ed in g o f liv esto ck b y co m p ellin g th e ex term in a tio n o f all diseased sto ck , th e tim e had co m e fo r th e “g o v ern m en t to co n sid er and apply th e sam e p rin cip les to th e h u m an ra c e ” C on g ressm an S o l B lo o m (N Y ) n ot only en d orsed th e “steriliz a tio n o f [the] u nfit and feeb le-m in d ed and in sa n e” bu t also believed th a t C on g ress should pass laws “m aking it a crim e fo r u n ­ d esirables to m arry ”129 S o m e sen ato rs approved th e p ro p o sed am en d m en t as a m eans to co rre c t th e fertility im b a la n ce b etw een th e classes. S e n a to r C. C. D ill o f W ash in g to n , fo r exam ple, believed “every effort should be m ad e to get th e know led ge to th e p o o r w o m en ” bu t th a t it w as a “great w rong . . . to have th is in fo rm a tio n used by m o re w ealthy w o m en ” M ary lan d S e n a to r W il­ liam C. B ru ce co n clu d ed th a t n o th in g could b e done to fo rce w ealthy w o m en to relinq u ish th e ir m e th o d s o f fertility lim itatio n . R ather, refo rm ers should spread th e cu sto m o f th e u p p er class to th e low er and less ed u cated classes.130 P olitician s su pportive o f th e bill, how ever, w ere in th e m inority. M o st co n g ressio n al m e m b ers opposed alterin g th e fed eral statute. S o m e believed easy a ccess to co n tracep tiv es w ould only au gm en t th e class differ­ en ce in T F R . S e n a to r Jam es A . R eed (M O ) “violently o p p o sed ” c o n tra ce p ­ tio n on th e ground s th a t it w as “chipping away th e very fou n d ation o f our civilization.” Likew ise, S e n a to r W . H. M c M a s te r (SD ) opined th a t o n ce such k now led ge w as readily available, w h ite u p p er-cla ss w o m en w ould red u ce th e ir alread y artificially low b irth s. E sp o u sin g a tra d itio n a l n ativ ist view ­ p o in t, S e n a to r R alp h H. C a m ero n (A Z) w ould only su p p o rt th e b ill if th e A B C L vow ed to do its “propagand a w o rk am on g th e p o o r foreigners.” C la im ­ ing h im s e lf “100% N ordic,” he d eplored th e fa ct th a t “o u r native sto c k ” used fam ily lim itatio n “to su ch a n alarm in g d eg ree” T he K K K lo b b y ist opposed co n tra ce p tio n b eca u se th e y ou n ger w hite g en era tio n refu sed to a cc ep t its resp o n sib ility to b e a r child ren; th e fib e r o f th e co u n try had w eakened to th e p o in t w here danger existed o f th e “race dying o u t” T he K K K also favored th e sterilizatio n o f u nd esirables as a m easu re to m a in ta in g ood ra cia l sto c k .131 M an y p o liticia n s op p osed co n tracep tiv es fo r o th er reason s. S o m e th o u g h t easier access w ould “lead to im m orality.” O th ers b elieved th a t th e fed eral g o v ern m en t had no rig h t to in terv en e in or even d iscuss ch ild b irth or child p rev en tio n .132 S till o th ers o b je cte d to th e “d o cto rs-o n ly ” lim itatio n . S e n a to r C lau se A . Sw an son (VA) co n d em n ed physicians as “an irresp o n sib le class o f m e n w ho w ould p ro fit by th is a m e n d m e n t” T h ere already existed a “su fficient

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n u m b er o f ch arlatan s and cro o k s in th e p ro fessio n ”; th e n ew law w ould only give th e m “on e m o re m e th o d o f preying on th e p u b lic” N u m erou s p o litician s m ad e sim ilar a tta ck s o n th e e c o n o m ic m o tiv a tio n o f th e m e d ica l p ro fes­ sion .133 O th ers refu sed to en d orse th e b ill due to C a th o lic in flu en ce. San g er did n o t m e e t w ith ch u rch lead ers, perhaps b eca u se o f h e r stron g antipathy tow ard C a th o lics.134 In stead , K en n ed y u nsu ccessfu lly a ttem p ted to con vin ce lead ers o f th e C a th o lic W elfare C o n fere n ce th a t th e d o cto rs-o n ly b ill w ould safeguard th e p u blic fro m th e m isu se o f co n tracep tiv es. T hey in fo rm ed K e n ­ ned y th e y w ould do all th e y cou ld to d efeat th e A B C L m easu re, inclu d ing w ritin g th e A M A p ro testin g its passage.135 S an g er to o sought out th e A M A and appeared w illing to do w hatever was n ecessa ry to gain its su p p ort. In 1914, fo r exam ple, S a n g er had w ritte n an a rticle in th e Woman Rebel criticiz in g th e re strictio n s p laced o n b o th c o n ­ tra ce p tio n and a b o rtio n .136 In th e 1 9 2 0 s she re ca n te d h e r earlier su p p ort o f a b o rtio n and pu rp osely sep arated co n tracep tiv es fro m a b o rtio n .137 B y delegitim izin g a b o rtio n S a n g er h op ed to w in leg itim a cy for co n tra ce p tio n . Sh e offered to w ord h e r 1 9 2 6 b ill in any w ay suitable to th e A M A , bu t th e A M A bo ard re co m m en d e d th e H o u se o f D eleg ates allow th e issue to die in co m m itte e .138 The A M A ad opted a n eu tra l stan ce, allow ing n e ith e r th e C a th o lic C h u rch n o r th e A B C L a victory. This p o sitio n w orked to th e advantage o f th e chu rch. A lth ou g h th e C a th o lic W elfare C o n fere n ce failed to gain A M A su pport, it m e t w ith su ccess am o n g p o liticia n s. L ette rs d isp atched to all sen ato rs ex ­ p ressed ch u rch h o stility to th e A B C L b ill— a ta c tic th a t K enned y con clu d ed “created an atm o sp h ere o f fear tow ard th is legislation, esp ecially w here th a t p articu lar S e n a to r had m any C a th o lic con stitu en ts.” Even th o u g h th e S ixty n in th C on g ress w as overw helm ingly P ro te sta n t, C a th o lic in flu en ce seem ed to hold sway over th e voting b eh av io r o f its m e m b e rs.139 S o m e p o liticia n s w ho p erson ally su p p orted th e leg islatio n w ould n o t en d o rse it fo r fea r o f p o litica l re p ercu ssio n s.140 C on g ressm an A lb e rt R. H all (IN ) affirm ed th a t his C ath o lic co n stitu e n ts, esp ecially th e “con serv ativ e elem ent,” o b je cte d to lib ­ eralization. A cco rd in g to H use, he w as “scared to d eath to even d iscuss th e s u b je c t” S e n a to r Edw in S. B ro u ssard (LA ) refu sed to m e e t w ith th e A B C L b ecau se h e w as a C a th o lic fro m a pred om in an tly C a th o lic state. The seco n d sen a to r fro m L o u isian a co n cu rre d ; Jo h n R. R an sd all p o stu lated th a t G od knew h ow m any ch ild ren a w om an should bear, and, th e refo re, no on e had n eed o f co n trace p tiv es.141 D esp ite heavy C a th o lic o p p osition , th e A B C L co n tin u ed its fight. B etw een Jan u ary and M ay A B C L m e m b ers in terview ed 8 6 sen ato rs b u t only 5 2 o f 4 2 2 m e m b ers o f C ong ress. O f th e sen ato rs, 11 su pported , 2 2 favored, 14 opposed , 3 9 w ere n o n co m m itta l, and 6 refu sed to b e interview ed. O f th e re p rese n ta ­

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tives, 9 su p p orted , 5 opposed, and 3 8 w ere n o n co m m itta l. T he n u m b er o f a c ­ tu al su p p orters, how ever, m ay have b e e n sm aller th a n th e figures reco rd ed by th e A B C L . C on g ressm a n E. C. M ic h e n e r (M I) claim ed th a t m any m em b ers o f C on g ress lied to A B C L rep resen tativ es b eca u se “it w as easier to p e rm it th e ladies to leave th e ir office believing th e y w ere sym pathetic.” H e p red icted th a t o n ce th e se p o liticia n s w ere beh in d closed d oors th e y w ould veto th e A B C L bill.142 H is p re d ictio n w as accu rate: C on g ress defeated it by a large m argin. Follow ing th is failure, S a n g er renew ed h er efforts w ith th e m e d ica l p ro ­ fession. In 1 9 2 7 she severed th e c o n n e c tio n b etw een th e B C C R B and th e A B C L , hoping th a t th e clin ic w ould receive a favorable re ce p tio n fro m th e m e d ica l p ro fessio n if it w ere d isasso ciated fro m th e n o n m e d ica l activ ities o f th e A B C L . The follow ing year she resig n ed as p resid en t o f th e A B C L and b e c a m e d ire cto r o f th e B C C R B , a p o sitio n th a t drew critic ism fro m som e d o cto rs.143 Dr. B o u g h to n did n o t co n sid er Sanger, a layperson, qualified to lead th e m o v em en t fo r a m e d ica l m o n o p o ly over co n tra ce p tiv es.144 S an g er en co u n tere d o p p o sitio n fro m o th e r p ro fessio n als. In 1 9 2 7 she o rganized th e first W o rld P o p u la tio n C o n fere n ce in G en ev a. S h e invited in tern atio n ally ren ow n ed sc ie n tists, in clu d in g sta tistic ia n s, b io lo g ists, and eco n o m ists. M an y o f th e m w ere le ery o f h e r ro le as org anizer and did n o t form ally acknow led g e her. M oreover, th e y refu sed to allow any d iscu ssion o f co n tra ce p tio n at th e co n fere n ce .145 Ironically, th e very p rofession als San g er actively sought to brin g in to h er cau se o ften rebuffed h er b eca u se o f h e r lack o f a ccep ta b le cred en tia ls and h e r gender. Th ese w h ite m ale elites did n o t believe th e y n eed ed th e d ire ctio n or inp u t o f a fem ale n urse to d ecid e th e p ro p er co u rse fo r p o p u latio n grow th. D o c to rs ’ efforts w ere generally m o re effectiv e th a n th o se o f lay w orkers. D ick in so n and his C M H receiv ed an in v itatio n in 1 9 2 7 to h o u se C M H h ead ­ q u arters in th e N ew Y ork A cad em y o f M ed icin e building. This in v itation , a c ­ cord ing to Dr. K a th erin e D avis, offered “p ro o f o f th e grow ing re co g n itio n o f th e im p o rtan ce o f th e w o rk o f th is co m m itte e ” Tw o org anization s co n cern e d w ith w om en ’s rep rod u ctive h ea lth — th e A m e rica n G y n eco lo g ical S o cie ty and th e N ew York O b ste tric a l S o c ie ty — also en d orsed th e C M H .146 Fem ale physicians and lay w orkers on th e lo c a l level had m o re su ccess th a n S an g er and o th e r n a tio n a l lead ers in tap p in g in to a g ra ssro o ts m o v e­ m e n t to d isp erse co n tra cep tiv es to w o m en w ho d esired th em . T he B a ltim o re B u reau fo r C on tracep tiv e A dvice op ened in 1 9 2 7 , h ead ed by Dr. B essie M o ­ ses w ith an all-fem ale staff. It so o n changed its n am e to th e B a ltim o re B irth C o n tro l C lin ic. M o ses establish ed th is clin ic as a m e d ica l service, co n sciou sly d ivorced fro m th e lay -d irected A B C L . Initially, M o ses lobbied to in co rp o ra te th e clin ic as on e o f th e serv ices provided by Joh n s H op k ins H osp ital, w here she w orked, b u t th e b o ard did n o t w ant to face rep ercu ssio n s fo r breakin g th e

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fed eral statu te.147 The C o m sto ck A ct co n tin u ed to in tim id ate con serv ativ e in stitu tio n s and physicians, b u t it did n o t reta rd th e estab lish m en t o f clin ics, eith er in hosp itals or in ex tram u ral cen ters. M o st activ ists involved in estab lish in g c lin ics w ere w o m en , p rim arily w hite, ed u cated , m id d le- and u p p er-class v o lu n teers o r paid staff. M issin g fro m th e ir agend a w as any b la ta n t eu genic rh e to ric . T h ese w o m en sought to help o th e rs gain a ccess to supplies n ecessa ry to co n tro l th e ir fertility as th ey saw fit ra th er th a n to fulfill a p o p u latio n c o n tro l agenda. Dr. S a ra h M a rcu s p ractice d in a sou th -sid e C leveland n eig h b o rh o o d o f p red om in an tly ea stern E u rop ean im m ig ran ts. In 1 9 2 8 she b eg an w orking in C leveland ’s b irth co n tro l clin ic, establish ed th a t year by th e M a te rn a l H ea lth League. The fou nd ers o f th e clin ic, “so ciety w o m en [and] . . . Sh ak er H eig hts w o m en " sought out M a r­ cus b ecau se as a w om an she cou ld ease c lie n ts’ d isco m fo rt d iscussing sexual m atters. Th ese v o lu n teers sm uggled in supplies fro m C anad a to provide for th e ir m o stly w hite w orkin g-class clientele. In 1 9 2 7 Dr. Em ily M udd set up th e sta te’s first clin ic in W e st P hiladelphia, a n area u nd er th e ju risd ic tio n o f Judge A llen O lm stead . H e and his w ife, M ild red , w ere “great lib era ls” su pporting th e cause. E ast Philadelp hia, o n th e o th e r hand , fell u nd er th e ju risd ic tio n o f h o stile C ath o lic jud ges. M udd elim in ated “b irth co n tro l” fro m th e clin ic title and in stead d ecid ed u p on th e M a te rn a l H ealth C lin ic b eca u se she w as “tr y ­ ing to straddle b etw een th e a ccep ta b le h ea lth care and th e n o t y et a ccep tab le spacing o f ch ild re n " S h e ex p ected th e clin ic to b e closed by officials, b u t th e in flu en tial sp o n so rs listed in h e r b ro ch u re p ro te c te d th e clin ic. M oreov er, little religiou s o p p o sitio n em erged: “A pp arently o th e r religiou s groups eith er didn’t th in k w e w ere doing enou gh to b o th e r ab o u t, or th e y w ere n o t org a­ nized at th a t tim e . . . to p ro test and fig h t" A lm o st all h er clien tele ca m e fro m “ra th er und erprivileged groups,” referred by “frie n d s” on th e b oard s o f so cial a g en cies.148 W o m e n ca m e d espite p ossible legal rep ercu ssio n s. These d o ctors and v o lu n teers risked a g reat deal in th e ir a ctio n s. T he state could have revoked m e d ica l licen ses to p ra ctice a n d /o r ja iled sta ff m em b ers fo r illegal d istrib u tio n o f co n tracep tiv es. They assu m ed th e se risks b ecau se th e y believed in w o m en ’s rig h ts to b e a r health y ch ild ren , to space th e ir ch il­ d ren acco rd in g to g row ing m id d le-class n o rm s, and to avoid p re g n a n cy if h ealth or so cio e c o n o m ic co n d itio n s co n tra in d ica te d it. P ro m o tin g free and o p en sexu ality did n o t en ter th e form u la, n o r did eu gen ic n o tio n s o f p op u la­ tio n co n tro l.

Illegal Abortions: North Carolina and Rhode Island The lack o f legal sa n ctio n also did n o t stop w o m en fro m seeking o r d o ctors and o th ers fro m p erfo rm in g a b o rtio n fro m th e tu rn o f th e cen tu ry th rou g h

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th e 1 9 2 0 s. The reco rd s o f on e N o rth C a ro lin a ho sp ital a ttest to th e co n tin u ed p rev alen ce o f ab o rtio n . D a ta fro m R h od e Island during th e 1 9 2 0 s co n firm th a t b o th d o cto rs and m idw ives p e rfo rm e d a b o rtio n s. B o th exam p les d is­ prove th e n o tio n th a t only single, d esp erate w o m en re so rted to th is p ro ce­ dure. The m ajo rity o f w o m en w ere m a rried and fin an cially secure. The ad m ittan ce log o f th e Tw in C ity H osp ital in W in sto n -S a le m , N o rth C arolin a, fro m 1 8 9 6 to 1914 d isclosed th a t 1 9 0 w hite w o m en sought m e d i­ cal a ssistan ce as a resu lt o f a b o rtio n co m p lica tio n s.149 T he te rm abortion in th e re co rd s did n o t im ply m isca rria g e ; “p reg n an cy w ith non v iab le fe tu s" “p reg n an cy w ith early dead fe tu s " “in co m p le te m isca rria g e " or “p rem atu re m isca rria g e ” d en oted th e n atu ral exp u lsion o f th e fetu s. Tw o in sta n ce s o f th e ra p e u tic ab o rtio n , b o th fo r cases o f ty p h oid fever, w ere n o t co u n ted in th e sam ple.150 These reco rd s provide c h a ra cte ristic s o f w o m en seekin g a b o rtio n s. O f 1 9 0 p atien ts, 133 (7 0 p e rce n t) w ere m arried , w hile 3 6 (18.9 p e rce n t) w ere single. The rem ain in g 21 w o m en w ere listed as “M r s " bu t w ere ch eck ed o ff as single; th e y cou ld have b e e n re cen tly w idow ed during on e o f th e n u m ero u s ep id em ­ ics th a t sw ept th e region , o r th e ir h usbands m ig h t have d eserted th em . W ith th e se 21 w o m en added to th e m a rried category, th e n u m b ers are startling: 1 5 4 (81.1 p e rce n t) w ere m arried . The w o m en ’s ages, re co rd ed in 179 cases, averaged 2 9 .7 years. O ccu p a tio n s ap p eared fo r 1 6 4 o f th e w om en: 135 (8 2 .3 p ercen t) w ere h o m em ak ers; 7 (4 .2 6 p e rce n t) w ere fa cto ry h and s; 3 ea ch (1.82 p e rce n t each) w ere m ill h and s, n u rses, seam stresses, d o m estic w orkers, and te a ch e rs; 2 (1.21 p ercen t) w ere sten o g rap h ers; and 1 ea ch (0 .6 p e rce n t each) w as a college stud ent, stud ent, m illiner, co o k , and vaudeville actress. O n ly 25 o f th e 1 9 0 w o m en (13.15 p ercen t) w ere “p o o r/n o n p a y in g " O f th e m , 19 w ere m arried and 6 w ere single; 11 w orked outsid e th e h o m e. R eligion w as reg ­ istered in 3 0 cases: 12 (4 0 p e rce n t) B a p tists; 10 (3 3 .3 3 p e rce n t) M oravian s; 4 (13.33 p e rce n t) C a th o lics; 2 (6 .6 6 p e rce n t) M e th o d ists; 1 (3 .3 3 p ercen t) P resb y terian ; and 1 (3 .3 3 p e rce n t) listed as “C h in e se " A ll w ere fro m N o rth C arolin a excep t seven: tw o fro m S o u th C arolin a, tw o fro m Illin ois, and one each fro m V irginia, A labam a, and M aryland . A ll bu t on e survived th e c o m ­ p lication s afte r an average h o sp ita l stay o f 1 4 .2 4 days.151 These reco rd s co n trib u te insights in to th e a b o rtio n co n tro v ersy during th e P rogressive Era. They do n o t co n firm th e a sse rtio n by som e h isto ria n s th a t a b o rtio n d isappeared fro m th e n a tio n a l d isco u rse during th is p erio d b ecau se th e w om en seekin g th e p ro ced u re w ere m ainly single and p o o r.152 In th is sam ple th e overw helm ing p ercen ta g e o f w o m en w ere older, m a rried , and able to pay fo r a prolong ed h o sp ita l stay. The log is also im p o rta n t b ecau se it attests to th e co n tin u ed p rev alen ce o f ab o rtio n . T he w o m en re co rd ed h ere ex p erien ced co m p lica tio n s fro m th e p ro ced u re; m an y m o re presu m ably u n ­

Race Suicide, Eugenics, and Contraception, 1900—1930

d erw ent safe and u n co m p lica ted a b o rtio n s. O f th e seven ou tsid ers, tw o cases are straightforw ard: a m arried vaudeville a ctress fro m C h icag o p erfo rm in g in W in sto n -S a le m and a sev en teen -y ear-old college stud ent fro m R o c k H ill, S o u th C arolin a, presum ably atten d in g Salem C olleg e.153 T he o th e r five w ere m arried , paying housew ives. Perhaps th e y traveled to th e area to seek th e a s­ sistan ce o f a sister or frien d in p ro cu rin g an a b o rtio n w ith ou t th e know ledge o f th e ir husbands. T h eir spou ses, on th e o th e r hand , could have b e e n part o f th e d ecisio n and eith e r traveled w ith th e ir w ives or rem ain ed at h o m e to w ork w hile th e ir w ives set o ff to o b tain and re cu p era te fro m th e p roced u re am o n g fam ily o r friends. A case in R h od e Island also co n firm s th e co n tin u a tio n o f th is p ractice. The state ch arged W a lte r L. Jo h n so n w ith “aid ing, a ssisting , and co u n sel­ ing an a b o rtio n u pon th e bod y o f D o ro th y V. H u g h es" w ith d eath resulting. The Su p erio r C o u rt found Jo h n so n guilty, bu t he w on an appeal b ased on a tech n icality. The tra n scrip ts reveal tellin g attitu d es and tren d s. First, th e case su b stan tiates th e p rev alen ce o f a b o rtio n : th e ju stic e s d iscu ssed nu m ero u s cases in w h ich w o m en “survived th e o p e ra tio n " S e co n d , th e ju s tic e s held m en, n o t w om en, resp o n sib le fo r ab o rtio n , ju s t as legislators had in th e p rev i­ ous century. “W e are aware," th e y argued, “th a t th e re is su b stan tial au th o rity fo r th e in tro d u c tio n o f testim on y, in cases o f a b o rtio n , to th e effect th a t th e d efend ant w as resp o n sib le for th e p reg n a n cy in o rd er to show a m otive for th e p ro cu re m e n t o f th e o p e ra tio n "154 The d efen d an ts in th e se ca ses w ere m ale. O n ce evid ence p o in ted clearly to th e d efend ant as th e father, he, n o t th e m other, w as held resp o n sib le fo r co e rcin g and arran g in g th e ab o rtio n . I f a b o rtio n co n tin u ed to b e relatively prevalent, w hy did th e n a tio n a l d is­ co u rse ab ate by th e tu rn o f th e centu ry? C om p ared to th e n in e te e n th century, ph ysician s w ere n o tice a b ly q u iet o n a b o rtio n and race su icid e in general. E u g en icists in aca d e m ic settin g s w ere th e m a in pu rveyors o f ra cia l doom . Perhaps th e su ccessfu l legal cam p aig n to b an a b o rtio n u nless p erfo rm ed by a licen sed p hysician to save th e m o th e r’s life fulfilled th e A M A ’s agenda. This legal lo o p h o le also allow ed physicians g reat latitu d e in d ecid ing w ho should o b tain an ab o rtio n . O th e r d o cto rs w ho faced th e “cleanu p" o f a b o rtio n ists could tak e n o fu rth e r legal a c tio n against w o m en w ith ou t v iolatin g d o cto rp atien t confidentiality. W ith co n tin u ed p ro fessio n alizatio n and reg u latio n o f m e d icin e, m any d o cto rs no lo n g er faced a significant fin a n cia l th re a t fro m irregulars or m idw ives. The ch a ra cte ristic s o f w o m en seeking a b o rtio n s m ay have also played a role in th e relative silen ce su rround ing th e issue. A cco rd in g to th e Tw in C ity H o sp ital d atabase, m o st w o m en w ere older, fu ll-tim e w ives and m o th ers. They m o st likely already had ch ild ren , and d o cto rs did n o t see th e m “shirk­ in g ” th e ir m o th erly duties. In fa ct, phy sicians m ay have co n sid ered th a t th ese

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w o m en w ere end eavoring to fulfill n ew n o tio n s o f ch ild rearin g by lim itin g th e ir progeny to b en e fit th e ir existin g fam ily eco n o m ica lly and socially. D o c ­ to r s ’ silen ce w as n o t ta n ta m o u n t to a cc e p ta n ce o f a b o rtio n as a m ea n s o f b irth co n tro l. They m ade no attem p t to ease a ccess to th e proced u re. A b o rtio n rem ain ed illegal during th e 1 9 2 0 s , y et w o m en co n tin u ed to seek it. In a case study o f C h icag o L eslie R eagan fou nd th a t 16 p e rce n t o f w om en w ho w ent to b irth co n tro l clin ics in 1 9 2 7 w ere seeking an a b o rtio n . W h ile th e p u blic perceived m idw ives as th e p rim ary p ra ctitio n e rs o f th is trad e, d o ctors and m idw ives p erfo rm ed a b o rtio n s at eq u al ra tes.155 E vid ence show s th e sam e to b e tru e in R h od e Island. In 1921 th e state fou nd Dr. A rth u r O ’L eary guilty o f p erfo rm in g an a b o rtio n bu t asked for a d eferred sen ten ce b eca u se he w as a “u ser o f drugs and had lo st his m ea n s o f ob tain in g a livelihood.” M oreover, th e w o m an had reco v ered fro m th e p ro ­ cedure. The co u rt agreed, bu t eight m o n th s la ter a B o s to n w om an traveled to P rovid en ce to seek ou t O ’L eary ; she also recovered . T he p ro se cu to r asked for a th re e -y e a r ja il te rm . The co u rt ag reed .156 O ’L eary d em o n strates th e relative safety o f ab o rtio n if done properly. M oreover, th a t a B o s to n w om an sought h im out sp ecifically co n firm s an u nd ergrou nd in fo rm a tio n n etw ork th rou g h w h ich w o m en could o b ta in th e serv ices th e y desired. Lastly, O ’L eary w as fro m a re sp ecta b le P rovid en ce fam ily and had enjoyed a rep u tab le m ed ica l p ra ctice u n til his foray in to drugs. O n ce he had fallen fro m g race, h e could rely on th e lu crative a b o rtio n m a rk et to su stain his drug habit. O n ly tw o o th e r m ale a b o rtio n ists faced charges in R h od e Island in th e 1 9 2 0 s . Fred C a rrin g to n B ro o k s o f P ro v id en ce p lead ed n o lo co n ten d ere to a b o rtio n in 1 9 2 4 ; th e co u rt deferred his sen ten ce b eca u se n o in ju ry resulted. Dr. B e n ja m in J. B u tle r o f E ast P rovid en ce w as arrested w hen R h od e Island H o sp ital n o tified p o lice o f a w om an in critic a l co n d itio n w ho id entified B u t­ ler as th e a b o rtio n ist.157 The u se o f dying d eclaratio n s and co o p e ra tio n b e ­ tw e en m e d ical and p o lice officials th a t R eag an found in C h icag o hold s for R h od e Island as well. Fem ale ab o rtio n ists also co n tin u ed to co m p ete in th is p rofitable venture. A lice Sto n e , a single w om an, died in 1921 follow ing a p ro ced u re p erfo rm ed by a P rovid ence fem ale a b o rtio n ist. The state w as u nable to p ro se cu te h er b e ­ cau se S to n e refu sed to id entify th e w om an. Even th o u g h she w as dying, S to n e w as gratefu l to and th u s p ro te cte d h e r a b o rtio n ist. Tw o years la ter th e state a rrested E lizab eth R odier, a m arried w om an in K en t C ounty, fo r p erfo rm in g an a b o rtio n on F lo ren ce B a co n , a m ill operative, bu t asked fo r a d eferred se n ­ te n ce b ecau se “no serious resu lts had follow ed th e operation,” an in d ica tio n th a t officials, as w ith th e B ro o k s case, m ay have b e e n m o re co n c e rn e d w ith w o m en ’s safety th a n w ith erad icatin g a b o rtio n p er se. That sam e year M rs. Jo se p h in e M o re tti o f C ra n sto n w as a rre ste d a fte r she p e rfo rm e d an a b o r­

Race Suicide, Eugenics, and Contraception, 1900—1930

tio n on M ab le E. H ou rtal, w ho died su bsequ en tly at R h od e Island H ospital. M erty s P atterso n , a d ivorced tw en ty -eig h t-y ear-o ld w om an fro m S eek on k , died at P aw tucket M em o ria l H o sp ital in 1 9 2 4 fro m a b o rtio n co m p licatio n s. D esp ite state pressu re, P a tterso n , sim ilar to S to n e , refu sed to id en tify th e ab o rtio n ist. Dr. C h a rlo tta N. G o lin e, th irty -six years old, w as n o t so lucky. A w om an critica lly ill at R h od e Island H o sp ital id entified Dr. G o lin e as th e ab o rtio n ist afte r rep eated q u estio n s by p o lice and so cia l w orkers. Tw o w eeks later Eva R o b e rts o f W e st W a rw ick w as a rrested fo r p erfo rm in g a b o rtio n s. T h ree cases in 1 9 2 6 also involved fem ale a b o rtio n ists. A n astazia M o ste ck i o f W o o n so c k e t faced tw o charges o f crim in a l a b o rtio n . R affaela N apolillo, a th irty -y e a r-o ld P ro v id en ce m idw ife, had p e rfo rm e d sev eral a b o rtio n s o f w h ich officials w ere aw are. The case o f E m eld a B o u rq u i, a sev en teen -y ear-old fro m M ossu p , C o n n e c tic u t, co n firm s th e u nd ergrou nd n etw ork. S h e tra v ­ eled to R h od e Island w ith a frien d to see an u n n am ed fem ale a b o rtio n ist. At h o m e she b e c a m e violently ill and later died o f sep tic p e rito n itis. The sam e fate aw aited L o d ier B. L eveille, tw en ty -o n e years old, o f P rovid en ce follow ing an a b o rtio n p e rfo rm e d in h er h om e. P olice a rrested a young m an , presu m ed to b e h e r lover, and a w om an , ap p arently th e a b o rtio n ist, seen leaving th e d o m icile.158 E ith er R h od e Island had a rem ark ab le n u m b er o f in c o m p e te n t a b o rtio n ­ ists o r th e n u m b er o f a b o rtio n s p erfo rm ed w as qu ite high. T he only cases to re a ch th e new spap er involved d eath or serious injury. Presum ably, th e m a jo r­ ity o f a b o rtio n s to o k p lace secretly and b rou gh t positive resu lts. For cases in th e pu blic eye, th e g end er im p licatio n s are significant. M an y m o re w o m en th a n m e n w ere arrested , at least acco rd in g to available new spap er evidence. This im b alan ce could signify th a t w o m en d om in ated th e a b o rtio n tra d e and th e refo re w ere m o re likely to fa ce a h ig h er n u m b er (b u t n o t p e rce n ta g e) o f in ju ries or fatalities am o n g th e ir clien ts. It could also in d icate th a t m ale d o c­ to rs w ere b e tte r tra in ed and m o re co m p ete n t. A lternatively, it could re flect re lu cta n ce on th e p art o f m ale p o lice officers and state officials to in terfere w ith th e m e d ica l p ra c tice o f physicians bu t n o t w ith fem ale a b o rtio n ists or m idw ives. Lastly, th e skew ed g end er arrests could re flec t th e ability o f m ale d o cto rs to co n v in ce officials th a t th e y p erfo rm ed only life-saving and thu s legal ab o rtio n s, a ju stific a tio n fem ale a b o rtio n ists cou ld n o t employ.

Conclusion R ace su icid e th e o ris ts blen d ed w ell w ith eu g en ic d oom sayers co n c e rn e d w ith th e co n stitu tio n o f th e p o p u lation . B o th groups a ttra c te d sig n ifican t follow ers am on g in flu en tial elites. S a n g er a ttem p ted to gain le g itim a cy for co n trace p tiv e ch an g es by appealing to th e se eu g en icists and to th e A M A

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w ith h e r m e d ica l m o n o p o ly fo r dispersal. P erm an en t m eans o f fertility c o n ­ tr o l in th e fo rm o f steriliz a tio n g ained a m a n tle o f re sp e c ta b ility w ith th e

Buck v. Bell d ecisio n, bu t steriliz a tio n w as im p ra ctica l for th e “u n fit” at large. O n ly legislative chang es to allow a ccess to th e se groups could save th e n a ­ tio n fro m th e p rop ag ation o f in ferio r peop les. This co n tra cep tiv e cam paig n failed fo r nu m ero u s re a so n s: th e lack o f A M A en d o rse m en t; fears th a t easy access to cheap p ro d u cts w ould exacerb ate, n o t alleviate, fertility differentials b etw een th e “fit” and “u n fit”; and a n x ieties am on g legislators ab o u t th e p o ­ litica l fallou t fro m th e C a th o lic C h u rch ’s op p osition. L eg al o b sta cles in th e 1 9 2 0 s did n o t discourage g ra ssro o ts activ ists fro m providing o r w o m en fro m seeking m ean s to c o n tro l fertility to suit individual w o m en ’s need s. A b o rtio n rem ain ed a re co u rse fo r w om en, m any o f w hom w ere m arried . The estab lish ­ m e n t o f b irth co n tro l clin ics spread in m an y areas. B y 1 9 3 2 th e re w ere 118 clin ics; by 1 9 3 4 , 1 4 4 clin ics; and by 19 3 5 , 2 4 0 clin ics in th e U n ited S ta tes and its te rrito rie s .159 M an y existed th ro u g h legal lo o p h o les th a t allow ed c o n tra ­ ceptives as a preventive h ea lth m easu re. The G rea t D ep ressio n revitalized th e n atio n al m o v em en t to lib eralize co n tra ce p tiv es w ith e c o n o m ic arg u m en ts co n cern in g th e co n tin u in g h ig h fertility o f th e p o o r on pu blic relief.

4

Population Control and the Great Depression, 1930-1939

The e co n o m ic sev erity o f th e D ep ressio n in crea sed a tten tio n to rep rod u ctive p o licies. W h ile c o n c e rn over th e fertility o f “d efectiv es” co n tin u ed , a new p u blic co m m e n ta ry focu sed o n th e high fertility o f fam ilies o n relief. In th is co n tex t th e d istrib u tio n o f co n tra cep tiv es could save n o t only th e ra ce but also taxp ay ers’ m oney. Sim ilarly, sterilizatio n w ould save state m o n ey in in ­ stitu tio n al care fo r th e socially, physically, and m entally “u n fit” or “u nd esir­ a b le” and th e ir p oten tially d efective offspring. W h ile th e fed eral co u rts lent a m an tle o f resp ecta b ility to co n tracep tiv es and sterilizatio n , no sim ilar push o ccu rred fo r ab o rtio n . W o m en co n tin u ed to o b tain th is p ro ced u re, bu t no groundsw ell o f activ ism to change its illegal status o ccu rred . M an y state o f­ ficials, how ever, lo o k ed th e o th e r w ay as w o m en sought a b o rtio n s to co n tro l th e ir fertility in th e m id st o f e c o n o m ic d evastation. P ro p o n en ts o f selective grow th did n o t to u t a b o rtio n as a so lu tio n to th e n a tio n ’s p ro b lem s, relying in stead on b irth c o n tro l and steriliz a tio n to shape th e p op u latio n along lines su itab le to th e w h ite elite pow er stru ctu re. M a n y w o m en to o k advantage o f th e new ly eased re strictio n s on b irth c o n tro l to suit th e ir ow n p u rp oses, nam ely, to lim it th e ir fam ily size. This clim ate o f grow ing a cc e p ta n ce spurred th e estab lish m en t o f b irth co n tro l clin ics. A ctiv ists in R h od e Island op ened th e first su ch clin ic in N ew England. They ig n ored th e classist and ra c ist a r­ g u m en ts d om in atin g th e n a tio n a l d iscou rse and in stead co n c en tra te d on th e c o n n e ctio n b etw ee n c o n tra ce p tio n and w o m en ’s im proved h ea lth and life ch o ices. U nlike th e sense o f d o om prevailing in th e n a tio n a l debate, R h od e Island a ctiv ists qu ietly served th e co n tra ce p tiv e n eed s o f th o u san d s o f cli­ ents.

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Limiting Families on Relief P op ulation co n tro l ad vocates co n tin u ed th e ir ra cia l d oom rh e to ric. R ed ucing th e b irth rate am o n g p eop le o f “in fe rio r h ered ita ry ” w as th e only way to im ­ prove society. The quality o f th e race w ould be regen erated , th e y con ten d ed , if th e “m asses o f stupid p e o p le” w ith th e ir “u n restrain ed fecu n d ity ” p rod uced few er child ren. U nless so ciety ch e ck ed th e b irth s o f “feeb lem in d ed ” p aren ts, th e co n tin u al “w eakening o f th e ra c e ” w ould lead to “a n o th e r R o m a n ruin.”1 W h ite m id d le- and u p p er-class ed u cated grou p s, o n th e o th e r hand , had a “d u ty” to p ro crea te. L o u ise G ilm an H u tch in s, a p h y sician and reform er, avow ed th a t “th is w as th e w ord th a t w e w ere given at W ellesley.” L o rain e L ee so n C am p bell, V assar grad uate and b irth c o n tro l a ctiv ist, claim ed th a t during th e D ep ressio n th e re w as a “g ood deal o f ta lk o f so -ca lled ‘ra ce suicide.’ A lo t o f peop le w ere co lle ctin g figures ab o u t how th e co lleg e-ed u cated m an or w o m an w eren ’t [sic] rep lacin g th em selv es, and th e grow th o f th e pop u la­ tio n w as all lopsid ed and it all cam e fro m th e poor, o r th e u neducated.” Em ily H a rtsh o rn e M udd, a p hy sician and fou n d er o f th e first b irth c o n tro l clin ic in Pennsylvania, re co u n ted a sim ilar story: I do re m e m b e r trem en d o u s p ressu res th a t if you w ere w hat th e y used to co n sid er . . . su p erio r in te rm s o f y ou r ed u ca tio n and b ackg rou n d th a t you should have ch ild ren , th a t th is w as essen tia l fo r th e fu tu re o f th e cou ntry[,] . . . th a t p eop le w ho w ere m o re privileged should n o t be com p letely o u tn u m b ered by th e so -ca lled u nderprivileged. A nd th ere w as trem e n d o u s p ressu re and m any young w o m en gained b o th status and statu re in th e eyes o f th e ir com m u nity, o f th e ir fam ilies, and th e ir husbands by having a n o th e r healthy, p in k -ch eek ed baby. . . . [T ]h is w as th e m o st im p o rta n t co n trib u tio n you cou ld m ake to th e fu tu re o f th e cou ntry.2 E d u cated w o m en su ch as H u tch in s, C am p bell, and M udd b e c a m e th e ta r ­ get o f positive eu g e n ic ists— th o se co n c e rn e d w ith p ro m o tin g ch ild b earin g am o n g th e “fit.” A B C L re so lu tio n s ad op ted in Jan u ary 1 9 3 3 re fle c t th is d esire to red u ce th e “u n fit” and in c re a s e th e “fit.” A B C L prop ag and a p lacated ra ce suicide th e o rists by em phasizing “b irth selection.” W h ile favoring steriliz a tio n laws fo r p eop le w ith seriou s h ered ita ry d efects, th e A B C L en cou rag ed b irth s in fam ilies w ith “good h ered ita ry and en v iro n m en tal endow m ent.” The “gifted, cap able and socially m in d ed ” m e m b ers o f so ciety had a duty to multiply. As E le an o r Jo n e s, p resid en t o f th e A B C L , stated: “W e w ant fam ilies th a t should have ch ild ren to have th e m . . . ; w e are ju s t as m u ch in tere ste d in helping

Population Control and the Great Depression, 1930—1939

th e right so rt o f p erso n s to have m o re ch ild ren w hen th e y w ant th e m as in helping o th ers to have few er"3 S u ch rh e to ric allow ed th e A B C L to co n tin u e to cu rry favor w ith eu gen icists. W h o should have few er ch ild ren ? The M ilb a n k M e m o ria l F ou n d ation w orked w ith th e U n ited S ta tes P u blic H ealth S erv ice on an e c o n o m ic h ealth survey in 1 9 3 2 . In v estig atin g eight th o u sa n d fam ilies in th e “w a g e -e a rn ­ ing class” in eight cities, th e fou n d ation found th a t fam ily size in crea sed as e co n o m ic m ean s d ecreased : w h ite-co lla r w orkers had a b irth ra te o f 1 3 4 per 1 ,0 0 0 , skilled lab orers 1 5 0 , and unskilled lab orers 182. Fam ilies w ith no e m ­ ployed w orkers had a 4 8 p e rce n t h ig h er b irth ra te th a n th o se w ith o n e or m o re fu ll-tim e w orkers. R e lie f fam ilies had a b irth ra te 5 4 p erce n t h ig h er th a n n o n re lie f fam ilies. P eople w ho w ere p o o r in 1 9 2 9 and rem ain ed so in 1 9 3 2 had th e h ig h est b irth ra te o f all. The au th ors co n clu d ed th a t “a high b irth rate during th e d ep ression prevailed in fam ilies w h ich cou ld le a st afford, from any p o in t o f view, to assu m e th is added resp o n sib ility "4 In a n o th e r investiga­ tio n th e Fed eral U n em p lo y m en t R e lie f C ensu s a sc erta in ed th a t th e 3 ,1 3 4 ,6 7 8 fam ilies on re lie f betw een O c to b e r 1 9 3 2 and O c to b e r 1933 prod u ced 2 3 3 ,8 2 2 in fan ts. These sam e fam ilies alread y had 1 ,5 8 9 ,4 8 0 ch ild ren b etw een th e ages o f on e and five. A d d ition al surveys provided th e sam e evid ence: re lie f fa m i­ lies had th e h ig h est b irth ra tes.5 The p u b licatio n o f th e se surveys in th e press led to a d em and for th e d is­ p ersal o f co n tracep tiv es am on g th e p o o r and unem ployed. A s Dr. M udd re ­ called, “A lm o st everybod y saw th is as a m eans o f avoiding th e trem en d o u s im p act on co m m u n ity m o n ies fro m th e w elfare sou rces . . . w here m o re and m o re p regn an cies . . . w ere piling up th e e x p e n ses" A New Republic ed itorial p ro m o ted g ov ern m en t d istrib u tio n to th o se on relief: “It cou ld b e done, ea s­ ily, as a co m m o n -se n se re lie f m easu re, su pported by a tid e o f p u blic op in ion even m o re p ow erful th a n th a t w h ich overw helm ed th e E ig h teen th A m en d ­ m ent.” Harper’s Magazine co n cu rred : “W ith th e individual n ee d so g reat and th e re lie f p ro b lem so a cu te, it m ig h t b e ex p e cted th a t b irth c o n tro l w ould have b e co m e during th e p ast few years a reco g n ized p hase o f p u blic h e a lth " S u ch a p ro g ram w ould d ecrease th e e c o n o m ic strain o n p u blic h ea lth and h o sp ital facilities w hile sim u ltan eou sly b ette rin g m a tern a l h ea lth .6 W h y w as th e fertility rate am o n g re lie f and p o o r w o m en so high? A M ilb an k M e m o ria l F ou n d ation study u nd er th e d ire ctio n o f Dr. R aym ond Pearl investigated b irth c o n tro l p ra ctices am o n g 3 0 ,9 4 9 u rb an w o m en o f all classes in th irte e n states east o f o r o n th e M ississip p i River. A m o n g w h ites, 51.6 p e rce n t o f m arried and 8 8 p e rce n t o f unw ed m o th e rs and, am o n g black s, 7 9 .2 p e rce n t o f m a rried and 9 3 .3 p e rce n t o f unw ed m o th e rs had n ev er used co n trace p tio n . Th ese sta tistics m ay n o t have re flected n a tio n a l n o rm s: m any

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single w o m en using b irth c o n tro l effectively w ould n o t have co m e to P earl’s a tten tio n , as he only lo o k ed at w o m en giving b irth in h o sp itals; m oreover, only o n e -th ird o f d eliveries o cc u rre d in h osp itals. N ev erth eless, his study provides insights in to ra c ist and classist n o tio n s. “O n ly ab o u t a th ird as m any N egro as w hite w o m en re so rt to co n tra c e p tio n " he argued, co n firm in g th e lack o f access h isto ria n Jo h a n n a S c h o e n d em o n stra te s fo r m an y A frica n A m e rican w om en. A m on g m an y p o o r b la ck and w hite w om en, th e ir “obvi­ ously stupid p ra c tice o f co n tra ce p tio n ” led to th e ir h ig h fertility ; p ra ctice s am o n g so m e b lack s w ere “far less effective th a n even th e relatively p o o r ones th e w hite w o m en are able to a ch iev e " H e co n tin u ed his ra c ist asse rtio n s in an a rticle in Science: “N egroes do n o t p ra ctice co n tra ce p tio n effectively, even a fter th e y have b e e n in stru cted .” In th e 1 9 3 3 M ilb a n k study he a sserted th a t b lacks “ex ercise less p ru d en ce and foresigh t th a n w hite peop le do in all sexual m a tte rs” and, in th e 1 9 3 6 re p o rt, th a t th e y lacked th e “s e lf-c o n tro l” to p ra c­ tice b irth co n tro l. P earl co n clu d ed th a t th e p o o r’s inability to ex ercise b irth lim itatio n , n o t th e ir d esire to have a large fam ily, appeared “alo n e to b e re ­ sp onsible fo r th e ir to o rapid propagation.” O n ly th e “p ro m p t rem ov al o f all legal re strictio n to th e free d issem in atio n o f co n tra cep tiv e in fo rm a tio n , and b arriers to th e u n restricte d d istrib u tio n o f co n tra cep tiv e d evices, w ould ten d to have th e effect o f brin gin g th e d ifferential fertility o f so cia l classes m o re n early in to b alan ce a g a in "7 For w o m en w ho did u se b irth co n tro l, a n u m b er o f op tio n s w ere available. M an y C ath o lics relied on th e rh y th m m eth o d , bu t w hile im proved m ed ical in fo rm atio n m o re accu rately p in p o in ted th e fertile p eriod , th is m e th o d r e ­ m ained unreliable. W o m en en co u n tered o th e r problem s. A lth ou g h th e 1 9 3 0 s w itn essed a “rev olu tio n ” w ith th e debut o f th e latex co n d o m , m any m e n r e ­ fused to u se th e m .8 W o m e n b o u g h t fem a le-o rien ted d evices at a rate o f “five to o n e ” co m p ared to co n d o m sales. D o u ch in g (prim arily w ith Lysol), despite its in effectiv en ess, w as th e ir first ch o ice and rem ain ed so th rou g h th e 1 9 5 0 s. S u ch fem in in e hygiene p ro d u cts w ere available at lo c a l fiv e-an d -d im e stores, th rou g h catalogs, and th rou g h d o o r-to -d o o r sales.9 D iap h rag m s, on e o f th e m o re reliable m eth o d s, w ere n o t an o p tio n fo r m any ind igent and w orkingclass w om en: th e y could n o t afford to visit d o cto rs, w ho legally m o n o p o lized th e d istrib u tio n o f diaphragm s, and th e y eith e r had no know ledge o f existing clin ics o r lived in areas w ith no clin ics.10 B y 1 9 3 2 eig h ty -six b irth co n tro l clin ­ ics w ere d istribu ted am o n g only eig h teen states. T w en ty-sev en states had no su ch facilities fo r low - or n o -in c o m e w o m en .11 In th e early 1 9 3 0 s so m e o rg a n iz a tio n s p u shed fo r so cia l and w elfare w orkers to in co rp o ra te co n tra cep tiv e in fo rm atio n in to th e ir regu lar duties. The A B C L co o p era ted w ith w elfare org anization s to in fo rm th e p o o r abou t

Population Control and the Great Depression, 1930—1939

clin ics. In a sp e ech in P rovid en ce A B C L P resid en t Jon es stated: “The p o o r w ill use b irth co n tro l a fter th e y have learn ed th e m e th o d s and th e p o o r are th e peop le w ho n eed it th e m ost.” The only way to re a ch th e se w om en, she con tin u ed , w as th ro u g h th e help o f so cia l w orkers, w ho d eveloped p erso n al relatio n sh ip s w ith re lie f w o m en and could ta lk candidly ab o u t fam ily lim ita ­ tio n .12 The A m e rica n C o n fere n ce o n B irth C o n tro l and N atio n al R eco v ery held in W a sh in g to n , D .C ., in Jan u ary 1 9 3 4 ad vocated b irth lim ita tio n as a n ecessa ry co m p o n e n t o f so cia l w o rk .13 Dr. Sid n ey E. G o ld stein , a ra b b i at th e F ree Synagogue in N ew York, su m m ed up th e c o n fe re n ce ’s attitud e: “Ev­ ery so cial w orker know s th a t it is n o t only cru e l and h ea rtle ss bu t socially u nw ise to allow fam ilies to in c re a s e during p eriod s o f d istress and d ep en ­ dency. . . . The g o v ern m en t m u st give n o t only food and clo th in g and sh elter to th e se fam ilies, it m u st give in ad d ition th a t in fo rm a tio n and in stru ctio n th a t is n ecessa ry to keep th e fam ily w ith in rea son a b le lim its.” D ire cto rs o f T em p o rary E m erg en cy R e lie f A d m in istration s a cro ss th e co u n try su pported adding co n tracep tiv e serv ices to w elfare and so cia l a g en cies.14 The a sso cia tio n o f so cia l w o rk w ith c o n tra ce p tio n w as new. B e fo re th e D ep re ssio n few so cia l w orkers d iscu ssed su ch private issues w ith clien ts. E co n o m ic d istress altered th is tren d . In m o st in sta n ce s, co n tracep tiv es w ere re co m m en d e d on th e in itiativ e o f individual so cia l w orkers co n c e rn e d ei­ th e r w ith m a tern a l and in fa n t h ea lth o r w ith p o p u latio n co n c e rn s; w elfare org anization s generally had n o set policy. O n ly tw o large w elfare ag en cies in N ew Y ork, th e Jew ish S o c ia l S e rv ic e and th e A sso cia tio n fo r Im p rov ing th e C o n d itio n o f th e Poor, in stru cte d field w orkers to send clien ts to clin ics w hen th e situ atio n seem ed to req u ire fam ily lim itatio n . S o m e believed th is “w ise p o licy ” should b e m od eled by o th e r “overly cau tiou s o rg a n iz a tio n s”15 W h y w ere o th e r ag en cies re lu cta n t to ad opt su ch a stand? S o m e dreaded accu satio n s o f co e rcio n . A llegations th a t re lie f re cip ie n ts w ere com p elled to use co n tracep tiv es plagued so m e lead ers. In P rovid en ce th e R everen d W il­ liam A pp leton L aw ren ce o f th e G ra ce E p iscop al C h u rch g u aran teed at a fund drive th a t co n tra cep tiv es w ere n o t a p rereq u isite fo r p u blic a ssistan ce. Yet P u b lic Safety D ire c to r Jam es J. M c M a h o n o f N ew Jersey receiv ed re p o rts fro m clergy m en in M o n tc la ir th a t E m erg en cy R e lie f A d m in istra tio n c a s e ­ w orkers com p elled re lie f fam ilies to p ra ctice co n tra ce p tio n o r fo rfe it pu blic assistan ce. C asew orkers d enied th e alleg ations; M c M a h o n th rea te n ed to fire anyone w ho spread co n tra ce p tiv e in fo rm a tio n to clie n ts.16 A lth ou g h m o st so cial w orkers did n o t fo rce clien ts to use co n tra ce p tio n , th e evid en ce sug­ gests th a t m any reco m m en d e d fertility lim ita tio n to large fam ilies on relief. A ny reco m m en d a tio n fro m a g ov ern m en t official cou ld be co n stru e d as c o ­ ercive o n th e p art o f th e recip ien t.

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O th e r ag en cies forbad e w orkers to d iscuss c o n tra ce p tio n b eca u se th e y feared charges o f in terferen ce in private fam ily m atters. Commonweal agreed th a t re lie f fam ilies should lim it offspring, b u t th e d ecisio n should b e th eirs alo n e ; th e state should n o t in itia te con v ersatio n s to safeguard th e sep ara­ tio n b etw een pu blic and private lives.17 T hat a C a th o lic p e rio d ica l ad vocated fam ily lim itatio n d em o n stra tes th e grow ing a cc e p ta n ce o f fertility co n tro l, alth ou g h th is p e rio d ica l’s view did n o t re flec t ch u rch policy.

Legislative Campaigns M o st g ov ern m en t ag en cies refu sed to ad op t co n tra ce p tio n as p art o f th e ir p rogram s b eca u se o f th e C o m sto c k Law. C lin ics o p erated m o stly th rou g h legal lo o p h o les th a t allow ed co n tra cep tiv es to preven t d isease a n d /o r to p ro ­ te c t m a tern a l h ea lth .18 S till w orking to rem ov e th e C o m sto ck Law, S a n g er fou nd ed th e N atio n al C o m m itte e on Fed eral L eg islation (N C F L ) in C hicag o in 1 9 2 9 , w ith K a th erin e H o u g h to n H ep bu rn, m o th e r o f th e risin g film star, serving as legislative chair. The N C F L ’s g oal w as to am end th e law to allow ph ysician s, h o sp itals, and clin ics to receiv e co n tra ce p tiv e in fo rm a tio n and supplies th rou g h th e m ail. S a n g er w as d eterm in ed to ch an g e th e statu te b e ­ cau se “big m o n e y ” w ould n o t b e invested in an en terp rise th a t w as against th e law. T h ree years la ter th e N C F L m oved its h ead q u arters to W ash in g to n , D . C ., and su rpassed th e lobby ing efforts o f th e A B C L .19 Finding sp on sors to in tro d u ce a bill in 1931 proved difficult. R etiring S e n a ­ to r F red erick H u n tin g to n G illet (R -M A ) ag reed b eca u se h e had n o re e le c ­ tio n co n cern s. The b ill rea ch ed a ju d icia ry co m m itte e co m p rised o f W illiam E. B o ra h (R -ID ), S am G. B ra tto n (D -N M ), and G illet. A lth o u g h o p p o n en ts w ere p red om in an tly C a th o lic, m any em ployed a n ti-C o m m u n ist propaganda ra th er th a n ch u rch d o ctrin e to d efeat th e bill. A rguing th a t c o n tra ce p tio n w as a R ussian in n ovation , th e y claim ed it ru in ed m o th e rh o o d and th e family. R ep resen tativ e M a ry T. N o rto n (D -N J), a C a th o lic, te stified th a t th e happiest fam ilies had m any child ren. The m a jo rity o f A m erican s w ere b o rn poor, she argued, bu t poverty w as a “b lessin g ” b eca u se it m ad e p eop le a m b itio u s.20 C loaking th e ir m o ra l o p p o sitio n in R ed S c a re rh e to ric w as effective; th e c o m ­ m itte e killed th e bill. S a n g er co n clu d ed th a t it failed b eca u se foreig n and d o m estic p ro b lem s d om in ated p o liticia n s’ m ind s: “To th e fra n tic, w orried , harassed , driven C o n g ressm en o f 1931 th e a n n o u n cem e n t o f a b irth co n tro l b ill w as like a m essage fro m M ars, only less in tere stin g and m o re rem ote.” R efu sing to ad m it C a th o lic in flu en ce, she in stead blam ed co n g ressio n al p re­ o ccu p atio n w ith th e w ar in M a n ch u ria , foreig n debt, p eace co n fere n ce s, d is­ arm am e n t, tariffs, P ro h ib itio n , sales ta x e s, bu dgets and b o n u ses, and u n e m ­ p loym ent relief.21

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The N C F L lau n ch ed a n o th e r cam p aig n th e follow ing year. S e n a to r H en ry D. H atfield o f W e st V irginia in tro d u ced S 4 4 3 6 , w hile R ep resen tativ e Frank H a n co ck o f N o rth C a ro lin a in tro d u ced H R 11 0 8 2 , b o th bills to exem p t li­ cen sed d o ctors, ch a rtered m ed ical colleges, leg itim ate druggists, and licen sed h o sp itals or clin ics fro m fed eral p rovision s on co n tra ce p tio n . This carefu l w ording in ten d ed to exclude m ed ical se c ts outsid e th e pu rview o f th e A M A . A d vocates o f th e bills em ployed variou s arg u m en ts, bu t th e glaring ab sen ce w as a fem in ist defense. In hund red s o f pages o f te stim o n y only th e R everend C harles Fran cis P o tte r o f th e F irst H u m an ist S o c ie ty o f N ew Y ork claim ed th a t w o m en had “an in alien able right to all in fo rm a tio n w h ich affected th e ir h ealth and th e ir e c o n o m ic co n d itio n , and n o m a scu lin e su p ervision o f th e ir m o rals . . . can p ossibly in th e long ru n succeed.”22 O th e r ad vocates steered clear o f fem in ist term inology . S o m e argued th a t re strictio n s in terfered w ith sta te s’ righ ts, w hile o th e rs em ployed p u b lic and m a tern a l h ea lth ju s tific a ­ tio n s. S an g er appealed to con serv ativ es by g u aran teein g th a t th e bills w ould “p lace th e resp o n sib ility o f giving co n tra cep tiv e in stru ctio n in th e hand s o f th e m e d ical p rofession , w here it rightly b elo n g s”23 D o c to rs te stified th a t th e bills w ould en su re th e “free d o m fo r phy sicians . . . to u se th e ir ju d g m en t w ith . . . th e ir p atients in th is m a tte r” and help d ecrease a b o rtio n s. A s in th e 1 9 2 0 s , S an g er d istan ced a b o rtio n fro m th e bills, con ten d in g th a t th e “co lo s­ sal” n u m b er o f an n u al a b o rtio n s w as “ex trem ely d etrim e n ta l to th e h ea lth and happiness o f w o m en ”24 Far m o re frequ ently, rep ro d u ctiv e p o licy w as a sso cia te d w ith u nem p loy ­ m e n t, child labor, crim e, low living stand ard s, and, especially, eu genic reform . S e n a to r H atfield ag reed to in tro d u ce th e 1 9 3 2 b ill becau se, as a p hy sician and fo rm er governor, h e had w itn essed th e “im b e cilic co n d itio n s” in state in sti­ tu tio n s and th e rapid p ro p ag atio n o f th e “u n fit”; th e b ill w ould im prove th e quality o f th e race. W rite r C h a rlo tte Perkins G ilm an argued th a t th e “in te l­ le ctu a l level o f o u r co u n try is th a t o f th e 12-year-old ,” and th e p o p u lation suffered fro m an “en o rm o u s p ro p o rtio n o f h an d icap p ed ch ild ren , inferior, d elinqu ent, d egenerate, a w eight u pon us to brin g u p”25 S a n g er claim ed th a t 4 0 p e rce n t o f th e p o p u latio n w as “generally classed as u nfit, m en tally and physically,” and inclu d ed “m o ro n s and m e n ta l d efectives w ho usually co m e u p on o u r so cial vista as p e rm a n en t u nem ploy ables and d epend ents.” O th ers argued th a t “th e least in telligen t sixth ” w as “b eg ettin g h a lf o f th e n ex t g en ­ eration,” calling fo r a greatly “n eed ed in tellig en t b irth co n tro l proced ure.” Dr. H en ry P ratt Fairchild o f N ew Y ork U niversity, w ho w as also p resid en t o f th e P op ulation R efere n ce B ureau, te stified th a t p op u latio n in c rea se m u st co m e “fro m th e b e tte r elem en ts o f so ciety ”26 A d vocates also end eavored to p lace th e b ill w ith in th e e c o n o m ic co n tex t o f th e 1 9 3 0 s . A m o s W . B u tle r o f th e In d ian a S o c ie ty fo r M e n ta l H ygiene

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m ain tain ed th a t th e p u blic cou ld b e “saved g reat ex p en se” if “pu blic charges su p p orted by th e ta x p a y er” w ere d ecrea se d th ro u g h “p ro p e r legislation.” Jam es S. B o ssard o f Philadelp hia found th a t 2 0 - 4 0 p e rce n t o f state exp en d i­ tu res during th e 1 9 2 0 s w en t fo r th e care o f d ep en d en t and “d efective cla sses” and th a t th is p ercen tag e had “in crea sed g reatly ” during th e D ep ressio n . A l­ th o u g h n o t all expend itu res could be elim in ated by “in tellig en t b irth control,” he co n clu d ed th a t “it could co n trib u te ap p reciably tow ard th a t end.” L. F oster W o o d o f C o lg a te -R o c h e ste r D ivinity S c h o o l claim ed th a t “th is b ill . . . w ould end th e depression.” R a b b i Sid ney G o ld stein m a in ta in ed th a t “th e u nem p loy ­ m e n t p ro b lem w ill n o t b e p erm an en tly solved u ntil w e ad op t th e b irth -c o n ­ tro l proced ure.” The U ta h S ta te F ed eratio n o f L a b o r stressed th a t th e la ck o f co n tracep tiv es am o n g th e w orking classes “co n trib u ted to our p resen t u n e m ­ p loym ent situation.”27 The e co n o m ic and eu gen ic rh e to ric o f ad vocates did n o t co n v in ce C o n ­ gress, and th e bills died in co m m itte e again.28 S ev era l fa cto rs explain th is failure. First, th e C a th o lic C hu rch , w ith N o rto n as its m o u th p iece, co n tin u ed w ell-organ ized o p p osition . The A m e rica n F ed eratio n o f L a b o r opp osed th e b ill b eca u se its p resid en t, W illia m G reen , cou ld n o t su p p ort any m easu re th a t “lead ers o f th e ch u rch d en o u nce as con d u civ e to bad m orals.” As R abbi Edw ard L. Israe l o f th e C en tra l C o n fere n ce o f A m e rica n R abbis stated: “R e ­ ligious fa n aticism o f a sin cere b u t a m isgu id ed so rt alon e preven ts th is w ise legislation.”29 S e co n d , C o n g ress re m a in e d u n co n v in ced o f th e so cia l and e co n o m ic n ecessity fo r fertility co n tro l. The R everend Jo h n A. Ryan o f th e N atio n al C ath o lic W elfa re C o n fere n ce ig n o red m o ra l co n d em n a tio n s and appealed in stead to so cia l w elfare liberals: th e “ad v ocacy o f b irth p rev en tion as a rem ed y fo r poverty d iverts a tten tio n fro m m easu res o f e c o n o m ic and so ­ cial ju stice.” H e criticiz ed p o p u latio n c o n tro l p ro p o n e n ts b eca u se “th e y lo o k u p on th em selv es as a su p erior sto ck , u nm ind fu l o f th e obvious m a th e m a tica l fa ct th a t th e y and th e ir kind are n o t rep ro d u cin g them selves.” S tricter, n o t m o re le n ien t, legislation w ould c o rre c t th e fertility im b alan ce. Third, m any S o u th e rn sen ato rs w ere u nw illing to d iscuss th e issue. B ec a u se child la b o r su b stitu ted for ag ricu ltu ral and ind u strial m ech a n iz a tio n in th e S o u th , m any p aren ts co n sid ered large fam ilies an e c o n o m ic a sset. In fact, w hen th e P ro t­ estan t Fed eral C o u n cil o f C h u rch es en d orsed co n tra ce p tio n in m id -1931, th e S o u th e rn P resb y terian G en e ra l A ssem b ly w ith d rew fro m th e fe d e ra tio n .30 Fou rth , several w itn esses em ployed R ed -b a itin g ta c tic s , claim ing th a t c o n ­ tracep tiv es w ere synonym ous w ith C om m u n ism and “superpacifism .” Fifth, op p o n en ts co n ten d ed th a t th e b ill w ould en co u rag e p rom iscu ity, free love, and a b o rtio n s as w ell as d estroy “th e n o rm a l G o d -g iv en fu n c tio n o f w o m an ­ hood,” th a t is, ch ild bearin g . L a st, so m e o p p o n en ts ad opted ra c ist arg u m en ts,

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claim in g th a t only w hites used co n tra ce p tio n ; leg itim izin g it w ould lead to a fu rth e r d ecrease am o n g th e “b e s t” group, w hile th e “b lack s, yellow s, b row ns, and th e m o n g rels” w ould “m ultiply th e ir rate o f in c re a s e ” 31 W ith so m u ch op p o sitio n , legislators believed th e status quo w as th e b est option. Follow ing d efeat, refo rm ers p laced h op e in F ran klin D. R o o se v elt’s a scen t to th e presidency. E le a n o r R oo sev elt had b e e n active in th e m o v em en t dur­ ing th e 1 9 2 0 s , serving as a bo ard m e m b e r o f th e A B C L . M oreover, Franklin R oo sev elt ap p oin ted som e co n tra cep tiv e su p p orters to his in n e r circle. E x ­ p e cta tio n s fo r a sh ift in fed eral p o licy disap peared w h en th e press re a cte d adversely to E le a n o r’s su pport o f co n tra ce p tio n ; she kept h e r op inions private a fter 1932. The p resid en t refu sed to m e e t w ith Sanger. P erhaps he feared alien atin g C ath o lics, w ho voted in large n u m b ers fo r D em o cra ts. Gradually, his in n e r circle d isasso ciated th em selv es fro m th e m o v em en t and rem ain ed silen t on th e issu e.32 N o t surprisingly, bills b efo re th e H ou se and S e n a te th e follow ing year m e t w ith defeat. A t th e sam e tim e, th e S e n a te C o m m itte e on In te ro c e a n ic C anals co n sid ­ ered am end in g th e p enal co d e in th e P an am a C an al Z o n e to allow physicians to d istrib u te co n tra ce p tiv es and receiv e th e m in th e m ail. R a cism tow ard b lacks d om inated . C harles F. W a h l o f th e C anal Z o n e C en tra l L a b o r U n ion testified th a t th e re w ere th irte e n th o u san d em ployees in th e zone: th re e th o u ­ sand “A m e rica n citiz e n s” and te n th o u san d “alien s” fro m Jam aica, B arb ad o s, and th e W e st Ind ies. The “a lien s” w ere raising eig h teen th o u san d child ren, and “ju s t by th a t on e sta tem e n t you ca n visualize w hat ch a n ce a w hite m an in P an am a has, if it k eep s u p” O n e sen ato r asked W a h l if th e ta rg e t o f th e cod e w as “aliens,” to w h ich W a h l responded : “I f th e y cou ld g et th a t advice and use it, th e y w ould b e b e tte r off, and so w ould w e, dow n th e re ” A lthou g h re c e p ­ tive, th e sen ato rs d ecid ed th a t a u n iform p o licy m u st b e m aintain ed ; w hen th e H ou se and S e n a te d efeated th e co n tra ce p tio n bills for th e m ainland , th e p en al cod e in P an am a rem ain ed u n ch an g ed .33 U n d au nted by d efeat, ad v ocates fo r chang e used th e re st o f 1 9 3 3 to r e ­ group fo r a pu sh in 1 9 3 4 . B y th a t tim e m o re th a n on e th o u san d org aniza­ tio n s had en d o rsed co n tra ce p tiv e re fo rm , in clu d in g th e F ed eral C o u n cil o f C h u rch es, w ith tw e n ty -th ree m illio n m e m b ers; th e N a tio n a l C o u n cil o f Jew ish W o m en ; th e C en tra l C o n fere n ce o f A m e ric a n R ab b is; th e G en e ra l F ed eratio n o f W o m e n ’s C lu b s; th e Young W o m e n ’s C h ristia n A sso cia tio n ; th e N atio n al C o m m itte e on M a te rn a l H ealth ; th e N atio n al W o m e n ’s Trade U n io n L eague o f A m erica; th e A m e rica n C ivil L ib e rties U n ion ; and lo c a l Ju ­ n io r L eagu es, rep resen tin g tw elve to th irte e n m illio n m e m b e rs.34 W ith th is su p p ort S an g er k ick ed o ff th e 1 9 3 4 cam p aig n w ith an A m e rica n C on fere n ce on B irth C o n tro l and N a tio n a l R eco v ery rally in W a sh in g to n , D .C . The rally ’s

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b a n n e r d ep icted th e N atio n al R eco v ery A c t’s blue eagle using lightning b o lts to fight o ff m u ltitu d es o f stork s and carried th e slogan: “S ix m illion s [sic] ch il­ d ren in th e U n ited S ta tes on p u blic relief. Tw o b irth co n tro l bills p end ing in C o n g re ss " The N C F L su cceed ed in g ettin g tw o bills in trod u ced , in th e H ou se by W a lte r M . P ierce (D -O R ) and in th e S e n a te by D a n iel O . H asting s (R -D E ). The N C F L gained th e su p p ort o f a few celeb rities, in clu d in g A m elia E arh art, and Newsweek en d orsed th e b ills.35 The C a th o lic C h u rch led th e re sista n ce, using n ativ ist and ra ce su icid e n o tio n s ra th er th a n ch u rch d o ctrin e to d efeat th e bills. F a th er C h arles E. C ou ghlin, th e D e tro it rad io p riest, argued th a t if th e g ov ern m en t rep ealed th e law, alien races w ould drive th e A n g lo -S a x on sto c k o u t o f ex isten ce, re ­ sulting in W a sh in g to n , D .C ., b ein g ren am ed “W a sh in g to n sk i” and “p ro lific” b lacks ov erru n n in g th e country. M a ry N o rto n applauded C ou ghlin: “In stead o f spreading in fo rm a tio n on how to preven t child b irth , w e should endeavor to in stru ct w o m en h ow to brin g happy, health y ch ild ren in to th e w orld, for th e tim e is fast ap p roach in g w h en w e shall b e obliged to d epend u p on th e co u n tries o f th e old w orld fo r fu tu re g e n e r a tio n s "36 C ou gh lin and N o rto n ig n ored th e fa ct th a t th e groups th e y d enigrated , Poles and O ld W o rld p o p u ­ latio n s, w ere p rim arily C a th o lic. R a th er th a n b a se th e ir re sista n ce to change o n m o ra l g rou n d s, th e y ch o se th e p o litica lly ex p ed ien t p ath o f aligning th em selv es w ith nativists w ho believed th a t lib eralized rep ro d u ctiv e p o licies w ould lead to th e dow nfall o f th e “A m e rica n ra c e " A d vocates o f a n ew p op u latio n p o licy fou ght back. H ep b u rn testified th a t th e “th e o ry th a t [the bill] is going to b rin g a b o u t ra ce su icid e is a b so lu te n o n sen se , b eca u se o f th e stro n g m a tern a l in stin c t in w o m e n " H ere again, refo rm ers w ere qu ick to affirm w hite u p p er- and m id d le-class w om an’s tru e role as m o th e r: b irth co n tro l w ould allow h er to ch o o se w hen to have ch il­ dren, n o t to avoid having th e m altogether. P ierce argued, “N o on e n eed w orry ab o u t ra ce suicide. W h a t w e seek is p ro te ctio n o f th e ra ce fro m th e suicidal effects o f th e p resen t co n d itio n s o f th in g s " B o th G uy Irv in g B u rch o f th e P op u lation R efere n ce B u reau and P ro fe sso r E llsw orth H u n tin g to n o f Yale U n iversity argued th a t in co u n tries w here c o n tra ce p tio n w as a ccessib le to all, “th e m o re fo rtu n a te classes" and th e “m o st su ccessfu l p eop le" had m o re ch ild ren th a n th e “less fortunate." S u ch a tren d w ould im prove th e A m e rica n p op u latio n and lead to e c o n o m ic re co v ery b eca u se th e se fam ilies w ould have m o re disp osable in c o m e to spend on th e ir ch ild ren .37 T h ese arg u m en ts failed to co n v in ce p olitician s. The N C F L lau n ch ed on e last a ttem p t in 19 3 5 . A gain, it em phasized th e e co n o m ic and so cia l need for a lib eralized policy. The F ed eratio n o f W o m en ’s C lu bs, an u p p er-class P ro te sta n t org anization , en d orsed th e cam p aig n and

Population Control and the Great Depression, 1930—1939

passed reso lu tio n s statin g th a t “b eca u se o f th e over 4 ,0 0 0 ,0 0 0 fam ilies de­ pending on Fed eral re lie f and th e 2 5 0 ,0 0 0 b abies b o rn to th e se fam ilies, th e fed eratio n is in favor o f th e re lie f a d m in istra tio n tak in g steps as to prevent th e re cu rre n ce o f su ch situ a tio n s"38 The g o v ern m en t refu sed to com ply. A sarcastic exp ose on th e co n g ressio n al d efeat o f th e 1 9 3 5 b ill appeared in th e

New Republic. “I jud g e fro m w hat I read in th e new spap ers th a t officiald om is very p leased w ith th e high b irth ra te am o n g our m illion s . . . on th e re lie f ro lls___ C on g ress w as im p o rtu n ed to pass a law p erm ittin g th e spread o f in ­ fo rm atio n ab o u t b irth c o n tro l . . . and d eclin ed " A d vocates o f th e b ill argued th a t “peop le on re lie f ought n o t to have so m any b abies. C on g ress evidently d isagreed w ith th is v iew "39 P u b lic o p in io n did n o t su p p o rt co n g ressio n a l actio n s. A Farm and Fireside poll show ed a tw o -to -o n e m arg in in favor o f co n tracep tiv e d istrib u tio n by phy sicians, w hile a P ro te sta n t Churchman poll fou nd alm ost u nan im ou s approval in 1935. A Fortune survey in 1 9 3 6 found th a t 6 3 p e rce n t en d orsed th e tra n sp o rta tio n o f co n tracep tiv e devices th rou g h th e m ails, 2 3 p e rce n t w ere opposed , and 14 p e rce n t w ere u nd ecid ed . A m ong C ath o lics, 4 2 .8 p e rce n t su p p orted a lib eralized policy, w hile 4 5 p e rce n t o b ­ je c te d . A lth ou gh th e sam ples in th e se surveys are su sp ect, a G allup p o ll th e sam e year found th a t 7 0 p e rce n t approved and 3 0 p e rce n t disapproved.40 W h y w as C on g ress so re lu cta n t to m o d ify its stance? S o c ia l and ec o n o m ic d islo catio n fro m th e D ep re ssio n h eig h ten ed a n x ieties regard ing sexu al b e ­ havior. The m arriag e rate fell, w hile th e divorce rate in creased . T hese sta tis­ tics p rom p ted o p p o sitio n to b irth c o n tro l am o n g sexu al con serv ativ es w ho feared an in crea se in illicit sex.41 Perhaps grow ing w arin ess o f G erm a n , Ita l­ ian, and Jap an ese ag gression m o tiv ated p o liticia n s’ co n c e rn ab o u t m a in ta in ­ ing a so u rce o f able b o d ies fo r a d raft, if needed. M o re im p o rta n t, m any p o liticia n s feared a loss o f votes if th e y opposed th e ch u rch ’s will. A 1 9 3 0 papal en cy clica l re itera ted th e ch u rc h ’s antipathy to all “a rtificia l” c o n tra ce p tio n and n ow co n d em n e d all a b o rtio n s w ith ou t ex cep tio n .42 This la tte r a sp e ct devalued th e m o th e r’s life in favor o f th e fe ­ tu s. The N atio n al C a th o lic W elfare C o u n cil lo b b ied su ccessfully: “I ask you, g en tlem en , in th e n am e o f th e tw en ty m illio n C a th o lic citizen s o f th e co u n ­ try, to w hose deep religiou s co n v ictio n s th e se vices are a b h o rre n t . . . to r e ­ p o rt unfavorably on th is d iab olical and d am nable bill!” The ch u rch also used th e pulpit to keep its flo ck in line. S a n g er told h er son G ra n t th a t she had “w asted five years" b eca u se m u ch o f C on g ress w as “full o f fears . . . m ainly fear o f C ath o lic o pposition."43 P olitician s realized th a t re fo rm e rs w ere n o t on e u nited p ow erful b loc. C a th o lics, o n th e o th e r hand, cou ld e x a ct p o liti­ cal rep risal if C on g ress lib eralized th e statute. The safest ro u te w as to avoid p o litica l resp o n sib ility and let th e p roposals die in co m m ittee.

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Judicial Reform W ith legislative ch an g e unlikely, S a n g er and h e r a sso cia te s sh ifted ta c tic s and sought a ju d icia l resolu tio n . They arran g ed to have a case o f vaginal p e s­ saries ship ped fro m Japan to Dr. H an n ah S to n e , a g y n eco lo g ist and lo n g tim e A B C L ally, and in fo rm ed th e cu sto m s office o f its arrival. W h e n th e g ov ern ­ m e n t seized th e p ro d u cts, th e A B C L had a re sp e c ta b le d o cto r as a c la im ­ an t.44 United States v. One Package ca m e b efo re Judge G ro v er M o sco w itz o f th e U.S. D istric t C o u rt o f S o u th e rn N ew Y ork in Jan u ary 1 9 3 6 . M o sco w itz d ecid ed in favor o f S ton e: w hile th e statu te seem ed to forbid th e im p o rta tio n o f a rticles to p revent co n cep tio n , h e b elieved it should b e co n stru e d m o re reason ab ly w ith regard to physicians. The g o v ern m en t appealed th e case, but ju d ges A ugustus N. H and, L earn ed H and, and T h om as Sw an in th e C ircu it C o u rt o f A ppeals upheld M o sco w itz in D e c e m b e r 1 9 3 6 . They added th a t d o cto rs had th e right to brin g su ch a rtic les in to th e cou ntry, to send th e m th rou g h th e m ails, and to use th e m fo r th e w ell-b ein g o f th e ir p atients. The ju d ges co n ten d ed th a t th e legislative in te n t w as to p rev en t co n tra ce p tiv es’ “im m o ra l" n o t p ro p e r m ed ical, use, esp ecially d isease p rev en tio n .45 T hese ju d g m en ts co n firm ed ju d icia l in te rp re ta tio n offered by C ra n e alm ost tw enty years earlier. One Package obviated th e N C F L b eca u se its goals had finally b e e n achieved , alth ou g h m an y state re strictio n s rem ain ed in ta ct. Sev eral co u rt d ecisio n s in th e early 1 9 3 0 s had laid th e basis fo r loo sen in g m e d ical re strictio n s on co n tra ce p tio n . In th re e cases co n cern in g im p o rted b o o k s th a t m e n tio n e d b irth c o n tro l th e co u rts ru led th a t th e m a teria l did n o t co n stitu te obscenity. In a n o th e r case involving a tra d e m a rk in frin g e m en t on co n tracep tiv e d evices Sw an re co m m en d e d a reev alu atio n o f th e legislative in ten t o f th e C o m sto ck Law.46 These fou r cases establish ed th e favorable ju ­ d icial clim ate th a t cu lm in ated in One Package. W h a t im p act did th e se co u rt cases have? P hysicians gained th e legal right to d istribu te con tracep tiv es. M o st A m erican s, how ever, pu rch ased b irth co n tro l th rou g h b o o tleg trade. O n ly on e p e rce n t o f an annual $ 2 5 0 m illio n in c o n tra ­ ceptive sales cam e fro m diaphragm s; th e m a jo rity o b tain ed d iaphragm s fro m p h arm acists w ith ou t a d o c to r’s p rescrip tio n . The sale o f co n d o m s b o o m ed u nd er th e guise o f d isease preven tion . The surge in m an u factu rin g as w ell as easier access did n o t sy m bolize a re je c tio n o f m o th e rh o o d . The initiative for co n tracep tiv e use cam e fro m w om en w ho w anted to im prove th e ir d o m estic situ atio n .47 They w ere generally n o t avoiding ch ild b irth bu t co n tro llin g th e tim in g o f b irth s eith e r to ach ieve e c o n o m ic stability or to attain th e grow ing n o rm o f a sm aller fam ily size. The 1 9 3 6 d ecisio n w as a tu rn in g p o in t. In its w ake th e A M A en d orsed co n tra ce p tio n in 19 3 7 . Failure to do so earlier did n o t im ply con sen su s: lo ca l

Population Control and the Great Depression, 1930—1939

g y n eco lo g ical s o cie tie s, th e A M A ’s O b s te tric , G y n eco lo g y and A b d o m in al Su rgery G rou p , and th e M e d ica l W o m e n ’s N a tio n a l A sso c ia tio n had e n ­ d orsed co n trace p tiv es years earlier, as had d o cto rs w orking in clin ics. The A M A jo in e d th e m in 19 3 7 n o t due to a b e lie f in a w om an’s right to co n tro l h er fertility bu t due to d o cto rs’ calls to cu rb th e d ispersal o f in effectiv e o r d anger­ ous co n tracep tiv es th a t had em erged to satisfy co n su m er dem and. T he FD A answ ered th is call in 1 9 3 7 by regu latin g and in sp ectin g co n d o m s. M ed ica l sch o o l cu rricu la in co rp o ra te d co n tra cep tiv e train in g , and m any d o cto rs now view ed b irth co n tro l as a m eans to avoid V D and p ro te c t w o m en ’s h ea lth fro m in cessan t ch ild bearin g . R ig hts to d istrib u te co n tracep tiv es m e a n t th a t so m e d o cto rs b en e fite d e c o n o m ica lly fro m a b o o m in g bu sin ess. C lin ics m u ltiplied, althou g h m an y d o cto rs favored h o sp ita l clin ics over freestan d in g clin ics b eca u se th e y view ed lay sta ff as p ossib le rivals.48 T hese chang es did n o t u sh er in a gold en age o f b irth co n tro l. The 1 9 3 0 s saw in crea sed p u blicity ab o u t and access to co n tracep tiv es co m p ared to earlier decad es. N o n e th e ­ less, m any w o m en and m e n still had no a ccess to a n d /o r little know ledge o f b irth con trol. Jud icial sa n ctio n also led to fed eral involvem ent in co n tracep tiv e d istrib u ­ tio n , alb eit on a sm all and qu iet scale. In 1 9 3 7 th e Farm S e cu rity A d m in istra­ tio n (FSA ), w h ich d ealt w ith m ig ran t cam p s and w as p articu larly co n c ern e d w ith m atern al and in fa n t h ea lth p rog ram s, acknow led ged th a t m an y w o m en req u ested in fo rm a tio n on co n tracep tiv es. S u ch initiative o n th e p a rt o f in d i­ gen t w om en dispelled th e n o tio n th a t th is group lacked th e d esire to co n tro l th e ir fam ily size. F SA staffers w orked w ith th e A B C L to d istribu te provisions in so u th ern and w estern m ig ran t cam ps, m ainly in C alifo rn ia. A B C L nurses in stru cte d F SA ag ents in viable co n tra cep tiv e m e th o d s, and by M a rc h 1 9 3 9 3 5 0 F SA w orkers w ere d istrib u tin g supplies. T h ese efforts fa ltered in th e S o u th fo r a n u m b er o f reason s: som e husbands opp osed b irth co n tro l; som e w o m en lacked n ec essa ry in fo rm a tio n ; so m e w o m en disliked th e m eth o d s available, esp ecially th o s e n o t su ited to h o m es or cam p s w ith ou t ru n n in g w ater; and so m e w o m en try in g to p ro cu re supplies w ith ou t a p re scrip tio n en co u n tere d re sista n ce o n ce th e A B C L ’s free sam ple k its ra n out. T h ese p rogram s rem ain ed in ta c t in C alifo rn ia th ro u g h o u t W o rld W a r II. D esp ite th e pop u larity o f th is plan, W a sh in g to n b u reau crats refu sed to m ak e know n th e ir w o rk w ith th e A B C L and w ithheld any m e n tio n o f co n tra ce p tiv es in th e ir re p o rts. The d eclin e o f th e F S A — due to w artim e e c o n o m ic prosperity, m ig ratio n o f farm ers to u rb an defense jo b s , in crea sin g o p p o sitio n in W a sh ­ in g to n to N ew D eal legislation, and ten sio n s betw een th e F S A and th e A M A over g ov ern m en t involvem ent in h ea lth care delivery serv ices— b ro u g h t an end to fed eral in volvem en t in m ainlan d b irth co n tro l d istrib u tio n u n til th e 1 9 6 0 s .49

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State-Funded Clinics The in creased n a tio n a l acc e p ta n ce o f co n tra ce p tio n co n trib u ted to th e em er­ g en ce o f pu blicly fund ed clin ics. They first ap p eared in th e S o u th , w here th e u nem p loyed sw elled re lie f rolls. N o rth C a ro lin a estab lish ed th e first state clin ic in 1937 u nd er Dr. G eo rg e M . C ooper, d ire cto r o f M a te rn a l and C hild H ealth and assista n t d ire cto r o f th e state bo ard o f health. C o o p e r receiv ed su p p ort fro m Dr. Jo h n N o rto n , a p u blic h ea lth officer w ho w as “on e o f th e earliest p eop le in th e co u n try to co m e rig h t o u t for b irth c o n tro l and to in sti­ tu te state-su p p o rte d serv ices” in 1 9 3 7 .50 C o o p e r w as w illing to in co rp o ra te co n tra ce p tio n in to th e p u blic h ea lth system , if h e cou ld secu re outsid e fu n d ­ in g .51 C la re n ce J. G am b le, lo n g tim e ad v ocate o f co n tra ce p tiv es, ag reed to co n trib u te $ 4 ,5 0 0 to fin an ce th e first year. F ou r years later, 7 5 p e rce n t o f state p u blic h ealth u nits offered co n tracep tiv e serv ices, a lth ou g h few w o m en su c­ cessfully o b tain ed in f o r m a t io n -o n ly 4 p e rce n t by 1 9 4 0 . G a m b le w ithdrew his m o n ey th e sam e y ear b eca u se officials k ep t th e p ro g ram q u ie t.52 Still, it gained n o to rie ty in so m e n a tio n a l p u b licatio n s as w ell as in state n ew sp ap ers.53 In 1 9 3 9 S o u th C a ro lin a m ad e c o n tra ce p tio n a p u blic h ea lth ser­ vice. In itiatin g a cam p aig n in 1 9 3 6 to red u ce m a tern a l and in fa n t d eath to lls, th e resu lting M a rc h 1 9 3 9 p ro g ram also in ten d ed to red u ce h ig h fertility o f th e p o o r and th o se on relief. O n e official reitera ted th e fam iliar axio m , “The p eop le least equipped to provide for th e m have th e bigg est fam ilies.” T hese serv ices m e t no p u blic o p p osition , p erhap s due to th e la ck o f a stron g C a th o ­ lic p resen ce. A labam a follow ed in 1941, as did F lorid a, G eo rg ia, M ississip pi, and V irginia by th e end o f th e d ecad e.54 G o v ern m e n t involvem ent in co n tra ce p tio n also em erged in P u erto R ico during th e m id -1 9 3 0 s. B etw een th e w orld w ars, b irth c o n tro l on th e island b e ca m e a co m p lex issue fou ght over by con ten d in g fa ctio n s. H ard -lin e eu g e n icists ad v o cated it to lim it p eop le o f color, p u b lic h ea lth w orkers and re fo rm e rs p ro m o ted it to red u ce m a tern a l and in fa n t m ortality, and m any w o m en fou ght fo r it to c o n tro l fam ily size. The C a th o lic C hu rch , on th e o th e r hand, opp osed it, as did th e N atio n alist Party, w h ich saw co n tra ce p tio n as an im p erialist and g en o cid al plan.55 W h ile ad vocates m anag ed to o p en v olu n ­ ta ry org anization s su ch as th e League fo r th e C o n tro l o f N atality, established in P on ce in 1 9 2 5 , and th e 1 9 3 2 B irth C o n tro l League in S a n Juan, th e y u lti­ m ately failed b eca u se o f ch u rch pressure. A s th e D ep ressio n w orsened , co lo ­ n ial b u reau crats believed o v erp op u lation exacerb ated grow ing jo b le ssn ess, d estitu tio n , m aln u tritio n , and so cia l tu rm o il.56 In M ay 1 9 3 5 th e P u erto R ico E m erg en cy R e lie f A d m in istration allow ed co n tra cep tiv es to b e disp ersed for m atern al h ea lth at fifty -th ree clin ics; so cia l w orkers referred individuals on relief. M ain lan d C a th o lic officials qu ashed th is plan. The follow ing year, E r­

Population Control and the Great Depression, 1930—1939

n est G ru en in g , d ire cto r o f th e D iv ision o f T e rrito rie s and Island P ossessions o f th e D e p a rtm e n t o f th e In terior, attem p ted to in c o rp o ra te co n tra ce p tio n in to P u erto R ica n R e co n stru c tio n A d m in istration p ro je c ts th a t d ealt w ith in ­ fan t and m atern a l health. B e c a u se 1 9 3 6 w as an e le c tio n year, th e g ov ern m en t b u ckled to C ath o lic o p p osition , esp ecially fro m C ard in al F ran cis J. S p ellm an o f N ew Y ork.57 A fte r One Package, how ever, th e P u erto R ica n legislature acted . A 1937 law allow ed d o cto rs to disp ense co n tra cep tiv es n o t only fo r m e d ica l reason s b u t fo r poverty and “bad so cia l co n d itio n s" and it legalized b o th eu gen ic and co n trace p tiv e sterilizatio n . Tw o years la ter th e In su lar H ea lth D e p a rt­ m e n t P ro gram in co rp o ra te d co n tra cep tiv e services. T w en ty -th ree privately fund ed clin ics o p en ed in P u erto R ico . In 1 9 3 9 a case ch allenging th e P u erto R ica n law reach ed th e fed eral co u rts. The ju d g e su stained th e legislation bu t, in line w ith One Package, b a rred e c o n o m ic and so cia l ju stifica tio n s. M ixed re a ctio n s ensued. W h ile m any fem in ists fou ght fo r th e rig h t to b irth co n tro l, th e C ath o lic C h u rch co n tin u ed its op p osition. M oreover, th e P u erto R ica n N atio n alist M o v em en t view ed co n tra ce p tio n as a m eans by w h ich im p eria l­ ists cou ld ig n o re th e s o c io e c o n o m ic p ro b lem s on th e island .58 N atio n alist aversion to co n tra ce p tio n re sem b les m ain lan d b la ck n a tio n a lists’ p o sitio n during th e 19 3 0 s.

The Response o f the Black Community B irth co n tro l w as n o t n ew to th e b la ck co m m u n ity during th e D ep ression . M an y b lack n ew spap ers had ad vertised m e th o d s sin ce th e late n in e te e n th century, B la ck B e lt p h a rm a cies had sto ck ed co n tra cep tiv es, and m any black s had p ractice d b irth c o n tro l p rio r to th e in tro d u c tio n o f clin ics in th e S o u th .59 N ev erth eless, co n tra cep tiv e prog ram s b ro u g h t m ixed re a ctio n s fro m b lack lead ers. S o m e o f th e m op p osed th e se prog ram s b eca u se o f race su icid e th e o ­ ries. D ea n Kelly M ille r o f H ow ard U niversity used arg u m en ts analogous to th o se em ployed by Teddy R oo sev elt and o th ers earlier: u p p er-class black s, th e in telle ctu al elite, w ere head ing tow ard ex tin ctio n , w hile th e m asses w ere m ultiplying. A lth ou g h h e d esired a re d u ctio n o f birth s am o n g th e poor, he believed access to co n tracep tiv es w ould only in c rea se an alread y w idening d ifferential b etw een th e b irth ra tes o f u p p er- and low er-class b la ck s.60 S o m e b lack n atio n alists also opposed liberalization . T hey believed th e sur­ vival o f th e race and th e au g m en tatio n o f its pow er depend ed u pon in crea sed n u m b ers. W . M o n ta g u e C ob b , a b la ck an th ro p o lo g ist, feared th a t in th e fu ­ tu re th e w hite m a jo rity m ig h t elim in ate a b la ck m inority. H e advised th e b lack A m e rican to “m a in ta in his high b irth rate. . . . This alo n e has m ad e h im able to in crea se in spite o f d ecim atin g m o rta lity hard ship s. I f th e tid e should

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tu rn against h im later,” he co n tin u ed , “stren g th w ill b e b e tte r th a n w eakness in n u m b er”61 This “pow er th ro u g h n u m b ers” rh e to ric did n o t a ttra c t a large au dience during th e 1 9 3 0 s. W .E .B . D u B o is criticiz ed th o se w ho w ere “led away by th e fallacy o f n u m b ers” and “ch e ere d by a cen su s re tu rn o f in crea sin g n u m b ers and a h igh rate o f in c re a s e ” D u B o is advised b la ck A m e rica n s to le a rn th a t “am o n g h u m an races and groups, as am o n g veg etables, quality and n o t m ere qu an tity really co u n ts” G eo rg e Schuyler, co lu m n ist fo r th e Pittsburgh Cou­

rier, agreed: it w as “fa r b e tte r to have less ch ild ren and im prove th e so cial and physical w ell-b ein g o f th o se th e y have.” Dr. C h a rle s H . G a rv in argued th a t co n tra ce p tio n w ould n o t lead to “race su icid e” b u t to “ra ce p reserv atio n and ad vancem ent.” R a cia l im p ro v em en t w ould b e realized w ith “few er and stron g er b abies, h ig h er quality, low q u an tity p ro d u c tio n ”62 S o m e lead ers opp osed co n tra ce p tio n on religiou s ground s. M a rcu s G a r­ vey and his follow ers believed it in terfered w ith G o d ’s will. A t th e S ev en th A n n u al C on v en tion o f G a rv ey ’s U niversal N egro Im p rov em en t A sso cia tio n , held in Jam aica in 1 9 3 4 , m e m b ers u nan im ou sly ad opted a reso lu tio n re c o m ­ m end in g th a t b lack s n o t “a cc ep t o r p ra c tice th e th e o ry o f b irth co n tro l su ch as is b ein g ad vocated by irresp o n sib le sp ecu lators w ho are attem p tin g to in ­ te rfe re w ith th e co u rse o f natu re and w ith th e pu rp ose o f th e G o d in w hom w e b eliev e” G arv ey ’s religiou s b ackg rou n d w as C a th o lic, and th e se view s re ­ fle cte d th e d ictates o f th e ch u rch .63 M o s t b la ck m in isters did n o t ag ree w ith th is m o ral o b je ctio n . M a n y spoke o f fam ily lim ita tio n fro m th e pulpit and d istribu ted p am p h lets am on g th e ir co n g reg a tio n s.64 O th e r p ro m in en t b lack s n o t only en d orsed co n tracep tiv es bu t su pported th e m o n fe m in ist g round s. D u B o is, fo r exam p le, co n ten d ed as early as 1919 th a t th e “fu tu re w om an m u st have a life o f w ork and fu tu re in d e p en ­ dence. . . . Sh e m u st have know ledge and she m u st have th e rig h t o f m o th ­ erh oo d at h e r ow n d isc re tio n ” T h ree years la ter he criticiz ed as “re a c tio n ­ ary b arb a ria n s” b irth c o n tro l o p p o n en ts w ho d esired w o m en to fulfill th e ir b io lo g ical fu n ctio n . G a rv in w ro te th a t it w as th e “in alien able rig h t o f every m a rried w o m an to use any physiologically sound p re ca u tio n ag ainst re p ro ­ d u ction she deem s justifiable.” D isp u ting D ean M ille r’s c o n te n tio n th a t b lack w o m en had to o few ch ild ren , jo u rn a list J. A. R og ers d eclared : “I give th e N egro w om an cre d it if she end eavors to b e so m eth in g o th e r th a n a m ere breed in g m ach in e. H aving ch ild ren is by n o m ea n s th e sole re a so n for b e ­ in g ”65 S im ilar th e m es are also apparent in th e w riting s o f so m e b la ck w om en. In plays p u blish ed a fter W o rld W a r I, fem ale au th o rs c riticiz e d th e la ck o f a ccessib le b irth co n tro l.66 B la ck w o m en ’s fic tio n also dealt w ith b irth co n tro l as a sign ifican t a sp e ct o f th e ir lives, esp ecially Jessie F a u set’s The Chinaberry

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Tree and N ella L a rsen ’s Quicksand. B la c k w om en, acco rd in g to h isto ria n L o ­ re tta J. R oss, “saw th em selv es n o t as b reed ers o r m a tria rch s b u t as builders and n u rtu rers o f a race, a n a tio n "67 S u ch fem in ist th e m es, n o tice a b ly a b sent am o n g w hite ad vocates o f co n tra ce p tio n , gained su p p ort fro m so m e w om en and m e n in th e b la ck com m unity. B la ck n ew sp ap ers generally su p p orted co n tra ce p tio n . T hey argued th a t b irth co n tro l cou ld red u ce th e n u m b er o f b la ck w o m en dying fro m bungled ab o rtio n s. N ew spapers offered re sp e c tfu l coverage o f b la ck d o cto rs arrested fo r p erfo rm in g safe, a lb eit illegal, a b o rtio n s. S to rie s re p o rte d th a t su ch a b o r­ tio n s w ere th e resu lt o f w om en ’s efforts at rep ro d u ctiv e co n tro l, n o t o f “p o o r h ealth o r sexually tra n sm itted d ise a ses" M a in strea m w hite new spap er cover­ age differed greatly: n e ith e r a b o rtio n ists n o r w o m en ten d ed to b e portrayed sym pathetically. W h ile su pportive o f b irth co n tro l, b la ck new spap ers c r iti­ cized any p o licies th a t p ro m o ted p op u lation co n tro l.68 Ind ivid ual au tonom y w as p aram o u n t, esp ecially in light o f w hite p op u latio n c o n tro l rh e to ric ca ll­ ing to red u ce th e fertility o f th e “inferior,” a te rm easily co n stru ed by th e b lack co m m u n ity to apply to th em . M an y b la ck a ctiv ists co n sid ered co n tra ce p tio n as p a rt o f a co m p re h e n ­ sive h ea lth prog ram . M o st p a rticip a n ts d istribu tin g co n tra cep tiv e in fo rm a ­ tio n w ere also active in h ea lth clin ics and b la ck w o m en ’s clubs. T hey believed co n tracep tiv es cou ld help im prove th e h ea lth and status o f th e ir n eig h b o rs as w ell as b rin g racia l uplift. In ru ral areas h o m e d em o n stra tio n ag ents (sim i­ lar to settlem e n t w orkers in u rb a n areas) visited h o m es to spread in fo rm a ­ tio n o n a h o st o f h ea lth issues, in clu d in g b irth co n tro l. U nlik e m any w hites w ho saw co n tra ce p tio n as a p an acea for th e poor, m any b lack s co n sid ered it on e a sp e ct o f a larg er agenda. It could help elim in ate on e cau se o f s o c io ­ e co n o m ic stress, bu t real p rog ress could only b e ach ieved if so ciety insured eq u al e co n o m ic, p olitical, and so cia l o p p o rtu n itie s.69 B la c k activ ists stressed th e h ealth a sp e cts o f co n tra ce p tio n and avoided any m e n tio n o f free sexu al­ ity, an u nd erstan d ab le ta c tic in light o f w hite stereoty p es su rround ing b lack sexuality, th a t is, th a t w om en w ere p ro m iscu o u s and m e n h y p erp o ten t. The b lack com m u nity, th e refo re, w as fairly recep tiv e to b irth co n tro l. The C olo red W o m en ’s C lu b M o v em en t ch am p io n ed it, as did th e N atio n al U rb an League, th e N atio n a l A sso c ia tio n fo r th e A d v an cem en t o f C olo red P eople (N A A C P ), th e N atio n al C o u n cil o f N egro W o m en , and lead ing b la ck n ew s­ papers su ch as th e Pittsburgh Courier and th e San Francisco Spokesman. The R everend A dam C lay ton Pow ell, Jr., p a sto r o f th e A byssinian B a p tist C hu rch in N ew Y ork City, to u red pu blicly to ad vocate b irth co n tro l. T he m inu tes and n ew sletters o f th e B u reau o f S o c ia l H ygiene and th e D iv ision o f N egro S e r­ vice (D N S), a d ep artm en t establish ed w ith in th e B irth C o n tro l F ed eratio n o f

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A m e rica (B C FA ) in 1 9 3 9 , show ed stron g su pport fo r co n tra cep tiv es am ong th e b lack com m u n ity.70 The n a tio n a l advisory co u n cil o f th e D N S inclu d ed D u B o is; M ary M cL e o d B eth u n e , fou n d er and head o f th e N atio n al C o u n cil o f N egro W o m en ; W a lter W h ite , execu tiv e d ire cto r o f th e N A A C P ; A dam C lay to n Pow ell, Jr.; and P ro fe sso r E. F ran k lin Frazier. A . P hilip R an d olp h , p resid en t o f th e B ro th e rh o o d o f Sleep in g C a r P orters, le n t his su p p ort, and th e N atio n al M ed ica l A sso cia tio n (th e b la ck co u n te rp a rt to th e w hite A M A ) en d orsed co n tra ce p tio n in 19 4 1 .71 L o re tta J. R oss has argued th a t h isto ria n s have o ften p ortrayed th e c o n tra ­ ceptive m o v em en t as having b e e n “th ru st u p o n re lu cta n t A frica n -A m erica n s by a p o p u lation co n tro l estab lish m en t anxious to co n tro l b la ck fertility " In ­ stead, S a n g e r’s early fem in ist arg u m en ts fo r b irth c o n tro l help ed to galvanize b lack w om en ’s “co v ert su p p ort for and use o f fam ily p lanning in to th e v is­ ib le pu blic su p p ort o f a ctiv ists in th e clu b m o v e m e n t"72 H isto ria n Joh an n a S c h o e n asse rts th a t in m any lo ca le s w hite officials h in d ered b la ck a ccess to b irth co n tro l b eca u se w hite w o m en o ften refu sed to u se a n in teg rated clin ic or b eca u se officials did n o t believe th e g ov ern m en t should provide h ea lth serv ices fo r b lack s.73 A frica n A m e rica n a ctiv ists form ed th e ir ow n clin ics, a feat so m e w hite p op u latio n co n tro l ad vocates h ailed as an effective ch e ck on b lack fertility. W h e n th e In tern a tio n a l U n io n fo r th e S c ie n tific In v estigation o f P op u lation P ro b lem s claim ed at its 1931 m e etin g th a t th e b la ck pop u la­ tio n would in crea se in th e U n ited S ta tes b eca u se o f im m ig ra tio n re strictio n s, h ig h er w ages, im proved h ygienic and so cia l co n d itio n s, and red u ced infant m ortality, A m e ric a n delegates refu ted th is co n clu sio n b ased on th e opening o f co n tracep tiv e clin ics, w h ich w ere b ein g “co n sid erably used by th e neg ro p o p u la tio n "74 D esp ite th e se in te n tio n s, b la ck w o m en b en efited fro m and h elp ed to spread su ch services. The in v olv em en t o f th e b la ck co m m u n ity ca n b e see n in th e esta b lish ­ m e n t o f n eig h b o rh o o d clin ics. In 1 9 2 5 th e N atio n al U rb a n League w orked w ith th e A B C L to estab lish a clin ic in th e p rim arily bla ck C olu m bu s H ill area o f th e B ro n x. Four years la ter th e U rb a n L eag u e and th e B C C R B o p en ed a clin ic in H arlem , en d orsed by th e b la ck new spaper, th e Amsterdam News. W h e n re strictio n s on co n tra cep tiv e in fo rm a tio n lo o sen ed during th e 1 9 3 0 s , b lacks op ened and op erated clin ics in n u m ero u s cities, inclu d ing B a ltim o re ; R ich m on d , F red erick sbu rg, and L ynchburg, V irginia; N ashville; and B erk ely C ounty, So u th C arolin a. K en tu ck y had a n u m b er o f clin ics, as did O k lah om a and W a sh in g to n , D .C . W e st V irg inia o p en ed th e first statew ide b irth co n tro l clin ic op erated by black s in 19 3 8 . L ittle organized re sista n ce to th e se clin ics w ith in th e b lack co m m u n ity em erged , and b la ck u rb a n b irth ra tes d eclined n o tice ab ly during th e 1 9 3 0 s , m im ick in g a tren d th a t had beg u n in th e 1 8 8 0 s.

Population Control and the Great Depression, 1930—1939

The n atio n al black T F R fell fro m 7 .5 in 1 8 8 0 to 2 .8 7 in 1 9 4 0 . T hat th is d ecline w as p art o f a co n scio u s attem p t by black s to lim it th e ir fertility is n o long er in dispute. The h ea lth th e sis p o sited by earlier h isto ria n s— th a t th e d eclin e in b lack fertility w as a resu lt o f p o o r h ea lth co n d itio n s and d iseases— has b ee n con vin cin gly refu ted by h isto ria n C arole R. M c C a n n and o th e rs.75

The Case o f Rhode Island The g rassro o ts activ ism w itn essed in so m e b la ck co m m u n itie s and in w hite v o lu n teerism in clin ics su ch as th e C leveland M a te rn a l H ealth A sso cia tio n w as also ap p aren t in R h od e Island. The situ atio n h ere w as u niqu e in several ways. N o t only did th e clin ic serve all ra ces, relig ion s, and e th n ic itie s, but it w as th e only on e in N ew England. D esp ite a large C a th o lic p resen ce, th e legislature did n o t re s tric t a ccess to b irth co n tro l, n o r did it clo se th e clin ic. S o m e claim ed th a t th is la ck o f reg u lation w as a legacy o f free exp ression and civic lib erty by state fou n d er R og er W illia m s.76 The clin ic sta ff follow ed th e n atio n al d isco u rse o n co n tra ce p tiv es closely b u t re je c te d th e eu gen ic and classist rh e to ric o f S a n g e r’s A B C L , a lth ou g h th e y did share th e aversion to fem in ist ju stific a tio n fo r b irth co n tro l. The clin ic em p h asized in stea d th e co n n e ctio n b etw een c o n tra ce p tio n and w o m en ’s h ealth , a ta c tic th a t helped q u iet o p p o sitio n to its program . The R h od e Island B irth C o n tro l League (R IB C L ) op ened on 31 July 1931 in P rovid en ce w ith a n an n u al bu dget o f five th o u san d dollars. T he presid ent o f B ro w n U niversity, th e d ean o f P em b ro k e C ollege, fou r P ro te sta n t c le r­ gym en, fo rty -th re e p h y sician s, and “civ ic-m in d ed citiz e n s ” sp o n so red th e clin ic, lend ing it a sen se o f au th o rity in th e com m u nity. The sta ff inclu d ed a m ale d octor, a tra in ed fem ale so cia l w orker, and a reg istered fem ale nurse. The execu tiv e officers over th e n ex t tw o d ecad es w ere w om en, w ith a few ex ­ cep tio n s; th e d o cto rs w ere all m en, o sten sibly to gain legitim acy. The R IB C L w orked closely w ith physicians: o f 8 0 h o n o ra ry m e m b ers, 3 9 w ere d o ctors, and th e R IB C L receiv ed en d o rsem en ts fro m 119 “p ro m in e n t” physicians. Dr. Edw ard S. B ra ck e tt, c h ie f o f sta ff o f P rovid en ce L ying-In H osp ital, b eca m e th e m e d ical advisor. Thus, th e te n sio n betw een d o cto rs and clin ics ex p eri­ en ced in o th e r studies does n o t apply to R h od e Island. M oreover, th e clin ic o p en ed six years p rio r to A M A en d o rse m en t o f co n tra cep tiv es, d em o n stra t­ ing th a t physicians did n o t speak in on e voice on th is issue. A s w hite elite m en , th e ir su p p ort m ay have b e e n p art o f th e p op u latio n co n tro l agenda, but th e reco rd s m ake no su ch referen ce. In so m e ways th e clin ic m irro red d evelop m en ts in o th e r reg ion s. M o st if n o t all o f th e officers and bo ard m e m b ers w ere P ro te sta n t: reco rd s m e n ­

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tio n u nsu ccessfu l attem p ts to in d u ce lo c a l C a th o lic lead ers to jo in th e board o f d ire cto rs. W h ile th e clin ic w orked w ith b la ck co m m u n ity lead ers, staff and b o ard m e m b ers appear to have b e e n w hite. The R IB C L op ened tw o ex ­ te n sio n clin ics, on e in N ew p o rt in F ebru ary 1 9 3 5 and on e in W a sh in g to n C ou n ty in Ju ne 1 9 4 0 .77 A ll th re e gave advice only to “p rop erly a ccred ite d m arried w o m en ” w ho “b eca u se o f m en ta l o r physical d isability ca n n o t safely b e a r ch ild ren ” and charged fees on a sliding scale. A referra l to th e clin ic had to b e m ad e by eith er a private physician, a hosp ital, a clin ic, or a “reco g n ized agency.” The fou nd ing w o m en boldly p rin ted “B irth C o n tro l C lin ic ” on th e door. The “m o re co n serv ativ e m e m b ers o f [the] m ed ical staff,” how ever, w ere n o t as w illing to p u blicize th e ir w ork. W h e n Life m ag azine sen t a re p o rte r to w rite ab o u t th e clin ic, sta ff “w ould allow n o n e o f it.”78 D o c to rs realized th e fine line th e y w ere w alking and th a t th e y stoo d to lo se re sp ec t and s o c io e c o ­ n o m ic status if th e y w ere p ortrayed in a negative light in th e n a tio n a l m ed ia, esp ecially in th e co n tex t o f A M A silen ce o n th e issue at th is poin t. A legal battle ensu ed follow ing th e clin ic ’s opening. T he board o f ald erm en voted eight to th re e to co n d em n th e clin ic b ased o n A n ton io C. V en tro n e’s argu m en t th a t it w as illegal and “m o rally w rong.” The Providence Visitor, a C ath o lic new spaper, jo in e d “th e fray in d esp erate fu ry ” and pu blished a fro n t­ page p ictu re o f R IB C L presid en t M rs. H en ry S a lo m o n th a t p ortrayed h er as “a m alev o len t old w itch scu rry in g ab o u t and carry in g a m o st sin ister lo o k ­ ing b lack bag.” A m o n th later th e ald erm en reversed th e ir d ecisio n b ecau se R h od e Island had n o law th a t regu lated su ch a clin ic and n o statu te th a t de­ nied an individual’s right to b irth co n tro l. V en tro n e resp o n d ed th a t “if a phy­ sician w ere to attem p t a n a b o rtio n , h e w ould b e fou nd guilty o f m u rd er in th e first degree. This is on e step earlier.” H is colleagu es disagreed. O n e defended b irth co n tro l o n th e basis o f free d o m o f ch o ice: “It is n o t for m e to d ecid e fo r o th ers w h eth er . . . b irth co n tro l . . . is right or w rong. . . . It is b est left to th e co n scie n ce o f ea ch individual,” an arg u m en t in line w ith R og er W illia m ’s ph ilosop h y o f civ ic liberty. A n o th e r argued th a t th e n a tio n w as inu nd ated w ith “repressive, p ro h ib ito ry legislation ” th a t resu lted fro m “in to lera n ce, big ­ otry, [and] fan atica l fren zy ” and th a t co n tra d icted th e A m e rica n h eritag e o f “p erso n al freedom .” W o m e n ’s h ea lth w as also a co n c e rn , one b est left to th e m ed ical, n o t legislative, arena: “T h ere ca n b e n o th in g im m o ra l in a d o cto r giving a p atien t in fo rm a tio n w h ich m ay la ter save a m o th e r’s valuable life.”79 W ith n o legal o b sta cles, th e clin ic p rim arily served R h od e Island ers, bu t it w as o p en to o th e r N ew E ngland ers as well. The “m a jo rity o f th e p a tie n ts” w ere “fro m fam ilies living on extrem ely lim ited in co m es.” T h irty -tw o p e rce n t o f w o m en had u nem ployed husbands “entirely d ep en d en t u p o n charity.” The rem ain d er lab ored u nd er “e c o n o m ic h an d icap s” th a t m ad e th e “ad d ition o f

Population Control and the Great Depression, 1930—1939

a n o th e r m o u th to feed . . . a real calam ity.”80 The reco rd s a ttest to w o m en ’s d eterm in atio n to c o n tro l th e ir fertility. They w ere n o t pu shed by ag en cies to visit th e clin ic, d espite th e strictu re th a t w o m en b e referred ; in stead , th e m ajo rity cam e “on th e ir ow n initiative.” O f th e first eight hu nd red clie n ts, 78 p e rce n t had u n su ccessfu lly trie d co n tra cep tiv es b efo re seeking aid. B y 1935 th a t p ercen tag e w as 8 4 .3 and by 1 9 3 9 91 p e rce n t.81 S u ch statistics are im p o rta n t fo r sev eral reason s. First, th e y co n firm A n ­ d rea T o n e ’s arg u m en t th a t m o st A m e rica n s o b ta in ed co n tra ce p tiv es from b o o tleg trad e, p h a rm a cists, and th e like.82 S e co n d , th e y co n firm th a t low erin co m e cou ples d esired to co n tro l th e ir fertility; access, n o t ig n o ra n ce and re tice n ce , as p op u latio n co n tro llers co n ten d ed , w as o ften th e barrier. C lin ics in o th e r areas fou nd sim ilar resu lts. Dr. S a ra h M a rcu s’s clin ic on C leveland ’s S o u th Sid e am o n g im m ig ran ts and w o rk in g -class w o m en m ad e h er aw are o f th e d esp erate d em and fo r safe and reliable co n tra ce p tio n . Dr. M a rie Kopp analyzed te n th o u san d cases fro m N ew Y ork C ity co lle cted by th e B C C R B in 1 9 3 2 and fou nd th a t n early all o f th e sam ple cam e fro m th e p o o re r classes.83 The average ap p lican t w as b etw een th irty and th irty -fiv e years old, had b ee n m a rried eight years, and had a fam ily in c o m e o f less th a n tw en ty dollars a w eek. B e fo re seekin g m e d ica l advice, 9 3 .3 p e rce n t had a ttem p ted som e fo rm o f b irth co n tro l (excluding a b stin en ce). A sim ilar 1933 in vestigation in a N ew ark, N ew Jersey, clin ic d eterm in ed th a t 91.5 p e rce n t o f th e clien ts had em ployed fam ily lim ita tio n b efo re visiting th e clin ic.84 W h ile th e se studies have an u rb an b ias, th e y still te stify to lo w er-in co m e w o m en ’s m o tiv atio n to co n tro l th e ir child bearing . W h o w ere th e se w om en? H isto rian Jim m y Elaine W ilk in so n M e y e r’s study o f th e C leveland M a te rn a l H ealth A sso c ia tio n lacked ra cia l or eth n ic data on clie n ts, bu t th e R IB C L k ep t su ch reco rd s. F ro m A ugust 1931 to D e c e m b e r 1933 R IB C L sta ff re co rd ed th e e th n ic /ra c ia l id en tity o f 7 7 6 w o m en (see table 4.1). In th e early years “A m e ric a n s” co m p rised 52 p e rce n t o f th e clien tele and im m ig ran ts and seco n d g en era tio n 4 8 p ercen t. W h ile th e eth n ic b ackg rou n d o f clien ts generally m a tch ed th a t o f th e state, d iscrep an cies w ere apparent w ith th e E nglish, Irish , and F ren c h C anad ians. A s W A S P s, B ritish im m i­ grants m ay have faced less d iscrim in a tio n and th u s w ere sou n d er financially. For th e Irish and F ren ch C anad ians, C a th o licism could have b e e n a d eter­ m inin g factor, althou g h it did n o t seem to a ffe ct Italian s significantly. In 1935 th e staff listed only th re e categ ories: A m erican , 6 9 p e rce n t; Italian, 9 p ercen t; and other, 2 2 p e rcen t. The in c rea se in A m e rica n s w as due to th e elim in atio n o f th e seco n d -g en era tio n division. The follow ing year th e Italian sep aration disappeared, leaving A m erica n , 7 0 p e rce n t, and other, 3 0 p e rce n t. H ad th e R IB C L b e e n sw ept up in th e ra c ist rh e to ric prevalent at th e n a tio n a l level,

1 01

T a b le 4 .1 . E t h n ic it y o f R I B C L C lie n t s a n d S t a t e R e s id e n t s R I B C L c l ie n t s

% s ta te p o p u l a t i o n

“A m e r ic a n ”

4 0 4 ( 5 2 .0 6 % )

—

I t a lia n

1 1 0 ( 14 .17 % )

19 .7

I t a lia n s e c o n d g e n e r a t io n

3 1 (3 .9 9 % )

—

P o rtu g u e se

3 0 ( 3 .8 6 %)

4 .3

E n g lis h

2 9 ( 3 .7 3 % )

1 2 .7

C a n a d ia n

2 1 ( 2 .7 0 % )

4 .2

A r m e n ia n

1 7 ( 2 .1 9 % )

0 .8

“A m e r i c a n N e g r o ”

1 7 ( 2 .1 9 % )

1.4

R u s s ia n

1 4 ( 1 .8 0 % )

2 .9

J e w is h

1 2 ( 1 .5 4 % )

—

I r is h

1 1 ( 1.4 1% )

1 4 .9

E n g l is h s e c o n d g e n e r a t io n

1 1 ( 1.4 1% )

—

S co tch

9 ( 1.15 % )

3 .2

I r is h s e c o n d g e n e r a t io n

4 ( 0 .5 1% )

—

P o lis h

4 ( 0 .5 1% )

4 .8

C a n a d ia n s e c o n d g e n e r a t io n

4 ( 0 .5 1% )

—

N o v a S c o t ia n

4 ( 0 .5 1% )

—

P o r t u g u e s e s e c o n d g e n e r a t io n

3 (0 .3 8 % )

—

J e w i s h s e c o n d g e n e r a t io n

3 (0 .3 8 % )

—

G e rm an

3 (0 .3 8 % )

2 .2

A u s tr ia n

3 (0 .3 8 % )

0 .4

S w e d is h

3 (0 .3 8 % )

3 .0

F r e n c h C a n a d ia n

3 (0 .3 8 % )

1 9 .6

F r e n c h C a n a d i a n s e c o n d g e n e r a t io n

2 (0 .2 5 % )

—

F ren ch

2 (0 .2 5 % )

0 .9

F r e n c h s e c o n d g e n e r a t io n

2 (0 .2 5 % )

—

L it h u a n ia n

2 (0 .2 5 % )

0 .5

R u s s i a n s e c o n d g e n e r a t io n

2 (0 .2 5 % )

—

B r a z il ia n

2 (0 .2 5 % )

—

“ R o u m a n ia n ”

2 (0 .2 5 % )

0 .2

S w e d is h s e c o n d g e n e r a t io n

2 (0 .2 5 % )

—

D a n i s h s e c o n d g e n e r a t io n

1 ( 0 .12 % )

—

D u tch

1 ( 0 .12 % )

—

N o r w e g ia n

1 ( 0 .12 % )

0 .3

S y r i a n s e c o n d g e n e r a t io n

1 ( 0 .12 % )

—

F in n

1 ( 0 .12 % )

0 .2

B e lg ia n

1 ( 0 .12 % )

0 .3

P o lis h s e c o n d g e n e r a t io n

1 ( 0 .12 % )

—

G e r m a n s e c o n d g e n e r a t io n

1 ( 0 .12 % )

—

A r m e n i a n s e c o n d g e n e r a t io n

1 ( 0 .12 % )

—

G reek

1 ( 0 .12 % )

0 .5

I n d ia n

1 ( 0 .12 % )

—

Sources : Monthly reports of social worker, files 1932, 1933, PPRI Records; U.S. Bureau of the

Census, F ifteenth Census o f th e U nited States: 1 9 3 0 , vol. 3, pt. 2 (Washington, D.C.: Government Printing Office, 1932), 762.

Population Control and the Great Depression, 1930—1939

th e sta ff w ould have lam en ted th a t th e m a jo rity o f clie n ts w ere A m erican , n o t im m ig ran ts, bu t n o su ch critic ism is evident. T he average clien t age was tw e n ty -n in e.85 O f th e 2 ,2 2 1 clien ts b etw een 1931 and 1 9 3 8 , 4 3 p e rce n t had n o t finished g ram m ar sch o o l, and only 11 p e rce n t had g rad uated h ig h sch o o l (versus a n atio n a l average o f 3 0 p e rce n t).86 Th ese low ed u catio n al levels did fit p op u latio n co n tro lle rs’ ta rg e t groups, bu t th e R IB C L reco rd s do n o t hail as su ccessfu l th e ir w ork to red u ce fertility am o n g th e p o o r and u ned ucated. W h ile th e y m ay have d iscu ssed th is a sp e ct am o n g st th em selv es, th e y left no w ritte n evidence. R IB C L sta ff did re co rd th e m otiv atin g fa c to r fo r clien ts. B etw een A ugust 1931 and D e ce m b e r 19 3 3 3 2 .4 8 p e rce n t o f th e w o m en cam e w ith a physician’s referral; 31.33 p e rce n t ca m e o f th e ir ow n a cco rd d espite re strictio n s on self­ referrals. M ed ica l and so cia l ag en cies re ferred 11 and 6 p e rce n t, respectively, w hile 3 .0 9 p e rce n t fell am o n g “o th e rs "87 Th ese sta tistics are telling . First, de­ spite th e A M A ’s silen ce p rio r to 1 9 3 7 , private physicians w ere reco m m en d in g co n tracep tiv e serv ices fo r p atien ts. T hat th e y referred ra th er th a n d ealt w ith w o m en could b e a resu lt o f la ck o f tra in in g in co n tra cep tiv es, fea r o f being affiliated w ith a co n tro v ersial to p ic, or a re co g n itio n o f p a tie n ts’ n eed s for subsidized d evices, a serv ice th e y w ere u nw illing to provide. S e co n d , phy­ sician and ag en cy referrals cou ld re flec t th e w hite elite e sta b lish m en t’s a t­ te m p ts to red u ce th e fertility o f th e p o o r and u ned u cated . Third, against th e n atio n al rh e to ric th a t lo w -in co m e w o m en w ere unw illing to em ploy c o n tra ­ ceptives, R IB C L clien ts d em o n strated m ark ed d eterm in a tio n to gain access. T h eir resolve in c rea sed as th e D ep re ssio n co n tin u ed (see ta b le 4 .2 ). M o st self-referrals h eard fro m o th e r p atients and sought advice even th o u g h th ey knew “th e y [were] ex p ected to brin g a p hy sician’s sta te m e n t"88 S e lf-referra ls w ere n o t tu rn ed away; p atien t co n fid en tiality w ould have preven ted o u tsid ­ ers fro m d iscern in g w h eth er th e sta ff ad hered to clin ic referra l policy. Self-referrals w ere m o re co m m itted th a n w o m en w ho had b e e n referred . R IB C L so cial w orker S o p h ie R. G o rd o n o ften called referrals “n o n -c o o p e ra ­ tive p atien ts" w ho refu sed to re tu rn fo r follow -ups. S o cia l w orkers in stitu ted a h o m e v isito r plan to re a ch th e m , b u t it w as ineffective: so m e argued th a t th e ir husbands or clerg y m en opp osed co n tra ce p tio n o r th a t co n tracep tiv es w ere to o “tr o u b le s o m e "89 That re fe rred w o m en w ere n o n co m p lia n t is n o t su rprising. They m ay have v isited d o cto rs or so cia l ag en cies fo r p ro b lem s u nrelated to b irth co n tro l. To have an ou tsid er suggest a n eed to red u ce fa m ­ ily size cou ld have b e e n co n stru e d as a critic ism o f existin g fam ily n o rm s. D o c to rs and ag en cies m ay have referred fam ilies th e y co n sid ered “u nfit" or “in ferio r" a d istin ctio n th e se w om en w ould have re je cted . T he sta ff offered no u nd erstan d in g o f th e d ilem m a th e se w o m en faced bu t sim ply lab eled th e m

1 03

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T a b l e 4 .2 . R e f e r r a l o f W o m e n t o R I B C L , 1 9 3 5 - 1 9 3 9 Y ear

S e lf - r e f e r r a l

P h y s ic ia n r e f e r r a l

C o m m u n ity a g e n c y

19 3 5

37%

33%

30%

19 3 6

38%

36%

26%

19 3 7

45%

34%

2 1%

19 3 8

59%

25%

16 %

19 3 9

53%

28%

19 %

“u n co o p erativ e” b eca u se th e y re je c te d advice th a t ag en cies and sta ff m e m ­ bers believed w as in th e re ferred w o m en ’s b est in tere st. The la tte r m ay have in terp reted su ch su ggestions as co e rcio n as th e y cam e fro m th o se w ith pow er and status. S o m e o f th e “n o n co o p era tiv e p a tie n ts” co m p lain ed a b o u t th e m eth o d s p rescrib ed . S im ila r to n a tio n a l tren d s, th e m o st p re scrib ed m e th o d w as th e diaphragm w ith jelly (9 3 .4 3 p e rce n t, versus th e co n d o m w ith jelly, 4 .3 7 p er­ cen t, th e sponge w ith foam , 1.87 p e rce n t, and th e cerv ica l cap w ith jelly, 0.31 p e rce n t).90 S o m e re ferred w o m en refu sed th e diaphragm b eca u se eith e r it w as to o cu m b e rso m e, or it cau sed irrita tio n , or th e y lacked th e co n fid en ce to u se it properly. O n e so cia l w orker con clu d ed , “F ortu n ately th e re is a very large group o f very co o p era tiv e and ap p reciativ e w o m en w ho m o re th a n ‘m ake up’ fo r th o se few p a tie n ts” w ho, o n ce referred , did n o t re tu rn .91 T hese ap p reciative w om en ca m e o f th e ir ow n v o litio n ra th er th a n b ein g fo rced to do so, an im p o rta n t d istin ctio n so cia l w orkers failed to m ake. N in ety p e rce n t re tu rn ed regularly, and th e y ex p erien ced a 9 7 p e rce n t su ccess rate fro m 1 9 3 4 to 19 4 1 .92 The h u sb an d ’s ro le in co n tra ce p tiv e d ecisio n s w as m ixed . The so cia l w orker claim ed th a t “w ith very few ex cep tio n s, th e ap p lican ts have talked over w ith th e ir husbands th e ad visability o f seeking advice and th e d ecisio n is, th e refo re, on e w h ich has b e e n re a ch ed by th o se m o st in terested .” The h u sb an d ’s co n se n t, how ever, w as n o t m an d ated . S o m e a cc o u n ts re p o rte d h u sb an d s’ refu sal b eca u se a w om an ’s duty w as to b e a r u n lim ited child ren. A tw en ty -sev en -y ear-o ld w om an w ith seven ch ild ren found p in h oles in h er diaphragm . The clin ic d o c to r gave h er a n ew on e and told h e r to hid e it and p lace th e old one in th e u sual sp o t.93 W h ile his a c tio n en cou rag ed m a rita l d ecep tio n , it d em o n strated co n c e rn fo r th e p a tie n t’s w ell-b ein g over socially accep ted n o rm s o f p atriarch y in m arriage. These reco rd s d em o n strate b irth c o n tro l’s im p a ct on m arried w om en. “M y husband has w orked o n and o ff fo r th e last five years,” d eclared on e w om an. “W e love o u r ch ild ren dearly, bu t w h en you are u nable to provide fo r th o se you alread y have, I don’t th in k it fa ir to b rin g m o re in to th e w orld.” O n e

Population Control and the Great Depression, 1930—1939

w o m an w ith fou r o f h e r six ch ild ren living and h e r hu sband u nem ployed to ld G o rd o n , “You ca n ’t im agin e w hat a ch an g e h as ta k e n p lace sin ce m y in stru ctio n s here. F or th e first tim e in o u r 16 years o f m a rried life w e are living naturally. The w orry, th e dread, and th e te n sio n has d isappeared and I feel young again.” Sim ilarly, a n o th e r clien t rem arked , “I w as sick and d is­ cou raged to d eath o f m arried life. I th o u g h t all o f th e tim e a b o u t d ivorcing m y husband,” b u t now, “w ith ou t any fea r o f g ettin g p regn an t it seem s as if w e are living a n ew l i f e - f r e e fro m w orry” B irth co n tro l also co n trib u te d to su ccessfu l child rearing . As on e w om an con clu d ed , “T he B irth C o n tro l C lin ic has ch an ged m e fro m a cross, irrita b le w om an w ho w orried h e rse lf sick fro m th e fear o f having a n o th e r baby to a ch eerfu l, happy, co n ten te d m oth er, w ith all fear g on e” A n o th e r w om an claim ed , “I have regain ed m y stren g th and can care fo r m y ch ild ren as I should ”94 The R IB C L cite d th is h u m ane a sp e ct m o re th a n th e A B C L . A t a fu n d ­ raiser Dr. B ra ck e tt argued th a t b irth co n tro l w as im p o rta n t bu t “should n o t b e ex p ected to tak e th e p lace o f o th e r re lie f m easu res: . . . th e re is d em o n ­ strated beyond a d oubt th e n eed fo r every form o f efforts w hich ca n c o n trib ­ u te to th e g en eral w elfare” P resid en t E le a n o r Jon es o f th e A B C L , on th e o th e r hand, advised th e crow d th a t w ith ou t clin ics, “b irth c o n tro l w ould n o t spread in th e righ t d irection s.” It m u st spread quickly in “city slu m s” am o n g th o se w ho “w ould have ch ild ren th a t w ould b e a bu rd en to so ciety and a d etrim en t to th e ra c e ” Jon es end eavored to persuad e R IB C L staffers th a t th e re d u ctio n o f th e “socially in ad eq u ate” w as “w o rth any am o u n t o f trou b le, any am o u n t o f m oney. For re d u ctio n o f th e fertility o f th e u nfit . . . m eans th a t th e re w ill be few er p eop le b o rn , good-for-nothing, for w elfare ag en cies to struggle w ith in vain and th e re st o f us to su p p o rt”95 A s A B C L presid ent, Jon es w as re sp o n ­ sible fo r raising fund s fro m a bro ad p u blic sector, a goal she presum ably b e ­ lieved could b e ach ieved w ith race su icid e th e o rie s and w elfare savings ideas. S u ch propagand a w as m issin g fro m R IB C L reco rd s w ith tw o excep tio n s: th e R IB C L spoke o f “physical b e tte rm e n t o f th e ra c e ” and th e bu rd en o f “public ch arges” in le tters to co n v in ce R h od e Islan d ’s n a tio n a l rep resen tativ es to sup­ p o rt legislatio n in 1 9 3 2 and 1 9 3 4 .96 S u ch arg u m en ts w ere m o re persuasive to legislators co n cern e d w ith n a tio n a l secu rity and b u d g etary issues th a n w ere th o se b ased o n w om en ’s health. The la tte r arg u m en t w as m o re likely to a t­ tr a c t m o th e rs, n o t m ale leg islato rs.97 The R IB C L was sim ilar in so m e ways to clin ics around th e country. First, it o p en ed during a tra n sitio n tim e fo r w o m en activ ists, a fter th e suffrage m o v e­ m e n t b u t b efo re W o rld W a r II drew large n u m b ers o f w om en in to th e paid w orkforce. Se co n d , it op erated p rio r to A M A en d o rse m en t o f b irth con trol. M ey er argues th a t clin ics d em o n stra ted th e p u blic d em and fo r re p ro d u c­

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tive serv ices, w h ich cou ld have served as a cataly st fo r th e A M A to a c t or get left behind . Third, b etw een 8 0 and 9 0 p e rce n t o f clien ts had p ra ctice d co n tra ce p tio n p rio r to seeking out a clin ic. T he R IB C L and o th e r clin ics, how ever, m oved in th e o p p osite d ire ctio n o f p h a rm a cists and th e b la ck m a r­ k et, p lacin g co n tra cep tiv es in w o m en ’s hands w ith d iaphragm s ra th er th a n in m e n ’s hands w ith con d om s. F ou rth , fem ale staff pu shed th e edge o f re sp e c t­ ability in pu rsuing th e ir m id d le-class activ ism w ith in th e d isrepu table realm o f sexuality.98 A lth ou g h b irth c o n tro l w as n o t illegal in R h od e Island , any a sso cia tio n w ith sex was still su sp ect. They situated th e ir activ ism w ith in th e larger co n tex t o f h ea lth fo r b o th m o th e rs and ch ild ren , th ereb y dim inishing th e sexu al natu re o f co n tra cep tiv es and avoiding n o tio n s o f sexu al lib era tio n fo r w om en, eith e r m arried or single. F em inist n o tio n s w ere a b sen t fro m th e reco rd s. Th ese m id d le-class fou nd ers o f th e clin ic served p rim arily w orkingclass clien ts in m u ch th e sam e way th a t o th e r m id d le-class v o lu n teers b e n ­ efited w o rkin g-class m o th e rs and ch ild ren in m o v em en ts fo r m ilk statio n s, settlem e n t h o u ses, child la b o r law s, and m a n d a to ry sch o o l atten d an ce.

Illegal Abortions The D ep ressio n led to a n exp an sion o f a b o rtio n services. E co n o m ic circ u m ­ stan ces o ften led officials to lo o k th e o th e r way, allow ing a b o rtio n s to o cc u r w ith less th re a t o f penalty. S o m e d o cto rs, a cco rd in g to L eslie R eagan, “sp e­ cialized ” in a b o rtio n and “ran w hat m ay b e called a b o rtio n clinics.” H er study o f a C h icag o clin ic fou nd eig h teen th o u san d a b o rtio n s o cc u rrin g betw een 1 9 3 2 and 1941. M o st o f th e w o m en w ere m arried , in th e ir tw en ties, and from varied class backg rou n d s. A pp roxim ately h a lf ca m e to th e clin ic w ith a phy­ sician ’s referral, d em o n stra tin g th e co llu sio n o f re sp e c te d p ro fessio n als in answ ering w o m en ’s dem and s fo r a b o rtio n . The c lin ic w as able to op erate th rou g h regu lar p aym ents to th e p o lice.99 S u ch o p en p ra ctice s o ccu rred in m any region s o f th e co u n try as in crea sin g n u m b ers o f w o m en sought a b o r­ tio n s. A lth o u g h R h o d e Islan d had n o o v ert a b o rtio n clin ic, a b o rtio n s w ere prevalent n o n eth eless. In th e R IB C L ’s first m o n th o f op eratio n , 3 7 p erce n t o f clien ts cam e to o b ta in an a b o rtio n ; th e n ex t m o n th , 18 p e rce n t; th e n ext, 15 p e rce n t. The d ecreasin g p ercen tag e resu lted fro m qu ick w ord o f m o u th th a t th e clin ic w ould n o t provide a b o rtio n s. U p o n re je c tio n , on e w om an self­ ind u ced and retu rn ed fo r m e d ica l a ssista n ce, d em o n stratin g h er d eterm in a ­ tio n b o th to a b o rt and to gain clin ic assistan ce. E lm er W rig h t, so cia l w orker, fou nd th a t w o m en sought a b o rtio n s “in spite o f th e possible co n se q u e n ce s. In fa ct, for th e average n u m b er o f living ch ild ren o f ea ch p a tie n t w e find a

Population Control and the Great Depression, 1930—1939

long list o f self-in d u ced a b o rtio n s " A th irty -th re e -y e a r-o ld m o th e r o f fou r told W rig h t o f eleven self-in d u ced a b o rtio n s, th e last o f w h ich land ed h e r in th e hosp ital. R IB C L sta ff estim ated th a t th re e th o u san d a b o rtio n s o ccu rred annually in R h od e Island and th a t 16.2 p e rce n t o f m a tern a l d eaths in 1 9 3 0 and 21.2 p e rce n t in 1 9 3 2 resu lted fro m ab o rtio n . F ro m th e ir ow n sam ple, th e first 8 0 0 clie n ts re p o rte d 3 ,6 1 7 p reg n an cies: 613 end ed p rem atu rely — 4 5 0 m iscarriages and 167 a b o rtio n s. B u t, as th e ir re p o rt con clu d ed , “figures for m iscarriag e are always d eceptive as few w o m en w ill ad m it a b o rtio n ; referrin g to it as a m iscarria g e and m ain tain in g it w as a cc id e n ta l" S ta ff p o in ted to 1 9 3 4 statistics fro m R h od e Island H osp ital th a t re p o rte d 189 w o m en h o sp italized fo r bu n gled a b o rtio n s; 1 0 9 had previou sly b e e n h o sp italized fo r a b o rtio n co m p licatio n s. Y et th e sta ff argued th a t th e ir co n tra cep tiv e services w ere de­ creasin g th e in cid e n ce o f a b o rtio n : at R h od e Island H osp ital 2 8 .9 p e rce n t o f g y n eco lo g ical ad m ission s in 1 9 3 2 resu lted fro m bu ngled a b o rtio n s, 2 3 .4 p er­ cen t in 1 9 3 4 , 18.6 p e rce n t in 1 9 3 5 , and 11.9 p e rce n t in 1 9 3 6 . T he sta ff failed to co n sid er rising h o sp ita l b irth s during th e 1 9 3 0 s , w hich cou ld explain th e relative drop in th e p ercen tag e b u t n o t th e n u m b ers o f ad m ission s fo r a b o r­ tio n co m p licatio n s. W h ile th e ir sta tistics m ay have h elp ed in fu n d -raisin g a c­ tiv ities, th e d ata do n o t re flec t th e reality regard ing a b o rtio n . In fa ct, a b o rtio n co n tin u ed to b e a w idespread reco u rse. T w en ty-tw o p e rce n t o f n ew p atients in 1 9 3 6 re p o rte d self-in d u ced a b o rtio n s, 2 3 p e rce n t in 1 9 3 7 , 2 2 p e rce n t in 1 9 3 8 , and 18 p e rce n t in 19 3 9 . The la tte r year saw an ad d itio n al tw e n ty -six w o m en w ho cam e to th e clin ic seeking an a b o rtio n , to ta lin g 2 7 p e rce n t w ho o b tain ed o r h op ed to o b ta in an a b o rtio n .100 W h ile th e R IB C L d ata set d ealt w ith m a rried w om en w ho self-ind u ced , R h o d e Island n ew sp ap ers co n firm ed th a t b o th m a rried and young single w o m en sought paid services. The m a jo rity o f ab o rtio n ists investigated w ere w om en. O fficials co n tin u ed to a rre st and p ro se cu te m e n involved in p ro ­ cu rin g ab o rtio n . O n e m an , a th irty -th re e -y e a r-o ld m a rin e, im p reg n ated a n in e te en -y e a r-o ld w om an, co n firm in g fears o f th e sexual th re a t sailors and sold iers p o sed to R h od e Island w o m en .101 The R IB C L h op ed co n tra cep tiv es w ould elim in ate a b o rtio n , bu t at least on e d o cto r saw th is stand as cowardly. Dr. A . J. Rongy, a R ussian Jew ish im ­ m ig ran t, rad ical, and A M A m em ber, co n ten d ed th a t n o m a tte r h ow hard co n tracep tiv e ad vocates end eavored to sep arate a b o rtio n fro m b irth co n tro l, th e tw o w ere “in tim ately and ind issolu bly linked " b eca u se w o m en w ho ex­ p e cte d to delay or forgo ch ild b earin g w ould o ften re so rt to a b o rtio n if th e ir co n tra ce p tio n failed. H e criticiz ed P ro te sta n t ch u rch es th a t su p p orted b irth co n tro l w hile co n d em n in g a b o rtio n as “sinfu l” and “o b sce n e ”: “It req u ires a gargantuan im ag in atio n to co n ceiv e o f a b o rtio n as indulged in fo r its ob scen e

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gratifications.” Even w orse w as th e C a th o lic C hu rch , w h ich aggravated th e “b a sic cau ses o f a b o rtio n . . . by its in siste n ce on th e sinfu ln ess o f c o n tra ­ ception.” R ongy claim ed th a t a “co u n terrev o lu tio n ” in W e ste rn so ciety had re sto red b irth co n tro l to individual ch o ice bu t lam en ted th a t th e “sam e ra tio ­ n ality . . . is n o t y et em ployed tow ard a b o rtio n ”102 R on g y ’s sym pathy fo r w o m en and fem in ism is clear. T he la ck o f a ccess to safe a b o rtio n s forced th e m to re so rt to u nw anted ch ild ren or to und ergrou nd and so m etim es fatal proced u res. A physician providing a b o rtio n services was “regard ed as a so rt o f b en ig n R o b in H o o d w ho defies th e law to help th e n eed y ” and th u s w as “n o t stam p ed w ith a stig m a o f sh a m e” The “organized p ro fessio n ” cou ld n o t “fly to o boldly in th e face o f th e p u blic stand ard s o f righ t and w rong,” bu t in private m any physicians favored “so m e so rt o f lib ­ eralizatio n ” b eca u se “n o m a tte r how callou s th e average p hy sician appears to be, h e is n o t left u naffected by th e p a th etic and o ften p itifu l pleadings o f th e w om an to w h o m a n ew p reg n a n cy is a gen u in e cau se o f d istress” In ­ creasin g e c o n o m ic p a rticip a tio n o f postw ar w o m en w as “p a rt and p arcel o f th e em an cip ated fem ininity,” b u t w om en cou ld n o t m anage b o th ca re e r and child bearing. R ongy co n d em n ed laws th a t forced w o m en to seek a b o rtio n s in “h aste and fear and secret.” C om p ellin g w o m en and a b o rtio n ists to b re a k th e law in creased co n tem p t for th e law in th e sam e way th a t P ro h ib itio n did.103 The A M A based its o p p o sitio n to a b o rtio n in p a rt on th e H ip p o cra tic oath, yet R ongy argued th a t H ip p o crates did n o t p ersonally opp ose a b o rtio n ; he end eavored to preven t m ale physicians fro m “e n cro a ch in g on a field already p o ssessed by . . . fem ale d o ctors o f G re e ce w ho w ere exp erts in a b o rtio n . The u tte ra n ce s o f H ip p o cra te s . . . m ay m e a n th a t th is w as a su b je c t m o re ex­ p ertly hand led by th e sag es-fem m es o f th e p e rio d ”104 R on g y ’s in terp reta tio n o f H ip p o crates m atch ed w ell w ith th e A M A ’s n in e te e n th -c e n tu ry p ortrayal o f ab o rtio n ists as p rim arily w om en. A b o rtio n , sim ilar to co n tra ce p tio n , w as p a rt o f supply and d em and in th e private sector. C om p ilin g h o sp ita l sta tistics, R ong y found th a t fo r every one hu nd red w o m en trea te d fo r a b o rtio n co m p lica tio n s, fo rty -th re e had had at least on e p rio r a b o rtio n , th irty -fo u r had had tw o, and eleven had had th ree. S in ce W o rld W a r I, R ongy conclu d ed , th e “dem and o f w o m en to have a b o r­ tio n s . . . has b e c o m e so in siste n t th a t th e en tire m e d ica l p ro fessio n has, in essen ce, b e e n revolutionized .” W h ile his sta tem e n t w as an ov erg en eraliza­ tio n , young d o cto rs w ere esp ecially involved in th e a b o rtio n trad e: young w o m en “re lu cta n t to go to th e ir fam ily d o c to r” sought a p hy sician startin g a p ra ctice and offered h im “te m p tin g fe e s”105 P h a rm a cists co n tro lled som e o f th is netw orking: w o m en m ad e a “beelin e for th e d ru g store” b eca u se th e druggist w as in a n “unusually effective p o sitio n to spread th e rep u ta tion o f a

Population Control and the Great Depression, 1930—1939

n eigh b o rin g ab o rtio n ist.” W ith a b o rtio n so “w idespread,” laws ag ainst it w ere in effectiv e b ecau se pu blic op in io n favored “g reater free d o m in th e m a tte r o f ch ild b e arin g ”106 R ongy re co m m en d e d a law th a t foreshad ow ed 1 9 6 0 s legislation. A b o rtio n should b e allow ed in cases o f rape and in c e st and to p reserv e th e physical and m e n ta l h ealth o f w om en. This la tte r a sp e ct w as a co n sid erab le exp an ­ sion o f existin g leg islatio n th a t allow ed a b o rtio n to save th e life, n o t p reserve th e h ealth , o f a p reg n an t w om an. H e stipu lated th a t illegitim acy, d esertio n , and w id ow hood should be ground s fo r ab o rtio n . M a rrie d cou ples w ith living ch ild ren should b e able to avoid an ad d ition al b irth to p ro te c t th e w ell-b e­ ing o f existin g child ren. R ongy argued th a t “eith er p a re n t” should “have th e righ t o f in vokin g ” a b o rtio n .107 W h ile his law w ould greatly ease re strictio n s, it did n o t p ro te c t all w o m en ’s rig h t to ch o o se. A health y m a rried w om an in an eco n o m ically secu re hou seh old w ould have n o legal re co u rse to ab o rtio n . F u rth erm o re, h e did n o t clarify h ow a husband could invoke a right to a b o r­ tio n . This stip u latio n co n flicted w ith a w o m an ’s rig h t to co n tro l h e r body. R ongy did n o t argue th e inverse, th a t is, th a t th e husband should have th e ability to p revent his w ife fro m a b o rtin g , as la te-tw e n tie th -ce n tu ry a n tich o ice activ ists did. B o th , how ever, p ro m o ted th ird -p a rty co n tro l over th e d ecisio n to a b o rt in so m e in stan ces. R on g y ’s en d o rse m en t o f legal a b o rtio n re a ch ed a lim ited au dience. M o st m agazines and n ew spap ers refu sed to ad vertise his bo o k . Even th o u g h m any d o cto rs w ere p erfo rm in g or referrin g w om en fo r a b o rtio n s, th e p rofession refu sed to pu sh fo r lib eralized laws b eca u se o f a b o rtio n ’s a sso cia tio n w ith rad ical groups w ith w h om con serv ativ e d o cto rs did n o t w ish to co lla b o ra te.108 F em in ists also did n o t pu sh fo r refo rm . A s ad am an t as p op u latio n co n tro llers w ere to ach ieve th e ir agenda, even th e y did n o t ad vocate a b o rtio n to shape th e popu lation. C on g ress, re lu cta n t as it w as to lib eralize co n tra ce p ­ tiv es, steered clea r o f any d iscu ssion o f a b o rtio n . W ith n o g roundsw ell for legislative chang e, a b o rtio n rem ain ed illegal u nless p e rfo rm e d to p ro te c t th e m o th e r’s life.

Sterilization W h ile p o p u latio n co n tro llers stayed away fro m a b o rtio n , th e sam e is n o t tru e o f sterilizatio n . In fa ct, steriliz a tio n g ained in c rea sed a tte n tio n as th e D ep ressio n w orsened . The e c o n o m ic situ atio n and th e em phasis on p o p u ­ latio n co n tro l led to a push fo r steriliz a tio n o f th e “u n fit” in p u blic in stitu ­ tio n s. Paul P op en oe, w ho had re je c te d steriliz a tio n in th e 1 9 2 0 s , b e c a m e one o f its m o st v o ca l ad v ocates. A n n u al steriliz a tio n s re a ch ed n ew h eig h ts as

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state h o sp ita l bu dgets d ecreased . L ack in g th e fin an ces to e re c t ad d ition al facilities, d ischarging th e m ildly retard ed to m ake ro o m fo r th e m o re severely retard ed seem ed a ccep ta b le , esp ecially o n ce th e p aro lee w as sterilized . As M o lly L ad d -T ay lor argues, officials p ortray ed co m p u lso ry steriliz a tio n “as a bargain fo r taxp ay ers, w ho w ould o th erw ise have to pay fo r ch a rity or th e co sts o f in stitu tio n alizin g th e ‘u n fit’ and th e ir children.” B etw een 1 9 0 7 and 1 9 2 7 8 ,5 0 0 in stitu tio n a liz ed individuals w ere sterilized ; during th e 1 9 3 0 s th e an n u al n u m b er peaked at 4 ,0 0 0 .109 To b u reau cra ts, steriliz a tio n provided a co st-effectiv e m ea n s to deal w ith u n d esirab le re p ro d u c tio n .110 The H u m an B e tte rm e n t F ou n d ation (H B F ), fou nd ed by P op en oe, stressed th e h u m an e a sp e cts: steriliz a tio n “rem ov es n o organs or tissu es fro m th e body, in terferes w ith no b loo d or nerve supply, p rod u ces n o phy sical chang es. It does n o t in any d eg ree u n sex th e individ­ ual, ex cep t in m aking p a ren th o o d im p o ssib le”111 The H B F estim ated th a t 18 m illio n A m e rica n s w ere in som e w ay physically and m en tally defective. The “e co n o m ic bu rd en ” th e y p osed w as “trem en d o u s and steadily grow ing w orse. A b illio n dollars a y ear w ould b e a low estim ate o f th e co st o f carin g for th ese u nfo rtu n ates.” M an y eu g en icists estim a ted th a t o f 1 2 5 m illio n A m e rica n s, at least 2 5 m illio n w ere socially m alad ju sted o r u nad ju sted , in clu d in g th e u nem ployed and u nem ployable, deaf, d eform ed , blind, d elinqu ent, m entally d eficien t, d egenerate, and in fe c tio u s.112 S u ch arg u m en ts h elp ed in c rea se th e acce p ta n ce o f th e p ro ced u re am o n g bu reau crats and legislators. L ead ers o f th e sterilizatio n cau se o ften overlapped w ith co n tra cep tiv e lib ­ eralizatio n activ ists. In P rovid en ce S a n g er asked th e crow d, “W h a t are w e to do w ith th e se d efectives?” N o on e w anted to b e a r th e bu rd en o f th e ir expense: “Even th e C ath o lic C h u rch . . . w ill n o t tak e care o f its ow n m e n ta l d efectives, bu t p u ts th e m b a ck on th e S ta te or nation.” I f so ciety did n o t ad op t d rastic m easu res, fu tu re g en eratio n s w ould b e forced to ca rry th e expand ing d ebt o f th e m entally and physically im paired. “The tim e has com e,” S a n g er insisted , “to dem and so m eth in g be d one to cu rb th e in c re a s e ” am o n g “defectives.” The p e rm a n en t so lu tio n o f sterilizatio n , acco rd in g to Sanger, w as p referable to th e te m p o rary and o ften u n c e rta in m e th o d s o f co n tra ce p tiv es.113 B y 19 3 6 tw en ty -sev en states had eith er co m p u lsory or volu n tary steriliz a ­ tio n laws. H arry H. Laughlin o f th e E u g enics R eco rd O ffice, w ho w as “an e n ­ th u siastic su p p o rter o f N azi Germ any,” ju stified th e se laws b eca u se th e state had n o qualm s im p o sin g th e d eath p en alty or denying individual free d o m th rou g h m ilitary c o n sc rip tio n .114 B o th cases w ere a ccep ta b le b eca u se “in th e long ru n , th e w elfare o f th e co m m o n w ea lth is o f vastly m o re im p o rta n ce to th e su m to ta l o f h u m an h appiness th a n is th e te m p o ra ry free d o m and p erso n al secu rity o f th e individual.” The sam e id eology cou ld be applied to rep ro d u ctio n : “B y all m eans aid . . . th e poor, th e u n fo rtu n ate and th e suffer­

Population Control and the Great Depression, 1930—1939

ing, bu t p e rm it only th o se individuals m o st splendidly endow ed by n atu re, w ith socially valuable physical, m e n ta l and m o ra l qu alities to reprod uce.”115 In o th e r w ords, only up p er- and m id d le-class w hite A n g lo -S a x on P ro te sta n ts should rep licate them selves. B etw een 1 9 0 7 and 1 9 3 6 23,118 peop le w ere sterilized und er state law; m o st o f th e m w ere m entally d eficien t, id io ts, in san e, ep ilep tics, o r im b ecile s. B u t so m e states stretch ed th e in terp reta tio n o f “u nd esirab les” to inclu d e p ro sti­ tu te s, p erson s co n v icted o f tw o crim e s, drug ad d icts, and so d om ites. H ard ­ liners em ployed racial d o om propagand a to con vin ce so ciety th a t laws should b e com pulsory, n o t voluntary, as a “n ecessa ry step to p revent ra cia l d eterio ­ ratio n ” and to p ro te ct th e g ov ern m en t fro m “m entally a b n o rm a l . . . v o te rs”116 A ll m e n tal in stitu tio n in m ates m u st b e sterilized b efo re release: “A fter all, th e real risk to so ciety co m es fro m hered itarily d angerous peop le w ho are at lib ­ erty ” T h eir steriliz a tio n w ould rem ov e “a bu rd en fro m s o cie ty ” b eca u se th ey n o t only th reate n ed ra cia l pu rity b u t could n o t b e resp o n sib le p aren ts. The C M H agreed: all “feeb le m ind ed and in san e p erson s in in stitu tio n s” should be sterilized b efo re retu rn in g to “co m m u n ity and fam ily life”117 S o c ia l D arw in ist n o tio n s abound ed: th e charity, w elfare, ed u cation , m ed icin e, and te ch n o lo g y o f th e m o d ern state in terfered w ith natu ral “survival o f th e fitte s t” B efo re a H ou se co m m itte e on d estitu te citiz en s, Dr. L ee S to n e o f M a d era C ou n ty te s ­ tified ab o u t “O a k ie s” H e believed th a t “to give th e se peop le a b ed and a m a t­ tress w ould b e like p u ttin g a blan k et over a pig. . . . I f you co m e dow n to me,” he co n tin u ed , “I w ould say, sterilize th e w hole b u n ch o f th e m ”118 P op en oe stated: “In m o d ern civ ilization s, w here th e w eak and helpless are p ro tected so carefully, it is n o t p ossib le to d epend on N atu re to solve th is p ro b lem o f th e survival o f th e u n fit” Th ese arg u m en ts, cou pled w ith e c o n o m ic d istress, in creased sterilizatio n s: b etw een 1 9 3 0 and 1933 5 0 p e rce n t m o re steriliz a ­ tio n s o ccu rred th a n over th e p reced in g tw enty -five y ears.119 B y th e 1 9 3 0 s few eu g en icists still b elieved th a t a b e rra n t so cia l b eh av ior w as genetically tra n sm itted to offspring. W h ile still in ten t on sterilizing th o se w ith g en etic d efects, m any officials n ow em phasized p reventing ch ild b irth am o n g p aren ts co n sid ered socially and eco n o m ica lly in ad eq u ate to care for child ren. This tra n sfo rm a tio n , a cco rd in g to h isto ria n Philip Reilly, brou ght an in cre a s e in fem ale steriliz a tio n . In 1 9 2 7 53 p e rce n t o f p eop le sterilized w ere m en ; b etw een 1 9 2 7 and 1 9 3 2 6 7 p e rce n t w ere w om en. W elfare agents and d o cto rs en co u n tered m o re w o m en th a n m e n and w ere m o re in clin ed to ta rg e t w o m en th a n m e n for sterilizatio n . M an y m ildly retard ed w o m en w ere in stitu tio n alized sp ecifically so th e y cou ld b e sterilized and th e n released . The H B F b o aste d th a t 7 5 p e rce n t o f th e “feeb lem in d ed ” girls sterilized u n ­ der C alifo rn ia law w ere actu ally “sex d elin q u en ts” likely to rely on pu blic funds if th e y b e c a m e p reg n an t; “only on e in every tw elve” resu m ed sexually

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d elin q u en t b eh av io r follow ing th e p roced u re. The H B F ’s goal w as tw ofold: save m o n ey and cu rta il w o m en ’s sexuality. The sex d iscrep a n cy in p ro c e ­ dures co n tin u ed even th o u g h m ales exceed ed fem ales in in stitu tio n s fo r th e retard ed by 10 p e rce n t and a v a se cto m y w as ea sier and safer th a n a tu b al ligation. B raslow argues th a t a n o th e r re a so n fo r th is skew ed g en d er ra tio was th a t by th e 1 9 3 0 s “phy sicians lo st th e ir fa ith in th e restorativ e pow ers o f m ale sterilization.” In his study o f S to c k to n H o sp ital m ale sterilizatio n s fell fro m 1 ,0 6 4 betw een 1910 and 1 9 2 6 to 5 3 7 b etw een 1 9 3 0 and 1 9 5 0 ; th e n u m b er o f fem ale sterilizatio n s in th e sam e p eriod s ro se fro m 4 6 0 to 5 8 8 . A llison C. C arey finds a sim ilar n a tio n a l tren d : p rofession als attack ed th e ratio n ale for m ale sterilizatio n bu t co n tin u ed to to u t th e b en efits o f fem ale sterilizatio n for b o th w o m en and society. The p rim ary ju stifica tio n fo r fem ale sterilizatio n , acco rd in g to Ladd-Taylor, w as th e savings in co st to th e state.120 Steriliz a tio n p ro p o n en ts look ed to N azi G erm an y as th e m o d el fo r p ro ­ gram s targ etin g th e “u n fit” Ironically , th e G erm a n s m od eled th e ir eu genic law, passed on 14 July 19 3 3 , on L au g hlin’s draft. In re a ctio n to th e G erm a n law, L e o n F. W h itn ey , sec re ta ry o f th e A m e rica n E u g enics So ciety , claim ed: “M an y far-sigh ted m e n and w o m en in b o th England and A m e rica have long b e e n w orking earn estly tow ard som eth in g very like w hat H itler has n ow m ade com pulsory.” A m e ric a n eu g en icists b o a ste d o f th e ir in flu en ce o n G erm a n law and b e ca m e en e rg etic p ro m o te rs o f it. Kopp studied G erm a n p o licy and reco m m en d e d its im p lem en ta tio n in th e U n ited S ta tes b eca u se it w as “im ­ perative to c o rr e c t co n d itio n s u nd erm in in g th e h ea lth o f th e nation.” Kopp p raised th e G erm a n law b eca u se it applied n o t only to peop le in in stitu tio n s bu t to th e p o p u latio n at large.121 The 1 9 3 5 In te rn a tio n a l C on g ress fo r P op u lation S c ie n c e in B e rlin m arked th e h eigh t o f in tern a tio n a l sa n ctio n o f N azi race p o licies. T he c o n fe re n ce ’s tw o v ice p resid en ts w ere A m e rica n s: L au g hlin and C la re n ce G. C am pbell. The la tte r lectu red th a t H itler had sy n th esized th e w orks o f A m e rica n eu g en icists “to co n stru c t a co m p reh en siv e race p o licy o f p o p u latio n d evelop­ m e n t and im p ro v em en t th a t p ro m ises to b e ep o ch a l in ra cia l history. It sets th e p a tte rn w h ich o th e r n atio n s and o th e r ra cia l groups m u st follow.” W h e n C am p b ell re tu rn ed h o m e, h e cam p aig n ed to sterilize at least 10 p e rce n t o f th e p o p u lation to p revent race d eg en eratio n .122 H is plan m e t resistan ce.

Aversion to Sterilization M an y A m e rica n s re je c te d steriliz a tio n . S o m e held a “d ee p -sea te d rep u g ­ n a n ce ” fo r any “m edd ling w ith th e sexu al organs.” N u m erou s scien tists o b ­ je c te d b eca u se o f th e sca rcity o f reliable d ata th a t show ed th a t d efects w ere hered itary. W h ile th e B S H con clu d ed th a t eu genics had “a ttra c ted p erso n s o f

Population Control and the Great Depression, 1930—1939

u neq u al atta in m e n t and scien tific stand ing . . . th e y n u m b ered in th e ir ranks id ealists w hose zeal p rom p ted th e m to form u late prog ram s b ased on s tro n ­ ger claim s th a n th e know n fa cts seem ed to w a rra n t" Sim ilarly, th e A m e rica n N eu ro log ical A sso cia tio n (A N A ) rep o rted in 1 9 3 6 th a t legislation w as based “m o re u p o n a desire to elevate th e h u m an race th a n u pon proven fa c ts " A l­ th o u g h th e y u n d ersto o d so cia l D arw in ists, w ho resen ted m easu res th a t a l­ low ed th e “sick , th e w eak, and th e u n fo rtu n a te to survive and propagate," th e y criticiz e d overzealou s eu g en icists w ho re co m m en d e d steriliz a tio n o f th e “ugly” and “a s o c ia l" W h ile ag reein g to sterilize so m e o f th e se groups, th e y believed m o re re se a rc h w as n ec essa ry b efo re tu rn in g to m ass steriliz a ­ tio n b ecau se m ad n ess could b reed geniu s, as in th e ca se o f H ans C h ristia n A n d ersen , Ludw ig van B ee th o v en , and o th e rs w ho w ere offspring o f q u asi­ m ad p a re n ts.123 S o m e scie n tific and p o litica l o rg an izatio n s also exp ressed d o u b t over h a rd -lin e rs’ view s th a t feeb lem in d ed n ess w as m o re prevalent am o n g black s and Italians. G e n e tic ists W a lte r L an d au er and H e rm a n n J. M u ller reviled th e “scien tific b asis” o f H itle r’s a n ti-S em itism and A ry an su p rem acy and d iscrim ­ in atio n against blacks and o th e r m in o rities. W h ile M uller, w ho w ould w in th e 1 9 4 6 N o b e l P rize in Physiology o r M ed icin e , and o th ers re je c te d hard -lin e eu gen ics, th e y su p p orted re fo rm eu genics. The A m e rica n E u g enics S o cie ty b e ca m e th e focu s o f th e eu genics m o v em en t; it follow ed a m o re tem p era te path, esp ecially in its re je c tio n o f u nfound ed ra c ist and classist th e o rie s. Dr. A b rah am M yerso n , a L ith u an ian im m ig ran t, p sy ch iatrist at B o sto n P sy ch o ­ p ath ic H osp ital, and la ter p ro fesso r o f neu ro lo g y at T ufts C ollege M ed ica l S ch o o l, d em o n stra ted th a t feeb lem in d ed n ess o cc u rre d equally a m o n g th e classes, n o t overw helm ingly a m o n g th e low er classes, as h ard -lin ers argued. P sych iatrists in elite p sy ch iatric ho sp itals su ch as B u tle r H o sp ital in P rovi­ d en ce re ach ed th e sam e co n clu sio n . M y erso n also led an A N A in v estig a­ tio n in to steriliza tio n am on g th e in stitu tio n a liz ed m entally ill. T he June 1935 re p o rt re n o u n ce d th e eu genic p rin cip le th a t m e n ta l d isease w as in crea sin g and ru in in g th e race; co m m itm e n t rates had in crea sed b u t as a resu lt o f upto -d a te tre a tm e n t at m o d ern in stitu tio n s and in crea sed longevity, lead ing to m o re cases o f senility.124 C a th o lic ed ito rs o f Commonweal added th is scien tific p o sitio n to th e ir m o ral co n d em n a tio n o f steriliz a tio n . C h u rch lead ers argued th a t in su ffi­ cien t co n cu rre n ce am o n g a u th o rities existed to w arran t “draw ing th e lines ab o u t a w hole group as to b e re stra in ed by law fro m rep ro d u cin g th e ir k in d " O n ce gov ern m en ts ad op ted su ch p rog ram s, th e lin e could b e stretch ed fro m “p ath olo gically in su fficien t" to “m erely v ery dull or very simple," all to e n ­ sure th a t so ciety w as “spared th e resu lts o f th e ir sexu al indulgence." N o one had licen se to m aim a n o th e r b ased on so cie ta l co n sid eratio n s. Commonweal

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also charged th a t th e “sexu al m u tila tio n o f th e p au per feeb le-m in d ed [was] a p iece o f a rran t class d iscrim in a tio n ” th a t co n tra d icted th e n a tio n ’s d em o ­ cra tic fou n d ation .125 S u ch arg u m en ts appealed to th e legacy o f individual righ ts in R h od e Is ­ land. A new sen ate m easu re em phasized th e “w elfare o f s o cie ty ” as ju stific a ­ tio n fo r th e p ro ced u re b u t added th a t th e “h ea lth o f th e ind ivid ual” w ould also b en efit. It applied only to in stitu tio n a liz ed clien ts suffering fro m “in sa n ­ ity, idiocy, im becility , feeb le-m in d ed n ess or epilepsy.” T he b ill revealed e c o ­ n o m ic co n cern s in language sim ilar to th a t heard at th e n a tio n a l level: “The state has in cu sto d ial care and is su pporting in variou s state in stitu tio n s m any d efective p erso n s w ho if now d ischarged or p aroled w ould likely b e c o m e , by th e p rop agation o f th e ir kind, a m e n a ce to society, bu t w ho, if in cap able o f p ro creatin g , m ig h t prop erly and safely b e d ischarged or p aroled and b eco m e self-su p p o rtin g, w ith b en e fit to th em selv es and to society.” T he eu genic strain w as also m o re evid ent, again re flectin g th e n atio n a l d iscourse: if a state su ­ p e rin ten d en t fou nd th a t an in m a te “by th e laws o f h ered ity is th e probable p o te n tial paren t o f socially inad equ ate offspring likew ise afflicted . . . and th a t th e w elfare o f th e in m a te and o f so ciety w ould b e p ro m o ted by sterilization,” th e state could ord er th e o p era tio n .126 W h ile su ch arg u m en ts w orked else­ w here, th e y fell on d eaf ears in R h od e Island, leaving sterilizatio n unregulated fo r th e rem ain d er o f th e century. W h ile C a th o lic pressure could have b ee n resp o n sib le fo r th e m e a su re’s defeat, th e scen ario w as unlikely; sim ilar p re s­ sure cou ld n o t co n v in ce th e G en e ra l A ssem b ly to b an b irth co n tro l. W ith n o legal re strictio n s, d o cto rs could set th e ir ow n stand ard s, and volu n tary sterilizatio n did ta k e p lace.127 Steriliz a tio n laws in o th e r states drew c riticism b eca u se o f th e ir co m p u l­ so ry natu re. H aw aii ex p erim en ted w ith co n tra ce p tiv es and steriliz a tio n to cu rtail “an tiso cia ls” and th o se o n relief, a pro g ram w ith class and ra cia l im p li­ catio n s. W o rk in th e can e fields a ttra c te d im m ig ran ts fro m P u e rto R ico and th e P hilippines, bu t officials claim ed th a t th e “m eltin g p ot o f ra ces h ere had p rod u ced som eth in g d etrim en ta l to th e com m unity.” Dr. N ils Paul L a rsen o f Q u e en s H osp ital in H onolu lu fou nd th a t th e rep ro d u ctiv e rate am on g re lief­ ers, th e in san e, th e n e u ro tic, and th e feeb lem in d ed w as m u ch h ig h er th a n th a t o f “norm als.” A s a resu lt, H aw aii passed a co m p u lsory steriliz a tio n law fo r th o se d eem ed by p sy ch iatrists to be “u n fit” for p ro c re a tio n .128 This law left p sy ch iatrists, m o st o f w h om w ere elite w hite m en , w ith a great deal o f pow er to d eterm in e w ho in th e ir view w as fit or n o t. The C a th o lic jo u rn a l

America d en o u n ced th e co m p u lsory a sp e ct o f th e law as a n “in trin sica lly im m o ral invasion o f th e h u m an person.” O m ittin g any d iscu ssio n o f ch u rch policy, th e ed itors argued th e state had n o right to d estroy th e “cap acity o f an in n o ce n t p erso n to p rocreate.” E co n o m ic ju stific a tio n w as dangerous to

Population Control and the Great Depression, 1930—1939

th e free d o m o f individuals: “O n ce w e ad op t m a teria listic ‘so cia l u tility ’ as an overrid ing stand ard o f pu blic m orality, m e rcy -m u rd er o f ‘so cia l m isfits’ w ill b e th e lo g ical n ex t step.” The law w as also class biased: it su b je cted p u blic in ­ stitu tio n p atients to co m p u lsory steriliz a tio n bu t exem p ted fin an cially secu re feeb lem in d ed p a tie n ts.129 H ow did th e b la ck co m m u n ity resp o n d to steriliz a tio n ? W h ile S c h o e n fou nd so m e b la ck physicians ad vocating a ccess to it as an effectiv e m eth o d o f b irth co n tro l, m o st b lack s opp osed sterilizatio n . T he C o lo red W o m e n ’s C lu b M o v em e n t criticiz ed its excessive u se o n b la ck w om en. D u B o is w rote in th e Pittsburgh Courier th a t “th e th in g w e w ant to w atch is th e so -ca lled eu genic steriliza tio n ” b eca u se th e bu rd en o f su ch prog ram s w ould “fall u pon co lo red p eop le and it b eh o o v es us to w atch th e law and th e co u rts and stop th e spread o f th e h a b it” E d itorials in th e Courier re je c te d steriliz a tio n b e ­ cau se eu gen icists ad vocated it fo r th e “w eak and op p ressed ” and fo r th o se on re lie f w ho w ere “having a large n u m b er o f children.” S o m e sterilizatio n ad­ v o cates p ro p o sed cand id ates w ho w ere h o m eless, unem ployed , or on relief. B eca u se b lacks o ften found th em selv es in th e se situ ation s, m any feared th ey w ould b e co m e th e p rim e targ et. As th e Courier conclu d ed , “W ith th e N egro d isfran chised , w hat w ill h e b e able to do a b o u t it?”130 B y th e late 1 9 3 0 s , as new s spread o f th e p erv erted N azi p rog ram , calls fo r m o d e ra tio n in p o p u la tio n p o licy in ten sified . The Population Bulletin, earlier an ad v ocate o f eu gen ic sterilizatio n , now criticiz ed “a la rm ists” w ho ad vocated th e steriliz a tio n o f hund red s o f th o u san d s or even m illio n s o f th e m entally or physically im paired. The ed itors also opposed “v o lu n ta ry ” ster­ ilizatio n as th e p rice o f a m arriag e licen se fo r ce rta in “u n d esirab le” elem en ts o f society. D u rin g d ep ression or war, w hen p eop le attrib u ted th e ir tro u b le s to scap eg oats, civil lib ertie s w ere at risk; “H itler-ty p e d em ag ogu es” cou ld “w hip up re sen tm en t ag ainst a m in o rity group.” S o c ie ty m u st be on guard against plans to im prove th e race, th e y w arned , lest th e U n ited S ta tes follow th e path o f dangerous d icta tors in o th e r co u n trie s.131 N azi p o p u latio n p o licy co n trib u te d to th e d eclin e o f h a rd -lin e eu g en icism in th e U n ited S ta te s, b u t n o t u n til th e 1 9 4 0 s . A d h eren ts w ere slow to acknow led ge N azi abu se; so m e co n tin u ed to travel to G erm an y early in th e w ar to m e e t w ith steriliz a tio n p ro g ram lead ers. T he la tte r co n v in ced th e fo r­ m e r th a t th e N azis w ere im p lem en tin g “a large scale breed in g p ro je c t, w ith th e p u rp o se o f elim in atin g fro m th e n a tio n th e h ered ita ry a ttrib u tes o f th e S e m itic race.”132 These A m e rica n s ca rrie d b a ck positive im p ressio n s o f N azi p rogram s, n egatin g in fo rm a tio n fro m Jew ish and G erm a n em ig res w ho e n ­ deavored to a le rt th e A m e rica n pu blic to th e in h u m an d evastation. N o t u ntil a fter th e w ar did A m e rica n eu g en icists claim th e y w ere critic a l o f N azi p ro ­ gram s. This attem p t w as to o little to o late.133

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O th e r even ts also led to th e d em ise o f h a rd -lin e eu genics. H en ry Fair­ field O sb o rn and M a d iso n G r a n t- p r o m in e n t eu g en icist and au th o r o f The Passing o f the Great R a ce-d ied , C harles D av en p o rt retired , H a rry Laughlin w as ou sted fro m im p o rta n t p o litica l and scien tific p o sts, and th e C arn eg ie F ou n d ation ceased fund ing th e E u g enics R eco rd O ffice in 19 3 9 . M a in strea m so ciety opp osed overt a n ti-S e m itic a sse rtio n s. G e n e tic b reak th ro u g h s u n ­ d erm in ed th e u n su b stan tiated asse rtio n s o f eu genics. M o re p eop le tu rn ed to so cio lo gy to answ er p ro b lem s asso cia ted w ith poverty. T he th e ra p e u tic value o f sterilizatio n fell o u t o f favor as n ew te ch n o lo g ie s and tre a tm e n ts, su ch as e le c tro sh o ck therapy, lobotom y, and o ccu p a tio n a l and re cre a tio n a l therapy, b e ca m e available to tre a t m e n ta l illness. E u g en icists and g en eticists c o n tin ­ ued to study individual g en etics, b u t c o e rcio n and p ro m o tio n o f program s to save th e race d eclined . In stead , so m e scien tists tu rn ed to n ew te c h n o lo g ie s - g e n e t ic cou n selin g and p ren atal d ia g n o s is - t o help individuals m ake ch o ice s th a t w ere rig h t fo r th e m . A s D ia n e B. P aul co n clu d es, re sea rch ers “shifted fro m co n c e rn w ith th e w elfare o f p o p u lation s to th e w elfare o f th e individual fam ilies, as d eterm in ed by th e fam ilies th e m se lv e s" R egard fo r p atie n ts’ righ ts, previou sly ig n o red by m any eu g en icists, b e c a m e a co n sid ­ eratio n follow ing th e war.134 P ro fessio n a l c o n c e rn fo r individual rig h ts did n o t extend to all, th e n or now. N ew te ch n o lo g ie s have b e e n used p rim arily to help m id d le- and u p p er-class w hite cou ples ex p erien cin g fertility p roblem s, n o t low er-class ra cia l and eth n ic m in o rities. Still, th e o v ert calls to sterilize th e “u n fit” did subside. In th e early 1 9 4 0 s th e Su p rem e C o u rt ack now led g ed th e class bias in sterilizatio n law s. The H abitu al C rim in a l S ta tu te o f O k la h o m a allow ed th e state to sterilize so m e re p ea t offend ers u n til Ja ck T. Skinner, a ccu sed again o f arm ed ro b b ery and ch ick en larceny, challenged it. In Skinner v. Oklahoma, 316 U .S. 5 3 5 (1 9 4 2 ), th e C o u rt invalidated th e statu te b eca u se it co n tra d icted th e eq u al p ro te ctio n clause by stipu lating steriliz a tio n fo r som e crim in als but n o t oth ers. E m b ezzlers (w h ite-co lla r crim in als), fo r exam ple, w ere exem pt. U nlike H olm es in Buck v. Bell, Ju stice W illia m O. D ou glas argued th a t th e “pow er to sterilize, if exercised , m ay have subtle, far reach in g and devastating effects [and in] evil or reck less h and s, it ca n cau se races or ty pes w h ich are in im ical to th e d o m in an t group to w ith er and disappear.” A lth ou g h h ard -lin e eu gen ics fell o u t o f favor, m a in stre a m eu gen ics, a c ­ cord ing to W en d y K lin e and L aura B riggs, lasted lo n g er th a n m o st h isto rian s assum e. The Journal o f the American Medical Association published C laren ce J. G a m b le’s eu gen ic a rtic les during th e 1 9 5 0 s and w ro te ed ito rials in sup­ p o rt o f eu gen ic fam ily p lanning as late as 1961. E u g enics shifted fro m a stric t h ered itary exp lan ation o f d eg en eracy to in c o rp o ra te en v iro n m en tal factors.

Population Control and the Great Depression, 1930—1939

M o th e rs cam e u nd er in crea sin g scru tin y b eca u se th e y shaped ch ild ren long a fter p regn an cy; th u s, m o th e rs m u st b e “fit” n o t only to b e a r b u t also to raise young ch ild ren . W ith th is n ew em p h asis, eu genics co n tin u ed w ell in to th e 1 9 6 0 s . K lin e co n clu d es th a t “continu ity, ra th er th a n discontinu ity, c h a ra cte r­ ize s” eu genics betw een th e 1 9 3 0 s and th e p ostw ar p erio d .135 This co n tin u ­ ity can b e seen in w elfare officials’ tre a tm e n t o f w hite versus b la ck m o th ers on A id to D ep e n d e n t C h ild ren (A D C ) and in co n tin u ed p op u lation co n tro l agendas in th e p o stw ar p eriod . In v olu n tary steriliz a tio n m ay have fallen out o f favor in th e im m ed iate a fterm a th o f H itle r’s g en o cid e, b u t it reem erg ed relatively quickly, rearin g its head o n ce again in th e 1 9 6 0 s as w elfare agents targ e ted in d igen t b la ck and w hite w o m en fo r co e rce d steriliz a tio n p ro c e ­ dures.

Conclusion A s th e n atio n co n c en tra te d on W o rld W a r II, th e p o p u latio n d iscou rse th a t had raged during th e 1 9 3 0 s subsided considerably. W h a t had b e e n a c c o m ­ plished? D o c to rs could n ow p re scrib e co n tracep tiv es in all states excep t M a s ­ sach u setts and C o n n e c tic u t, and seven so u th ern states in co rp o ra te d c o n tra ­ ceptives in to th e ir pu blic h ea lth p rogram s. The d iscu ssion th a t b rou gh t abou t th e se ch an ges generally lacked any fem in ist rationale. In stead , p ositive and n egative eu genic arg u m en ts b ased on th e “fit” versus th e “unfit,” race, and class d om inated . W h ite elite p o p u latio n co n tro lle rs’ crie s o f ra cia l d eg en ­ eracy su persed ed any assu m p tio n o f a w om an’s right to c o n tro l h e r body. The pu sh fo r ch an g e ca m e p red om in an tly fro m w hite u p p er- and m id d le-class m e n and w o m en co n cern e d w ith th e co m p o sitio n o f th e popu lation. Iro n i­ cally, th e m o v em en t ben efited m id d le- and u p p er-class w o m en w ith a ccess to safe and regu lated co n tra cep tiv es th rou g h th e ir d o cto rs, a ch o ice n o t afford ­ able to m any lo w -in co m e and ind igent w om en. C lin ics su ch as th e R IB C L helped bridge th e gap in access for lo w er-in co m e w om en. T hese clien ts either ig n ored or w ere unaw are o f th e classist and ra c ist rh e to ric o f p o p u lation co n ­ tro lle rs: w o m en availed th em selv es o f co n tra cep tiv e serv ices to fulfill th e ir ow n agend a, nam ely, to c o n tro l th e ir fam ily size and p ro te c t th e ir health. L ib eralizatio n o f co n tracep tiv es did n o t extend to ab o rtio n . N o g rou nd sw ell fo r re fo rm em erged am o n g fem in ists, d o cto rs, or p o p u latio n c o n tro l­ lers. A few rad icals su ch as R ong y did p ro m o te chang e, b u t th e y receiv ed little or n o atten tio n . N o t surprisingly, th e n , th e co u rts and legislatures ig­ n o red th e issue, and a b o rtio n rem ain ed illegal ex cep t to save th e m o th e r’s life. Sterilization , on th e o th e r hand, w as ce n tra l to th e d iscourse on pop u lation

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policy. D u rin g th e D ep ressio n p o p u lation co n tro llers ad vocated it as th e a n ­ sw er to b o th state b u d g etary p roblem s and ra ce d eg eneration. The p roced u re b u rgeon ed in num ber, targ etin g fa r m o re w o m en th a n m e n co m p ared w ith earlier d ecad es. W elfare m easu res allow ing officials to d eterm in e w ho was “u n fit” b rou gh t m o re w o m en to officials’ a tten tio n as generally w om en, n ot m en , applied fo r a ssista n ce th ro u g h p rog ram s su ch as A D C . W h ile a sso cia ­ tio n w ith H itle r’s g en o cid e qu ieted overt calls fo r sterilizatio n , th is situ ation w as only tem p orary . B y th e late 1 9 5 0 s and 1 9 6 0 s officials o n ce again tu rn ed to sterilizatio n as a sim p listic an sw er to perceived p ro b lem s o f popu lation.

5

World War II, the Baby Boom, and the Population Explosion, 1939-1963

D u rin g and after W o rld W a r II A m erican s had g rea ter a ccess to c o n tra ce p ­ tives th a n previous d ecad es. The m ilita ry d isp ensed co n d o m s to sold iers as p art o f a cam p aig n ag ain st v en erea l disease. B irth and p o p u latio n c o n tro l ad vocates cap italized on th e n a tio n a l p re o ccu p a tio n w ith th e w ar to p ro m o te co n tra ce p tio n ’s co n trib u tio n to n a tio n a l h ealth , so ld iers’ fitness, th e w artim e econom y, and w o m en ’s ability to u n d ertak e w ar w ork. W h ile a b o rtio n re ­ m ained illegal u nless th e w o m an ’s life w as at stake, officials o ften ig n ored th e p ractice , as it help ed m a in ta in a stable defense w orkforce. S teriliz a tio n did n o t disappear, b u t in th e w ake o f N azi abu se p op u latio n co n tro llers no long er pu blicly to u te d it as th e so lu tio n to so cie ta l p roblem s. T he d ram atic loss o f life at w ar’s end led to p ro n atalist attitu d es sim ilar to th o se o f Dr. H o ra tio S to re r in th e p o s t-C iv il W a r period : w hile n o t as b latan t as Storer, pop u lation co n tro llers w orried over w ho w ould rep lace th e w ar dead. T he p ostw ar baby b o o m , w h ich affected w o m en in all s o cio e co n o m ic classes, qu ieted b u t did n o t erase p o p u latio n co n tro lle rs’ a n x ieties over differential fertility rates b e ­ tw een th e ed u cated and u ned ucated. They tu rn ed th e ir efforts to th e “p op u la­ tio n exp losion ” in th e Third W orld . By th e 1 9 5 0 s re sea rch ers had developed a n ew te ch n iq u e — th e p ill— th a t cou ld b e readily d isp ensed to lo w -in co m e and ind igent w o m en overseas, and th e y b eg an te stin g its effectiv en ess on “h um an gu inea p igs” in P u erto R ico . C o n c e rn over th e “q u ality ” o f th e p o p u latio n b o th at h o m e and abroad co n tin u ed to d om inate th e n a tio n a l discourse. G e n ­ erally u n to u ch ed by th e se tren d s, th e R IB C L evolved in to a com p rehensive h ealth care facility, w h ich b rou gh t it in co n flict w ith PPFA . A t th e sam e tim e, th is expansive h ea lth care p ro g ram led to a stron g ra p p o rt w ith th e lo c a l b lack com m unity. A m icro lev el analysis o f d evelop m ents at th e R h od e Island clin ic in th e 1 9 4 0 s and 1 9 5 0 s show s th e im p a ct o f g ra ssro o ts a ctiv ists o n th e lives o f individual w o m en d eterm in ed to c o n tro l th e ir fertility.

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World War II W a r led to c o n c e rn over n o t only th e c o m p o sitio n o f th e p o p u latio n but, specifically, th e quality and h ea lth o f m e n in th e arm ed forces. T h om as P arran , ap p o in ted su rgeon g en eral in th e spring o f 1 9 3 6 , co n ten d ed th a t th e re je c tio n or d eferm en t o f 4 0 p e rce n t o f d raftees w as a “n a tio n a l d isg ra ce" In an a rticle in W a sh in g to n ’s Sunday Star, B le m o n t Farley, d ire cto r o f pu blic relatio n s o f th e N atio n al E d u cation A sso cia tio n , stated: “W e have lo st m o re m e n in W o rld W a r II b eca u se o f ed u catio n al and physical d eficien cy th a n we had u nd er arm s in W orld W a r II.” As o f 1 F ebru ary 1 9 4 5 , a cco rd in g to Farley, 5 ,7 0 4 ,0 0 0 m en had b e e n re je c te d fo r m ilita ry service. A ppalled, G uy Irving B u rch o f th e P op u lation R eferen ce B u reau w ro te th a t co n tin u ed pro liferatio n am o n g th e “w rong groups o f p e o p le” w as ru in in g A m e rica n d efense cap ab il­ ity. “U n co n tro lled h u m an rep rod u ction ,” h e co n ten d ed , favored th e “survival and m u ltip licatio n o f th e least gifted m e m b ers o f s o cie ty ” and end angered “h u m an lib e rtie s and any ch a n ce fo r a w orld at peace.”1 F o rm er d o m estic co n cern s now had in tern a tio n a l and n a tio n a l secu rity im p lication s. A year later P resid en t H arry T ru m a n ad dressed C on g ress regard ing de­ clining m e n tal and physical stand ard s. S e le ctiv e S e rv ic e exam s “revealed th e w id e-sp read phy sical and m e n ta l in ca p a city am o n g th e young p eop le o f th e nation.” The ap p roxim ately five m illio n m e n b etw ee n th e ages o f eig h teen and th irty -se v e n classified as u nfit fo r m ilita ry serv ice had co st th e n a tio n dearly; “m e n tal ca s e s” o ccu p ied m o re th a n h a lf o f h o sp ital bed s at a co st o f $ 5 0 0 m illio n a year, “p ractically all o f it co m in g o u t o f taxp ay ers’ m oney.” In ad d ition, m o re th a n 1.5 m illio n sold iers had b e e n d ischarged due to physi­ cal or m e n ta l disability, exclusive o f w ound s, and an eq u al n u m b er had b ee n trea te d fo r d iseases and d efects th a t existed b efo re in d u ctio n .2 This rh e to ric did n o t n ecessa rily re fle c t reality. A n ig n ored g ov ern m en t survey fou nd th a t th e th re e p rim ary reason s fo r d eferral w ere “d efective v i­ sion,” “in su fficien t teeth ,” and syphilis. A navy re p o rt p rod u ced sim ilar data and added th a t th e o fte n -q u o te d “d efective phy sical d ev elo p m en t” g e n e r­ ally referred to m e n w ho w ere over- o r u nd erw eigh t, over o r u nd er a c e r­ ta in h eigh t, o r to o sm all chested . W h ile h eig h t and w eight stand ard s w ere a safety issue, o th e r d eferm en ts w ere th e resu lt o f a “d esire to p ro te c t th e taxpayers fro m th e trea su ry drainage o f pen sio n s and re h a b ilita tio n o f unfit cand id ates. . . . W e w ill have enou gh p en sio n ers a fte r a n a tio n a l em erg en cy w ith ou t re cru itin g d efective individuals.”3 P ro p h ets o f ra cia l d o om failed to d ifferentiate b etw een m ed ically valid d efects and d efects d eem ed so by th e g o v ern m en t to save m oney. V D , o n th e o th e r hand, w as a seriou s m ed ical “evil” th a t co st th e arm ed serv ices in lo st duty and diversion o f m e d ica l reso u rces d esp ite rapid and

World War II, the Baby Boom, and the Population Explosion, 1939—1963

effective tre a tm e n t w ith sulfa drugs and p e n icillin by 1 9 4 4 . P rio r to th e war, P arran lab eled V D th e p rim ary p u blic h ea lth p ro b lem and called o n th e fed ­ eral gov ern m en t to provide funds to b attle it. C on g ress resp o n d ed w ith th e N atio n al V en ereal D isease C o n tro l A ct in M ay 1 9 3 8 , a llo catin g fed eral grants to state b oard s o f h ea lth to expand p rog ram s and investigate n ew rem ed ies. Yet C on g ress did n o t ap p rop riate m o n ey fo r ch e m ic a l p rop h y lactics and c o n ­ dom s, th e m o st im p o rta n t safeguards, due to th e in flu en ce o f sexu al co n se r­ vatives and th e C a th o lic C h u rch .4 The acu te level o f in fe c tio n am on g tro o p s and its im p act on A m e rica n fighting pow er chang ed th e g o v e rn m en t’s p o si­ tio n . The m ilita ry ’s m a in c o n c e rn w as co m b a t read in ess, n o t sexu al m o res and p o litica l w rangling w ith th e ch u rch. The arm y in itiated a V D cam paig n and in 1 9 4 2 establish ed th e V en ereal D isease C o n tro l B ra n ch in th e P rev en ­ tive M e d ica l D ivision, w ith Lt. Col. Paul Padget as its head. Film s, p o sters, and p am p h lets urged m e n to avoid illicit sex. M e n w ho could n o t rem a in ab ­ stin en t should u se m e ch a n ic a l and ch e m ic a l p ro p h y lactics provided in th e ir supplies so th a t, as Padget said, sold iers “drew co n d o m s at th e sam e tim e th ey drew th e ir soap and b ru sh e s" The arm y also sca ttered p rop h y lactic station s around p o p u lar leave a re a s.5 C on troversy arose over w h eth er sim ilar ta c tic s should b e used in th e new ly form ed W o m en ’s A rm y C orp s (W A C ). Its estab lish m en t h eig h ten ed a n x ie t­ ies ab o u t changing g end er n o rm s. W o m e n in th e form erly a ll-m a le m ilitary assu m ed th e trad itio n a l m ale roles o f p rim ary bread w in n ers and d efend ers o f th e n atio n . M an y civilians and even th e m a in stre a m press d ep icted m ilitary w o m en as sexually ad venturou s, a c h a ra cte ristic co n d o n ed in m ale G Is but n o t in w om en. In re a ctio n , W A C D ire c to r O v eta Culp H o b b y attem p ted to p o rtray W A C s as celibate. The m ilita ry su p p o rt o f co n d o m d istrib u tio n to m e n did n o t extend to w o m en .6 O n th e d o m estic fro n t, p o p u latio n co n tro l ad vocates feared a w idespread cam p aign en cou rag in g p a trio tic w o m en to have ch ild ren to rep lace m e n lost overseas. L iberalized co n tra cep tiv e p o licies seem ed th reaten ed . To co u n te r th is an ticip ated baby drive, th e y adapted th e ir o ra to ry to th e n a tio n a l p re o c ­ cu p atio n w ith war. They argued fo r quality versus q u an tity as a so u rce o f n atio n al stren g th and co n ten d ed th a t im m ed iate ad d ition s to th e p o p u lation w ould b e o f n o d irect value in w inning th e war. A 1 9 4 3 a rticle in American

Mercury by M ild red G ilm an claim ed th a t “to o m any su b n orm al p eop le, to o m any ‘b o rd erlin e’ cases, are b reed in g to o h ig h a p ro p o rtio n o f our infants,” th ereb y “filling our asylum s, ju ven ile co u rts and h o sp ita ls” O th ers w ere qu ick to em p hasize th a t th e re je c tio n o f 4 0 p e rce n t o f draftees left th e healthy, fit, and intelligent to serve and die; th e “b illion d ollars” spent annually to support th e “feeb le m in d ed and m en tally d iseased ” should b e d iverted to w artim e effo rts.7 C u tb ack s in so cia l and re lie f p rog ram s to pay fo r th e w ar m ade free

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co n tracep tiv es cru c ia l fo r lo w -in co m e and in d igen t w om en. In a vein sim ilar to th a t em ployed by S to re r a fte r th e C ivil W ar, p o p u latio n co n tro llers argued th a t rep lacem en ts fo r th e w ar dead should co m e fro m th e healthy, ed u cated , m id d le- and u p p er-class pop u lation, n o t fro m u ned u cated , lo w -in co m e fam i­ lies. P op ulation co n tro llers to u te d co n tracep tiv es to lim it “u n fit” progeny and stren g th en th e fam ily and th u s n a tio n a l stability : p lan n ed p reg n an cies led to happy u n io n s, w hile th e stress and d rain o f an u np lanned child led to m a rita l discord. Loving cou ples w ere less likely to b e tem p ted by en em y rh e to ric .8 The an ticip ated p ro n atalist w ave did n o t m aterialize, how ever, and new w artim e ro les fo r w o m en in c rea sed a cc e p ta n ce o f co n tra ce p tiv es. The In ­ d u strial D iv isio n o f th e U n ited S ta te s P u b lic H e a lth S e rv ic e in M ay 1 9 4 2 san ctio n ed fam ily planning fo r m a rried w o m en in w ar in d u stries. A pu blic relatio n s sp ecialist c o n c o c te d th e te rm to p lace co n tra ce p tio n w ith in th e safe con fin es o f m arriage. N o t a n ack n ow led g m en t o f a w om an’s rig h t to co n tro l h e r body, th is m ove expressed co n c e rn fo r a reliable la b o r force in vital w ar in d u stries. M an ag ers re p o rte d th a t w ork days lo st to p reg n a n cy and even a b o rtio n cau sed sh ortag es th a t cou ld w o rsen if th e n a tio n had to rely heav­ ily on fem ale w orkers. D o c to rs w ho faced w o m en su ffering fro m bu ngled ab o rtio n s b eg an to view th e p ra ctice as a “p u blic h ea lth problem .” Suddenly, co n tracep tiv es b e c a m e a p a trio tic sy m bol.9 By Jan u ary 1 9 4 3 m a rried w o m en cou ld o b tain in fo rm a tio n o n fam ily p lan n in g at 7 9 5 clin ics: 219 in h o sp i­ tals, 2 7 2 in h ealth d ep artm en ts, and 3 0 4 extram ural. The m e d ica l p rofession ju m p ed on th e bandw agon: tw e n ty -o n e m e d ica l sch o o ls gave in stru ctio n in co n tracep tiv e te ch n iq u e s, and 9 7 .8 p e rce n t o f d o cto rs surveyed by Dr. A lan F. G u ttm a ch er o f Joh n s H op k ins S c h o o l o f M ed icin e approved o f c o n tra ce p ­ tives fo r th e m o th e r’s h ealth ; 7 9 .4 p e rce n t approved fo r e c o n o m ic re a so n s.10 P u b lic op in io n also su p p orted co n tra ce p tiv e use. A G allup p o ll found th a t 7 7 p e rce n t o f A m erican s favored te a ch in g co n tra ce p tio n th ro u g h gov­ ern m en t h ealth clin ics.11 In a n A ugust 1 9 4 3 Fortune survey 8 4 .9 p e rce n t o f w o m en agreed co n tracep tiv es should b e available to m a rried w om en; 6 9 .8 p e rce n t believed th e sam e fo r u n m arried w om en. In a fu rth e r breakdow n, 9 2 .6 p e rce n t o f co lleg e-ed u ca ted w om en, 7 0 .2 p e rce n t o f g ram m ar s c h o o led u cated w om en, and 6 9 p e rce n t o f C a th o lic w o m en approved o f c o n tra ce p ­ tives fo r all m arried w om en; 7 8 .5 p e rce n t o f co lleg e-ed u cated , 5 5 .3 p erce n t o f g ram m ar s c h o o l-e d u c a te d , and 5 8 .9 p e rce n t o f C a th o lic w o m en approved fo r u n m arried w o m en .12 Thus, A m e ric a n s’ b re a k w ith ch u rch p o licy b eg an w ell b efo re th e p u blicized gap in th e 1 9 6 0 s . The W h ite H ou se m oved w ith th e flow. E lean or R oosev elt brok e h er silence and renew ed h er su p p ort follow ing F D R ’s re e le c tio n in 1 9 4 0 . A y ear la ter she o rganized a W h ite H ou se co n fe re n ce o n c o n tra ce p tio n , w ith activ ists and rep resen tativ es fro m th e C h ild ren ’s B ureau, th e P u blic H ea lth S e rv ice, and

World War II, the Baby Boom, and the Population Explosion, 1939—1963

th e D ep a rtm en t o f A g ricultu re. The resu lting “N egro P ro je c t” targ eted black s suffering fro m in ad eq u ate pu blic h ea lth services. T he p ro p o sal fo r th is p ro j­ e ct claim ed th a t “b irth co n tro l, p er se, ca n n o t c o rre c t e c o n o m ic co n d itio n s th a t resu lt in bad h ou sin g , overcrow d ing, p o o r hygiene, m a ln u tritio n and n eg lected san itation , b u t can red u ce th e a tten d an t loss o f life, h ea lth and h ap ­ piness th a t spring fro m th e se cond itions.” A D iv ision o f N egro S e rv ic e was established w ith in th e N ation al H ealth C ou n cil, w ith an advisory co u n cil th a t inclu d ed W .E .B . D u B o is, M a ry M cL e o d B eth u n e , A dam C lay ton Powell, Jr., and o th e r b lack m in isters, d o cto rs, and ed u cators. M rs. R o o se v elt organized a seco n d W h ite H o u se co n fe re n ce fo r D e c e m b e r 1941. Tw o m o n th s later P arran en d orsed state fam ily -p lan n in g p ro je c ts fo r m arried co u p les.13 The n ew em phasis on fam ily p lanning w as obvious in th e 1 9 4 2 tra n sfo r­ m atio n o f th e A B C L in to th e PPFA . Dr. K e n n eth R ose, ap p oin ted n a tio n a l d ire cto r in 1 9 4 0 , m e t w ith m ale lead ers o f variou s p o p u lation c o n tro l groups and en g in eered th e n am e chang e over S a n g e r’s o b je ctio n . “P lanned p a ren t­ h o o d ” conveyed m arried couples p lanning and sp acing ch ild ren , w hile “b irth co n tro l” carrie d a negative im age o f p eop le enjoying sex. U n d er R ose, PPFA follow ed a p ro n atalist p ath th ro u g h o u t th e w ar and played dow n any fem in ist affiliation w ith b irth co n tro l.14

Rhode Island during the War R IB C L evolved in to th e R h od e Island M a te rn a l H ealth A sso cia tio n (R IM H A ) in 1939 b ecau se th e te rm birth control w as “o b so le te ” The n ew title reflected co m p reh en siv e h ea lth care and serv ed as a disguise in a p red om in an tly C ath o lic state. The n ew n am e b rou gh t a 2 5 p e rce n t in crea se in co n trib u to rs. Still, R IM H A fell sh o rt fin an cially b eca u se o f n ew p re m a rita l and m a rita l cou nseling program s and evening clin ics to m e e t w orking w om en ’s dem ands. It o p en ed a n ew clin ic in W a sh in g to n C ou n ty in 1 9 4 0 . In 1941 lead ers c o n ­ te m p lated o fferin g in fertility serv ices to an sw er clie n t re q u e sts, au g m en t R IM H A ’s legitim acy , and u n d e rcu t C a th o lic o p p o sitio n , bu t la ck o f funds prevented th is exp an sion .15 D u rin g th e w ar R IM H A w orked w ith n a tio n a l org anization s. It w as on e o f th irte e n states to send a d elegate to a B C F A co n fere n ce in N ew Y ork C ity in M ay 1 9 4 0 th at stressed fin an cial in cen tiv es to so licit phy sicians’ su pport: “The id ea m u st b e sold th a t co n tra ce p tio n u nd er m e d ica l care w ill m e a n m o n ey in th e physician’s p o c k e t” R IM H A disagreed: co o p e ra tio n w ith physicians could ensu re to ta l h ealth fo r clien ts, n o t profits fo r d o ctors. Still, R IM H A did elect a d elegate to th e B C F A b o a rd .16 B o th B C F A and R IM H A ad opted “planned p arenthood .” R IM H A had em ployed th e te rm in re p o rts and m em o s as early as 1938. Tw o years la ter R IM H A circu lated le tters to clergy m en asking th e m

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to m e n tio n “plan n ed p a re n th o o d ” in th e ir M o th e r’s D ay serm o n s. The 1941 fu n d -raisin g m an u al em b lazo n ed “P lan n ed P a ren th o o d fo r H ealthy M o th ­ ers and H ealth y B a b ie s” o n its cover. Thus, w h en th e n a tio n a l o rg anization changed its n am e to PPFA in 1 9 4 2 , R IM H A presid ent D o ro th y H eg em an ap­ plauded th e m ove w hile sim u ltaneou sly affirm ing R IM H A ’s title: “W e in R .I. are hold ing to th is em phasis. . . . [ W ]e are stressin g th e health, b o th in m ind and in body, o f our p atients.”17 D esp ite th e ir co n g ru e n ce over p lan n ed p a ren th o o d , R IM H A and PPFA did n o t always see eye to eye. First, PPFA co n tin u ed to stress th e quality o f th e race in its propaganda, w hile R IM H A em phasized w o m en ’s and ch ild ren ’s h ealth . Its fu n d -raisin g m an u al in stru cte d v o lu n teers th a t if p eop le asked, “D o e s b irth co n tro l m e a n race su icid e?” th e y should answ er, “The p u rpose o f b irth co n tro l is n o t few er ch ild ren b u t a b e tte r c h a n c e in life fo r m o re children.” M issin g w as any co m m e n t regard ing th e race, eth n icity, religion, or class o f th e ch ild ren c o m m o n in PPFA rh e to ric . As fo r qu eries reg ard ­ ing shirking m o th e rh o o d , R IM H A sta ff p o in ted to a clie n t w ith five sons. Se co n d , R IM H A refu sed to b u ck le to pressu re fro m PPFA in 1 9 4 4 to change fro m a C lass B affiliated lo c a l co m m ittee to a C lass A state leagu e o f PPFA . R IM H A m ain tain ed co n tro l over clin ic prog ram s: n a tio n a l p o licy o ften had n o b earin g on lo c a l need s and little u nd erstan d in g o f state p o litics.18 D u rin g th e war, fo r exam ple, R IM H A found its e lf in a bind betw een g row ­ ing p u blic a cce p ta n ce and d ecrea sed g ov ern m en t em pathy: a C a th o lic a d ­ m in istra tio n governed R h od e Island in 1941. R IM H A ’s bo ard set a p o licy o f “very little p u b licity ” b eca u se o f th e “p re ca rio u s p o sitio n w ith th e p resen t C ath o lic a d m in istra tio n in th e state.” O fficers felt p articu larly vu lnerable due to th e ir “p ro xim ity to C o n n e c tic u t and M assach u setts,” w here laws p ro h ib ­ ited clin ics. R IM H A did n o t p a rticip a te in PPFA’s fund drive b eca u se officers receiv ed “w arnings fro m p eop le clo se to th e S ta te H o u se th a t w e m u st be extrem ely careful.” The in ab ility to p u blicize th e W a sh in g to n C ou n ty clin ic led to its closu re in M ay 1 9 4 3 .19 Fortunately, R IM H A w as able to c o n n e c t co n tra ce p tio n to th e w ar effort. R IM H A w orked w ith th e W o m e n ’s D efen se C o m m itte e on jo in t press r e ­ leases and em phasized “defense in our publicity.” In 1 9 4 3 H eg em an argued th a t “fam ily p lanning is as m u ch a p art o f any co m p lete p ro g ram fo r N ation al D efen se as th e n u m b erless o th e r steps w e are tak in g to p reserv e our n ation. M illio n s o f m o th e rs are going in to w ar w ork— th e A m e rica n w o m an is now facing heavy resp o n sib ilities and h e r h ea lth is p aram o u n t w hen she is doing th e trip le jo b o f h om em ak er, p ro d u ctio n w orker and breadw inner.” F acing th e se resp o n sib ilities “w ith ou t th e fear o f p re g n a n cy ” provided th e “se c u rity ” w o m en co v eted .20 This focu s on h ea lth care led to a relatio n sh ip b etw een R IM H A and lo ca l

World War II, the Baby Boom, and the Population Explosion, 1939—1963

b la ck lead ers. R IM H A p rid ed its e lf on its lo n g -sta n d in g ra p p o rt w ith th e b la ck com m u nity. The clin ic had b e e n in teg rated sin ce its beg in n in g s and ex p erien ced an in c rea se in b la ck clien ts fro m 2.19 p e rce n t in 1931 to 10.8 p er­ cen t in 1941, even th o u g h black s co n stitu ted ju s t 1.3 p e rce n t o f P rovid ence C ou n ty and 1.4 p e rce n t o f th e state in 1 9 3 0 and 1.5 p e rce n t o f b o th cou n ty and state in 1 9 4 0 .21 This in c re a s e differs fro m Jim m y M e y e r’s study o f th e C leveland M a te rn a l H ea lth A sso cia tio n , w here th e sta ff a ccep ted b la ck cli­ ents b u t lab eled th e m “socially and eco n o m ically hand icap p ed and inferior,” leading to a drop in b la ck p atro n s fro m ab o u t 3 0 p e rce n t to 12 p e rce n t during th is sam e p erio d .22 The U rb an L eag u e o f R h od e Island (U L R I) co n sid ered R IM H A a “m a jo r” co n trib u to r to th e h ea lth and w ell-b ein g o f th e b la ck com m u nity. T he U L R I d istribu ted p am p h lets ad vertising clin ic serv ices and to u tin g b la ck lead ers’ view s on co n tracep tiv es. A . Philip R andolph, th e p resid en t o f th e B ro th e r­ h o o d o f Sleep in g C a r P orters, believed th a t “b e tte r sch o o ls, b e tte r em ploy ­ m e n t, b e tte r m e d ica l and re cre a tio n a l fa cilitie s w ill do m u ch to p ro d u ce a b e tte r g en eratio n , bu t p lanning fo r h ea lth m u st b eg in at h o m e and if possible even B E F O R E th e n ex t g en era tio n is b o rn . Fam ily planning is th e first step in attain in g th is g oal” M a ry M cL e o d B eth u n e , p resid en t o f th e N atio n al C o u n ­ cil o f N egro W o m en , co n ten d ed th a t “we, th e org anized w o m en o f A m erica, have a sp ecial resp o n sib ility in creatin g a g rea ter u nd erstan d in g o f th e sig­ n ifican ce o f planned p aren th o o d . O u r w elfare activ ities as w ell as our so cial co n ta cts have m ad e us aw are o f th e m any p roblem s th a t arise fro m ig n o ran ce o f child sp acing and fam ily p la n n in g ” M rs. E stelle M a ssey Riddle, con su ltan t to th e N atio n al N u rsing C o u n cil fo r th e W ar, rem arked , “It is stran ge th a t in a co u n try w here ed u catio n and tra in in g co u n t fo r so m u ch , w e have b e e n so long in realizing th e g reat n eed fo r sound in fo rm a tio n and ca refu l planning in th e crea tio n o f our fa m ilie s” U L R I lead ers d escrib ed b irth co n tro l as “p re­ ventive m edicine,” allow ing w o m en to “u nd ertak e p reg n an cies w h en th e y are physically eq u al to th e ta s k ”23 B la ck ch u rch es also en d orsed R IM H A , inviting R IM H A sta ff to address th e ir co n g reg atio n s. R IM H A ’s b o ard w orked w ith M rs. W a lte r C. W y n n , a b lack activ ist, to p rio ritiz e h ea lth p ro b lem s am on g black s. F or th e re m a in ­ der o f th e w ar R IM H A held “w ell-atten d ed ” ed u ca tio n a l m eetin g s at b lack ch u rch es, parson ag es, and club g ath erin gs. R IM H A w as h o n ored to play “an im p o rta n t ro le in th e co m m u n ity ” during su ch difficult tim e s.24 The w ar p o sed d ifficulties fo r b o th R IM H A clien ts and staff. M an y new clien ts had husbands in th e serv ice o r had physically or m entally in ju red h u s­ ban d s; all w ished to “p o stp o n e fu rth e r p re g n a n c ie s” T he sta ff also felt th e effects o f war. Four o f six d o cto rs had en tered th e service by O c to b e r 1 9 4 2 , leaving th e rem ain in g tw o to “find so m e w om en d o cto rs”— a feat th e y failed

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to acco m p lish . E ith er no w o m en d o cto rs lived in th e v icin ity or a w om an d o cto r w as u nw illing to risk h e r re p u ta tio n at a co n tro v ersial clin ic. B y 1 9 4 4 on e o f th e tw o rem ain ing d o cto rs had en tered th e war, b u t th e clin ic did n o t tu rn p atien ts away. W h e n gas sh ortag es cu rta iled th e h o m e v isito r p rog ram and w o m en ’s ability to travel to th e clin ic, th e sta ff m ailed supplies h o m e. The clin ic had its ow n tro u b le p ro cu rin g supplies; so m etim es “in fe rio r” m aterials arrived w hen n o t delayed by Railw ay E xp ress strik es.25 D esp ite th e se b a rriers, R IM H A co n tin u ed to provide serv ice to th e trista te area.26 D esp ite C a th o lic policy, th e m a jo rity o f w o m en w ere C a th o lics (4 7 .9 p e rce n t), follow ed by P ro te sta n ts ( 4 4 .9 6 p e rce n t), Jew s (6 .3 5 p e rce n t), and “o th e rs” (.6 8 p ercen t). B etw een 9 3 .4 and 9 6 .5 p e rce n t o f w o m en receiv ed a diaphragm and jelly, d espite available in stru ctio n in th e rh y th m m e th o d to suit C ath o lic clien ts. B o th sta tistics co n firm a gap b etw een C a th o lic p olicy and p ra ctice s w ell b efo re th e 1 9 6 0 s . S o m e w o m en ca m e fo r a b o rtio n s: eleven in 1 9 4 0 , fifte en in 1941, seven in 1 9 4 2 , and n in e te e n in 1 9 4 3 , a “m ark ed de­ cre a se ” fro m an an n u al average o f fifty-five in th e 1 9 3 0 s . A ccess to effective b irth co n tro l o r in creasin g e c o n o m ic op p o rtu n ities could explain th is red u c­ tio n . P atien ts’ an n u al in c o m e in crea sed w ith th e war, fro m $ 1 6 .0 7 in 1 9 3 9 to $ 2 9 .5 8 in 1 9 4 3 . A s e c o n o m ic p ro sp e cts brig h ten ed , new p atients d ecreased fro m 3 0 5 in 1941 to 2 5 8 in 1 9 4 2 to 2 3 2 in 1 9 4 3 . E co n o m ica lly stable fam ilies could afford eith e r “p lan n ed ” ch ild ren or private co n tracep tiv e care; as m o re physicians receiv ed tra in in g in b irth co n tro l, th e dem and on clin ics eased. The d eclin e could also b e a resu lt o f th e d ecrea se d p u b licity due to p o liti­ cal co n sid eratio n s. F riends w ere th e m a in so u rce o f referrals (6 5 p e rce n t), follow ed by phy sicians a t Q u o n se t N aval A ir S ta tio n . B etw een 2 0 and 2 5 p e rce n t o f n ew clien ts during th e w ar w ere w ives o f serv icem en .27 A s th e w ar w ound dow n th e n u m b er o f p atien ts su rpassed prew ar levels, w ith 318 n ew clien ts b etw een A pril 1 9 4 4 and A pril 1 9 4 5 . A n “u np reced en ted n u m b e r” w ere serv ice w ives, re flectin g th e e c o n o m ic u n certa in ty o f th e w a r’s end as w ell as re tu rn in g in ju red veterans. D ischarg ed physicians serv iced th is grow ing clien tele: on e d o cto r in 1 9 4 5 grew to seven by 1 9 4 7 , all m ale. The staff found “an ea rn est a c c e p ta n c e ” am on g th e pu blic o f th e “fa ct th a t child sp acin g ” w ould help fo ster stable fam ilies. R uth B. L u b ran o, R IM H A so cial w orker, co n clu d ed th a t “m any h o m es have b e e n saved fro m a sep aratio n b e ­ cau se o f th e help o b ta in ed at th e center.”28 C o n tra ce p tio n h elp ed p revent divorce; stable fam ilies, in tu rn , could w ard o ff th e th re a t o f C om m u n ism .

The Postwar Period W ith th e w ar’s end, selectiv e-g row th p ro p o n e n ts resu m ed th e ir drive to de­ crease “und esirables.” D raftin g d o ctors during th e w ar had d ecreased steril­

World War II, the Baby Boom, and the Population Explosion, 1939—1963

izatio n s; as d o cto rs retu rn ed , sterilizatio n s in crea sed bu t did n o t a tta in p re­ w ar levels.29 C on tracep tiv e d istrib u tio n offered th e m o re a ccep ta b le solu tion to th e “p o p u latio n p ro b lem " re flected in a p ro n o u n cem e n t fro m th e Fed eral C o u n cil o f C h u rch es in 1 9 4 6 : “The irresp o n sib le w ho p ropagate reck lessly ” w ould so o n “b e rep resen ted in d isp ro p ortion ate nu m bers,” u nless so ciety en ­ cou raged co n tra ce p tio n to d iscourag e p a ren th o o d am o n g th o se “u n fitted ” to rep ro d u ce.30 T h eir m a in c o n c e rn w as d ifferential b irth ra tes. A study by th e M ilb a n k M em o ria l Fund and S crip p s F ou n d ation fo r R esea rch in P op u lation P ro b lem s suggested th a t low er e c o n o m ic and so cia l groups had th e h ig h est b irth ra te b eca u se th e y did n o t possess “as reliable [a] m eans o f con tro llin g th e ir fertility as th e ir m o re w ell-to -d o n eigh bors.” T h ese re se a rc h e rs c o n ­ cluded th a t th e “eq u alizatio n o f size o f fam ily am o n g th e variou s ec o n o m ic groups is . . . essen tia l to th e w elfare o f th e n a tio n " B u rch co n ten d ed th a t w ith ou t an effectiv e “h u m ane selec tio n o f th e fitte s t" th e p o p u latio n w ould “d eterio ra te b o th phy sically and m e n ta lly "31 S u ch a tre n d cou ld dam age A m e rican m ilita ry and scien tific co m p etitio n w ith C om m u n ists. The 1 9 4 5 p u b licatio n o f th e 1 9 4 0 cen su s co n firm ed th a t ed u catio n al lev­ els im p acted w o m en ’s prolificity. W h ite A m e ric a n -b o rn w o m en b etw een th e ages o f forty-five and fo rty -n in e w ith fou r years o f college had few er th a n 1.25 ch ild ren — a 4 5 p e rce n t rep la cem en t failure. W ith fou r years o f h ig h scho o l, th e co rresp o n d in g figures w ere 1.75 ch ild ren and a 21 p e rce n t re p la cem e n t failure. W o m e n w ith on e to fou r years o f grade sc h o o l had 4 .3 3 ch ild ren and a re p lacem e n t surplus o f 9 5 p ercen t. For w hite A m e ric a n -b o rn w o m en b etw een th e ages o f th irty and th irty -fo u r th e fertility d ifferences w ere even sharp er: w o m en w ith fou r years o f college had .7 ch ild ren ; w ith fou r years o f h ig h sch o o l, 1.2 child ren; and w ith on e to fou r years o f grade sch o o l, 3.1 child ren. N atio n al d isco u rse failed to n o te th a t th e low er rates fo r th e secon d group cou ld b e explained in p a rt by th e ir y ou n ger age: so m e probably had n o t co m p leted th e ir fam ilies. In ad d ition, th e y ex p erien ced th e ir fertile years during th e D ep ressio n , w h en th e fertility rate declined . P op u lation co n tro l ad vocates co n ten d ed th a t th e se b irth ra te d ifferences w ere th e “m o st serious p op u latio n p roblem s w h ich th e n a tio n m u st fa c e " I f th e tren d co n tin u ed for th re e g en eratio n s, d escen d an ts o f th e low est ed u catio n al and e c o n o m ic level w ould o u tn u m b e r th e top th ird at least n in e tim es. S o c ie ty w ould d eterio rate b ecau se “to u n d erstan d and b e able to help solve th e co m p lex p ro b lem s o f a m o d ern d em o cra cy req u ires at least a h ig h sc h o o l ed u ca tio n if n o t a college e d u catio n " To reverse th is tren d , ed u cated w o m en m u st stop “shirking m o th ­ erhood," and co n tracep tiv es m u st b e d isp ersed am o n g low er ed u catio n al and e co n o m ic lev els.32 These ad vocates lo o k ed to Sw ed en as a m od el. B y im p le­ m en tin g free o b ste tric serv ices, n u rsery sch o o ls, and p ed ia tric d ental clin ics to low er th e co st o f b ea rin g and rearin g child ren, Sw ed en’s w ealthy and ed u ­

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cated w ere “scorin g th e h ig h est b irth rates,” w hile w o m en w ith less ed u catio n and fin an cial reso u rces w ere b ea rin g few er ch ild ren b eca u se nationw id e th ey had access to co n tracep tiv es. Colliers called on C on g ress to investigate Eu­ ro p ean m od els to reverse th e A m e rica n b irth ra te “sh rin k ag e” T hey w ere n o t b en e a th R ed -b aitin g : th e R ussians and th e C h in ese had to o m any peop le; th e U n ited Sta te s w as falling far behind . T o b e a p ow erful in tern a tio n a l force, th e “dow nw ard p op u lation spiral” m u st b e rev ersed .33 O th e r facto rs exacerb ated th e ir fears. M any w o m en w ho en tered th e w ork­ fo rce during th e w ar h op ed to advance in o r at least m a in ta in th e se h ig h erpaid skilled jo b s . M an y o b serv ers p red icted a d ra stic d eclin e in fertility if w o m en rem ain ed em ployed. L a rg e-sca le fem ale em p loy m en t w as a ccep tab le fo r em erg en cies, bu t th e defeat o f G erm an y and Japan led m an y A m erican s to ex p e ct w o m en , p articu larly w hite m id d le-class w om en, to re tu rn to th e ir “righ tfu l p lace” in th e h om e. R etu rn in g m ale G Is n eed ed th e jo b s th a t som e w o m en o ccu p ied .34 N o call em erged fo r eth n ic and m in o rity w o m en to r e ­ tu rn h o m e: em ployers d esired th e ir cheap labor, and p o p u lation co n tro llers re je cte d th e m as su itab le m o th e rs for A m e rica n citizen s.

The Baby Boom B y 1 9 4 7 th e tra n sitio n to private life and e c o n o m ic p ro sp erity had p rod u ced an u n p reced en ted n a tio n a l p h e n o m e n o n , o n e th a t allayed tem p o ra rily th e o racles o f g en etic ru in as it cap tu red A m e ric a n “h ea rts and m in d s” The d eclin e in fertility th a t had ch a ra cte riz ed A m e ric a n so ciety sin ce th e early n in e te e n th cen tu ry halted in th e late 1 9 4 0 s . The T F R ro se fro m b etw een 2 and 2.5 fo r th e D ep re ssio n to b etw een 3 and 3 .7 fo r 1 9 4 7 to 1 9 6 4 .35 C ath o lic and b la ck fertility ro se p ro p o rtio n a lly faster: 3 .7 fo r w h ites versus 4 .3 for C ath o lics and black s. A lthou g h b o th b lack s and C a th o lics trad itio n ally had h ig h er fertility rates th a n w hite P ro te sta n ts, in th e 1 9 3 0 s b la ck s’ fertility had fallen to all-tim e low s.36 This d eclin e a ccen tu a ted th e rise in b la ck fertility a d ecad e later. W h a t cau sed th is a b erra tio n ? D em o g ra p h ic o b serv a tio n s inclu d e th e in crea sed n u m b er o f w o m en having at le a st tw o ch ild ren ; th e d ecrea se in w o m en rem ain ing single and child less and th e ir average age at m arriage; and th e sh o rte r in terv al betw een m arriage and first and su cceed in g b irth s. U n ­ p reced en ted e co n o m ic g row th fro m th e late 1 9 4 0 s to th e early 1 9 6 0 s along w ith th e G I B ill and v etera n s’ b en e fits ec o n o m ica lly su p p o rted th e b o o m . The ab u n d an ce o f jo b s fo r th e D ep re ssio n c o h o rt m ales m ay have en c o u r­ aged cou ples to m a rry young and have sev eral child ren. The psy ch olog ical re a ctio n to th e loss o f life and th e sep aratio n o f fam ilies during W o rld W a r II led to a d esire fo r a stable fam ily life and th e resu rg en ce o f p rom arriag e, p ro ­

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h ousew ife, and p ro n atalist id eologies. C hild b earin g and ch ild rearin g w ith in m arriage retu rn ed as on e o f th e only accep ta b le avenues fo r w o m en en terin g ad u lth o o d .37 The su rp risin g rise in w h ite fertility a m o n g all s o c io e c o n o m ic classes cau ght selectiv e-g ro w th p ro p o n e n ts o ff guard. U n su re if th e rise in fe rtil­ ity w as a s h o rt-te rm a b erra tio n , g o v ern m en t and bu siness lead ers co n tin u ed to exert p ressure to oust w o m en rem ain ing in th e hig her-p aid , skilled jo b s o f w artim e. D efy in g su ch p ressure, w om en in crea sed in th e w o rk fo rce dur­ ing th e 1 9 4 0 s m o re th a n any previou s d ecad e, alb eit in m o stly tra d itio n a l p in k -co llar jo b s . The American Journal o f Sociology claim ed th is tren d w ould d ecrease th e b irth rate. Newsweek blam ed th e im p en d in g d o om on ed u cated w om en: “For th e A m e ric a n g irl b o o k s and b ab ies don’t m ix . . . ; it is th e h ig h er-ed u cated w ife, ra th er th a n th e husband, w ho b rin gs dow n th e b irth r a te " 38 Ladies Home Journal co n cu rred : ed u cated w o m en generally had one child, w hile w o m en w ith a fo u rth -g ra d e ed u ca tio n w ere “a lm o st ce rta in to have at le ast fou r" “D a n g er o f o u trig h t d eclin e in th e phy sical and m en ta l m akeup o f o u r p o p u latio n ” lo o m e d , b eca u se ch ild ren o f co lleg e-ed u ca ted p aren ts have a “h ig h er average in tellig en ce th a n ch ild ren b o rn in to n o n ed u ­ cated h o m e s " E d u cated w o m en w ere “guilty o f sq u an d erin g th e ir g en etic in h e rita n ce ” and “low ering th e stand ard s o f fu tu re g e n e r a tio n s "39 Y et th e sh arp est in crea se in th e b irth ra te o cc u rred am on g th e m o st highly ed u cated w o m en .40 A b sen t in th e se critiq u es w as any co n d em n a tio n o f ed u cated m e n ’s behavior. P ro p h ets o f g en etic d o om b lam ed w om en, im plying th a t th e ir self­ ishn ess and p ow er over th e ir husbands w ere th e cau ses o f n a tio n a l ruin. O n e ta c tic to leg itim ize co n tracep tiv es during th is p erio d w as to change activ ists’ im age. The M a rg a ret S a n g er R esea rch B u reau (M S R B ), fo r exam ple, op ened an in fertility clin ic in 1 9 4 6 u nd er th e d ire ctio n o f Dr. A brah am Stone. E lizab eth C o h e n A rnold , reg istered n urse and later clin ica l M S R B su p erv i­ sor, asserted th a t n ew in fertility serv ices “m ad e it easier to raise m o n ey fro m so m e people. It o p en ed up d oors and w as a th resh o ld to respectability.” It also red u ced C ath o lic o p p o sitio n b eca u se th e M S R B help ed cou ples have babies. The ch o ice o f a m ale d ire cto r in c rea sed th e c lin ic ’s legitim acy. T he M S R B accep ted only m a rried cou ples w ith a copy o f th e ir m arriag e certifica te. C o n ­ ce rn for its im age also in flu en ced th e c lin ic ’s d ecisio n to avoid a b o rtio n re fe r­ rals.41 Sim ilarly, PPFA sought leg itim a cy in p art by in co rp o ra tin g m ale leaders and m e m b ers. Dr. M a ry S. C ald eron e, m e d ica l d ire cto r o f PPFA ( 1 9 5 3 - 6 4 ) , claim ed th a t PPFA w an ted a m an fo r h e r p o sitio n , “b u t m o st m ale physi­ cian s w ould n o t risk th e ir reputations.” B ec a u se she had “n o n e to risk ” she accep ted , bu t h e r p u blic h ea lth colleagu es “p itied ” h e r fo r “p ro fessio n al su i­ cid e” N ev erth eless, she h elp ed w in a p lace for fam ily p lanning in A m e rica n

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m e d ica l and p u b lic h ea lth e sta b lish m en ts. In 1 9 5 9 C ald ero n e, along w ith M a rth a E lio t, head o f th e C h ild ren ’s B u reau , h elp ed persu ad e th e A m e ri­ can P u b lic H ealth A sso c ia tio n to en d o rse p lan n ed p aren th o o d . C ald ero n e also co n v in ced th e N a tio n a l H ea lth C o u n cil to a cc e p t PPFA as a m em ber. In 1 9 6 4 , h e r last y ear as m e d ica l d irector, she p ersuad ed th e A M A to issue a sta tem e n t on co n tra ce p tio n , its first sin ce 19 3 7 : “Fam ily p lanning is n o t only resp o n sib le p aren th o o d , it is resp o n sib le m e d ica l practice.” In spite o f h e r sign ifican t co n trib u tio n s, C ald ero n e faced “sexist a ttitu d es” w ith in PPFA. W h e n she left, PPFA rep laced h e r w ith tw o m ale phy sicians, th e y ou nger o f w h om receiv ed a h ig h er salary th a n C ald ero n e had in eleven years. Planned P aren th oo d activ ist B e a tric e B la ir n o te d th e en o rm o u s p ressure to hire m ale execu tiv e d irecto rs and to have m e n on lo c a l P lan n ed P a ren th o o d board s. S u ch m e n w ere c o n c e rn e d over th e “aw ful p o p u latio n exp lo sio n ” in Third W o rld co u n tries. C a ld ero n e re ca lled th a t C ass C anfield ’s a p p o in tm e n t as p resid en t re p rese n te d th e a ck n o w led g m en t o f th e p op u latio n exp losion in und erd eveloped co u n tries in th e face o f d ecreasin g fertility in th e developed w orld. C anfield received m ale and big bu siness su pport previously lacking for P PFA .42 The en tra n ce o f large n u m b ers o f m e n angered m any w o m en long active in th e m o v em en t. Dr. Sarah M a rcu s stopp ed w orking at P lanned P aren th oo d in C leveland b eca u se it “had alread y sta rted p u ttin g m e n on, a lo t o f m e n on.” Sh e re sen te d th e m b eca u se th e y d iscrim in ated ag ainst w o m en and b ecau se, u nlike fem ale activ ists co n c ern e d w ith b irth co n tro l, m e n w ere in tere ste d in p o p u latio n co n tro l. R a cism and classism w ere ap p aren t am on g m an y new PPFA b en e fa cto rs. A s B la ir con clu d ed , th e y h op ed PPFA w ould help red u ce u nd esirab le groups. L o ra in e L. C am p b ell co n ten d ed th a t D o ris D uk e gave su b stan tial co n trib u tio n s fo r “th e w rong re a so n ” as p a rt o f an “a n ti-b la c k ” cau se.43 W h ile B la ir and C am p b ell o b je c te d to th is em p h asis, it w as n o t new : th e A B C L had p ro m o ted th e co n tro l o f u nd esirables since its b eg inning.

The International Population "Problem" B y th e 1 9 5 0 s a n u m b er o f private o rg an izatio n s, su ch as th e H ugh M o o re Fund, th e P op u lation R efere n ce B u reau , and th e C o m m itte e to C h e ck th e P op u lation E x p lo sion , had engaged in a n a tio n a l d isco u rse on th e w orld p o p u latio n “p red icam en t.” N o clearly o rg anized m o v em en t em erg ed u ntil Jo h n D. R o ck e fe ller III fou nd ed th e P op u lation C o u n cil in 19 5 2 . The co u n cil h elp ed estab lish an in tern a tio n a l p o p u latio n ag end a and p rog ram s and le ­ g itim ize th e bu rg eon in g field o f dem ography. R o ck efeller ch aired th e board , and F red erick O sb o rn w as execu tiv e v ice p resid en t w hile sim u ltan eou sly p resid en t o f th e A m e ric a n E u g en ics So ciety . The co u n cil gave p ro fessio n ­

World War II, the Baby Boom, and the Population Explosion, 1939—1963

als a rep u table fou n d ation to u nd erw rite a “p ro b lem -o rie n ted ap p roach ” to p o p u latio n .44 M a jo r fou n d ation s su p p orted it b eca u se it sought to co n tro l p op u latio n overseas, n o t fight fo r a w o m an ’s rig h t to co n tra cep tiv es at h om e. C am p b ell co n sid ered th e e sta b lish m en t o f th e co u n cil a “strik in g blow at P lan n ed P arenthood ,” w h ich had b e e n receiv in g fin an cial su p p ort fro m th e R o ck efellers.45 PPFA w as “consid erably w eak er” th a n p o p u lation o rg an iza­ tio n s and in fa ct lo st clien ts, w orkers, and lo c a l affiliates in th e 1 9 5 0 s .46 U n ­ p reced en ted p ostw ar p ro sp erity u n d erm in ed th e e c o n o m ic ju stific a tio n for co n tracep tiv e d isp ersal so pop u lar during th e D ep ressio n , and th e end o f th e w ar elim in ated th e em erg en cy arg u m en ts used during th e con flict. W h ile PPFA co n tin u ed to focu s on d o m estic issues, cold w ar zealo ts su ch as H ugh M o o re, a u th o r o f “The P op u lation B om b,” splashed a tten tio n on th e Third W o rld “problem .” M o o re argued th a t p o o r n a tio n s n eed ed c o n tra ce p ­ tives b ecau se a starving p o p u latio n w as rip e fo r M o sc o w ’s rh e to ric . T he cold w ar attra cted su p p orters to th e p o p u lation lobby am o n g w hite elite b u sin ess­ m e n w ho argued th a t in v estm en t cou ld solve p rivation and h alt th e spread o f C om m u n ism in A sia, L a tin A m e rica , and A fric a .47 M u c h o f th is “problem ,” acco rd in g to th e m , w as lo ca te d am o n g th e se p eop le o f color. B y 1959 th e fed eral g ov ern m en t had exam ined th e p op u latio n “p ro b lem ” and co m m issio n e d G en . W illia m H. D ra p er to study th e U n ited S ta tes M ili­ ta ry A ssistan ce P ro g ram , p ro m p ted by S e n a te a ccu sa tio n s th a t th e U nited States spent to o m u ch m o n ey overseas on m ilitary assistan ce ra th er th a n e c o ­ n o m ic d evelopm ent. The D ra p er R ep o rt, m ad e p u blic o n 2 3 July 1 9 5 9 , c o n ­ cluded th a t o v erp op u lation h in d ered fin an cial p rog ress and reco m m en d e d th a t U.S. foreign aid p rog ram s in c o rp o ra te co n tra ce p tio n .48 R e a ctio n varied. The W orld C o u n cil o f C h u rch es, th e U n ited P resb y terian C hu rch , th e U n ion o f A m e rican H eb rew C on g reg atio n s, and th e A m e ric a n B a p tist C on v en tion en d orsed th e re p o rt in 19 5 9 . C a th o lic bish op s o b jected . A s a resu lt, P resid ent D w ight D. E isen h ow er ig n o red th e r e p o rt’s re co m m en d a tio n s, statin g at a press co n fere n ce : “I ca n n o t im agin e an yth in g m o re em p h atically a su b je ct th a t is n o t a p ro p er p o litica l o r g ov ern m en tal activ ity or fu n c tio n or re sp o n ­ sibility. This g ov ern m en t has n o t, and w ill n o t . . . have a p ositive p o litica l d o ctrin e in its p ro g ram th a t has to do w ith th is p ro b lem o f b irth co n tro l. T h at’s n o t o u r business.”49 This sp e ech ca m e m o re fro m p o litica l co n sid er­ ation s th a n p erso n a l co n v ictio n s. In fa ct, a y ear earlier E isen h ow er had asked th e N atio n al S e cu rity C o u n cil h ow foreig n aid could su cceed if p o p u lation grow th co n tin u ed at its p resen t rate. W h e n D ra p er asked E isen h ow er years later w hy h e had re je c te d th e re co m m en d a tio n s, h e said h e did n o t w ant to divide th e n atio n on th e eve o f a sensitive e le c tio n .50 Iron ically, th e ea rliest p resid en tia l en d o rse m en t o f p o p u latio n c o n tro l cam e fro m th e co u n try ’s first C a th o lic leader. Jo h n F. K en n ed y involved over­

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seas p op u latio n co n tro l as p art o f his Third W o rld p ro g ram fo r e c o n o m ic de­ velop m ent. In a sp ecial m essage on foreig n aid in 1961 K en n ed y w arned th a t th e w orld p op u latio n p ro b lem was “staggering. In L a tin A m e rica , p o p u lation grow th is alread y th rea te n in g to ou tp ace e c o n o m ic g row th . . . and th e p ro b ­ lem s are no less seriou s or d em and ing in o th e r developing p arts o f th e world.” K en n ed y d irected his sta ff to revise outd ated re p o rts on p op u latio n con trol. In ad d ition, S e cre ta ry o f S ta te D ean R usk ap p oin ted R o b e rt A. B a rn e tt as a fu ll-tim e officer to th e u n d e rse c re ta ry fo r e c o n o m ic affairs “to m a in ta in a con tin u in g review o f th e foreig n p o licy im p licatio n s o f th e w orld p o p u lation p ro b lem and to tak e su ch a ctio n s as are called fo r in th e n a tio n a l in te re st”51 B a rn e tt co n su lted D raper, R o b e rt C o o k o f th e P op u lation R eferen ce B ureau, C anfield and Fred Jaffe o f PPFA , O s c a r H arkavy o f th e Ford F ou nd ation, and R o ck efeller III. B y late 1961 a sm all group o f p op u latio n co n tro l ad vocates in th e S ta te D e p a rtm e n t had ch an g ed th e A g en cy fo r In te rn a tio n a l D ev elo p ­ m e n t (A ID ) policy, allow ing A ID p u blic h ea lth te ch n icia n s to give re p ro d u c­ tive in fo rm atio n on re q u e st.52 The follow ing year Sw ed en a n n o u n ced th a t p op u latio n c o n tro l w ould be a m a jo r co m p o n e n t o f its foreig n aid and p laced a reso lu tio n en titled “P opu­ latio n G row th and E co n o m ic D ev elo p m en t” on th e U N G en e ra l A ssem bly agenda. The m o st co n tro v ersia l parag rap h stated th a t th e U n ited N ations should “give te ch n ic a l assistan ce, as req u ested by g ov ern m en ts, fo r n atio n al p ro je c ts and p rog ram s dealing w ith th e p ro b lem s o f p o p u latio n ”53 T he K e n ­ ned y a d m in istra tio n su p p o rted it, b u t C a th o lic lead ers d en o u n ced th e in ­ clu sio n o f “te c h n ic a l assistance.” K en n ed y co m p rom ised : th e U n ited S ta tes su p p orted th e reso lu tio n in its en tirety bu t ab stain ed fro m th e vote in c o m ­ m ittee. D esp ite its d efeat, R ich ard N. G ard ner, deputy assista n t sec re ta ry for in tern a tio n a l o rg a n iz a tio n a l affairs, d escrib ed th e re so lu tio n as a “tu rn in g p o in t” in w orld re co g n itio n o f th e p op u latio n “p ro b lem ”54 In A pril 1 9 6 3 th e N atio n al A cad em y o f S c ie n ce s released The Growth of World Population, a study in itiated by p riv a te -se cto r scien tists w ho believed th a t if th e y did n o t re sea rch th is to p ic, g o v ern m en t scien tists w ould n o t be allow ed to act. T h eir re p o rt claim ed th a t “eith e r th e b irth rate o f th e w orld m u st co m e dow n or th e d eath rate m u st go b a ck up.” It called fo r in creased private and g ov ern m en t spending fo r biom ed ical, d em og rap h ic, and so cial re sea rch and train in g in th e area o f p op u latio n co n tro l. A t a su b seq u en t press co n fere n ce K en n ed y a sserted th a t A m e rica n s should “k now m o re ab o u t th e w hole rep ro d u ctiv e cy cle and . . . th is in fo rm a tio n [should] b e m ad e m o re available to th e w orld so th a t every one could m ake th e ir ow n jud g m ent.”55 D rap er p raised K en n ed y ’s “w ise leadership.” O n 2 0 July 1 9 6 3 th e S e n a te F or­ eign R elatio n s C o m m itte e am end ed th e F oreig n A ssista n ce A ct o f 1 9 6 3 o f­ fered by S e n a to r W illia m Fulbright (D -A R ) to a u th o riz e “re sea rc h assistan ce

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to co o p e ratin g co u n tries in carry in g out p ro g ram s o f p op u latio n c o n tro l” b ased on th e “profou nd im p act o f p o p u lation g row th o n e c o n o m ic d evelop­ m ent.” This am en d m en t, along w ith a sim ilar on e to th e F ood for F reed o m A ct, ap p rop riated U.S. funds fo r overseas p op u latio n c o n tro l p ro g ram s.56 O n ce K en n ed y en d o rsed p o p u latio n co n tro l to “h elp ” Third W o rld n a ­ tio n s, o th e r p ro m in en t lead ers follow ed suit. E isen h o w er re ca n te d his early sta tem e n ts, b e c a m e an h o n o ra ry co sp o n so r w ith H a rry S. T ru m a n o f th e P lan n ed P a re n th o o d -W o r ld P op u lation cam p aig n in 1 9 6 5 , and m ad e an a b o u t-face on th e g o v e rn m en t’s role in rep ro d u ctiv e m atters. In a le tte r to S e n a to r E rn e st G ru e n in g (D -A K ), E isen h ow er co n ten d ed th a t co n tra c e p ­ tio n w as an “ob lig atio n restin g u p o n every en lig h ten ed governm ent.” I f gov­ ern m en ts ign ored th e plight o f u n b o rn g en eratio n s, “w hich, b eca u se o f our u nread in ess to tak e co rrectiv e a c tio n in co n tro llin g p op u latio n grow th, w ill b e d enied any ex p e cta tio n s bey on d a b je c t p overty and suffering, th e n h is ­ to ry w ill rightly co n d em n us.”57 The N atio n al In stitu tes o f H e a lt h -r e s e a r c h arm o f th e U n ited S ta tes P u blic H ea lth S e r v ic e -p u b lis h e d in Jan u ary 1 9 6 3 a catalo g o f 3 8 2 co n tracep tiv e p ro je c ts fin an ced by g ov ern m en t and private ag en cies at an an n u al co st o f $ 6 m illio n .58

Contraceptive Experimentation To im p lem en t p op u latio n co n tro l, co n tracep tiv es had to b e easily d istribu ted and highly effective. R esea rch ers devised a n oral co n tra cep tiv e and te ste d it on w o m en o f co lo r a n d /o r lo w -in co m e w om en. PPFA provided som e fu n d ­ ing, bu t th e b u lk ca m e fro m individuals su ch as C la re n ce G am b le and esp e­ cially K ath erin e D ex te r M cC o rm ic k , h eir to th e M c C o rm ic k reap er fortu ne. G reg o ry P in cu s o f th e W o rc e s te r F ou n d ation fo r E x p erim en ta l B io log y in M a ssa ch u se tts te a m ed up w ith Jo h n R o ck , a facu lty m e m b e r at H arvard M e d ica l S c h o o l and devout C a th o lic, to develop a co n tra cep tiv e o f w h ich so ­ ciety and th e C ath o lic C h u rch w ould approve. They co n c en tra te d o n a pill for w o m en b ecau se it re flected advanced m e d ica l tech n olog y. The resp o n sib ility fo r tak in g a pill w ould b e in w o m en ’s h and s, w here San g er and M c C o rm ic k believed it should be, and P in cu s and R o c k believed it w as easier to co n tro l on e ovum th a n m illio n s o f sp erm .59 H isto rian L au ra B riggs has show n th a t re sea rch ers k new th e key to p re­ v en tin g o v u lation by 1 9 4 0 . N o u rgent n ee d existed , how ever, to develop a co n trace p tiv e w ith ex p e cted side effects th a t cou ld h a rm h ealth y w om en. N o t u n til Third W o rld o v erp op u lation b e c a m e a “p ro b lem ” in n eed o f a qu ick fix did clin ica l tria ls begin. A s B riggs argues, by 1 9 5 5 “th e dangers o f over­ p op u latio n w ere co n stru e d as life th rea te n in g and h e n c e w o rth a g reat deal o f risk.” Su p p o rters o f th is te ch n o lo g y lo o k ed to P u erto R ico fo r volu nteers.

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F em in ists on th e island w ho had lo n g fou ght fo r b e tte r co n tra cep tiv e care fou nd th em selv es cau ght b etw een lib erals ad vocatin g b irth co n tro l to save w o m en fro m th e hazard s o f and p overty asso cia ted w ith co n sta n t ch ild b ear­ ing and con serv ativ es p ro m o tin g p op u latio n co n tro l to save so ciety fro m th e e co n o m ic bu rd en and ra cia l im p licatio n s o f large P u erto R ica n fam ilies.60 P rio r to th e pill, p op u latio n co n tro llers had look ed to steriliz a tio n to solve th e islan d ’s perceived p op u latio n p roblem . In th e 1 9 4 0 s U .S. in d u stries lo ­ cated th e re, en ticed by ta x -fre e fin an cial o p p o rtu n ities and a cu t-ra te w ork ­ force. W ith w o m en a large p art o f th is w orkforce, m any em ployers co n sid ­ ered co n tra ce p tio n necessary. It w as m u ch ch eap er th a n o n -site day care. The In tern atio n al P lanned P aren th oo d F ed eration, G am ble, and oth ers ad vocated free or lo w -co st steriliz a tio n .61 M a n y phy sicians p ro m o ted it b eca u se th e y believed lo w -in co m e and in d igen t P u erto R ica n w o m en could n o t p ra ctice reliable co n trace p tio n . Facing th is type o f pressure and w ith o th er co n tra ce p ­ tives eith e r to o costly, in effectiv e, o r in accessib le, o n e -th ird o f P u e rto R ica n w o m en o f child b earin g age had b e e n sterilized by th e 1 9 6 0 s — th e largest p ro ­ p o rtio n in th e w orld.62 A t face value, th is sta tistic seem s to im ply an effective p op u latio n co n tro l agenda, bu t Briggs has d em on strated a m u ch m o re co m p lex picture. A lthough th e 1937 law legalized steriliz a tio n fo r eu gen ic o r co n tra ce p tiv e p u rp oses, th e m ajo rity o f op eratio n s w ere d one in th e la tte r ca teg o ry during th e 1 9 4 0 s and 1 9 5 0 s . W h ile n atio n alists and th e C a th o lic C h u rch co n d em n ed steriliza­ tio n as a gen o cid al and im p erialist p lot, m any island fem in ists su p p orted it as an effectiv e m ean s for w o m en to c o n tro l th e ir fertility. W h ile p o p u lation co n tro llers, esp ecially G am b le, w anted to extend eu genic sterilizatio n , th is plan failed: th e m e d ica l in fra stru ctu re w as n o t su fficient to hand le th e p ro ­ ced u re d one en m asse; and d o cto rs lacked a ccess to th e m a jo rity o f w om en, w ho lived in ru ra l areas w here h o m e b irth s pred om inated . M oreover, Briggs fou nd th a t w o m en traveled far to h osp itals th a t offered steriliz a tio n and re ­ p o rted satisfa ctio n w ith th e o p eratio n . Thu s, w hile p o p u latio n co n tro llers p ro m o ted it as a qu ick fix to th e p o p u latio n p ro b lem , w o m en ig n ored such rh e to ric and d em o n strated ag en cy in a ccep tin g fund ing fro m G a m b le and o th e r zealo ts to shape p rog ram s th a t ben efited w o m en .63 W ith steriliz a tio n available p rim arily in u rb a n areas, ru ra l w o m en , th e m ajority, had lim ited a ccess. M an y p op u latio n co n tro llers co n tin u ed to de­ p lore P u erto R ic o ’s “p o p u latio n ex p lo sio n " Five b irth s fo r every d eath and a d eclin in g in fan t m o rta lity w ould n o t d ecrea se u nem p loy m en t. A lth ou g h em ig ration provided a solu tion, p o p u lation co n tro llers d esired to red u ce “th e flow fro m th e fa u c e t” to N ew Y ork fo r ra c ist re a so n s.64 G a m b le argued th a t P u erto R ico ’s p op u latio n p ro b lem w as “d irect and im m ed ia te” b eca u se im ­

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m igran ts exhau sted “m e d ica l serv ices and re lie f fu n d s"65 The pill seem ed a lo g ical solu tion. D ev elop ers o f th e pill te ste d it o n tw o hu nd red an im als, bu t th e y had to co n firm th e ir findings on h u m an su b jects. M cC o rm ic k stated th a t for research to co n tin u e, d evelopers m u st find “a cag e o f ovulating fe m a le s" B ec a u se o f th e ir m arginalized and ra cia l status, P u e rto R ic a n w om en w ere p e rfe ct sub­ je c ts ; re sea rch ers could p e rfo rm ex p erim en ts in P u erto R ico th a t w ould be d ifficult to do on th e m ainland . P u e rto R ica n w o m en gave re sea rch ers an advantage b ecau se th e y n ow had “g u inea pigs w ho could talk." M an y P u erto R ica n w o m en again ig n ored su ch ra cism and vo lu n teered to p a rticip a te in ex p erim en ts, hoping th a t th e ir a ctio n s w ould brin g an effectiv e alternative to sterilizatio n .66 S o m e h isto ria n s have argued th a t th e se ex p e rim e n ts w ere “n o t at all in co n siste n t w ith co n te m p o ra ry clin ic a l re se a rc h p ra c tic e s " W h ile tru e, M c C o rm ic k ’s sta te m e n ts and th e la ck o f in fo rm ed c o n se n t d em o n stra te disregard fo r th e su b je cts in m u ch th e sam e w ay th a t re se a rc h e rs view ed th e T u skegee p a rticip a n ts. A lth ou g h n o t en fo rced , th e N u rem b erg C o d e ’s te n -p o in t m an d ates regard ing h u m an ex p e rim e n ta tio n had b e e n passed and applied to th e se exp erim en ts. These sch o lars also co n clu d e th a t P in cu s and R o ck ch o se P u erto R ico fo r reason s u nrelated to race: th e y had p rofession al co n n e ctio n s w ith re sea rch ers at th e U niversity o f P u erto R ico and w ith clin ­ ics staffed by re sp e c te d p hy sician s; th e g eo g rap h ic iso la tio n o f th e island sh eltered ex p e rim e n ts fro m prying m ed ia eyes and allow ed re sea rch ers to m o n ito r p articip a n ts, b eca u se it w as difficult fo r th e m to leave th e island; and M assa ch u setts, R o c k ’s and P in c u s’s h o m e state, still had laws ag ainst b irth co n tro l.67 I f laws w ere a co n c e rn , how ever, P in cu s and R o c k cou ld have c o n ­ d ucted th e ir ex p erim en ts in R h od e Island, w here n o legislative p ro h ib itio n s existed. To w ard o ff C a th o lic o p p o sitio n th e re, P in cu s and R o c k cou ld have em p h asized th e h ea lth a sp e cts o f th e ir ex p e rim e n ts, as R IM H A had done fo r decad es. R IM H A had re sp ec te d physicians w ith w h om P in cu s and R o ck could have w orked. M ov in g th e ir h ead q u arters less th a n a n h o u r dow n th e road to R h od e Island w ould have b e e n easier th a n relo ca tin g to P u erto R ico. In R h od e Island, how ever, th e re w ere n o captive island p op u latio n o f w o m en o f co lo r and n o p ro te ctio n fro m m ed ia exposu re. R esea rch ers ch o se P u erto R ico p rim arily b eca u se th e re w ere n o d ru g -testin g re strictio n s and b ecau se m in o rity groups h isto rically have b e e n targ eted for “u n e th ica l re se a rc h and m e d ica l p ractices." As R u th M a ck lin argues, m ain lan d ex p e rim e n ts w ould n o t have o ccu rred “w ith ou t in fo rm in g w o m en th a t th e y w ere involved in a re sea rch p ro je c t or ab o u t th e side effects th e y m ight exp erien ce, inclu d ing th e ch an ce o f b ec o m in g p re g n a n t" Even th o u g h fed eral guidelines regu lating

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h u m an ex p e rim e n ta tio n had n o t y et b e e n passed, “th e scru p les o f re se a rc h ­ ers prevented th e ir d oing th e sam e study on m o re ed u cated w o m en in th e U n ited S ta te s " R esea rch ers ch o se P u erto R ica n w o m en b eca u se th e y w ere easily exp loited and less likely to p ro test th a n m ainland w om en, n o t b ecau se th e ir subgroup had any d irect bearin g on th e research . T hey w ere healthy, n o t ill w ith a d isease fro m w h ich th e se ex p e rim e n ts w ould b en e fit th em . Lastly, p o p u latio n co n tro llers had lo n g targ eted P u erto R ico as “p ro b le m a tic ” b e ­ cau se o f p overty and o v erp op u lation .68 E x p erim en ts b eg an in th e 1 9 5 0 s u nd er E d ris R ice-W ray , a lo c a l p u blic h ealth p hysician and m e d ica l d ire cto r o f th e P u erto R ica n Fam ily Planning A sso cia tio n w h om G reg o ry P in cu s had m e t in S a n Juan. B y th is tim e th e re w ere six ty -th re e co n tra ce p tiv e clin ics on th e island. R ice -W ra y co n d u cte d th e ex p e rim e n t at o n e situated in R io P ied ras, a p o o r su burb o f S a n Juan. W h e th e r or n o t th e se tria ls seem exploitive in h ind sight, at th e tim e m any w o m en w ere w illing to try th e pill b eca u se th e y did n o t w ant to b e s te ril­ ized and few o th e r reliable o p tio n s w ere available. R ice -W ra y co lle cted data on 2 2 1 w om en: alth o u g h n o n e b e c a m e p reg n an t, 2 5 p e rce n t dropped out b ecau se o f no xio u s side e ffe c ts— nau sea, v om itin g , fluid re ten tio n , and diz­ ziness. L ow ering th e dosage help ed w hile retain in g a h ig h rate o f effectiv e­ ness. Dr. A daline P en d leto n S atterth w aite, a g y n eco lo g ist at Ryder M em o ria l H osp ital in H u m acao, th irty m iles fro m S a n Juan, co n d u cted a seco n d exp eri­ m e n t, co lle ctin g d ata fro m 2 4 3 w om en. P in cu s used th e se findings to argue fo r th e approval o f Enovid b efo re th e U n ited S ta tes F ood and D rug A d m in ­ istratio n (FD A ). A pproval ca m e in 1 9 5 7 fo r g y n eco lo g ica l d isord ers, n o t for co n tracep tiv e p u rp oses. Still, 5 0 0 ,0 0 0 w om en w ere using it by 1 9 5 9 .69 P in cu s, how ever, did n o t re p o rt to th e F D A R ice -W ra y ’s co n clu sio n th a t d espite effectiv en ess in p reventing pregnancy, th e pill w as u n a ccep ta b le b e ­ cau se o f adverse side effects. O n e w om an died o f co n g estiv e h ea rt failure, and a n o th e r developed p u lm o n ary tu b e rcu lo sis, bu t developers dism issed findings linking th e pill to circu la to ry d isord ers. Dr. S atterth w aite expressed c o n c e rn th a t th e pill w orsen ed cerv ica l erosio n , b u t su ch co n c e rn s w ere d is­ m issed. A s late as 1 9 7 0 G a rre tt H ardin claim ed th a t “th e w om an’s m ind was involved___ [T ]h e ex p e cta tio n o f u np leasan t side effects in crea sed th e p ro b ­ ability o f ex p erien cin g th em . W h a t w e see h ere is w hat is called a self-fulfill­

ing prophecy" P in c u s’s co n c e rn for effectiv e p op u lation co n tro l ra th er th a n w o m en ’s h ealth led h im to a ccep t p sy ch o lo g ical over p h y siolog ical explanatio n s .70 H e and o th ers attem p ted to gain PPFA’s en d o rsem en t, b u t C ald eron e refu sed in 1 9 5 8 and 1 9 5 9 b eca u se th e F D A had n o t a ccep ted th e pill for c o n ­ tracep tiv e p u rp o ses.71 Yet as early as th e 1 9 5 0 s PPFA w as circu latin g in fo rm a tio n on an o ral c o n ­ tracep tiv e to clin ics. A t th a t tim e R IM H A p re scrib ed th e diaphragm and jelly

World War II, the Baby Boom, and the Population Explosion, 1939—1963

to n early 1 0 0 p e rce n t o f its clien ts; sta ff m e m b ers co u n seled a few C ath o lics in th e rh y th m m eth o d . Physicians at R IM H A ad opted a p o licy in 1 9 5 2 th a t if p atien ts asked ab o u t th e “pill fo rm o f co n tra ce p tiv e" th e y w ould b e told th a t th e re w as “n o proven m e th o d o f co n tra cep tiv e th a t ca n b e ta k en by m o u th " The follow ing year M rs. C. T ra cy B a rn es, sec re ta ry o f th e PPFA board , in ­ form ed R IM H A ’s an n u al m e etin g th a t th e failure to re a ch m o re lo w -in co m e w o m en resu lted fro m th e la ck o f a “sim ple effectiv e m e th o d o f c o n tra ce p ­ tio n " R ep o rts p u blished in 1 9 5 3 claim ed th a t a pill w ould so o n b e p erfected . In 1 9 5 4 PPFA persuad ed R IM H A to p a rticip ate in a new p ro je c t: “This ex ­ p e rim e n t calls fo r th e use o f a new ta b le t called F O M O S " R IM H A had to “get tw enty-five p atients to tr y th e n ew ta b le t” w ith in six m o n th s. R IM H A agreed. B y 1955 th re e “co o p e ra tin g ” w om en had rep o rted “favorable” use o f F O M O S . The annual PPFA m e etin g th a t year em phasized th e im p o rta n ce o f p erfectin g a “m o re sim ple m e th o d o f co n tra ce p tio n ” in o rd er to re a ch “a se c tio n o f th e p op u lation , w h ich b eca u se o f ig n o ran ce, req u ired th e u tm o st sim p licity "72 S u ch class bias led PPFA to su pport ex p erim en ts n o t only in P u erto R ico but also in R h od e Island. W h y ta rg e t R h od e Island? In v estigation s found high approval fo r c o n tra ­ cep tio n . A B ro w n U n iversity S o cio lo g y D ep a rtm en t survey in 1 9 5 7 o f one hu nd red lo w -in co m e fam ilies in P rovid ence found n o n o tice a b le difference in attitud es tow ard co n tra ce p tio n b etw een C a th o lics and n o n -C a th o lics: al­ th o u g h sev enty-tw o o f th e on e hund red w ere C a th o lic, 8 7 p e rce n t approved o f “so m e ty p e" o f b irth co n tro l, and 5 8 p e rce n t had em ployed co n tra c e p ­ tio n “b u t w ith varying s u c c e s s " P op u lation co n tro llers to o k ad vantage o f th is g rassro o ts dem and. In 1 9 5 7 G. D. S e a rle and C om p any con v in ced som e physicians to p re scrib e Enovid to lo w -in co m e p atients. R IM H A did n o t par­ ticip a te b ecau se its M ed ica l A dvisory C o m m itte e re je c te d Enovid b ased on “th e o re tic a l and p ra c tica l co n cern s,’’ inclu d ing “possible side e ffe c ts " R IM H A officials d eem ed th e pill to o d angerous, althou g h th e y had b u ck led to PPFA pressure th ree years earlier w ith F O M O S . O v er th e n ext several years C harles H ach ad orian and D avid G leason , m ed ical rep resen tatives in R h od e Island for G. D. Searle, re p o rte d n o co m p lain ts fro m p articip atin g d o cto rs ab o u t ad ­ verse re a ctio n s to th e pill am on g th e ir p a tie n ts.73 G le a so n claim ed th e m o st seriou s side effect w as “m o rn in g sick ness" cau sed by E novid ’s “clo se d up lica­ tio n o f th e h o rm o n a l co m p lex in a real p re g n a n cy "74 S u ch co n clu sio n s are su sp ect. P hysicians w illing to ex p erim en t w ith lo w -in co m e w o m en ’s bod ies as p art o f a larger plan to p ro m o te selective p o p u lation g row th m ight h esitate to re p o rt o r even tak e seriously co m p lain ts lodged by patients. In 1 9 6 0 th e FD A approved th e pill as a co n tra cep tiv e fo r n o m o re th a n tw o years b eca u se its lo n g -te rm safety w as u n certain . Tw o years later S ea rle was m ad e aw are o f m o re th a n on e hu nd red cases o f th ro m b o sis and em b olism

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related to pill use, inclu d ing eleven fatalities. Th ese p ro b lem s led th e W o rld H ealth O rg an iza tio n (W H O ) in 1 9 6 5 to study th e pill, b u t, as a ta s k force m e m b e r told a rep o rter, “th e p eop le w ho w ere co n c e rn e d w ith p op u lation p ro b lem s had already d ecid ed th a t w e w ere going to deliver a w h itew a sh "75 The “p o p u latio n exp lo sio n ” outw eig hed c o n c e rn fo r th e h ea lth o f w o m en seeking reliable b irth con trol. In ad d ition to th e ex p erim en ts b ased on th e pill, th e S u n n en P ro je c t to o k p lace in P u erto R ico during th e 1 9 5 0 s . Jo sep h S u n n en , a P ro te sta n t, R ep u b ­ lican co n tracep tiv e m a n u fa ctu rer fro m S t. L ou is, M isso u ri, believed pop u la­ tio n co n tro l w as an e c o n o m ic n ecessity in P u erto R ico. H e offered fin an cial en co u rag em en t for sterilizatio n . F or ru ral p eop le w ho cou ld n o t co m m u te to u rb an clin ics fo r th e p ro ced u re, he d istribu ted E m ko, a vaginal foam , at no charge. C lo se to fifte en h u n d red v o lu n teers, so m e fro m th e co m p any th a t p rod u ced E m ko and o th ers fro m P u erto R ico , b ro u g h t th e p ro d u ct to ru ral w o m en and re tu rn ed to re sto c k supplies. Ironically, clo se to 8 0 p e rce n t o f th e se v o lu n teers did n o t u se E m ko th em selv es. A s w ith th e pill, E m ko was ex p erim en tal and p ossibly in effectiv e or d angerous.76 R ea ctio n w as m ixed. M o st p eop le w h om v o lu n teers en c o u n tere d su p p o rted b irth co n tro l. Yet m o st w o m en had a ccess only to ex p e rim e n ta l a n d /o r d angerous m eth o d s, su ch as th e pill and E m ko, or to p e rm a n en t m eth o d s, su ch as sterilization . The p rim ary o p p o sitio n ca m e fro m th e C a th o lic C h u rch and P u erto R ica n n atio n alists w ho op p osed b irth co n tro l itself, n o t sp ecific m eth o d s. Pedro A lbizo C am p o s, head o f th e N atio n alist Party, exalted th e p easan t w om an w ho b o re ch ild ren fo r th e h om eland . M a ch o m e n w ere also a n ta g o n istic to co n tracep tiv es b eca u se th e y believed th e ir v irility w as called in to qu estio n if th e ir w ives and m istresses w ere n o t b ea rin g th e ir ch ild ren .77 In th e end, c o n tra c e p tio n on th e island w as a co m p lex issue. W o m en d em o n strated ag en cy in th e ir w illingness to p a rticip ate in ex p erim en ts th a t req u ired th e m to keep re co rd s, to show up fo r te stin g , and to r e je c t in e f­ fectiv e or h arm fu l co n tra cep tiv es. S o m e w o m en re je c te d p rog ram s due to spou sal an tag o n ism or to ch u rch a n d /o r n a tio n a list op p o sitio n . F em inists and w orking w o m en d esired effective co n tra ce p tio n ; steriliz a tio n answ ered th a t d em and .78 W h ile th e p o p u latio n ag end a pu shed steriliz a tio n to solve th e “problem ,” and w hile m any w o m en w ere exp loited in th e system , oth ers u tilized p rogram s to c o n tro l th e ir fertility.

Abortion The p o stw ar era w itn essed tra n sfo rm a tio n s in a b o rtio n . W h ile th e m isery o f th e D ep ressio n and th e dire n eed o f w o m en w orkers in W o rld W a r II covertly co n d o n ed ab o rtio n , th e p o stw ar years, a cco rd in g to L eslie R eagan, w itnessed

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th e “h a rsh e st” crack d ow n on illegal a b o rtio n s. This siege, she argues, “was p art o f th e rep ressio n o f p o litica l and p erso n al d eviance th a t to o k p lace in th e 1 9 4 0 s and 1 9 5 0 s ” The p o stw ar offensive ag ainst a b o rtio n clin ics u nd er­ m ined a rep rod u ctive h ea lth care system th a t m any physicians had su pported th rou g h referrals. R oss argues th a t w hite officials d isp rop ortion ately targeted b lack physicians and m idw ives during th is crack d ow n .79 R h od e Island offi­ cials jo in e d th e siege. A n am end ed a b o rtio n law allow ed dying d eclaration s as ad m issible evid en ce at tria l— a tren d R eagan fou nd in o th e r p arts o f th e country. P o lice bu sted a d ecad e-old a b o rtio n n etw ork th a t served n o rth e rn R h od e Island, p rim arily th e tow n s o f C u m b erlan d and W o o n so c k e t. Every ab o rtio n ist a rrested in th e crack d ow n w as m ale. E ith e r m e n b eg an to d o m i­ n ate w hat th e y co n sid ered a lu crative en terp rise or w o m en w ere m o re subtle in plying th e ir trade. W o m e n cou ld have b e e n m o re co m p ete n t th a n m e n : th e co u rt cases evolved fro m m e d ica l co m p lica tio n s th a t fo rced th e p atients in to lo ca l h o sp ita ls.80 D esp ite th is onslau ght, w o m en co n tin u ed to seek a b o rtio n s. The d em o ­ graphics rem ain ed fairly co n sta n t. The m a jo rity co n tin u ed to b e m arried , n o t single, w om en. As Dr. C harles Potter, R IM H A ’s m ed ical d irector, told a group o f B ro w n -P em b ro k e stu d ents in 1 9 4 8 , “a b o rtio n s are n o t m o st usual in single girls, as is popu larly supposed. N in ety p er ce n t o c c u r in m a rried w o m en ” That sam e year, a m a rried w om an visited R IM H A fo r reliable co n tracep tiv es b ecau se she had alread y re so rted to th re e illegal a b o rtio n s.81 The illegal n atu re o f a b o rtio n m ak es p re cise a sse ssm en ts difficult. M a ­ rie K opp’s study o f a N ew Y ork clin ic in th e early 1 9 3 0 s fou nd th a t w o m en a b o rte d on e o f five p reg n an cies. Illegal a b o rtio n s in crea sed during th e war, esp ecially in large cities. In June 1 9 4 2 th e N atio n al C o m m itte e on M a te rn a l H ealth sp on sored a co n fere n ce at th e N ew Y ork A cad em y o f M ed icin e e n ­ titled “The A b o rtio n Problem .” In A pril 1 9 5 5 a co m m itte e ap p oin ted by th e C o n fere n ce on A b o rtio n at A rd en H ou se, N ew York, con clu d ed th a t betw een 2 0 0 ,0 0 0 and 1.2 m illion a b o rtio n s o ccu rred per year. B y th e m id -1 9 5 0 s PPFA’s Dr. C ald ero n e ad d ressed R IM H A co n cern in g in crea sin g a b o rtio n s. In 1 9 5 6 she p laced th e an n u al n u m b er at 7 5 0 ,0 0 0 . In Pregnancy, Birth and Abortion (1958) Paul G eb h ard estim ated th a t tw o th o u san d a b o rtio n s o ccu rred daily, m o stly am o n g m a rried w om en. A lfred K in sey found th a t 2 2 p e rce n t o f his sam ple o f m arried w o m en had ex p erien ced an a b o rtio n . In th e ta il end o f th e baby b o o m , p o lice ex p erts believed a b o rtio n to b e th e th ird largest crim e b eh in d n a rco tics and g am b lin g .82 O n e m ean s to estim a te illegal a b o rtio n s w as th e in cid e n ce o f w o m en seeking a ssista n ce at em erg en cy ro o m s. Ju st as w o m en tu rn ed in creasin g ly to h osp itals fo r ch ild b irth in th e p o stw ar years, th e sam e w as tru e fo r co m p licatio n s fro m ab o rtio n . L egal a b o rtio n s also o ccu rred . B y th e late 1 9 4 0 s d o cto rs w ere p e rfo rm -

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ing legal a b o rtio n s “o ften and rou tin ely " T h erap eu tic ju stific a tio n s inclu d ed card io v ascu lar co n d itio n s, kid ney d ysfu nction, n eu ro lo g ic d iseases, to x em ia , resp irato ry disease, o rth o p e d ic p ro b lem s, and b loo d d iseases. S o m e d o ctors even p e rfo rm e d a b o rtio n s if th e m o th e r suffered fro m serious m e n ta l illness. In th e early 1 9 5 0 s , how ever, th e situ a tio n changed . T h era p eu tic a b o rtio n s d ecreased fro m 5.1 to 2 .9 p er 1 ,0 0 0 live b irth s b etw een 1 9 4 3 and 1 9 5 3 .83 This drop m ay have resu lted in p art fro m in crea sed m e d ica l tech n o log y , w hich elim in ated so m e p roblem s th a t had earlier proved d angerous during preg­ nancy. H osp ital ab o rtio n co m m ittee s also co n trib u ted to th e d ecrease. E sta b ­ lished as early as 1 9 3 9 , m o st h osp itals had th e m by th e 1 9 5 0 s . T h eir goal was to provide legal and m o ra l im p u n ity to phy sicians p erfo rm in g th e ra p e u tic a b o rtio n s and red u ce an individual d o c to r’s pow er to g ran t a th e ra p e u tic a b o rtio n ; th e case had to co m e b efo re th e c o m m itte e .84 A 1 9 5 5 p o licy at P rovid en ce L yin g-In H osp ital m and ated th e d iagnosis o f seven sen io r sta ff physicians th a t p sy ch iatric, m ed ical, or g en etic in d ica tio n s w ere clear.85 N o n eth eless, R eagan argues th a t d em and actually in creased . W h e n h o s ­ p ital co m m ittee s refu sed w o m en ’s re q u e sts, so m e th rea te n ed suicide. D o c ­ to rs generally a cq u iesced bu t pu nished th e w om an w ith sterilizatio n : w o m en in im ica l to fulfilling th e ir d estiny as m o th e rs should n o t have a n o th e r o p ­ portunity. Su ch ta c tic s cu rb ed legal a b o rtio n s b u t did n o th in g to co n ta in il­ legal a b o rtio n s. B etw een h o sp ital and state efforts to cu rb a b o rtio n s w om en paid m o re fo r p ro ced u res th a t w ere in creasin g ly d ifficult to p ro cu re. S e c re c y intensified : m any w o m en w ere blind fold ed and led to th e a b o rtio n ist. The d eath rate fro m a b o rtio n s ro se, d oubling fo r N ew Y ork C ity b etw ee n 1951 and 1 9 6 2 . For w o m en o f co lo r th e d eath rate quadrupled. P sychologically, th e back-alley a b o rtio n seem ed w orse to w om en w ho had grow n to ex p e ct m e d ical tre a tm e n t in a sterile en v iro n m en t.86 S o m e w ere able to find w hat C arole Joffe calls “physicians o f co n scien ce,” w ho p erfo rm ed ab o u t o n e-th ird o f an n u al illegal a b o rtio n s in th e 1 9 5 0 s. These d o ctors w ere co m p ete n t, held m e d ica l lice n ses, and faced im p riso n m e n t and fo rfe itu re o f th e ir lice n ses, so u rce o f in co m e, and rep u tation , y et th e y co n tin u ed b eca u se th e y believed denying w o m en a b o rtio n s w as w ron g.87 For w o m en w ith ou t su ch a cc e ss, o th e r o p tio n s w ere available. W ealth y w o m en cou ld fly to P u erto R ico , E ngland , Sw itzerland , and M ex ico . They generally o b tain ed a referra l fro m th e ir private d o cto rs, w ho ag reed to a fo l­ low -up visit to en su re recovery. W o m en lack in g fin a n cia l reso u rces could be referred to d o m estic u nd ergrou nd serv ices, b u t even th e se serv ices w ere g en ­ erally out o f re a ch for lo w er-in co m e w om en. B la c k w o m en cou ld so m etim es rely on b lack phy sicians or m idw ives, a lth ou g h officials d isp rop ortion ately targ eted th e se providers. W h ile h o sp ital serv ices had supplanted m idw ifery p ractice s am o n g m o st o th e r m in o rities by th e 1 9 5 0 s (9 0 p e rce n t o f b irth s o c ­

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cu rred in hosp itals by 1 9 4 8 ), b lack m idw ives co n tin u ed to op erate in th e ru ral So u th , offering b o th a b o rtio n s and co n tracep tiv es to th ou san d s o f w om en, b o th b la ck and w hite.88 M e d ica l opinion, th e refo re, w as n o t u nited tow ard ab o rtio n . S o m e d o c­ to rs called fo r lib eralizatio n o f re strictio n s at th e sam e tim e th e ir colleagu es w ere closing legal loop h oles. S o m e pushed fo r re fo rm becau se th e y w itnessed firsth an d w o m en w ho ca m e to h o sp itals follow ing bu ngled a b o rtio n s. Dr. C ald eron e organized an a b o rtio n sym posiu m in 1 9 5 4 th a t w as atten d ed by physicians, p sy ch iatrists, a n th ro p o lo g ists, religiou s lead ers, and legal exp erts w ho re co m m en d e d easing re strictio n s on th e ra p e u tic a b o rtio n s and c o n tra ­ ceptive d isp ersal.89 Yet no re fo rm o ccu rred fo r over a decad e, leaving d esp er­ ate w om en scram b lin g for th e safest and m o st accessib le illegal a b o rtio n s.

Rhode Island in the Postwar Period B y th e late 1 9 4 0 s th e baby b o o m had h it N ew E ngland, y et it did n o t lessen th e n eed fo r co n tracep tiv es. L o c a l and state a ctiv ists co n tin u ed th e ir re fo rm efforts. In M a ssa ch u se tts L o ra in e L ee so n C am p bell, a m e m b e r o f PPFA ’s bo ard o f d irecto rs ( 1 9 4 1 -6 9 ) and la ter its presid ent ( 1 9 5 6 - 5 9 ) , jo in e d w ith th e L eagu e o f W o m en V oters in th e 1 9 4 0 s to p e titio n fo r chang e bu t collid ed w ith th e C ath o lic C hu rch , w hich had a g reat deal at stake in th is cam paign. It had lo st m u ch o f its hold over its p a rish io n ers’ e c o n o m ic w ell-b ein g w ith th e N ew D eal and th e w elfare state, w hich also u n d erm in ed th e p o litica l m ach in e in M a ssa ch u setts, w ith w h ich th e ch u rch w as strong ly co n n e cte d . C o n tra ­ ce p tio n b e c a m e th e ch u rch ’s la st-d itch effort to a sse rt its p o litica l and re li­ gious pow er.90 In R h od e Island, on th e o th er hand, th e ch u rch w as u nable to close R IM H A . Sev eral fa cto rs explain th e difference. First, in M a ssa ch u setts th e ch u rch had only to m a in ta in th e status quo, w hile in R h od e Island th e ch u rch w ould have had to cam p aig n to clo se an establish ed clin ic. S eco n d , M assach u setts activ ists w ere pu shing solely for lib era liz a tio n o f c o n tra ce p ­ tives. R IM H A em phasized w o m en ’s health, o f w h ich b irth co n tro l w as only on e asp ect. In th e p o stw ar years PPFA attem p ted to in flu en ce lo c a l affiliates. It re c ­ om m en d ed th a t R IM H A au g m en t its resp ecta b ility by em ploying only c o l­ lege-ed u cated m arried w o m en at least th irty -fiv e years old. R IM H A agreed bu t re je cte d th e m a le-led m o d el o f th e PPFA . S in ce th e 1 9 3 0 s th e p resid en ts, officers, and 9 6 p e rce n t o f th e bo ard had b e e n w om en. This tren d co n tin u ed u n til 1 9 5 5 , w hen th e clin ic, p erhap s su ccu m b in g to PPFA p ressure, en co u r­ aged m e n to sit on th e board : “M a te rn a l H ea lth in all its a sp e cts is o f in tere st to m e n as w ell as to w om en.” B y 1 9 5 9 seven m e n w ere sittin g o n th e board , b u t aside fro m th e tre a su re r and a ssista n t treasu rer, th e officers rem ain ed

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w om en. Even w ith th e se a d ju stm en ts R IM H A w as still out o f step w ith PPFA. It tw ice “u n an im o u sly ” re je c te d PPFA re co m m en d a tio n s to ch an g e its nam e to P lan n ed P aren th oo d League o f R h od e Island, in sistin g th a t R IM H A m o re accu rately re flected its g oals, bu t fin an ces also played a role: n a tio n a l affilia­ tio n req u ired clin ics to tu rn over 2 5 p e rce n t o f m em b ersh ip fees.91 P lanned P aren th o o d L eag u e o f M a ssa ch u setts and P lan n ed P a ren th o o d L eag u e o f C o n n e cticu t gave in, bu t n e ith e r could op erate a clin ic. R IM H A also ap p or­ tio n ed less cam p aig n funds to PPFA th a n th e la tte r ex p e cted .92 R IM H A and PPFA also clash ed over th e role o f co n tra ce p tio n . PPFA’s 1 9 4 8 fu n d -raisin g p am p h let argued th a t “th e co st o f u np lanned fam ilies, o f b ro k en h o m es, o f delinqu ency, disease and b ro k en h ea lth is always paid for by th e co m m u n ity in ta x -su p p o rte d co u rts and in stitu tio n s, in co n trib u tio n s fo r w elfare and re h a b ilita tio n in all its fo rm s” R IM H A spu rned th is “H u ­ m an B e tte rm e n t” philosophy, con ten d in g th a t it sm acked o f “F ascism , H it­ ler, M u ssolin i, Stalin , etc. [w h o ] w ere or are in favor o f h ig h b irth ra te s” for ce rta in groups w hile elim in atin g th e rep ro d u ctiv e ch o ice o f oth ers. R IM H A in stead believed first th a t “parents should be the ones to decide how many

children they will have” and seco n d in co m p reh en siv e h ea lth care. Its goal w as “to ed u cate th e p u blic in m ed ical, so cial, e c o n o m ic, d em o c ra tic, and scien tific a sp e cts o f volu n tary p a ren th o o d as a p art o f a w ell-rou nd ed state p ro g ram o f pu blic h ea lth ”93 To th a t end, R IM H A expand ed its h ea lth care services. In A pril 1 9 4 7 th e clin ic in stitu ted an n u al pelvic exam s, and in O c to b e r 1 9 5 0 it offered annual b reast exam s. Fem ale execu tiv e officers ad vocated a n in stru ctio n a l p rog ram on b reast self-exa m in a tio n ; th e m ale m e d ica l c o m m itte e argued th a t w o m en w ere in cap ab le o f le a rn in g su ch te c h n iq u e s bu t acq u iesced in th e face o f execu tiv e pressure. R IM H A expanded h ea lth care fu rth er in 1 9 5 3 w ith Pap sm ears as a ca n c e r preventive m easu re fo r w o m en over thirty -five. R IM H A staff m e m b ers co n sid ered th em selv es th e “definitive h ea lth serv ice to th ese m o th e rs, m any o f w hom w e know, w ould oth erw ise b e n eg lected .” As a re ­ sult, th e y co n tin u ed offering Pap sm ears and b re a st and pelvic exam s to old er p atien ts w ho n o lo n g er n eed ed co n tracep tiv es. T hey exten d ed Pap sm ears in 1 9 5 5 to n ew p atien ts and re tu rn in g p atien ts over th irty .94 T hese prog ram s d etected p oten tially life-th re a ten in g m e d ica l p roblem s th a t o th erw ise w ould have gone u ntreated , referrin g b etw een 10 and 21 p e rce n t o f p atients to sp e­ cialists.95 The tim e and exp en se o f th e se te sts raised co n tro v ersies am o n g R IM H A lead ers. Its M e d ica l A d visory C o m m itte e re co m m en d e d in 1 9 5 7 th a t th e clin ic p articip ate as on e o f seven states in th e fed eral cy tology p ro g ram for d etectin g u terin e c a n c e r in w o m en over tw enty. T he bo ard h esita ted b ecau se

World War II, the Baby Boom, and the Population Explosion, 1939—1963

it w ould p o se a fin a n cia l “strain ” and p lace an “added b u rd en ” on alread y inu nd ated d o ctors. In fa ct, th e “d o cto r situ atio n [was] n o t health y alread y ” b ecau se large private p ra ctice s lim ited th e ir tim e, and “u nfo rtu n ately m o st o f th e n ew G Y N m e n co m in g to sta rt p ra c tice are C a th o lic and so n o t available to us.” Dr. P o tter co u n tered w ith th e “lifesaving im p o rta n c e o f early d etec tio n o f cancer.” The bo ard voted to p articip ate, b u t by late 1 9 5 8 th e clin ic w as ru n ­ n in g a deficit. The bo ard re stricte d te stin g to R h od e Island ers: fed eral pay­ m e n ts did n o t cover o u t-o f-sta te w om en, w ho by th a t tim e co n stitu ted o n eth ird o f th e c lin ic ’s clien ts. A b a ttle m u st have raged b eh in d th e scen es, as th e n ex t m o n th saw th e board “em pow er ou r d o cto rs to p erfo rm su ch te sts on o u t-o f-sta te p a tie n ts” b eca u se “a lo t o f our p atien ts are afraid o f th e th o u g h t o f a ca n c e r C lin ic, b u t w ill co m e to us.” W h ile h ea lth care w as im p o rta n t, so m e board m e m b ers reco g n iz ed th e p ra c tica l value o f c a n c e r te stin g , w hich provided th e clin ic w ith “an en o rm o u s leg to stand on if w e should ever get any criticiz m [sic] fro m th o se w ho m ig h t oppose us.” O th ers realized th a t th e p ro g ram w as “a w ond erfu l m o n ey raiser.” S o m e saw c a n c e r te sts as “a n o th e r ‘draw ing card ’ fo r a ttra ctin g n ew p a tie n ts”: clien ts stated th e y p referred to have a pelvic exam and c a n c e r sm ea r at th e sam e tim e ra th e r th a n at tw o clin ics.96 This p ro g ram again b ro u g h t R IM H A in to c o n flict w ith th e n a tio n a l o r­ ganization. PPFA w ro te to R IM H A in 1 9 5 6 th a t Pap sm ears w ere n o t to be ren d ered at clin ics. R IM H A co u n tered , “W e feel th a t th is is on e o f our m o st im p o rta n t serv ices . . . and w e w ill co n tin u e it as long as o u r d o cto rs feel it is th e th in g to do.” The follow ing year, a PPFA d irective re itera ted th a t yearly pelvic exam s w ere n o t n ecessa ry or th e d om ain o f a clin ic. R IM H A refu sed to b u ck le, resp on d in g th a t “alth ou g h b irth co n tro l is o u r p rim ary fu n ctio n very few o f our p a tie n ts w ould go elsew here fo r a pelvic ex a m in a tio n and w e co n sid er th is and ou r P ap anicolaou sm ea r p ro g ram tw o o f our m o st im ­ p o rta n t b en e ficia l services.” Dr. P o tte r d efended R IM H A ’s p o sitio n at a C h i­ cago m e etin g o f P lan n ed P a ren th o o d d o cto rs and w on th e m over. R IM H A ’s p resid en t re p o rte d th a t “ju s t re cen tly th e M e d ica l C o m m itte e o f N atio n al has d ecid ed th a t yearly ex am in ation s are valuable and should b e co n tin u ed in planned p aren th o o d clin ics. W e are pleased th a t th e y ag ree w ith us.” O th e r co n flicts con tin u ed . PPFA in 1 9 5 8 w anted th e R IM H A execu tiv e d ire cto r and so cial w orker to “receiv e o rie n ta tio n at N atio n al H e a d q u a rters” and to “im ­ prove our cam p aig n and see th a t it is m o re in line w ith N atio n al p ractices.” R IM H A , how ever, re je c te d th e “co n sta n t em p h asis” o f n a tio n a l on “th e in ­ te rn a tio n a l asp e cts o f th e p op u latio n problem .” In 1 9 5 9 PPFA again trie d to co m p el R IM H A to ch an g e its nam e. Dr. P o tte r to o k issue: “M a te rn a l H ealth in to to has cau ght on locally, b u t n o t nationally. N o en th u siasm th e re abou t

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to ta l p ro d u ct o f m a tern a l health . T h ere is a feeling th a t it is a diversionary ty p e o f th in g , tak in g energ ies away fro m th e p rin cip a l purpose.” T he board agreed to keep “Maternal Health ra th er th a n P lan n ed P a ren th o o d b ecau se w e have always felt th a t w e w anted to b e more th a n a b irth co n tro l C lin ic ”97 These new services in creased clients. By 1 9 4 8 th e clinic had experienced a 2 2 p ercen t increase. C lien ts’ average m on th ly salary w as $ 3 5 .1 2 in 1 9 4 6 ; it fell to $ 3 2 .0 0 in 1 9 4 7 as recession h it th e state and in creased to $ 4 0 .8 3 w ith eco n o m ic recov ery in 1 9 4 8 . M any clients w ere wives o f veterans w ho w ere either inju red an d /o r unem ployed or delaying fam ilies w hile attending college on th e G I Bill. P atien ts’ average age fell slightly, reflectin g a n ation al trend. The only d ecrease in patients (6 p ercen t) o ccu rred b etw een 1951 and 1952, dur­ ing th e state’s eco n o m ic boom . The upsw ing retu rn ed in 1953 and continued for th e rem aind er o f th e decade. Two factors explain this increase. First w as a recession: “O ld patients are retu rn in g becau se th ey can n o longer afford p ri­ vate d o cto rs— new p atients are com in g becau se th e y ca n n o t afford a larger family” This circu m stan ce burdened th e clinic, as p atients could pay less, if at all, especially in light o f th e enhanced h ealth services. R ejecte d as a m em b er o f th e C om m u nity C hest, R IM H A depended on private funds, w hich ebbed and flow ed w ith th e econom y. Seco n d , w om en cam e becau se o f “excellent and com p lete exam inations.” B efo re M ed icaid , R IM H A h ealth services w ere one o f th e few available to lo w -in com e w om en. M any earned to o m u ch to qualify for w elfare and public h ealth program s but to o little to afford private physicians. By 1 9 6 0 R IM H A w as caring for m o re th a n 3 ,8 0 0 w o m en p er year, rem ark­ able in light o f little publicity. O nly 5 p ercen t o f clients w ere referred, re flect­ ing cau tion by “key” officials: in 1 9 5 5 R IM H A applied for Providence U nited Fund m em bership but was re je cted b ecau se th e agency feared w ithdraw al o f its C atholic sponsors. A pproxim ately 7 7 p ercen t o f clients heard o f th e clinic by w ord o f m outh, including financially secure w om en w hose “private d o ctor w ill n o t . . . give contraceptive advice” O th e r referrals cam e from private physi­ cians and m inisters sending couples for prem arital counseling.98 C lie n ts’ ch a ra cte ristic s did n o t ch an g e significantly fro m previou s years. D esp ite religiou s d o ctrin e, 5 5 p e rce n t w ere C a th o lic, 3 6 p e rce n t w ere P ro t­ estan t, and 9 p e rce n t w ere listed as “o th e r” (prim arily Jew ish). O n e ex cep tio n o ccu rred in 1959 follow ing ed icts by C a th o lic bishop s reaffirm in g ch u rch op ­ p o sitio n to artificia l co n tracep tiv es. That year alon e P ro te sta n ts d om inated (51 p e rce n t), w ith C a th o lics clo se beh in d ( 4 4 p ercen t) and a sm all n u m b er o f “o th e rs” (5 p ercen t). C lien ts w ere m arried , w ith m o st b etw een th e ages o f tw en ty -o n e and thirty. M o s t clien ts w ere R h od e Islan d ers, w ith 17 p erce n t outsid ers in th e 1 9 4 0 s , in crea sin g to 2 3 p e rce n t in 1951 and 4 3 p e rce n t by 1 9 5 9 .99 W h ile a few ca m e fro m N ova S c o tia and Q u e b e c , a lm o st all w ere

World War II, the Baby Boom, and the Population Explosion, 1939—1963

fro m M a ssa ch u setts and C o n n e c tic u t. T h ese w o m en refu sed to allow th e C ath o lic hold o n state laws to d ictate th e ir fam ily planning; th e y traveled to P rovid en ce fo r th e serv ices th e y desired. The clin ic also co n tin u ed to a ttra c t b la ck w om en. B y th is tim e physicians and re sea rch ers had re je c te d ea rly -tw e n tieth -cen tu ry ra cia l d o ctrin e s to ex­ plain th e d ifference in m o rta lity rates b etw een b lack s and w h ites. In stead , acco rd in g to h isto ria n D avid M cB rid e , “th e n a tio n ’s m e d ica l co m m u n ity had discovered th a t th e ro o ts o f im proved h ea lth care for A m e ric a n black s lay . . . in greater a ccess to m e d ica l care fo r fam ilies, esp ecially m a tern a l and child p o p u la tio n s"100 B la c k h ea lth ex p erts had re a ch ed sim ilar con clu sio n s earlier and w elco m ed co n tracep tiv es to alleviate h ea lth risks am on g ch ild ren and m o th e rs. R IM H A ’s ad d itional h ea lth services w ere esp ecially attractiv e to b lack w o m en w ho lacked afford able a ccess to Pap sm ears and pelvic ex ­ am s. A t an o p en h o u se in N o v em b er 1 9 4 6 U L R I rep resen tativ es co n stitu ted th e largest contingency. The follow ing F ebru ary U L R I invited R IM H A sta ff to a U L R I social. In A pril th e R IM H A an n u al lu n ch e o n fou nd M r. A nd rew B ell, p resid en t o f U L R I, at th e head table. M ath ild C. S m ith , execu tiv e d ire cto r o f R IM H A , w orked closely w ith U L R I to d issem inate in fo rm a tio n a b o u t clin ic services. B y 1 9 4 8 th e R IM H A could re p o rt th a t “a n excellen t group o f lead ers in th e N egro C om m u n ity has b e e n found. . . . They have also arran g ed ex­ h ib its o n Fam ily P lanning at th e U rb a n League during N egro H ealth W e e k " R IM H A w orked w ith U L R I in su b seq u en t h ea lth cam p aig n s and on su it­ able speakers to sponsor. R IM H A also co llab o rated w ith th e Ju n ior S e rv ice League, a “group o f a b o u t 10 young m arried co lo red w om en, w ho w ere m o st en th u siastic ab o u t our w o rk " and w ith th e Jo h n H o p e C om m u n ity C en ter.101 R IM H A ’s b lack clie n ts in c rea sed fro m 6 p e rce n t in 1 9 4 5 to 13 p e rce n t in 1 9 5 5 , w hen b lack s co n stitu ted only 1.8 p e rce n t o f P ro v id en ce C ou n ty and 2.13 p e rce n t o f th e sta te.102 Tw o fa cto rs explain th is in crease: th e au gm ented h ealth serv ices and th e d issem in atio n o f in fo rm a tio n by b la ck lead ers am ong th e R oxbury, M a ssa ch u setts, com m u nity.103 The c lin ic ’s ex p erien ce w ith th e b la ck co m m u n ity help ed shape n a tio n a l policy. In 1 9 4 9 PPFA m ailed a lo n g -ran g e p lanning qu estio n n aire to affiliates asking, “Should th e F ed eratio n have a sp ecial p ro g ram for w o rk w ith m in o r­ ity g ro u p s?” S u ch a p ro g ram had b e e n in p lace sin ce 1 9 4 0 , w ith sep arate funds fo r tw o p rofession als and on e sec re ta ry “fo r th e m " R IM H A criticiz ed th is seg regatio n ist policy, reco m m en d in g PPFA “elim in ate [the] sp ecial p ro ­ gram fo r w ork w ith m in o rity groups. M in o rity p roblem s should be dealt w ith th rou g h already establish ed ch an n els. . . . Q ualified n eg ro p e rso n n el should w ork on all problem s in [the] Field D ep artm en t.” This in teg ratio n ist ap p roach led PPFA to follow suit in 1 9 4 9 .104

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O th e r co n flicts p ersisted . By th e early 1 9 5 0 s PPFA w as active in w hat it co n sid ered “The W o rld ’s M o st P ressing Problem .” W illia m V ogt, its n a tio n a l d irector, spoke in P ro v id en ce in 1 9 5 2 ab o u t th e “p o p u latio n ex p lo sio n ” In a sp e ech at R IM H A in 1 9 5 6 Dr. C ald ero n e u n d ersco red th e im p o rta n ce o f co n tro llin g p o p u latio n grow th intern atio n ally : “F or to o long now I have b ee n tak in g th e easy way o f n o t facing up to our b a sic p ro b lem tod ay ; overp op u la­ tio n can n o lo n g er b e assessed in te rm s o f th e individual fam ily, as it w as in M arg aret S a n g e r’s day, bu t in te rm s o f o u r to ta l w orld ” T he R IM H A p re si­ d en t’s re p o rt re flected dism ay at th is ob session : “A t th e R h od e Island M a te r­ n al H ealth A sso cia tio n , w e are n o t so m u ch co n cern e d w ith over-p o p u latio n as w e are w ith h elping th e w o m en o f o u r state and m any fro m M a ssa ch u setts and C o n n e cticu t so th a t th e y and th e ir fam ilies m ay lead hap p ier and m o re fru itfu l lives”105 L o ca l w o m en ’s h ea lth and ch o ice s to o k p re ce d e n ce over th e cru sad e to co n tro l w om en overseas. B y th e late 1 9 5 0 s re tire m e n ts a m o n g lo n g tim e officers and sta ff had b rou gh t a turnover. In 1 9 5 9 th e first fem ale m e d ica l d irector, Dr. Evelyne L. Slabey, assu m ed office.106 The bo ard co m m e n te d th a t th e clin ic seem ed “to b e en terin g a n ew regim e,” on e w ith a different vision. M rs. B urgess G reen , new ly electe d p resid en t in 1 9 5 9 , argued a line th e PPFA had u sed several years earlier: she w as “d istressed b eca u se ou r ca n c e r d e te c tio n p ro g ram has seem ed to receiv e m o re a tten tio n and a g rea ter re a c tio n fro m th is bo ard th a n our B irth C o n tro l P rogram . I am n o t d ep recatin g o u r c a n c e r prog ram . I, p er­ sonally, feel th a t ea ch m e m b e r o f th is board need s to b e m o re aw are o f how B irth C o n tro l has h elp ed individual p atien ts ra th er th a n how m any p rein va­ sive ca n cers w e have d e te c te d ” M rs. D avid K ennedy, new ly elected execu tiv e d ire cto r in 1 9 6 0 , also ad opted a PPFA stance: “W o rld p op u latio n is grow ing m u ch to o rapidly fo r w orld reso u rces as w e k now th e m . . . ; w e m u st assu m e th e resp o n sib ility th a t has b e e n th ru st u p o n us as th e only co -o rd in a tin g ag en cy th a t is d oing so m eth in g ab o u t h u m an fertility ” T he follow ing year saw M rs. Jo h n L. C lark electe d as presid ent. S h e argued th a t w ith in creased B lu e C ross coverage, m an y p a tien ts cou ld receiv e m e d ica l care elsew here; co m p reh en siv e h ea lth care w as n o t th e c lin ic ’s responsibility. T e n sio n b e ­ tw een new and old lead ers cam e to a head in th e early 1 9 6 0 s ; th e la tte r w on th e d ebate and con vin ced officers to expand ca n c e r d etec tio n p rogram s. B o th sides u ltim ately ach ieved th e ir o b jectiv e s. N ew lead ers reco g n iz ed th e fu n d ­ raising p o te n tia l o f in creasin g ly po p u lar p op u latio n co n tro l rh e to ric , b u t th e bo ard and th e M e d ica l A d visory C o m m itte e co n v in ced th e m th a t th e r e ­ sp ectab ility th e clin ic gained fro m its h ea lth serv ices w as also “a w ond erfu l m o n ey raiser”107 R IM H A im ita ted th e n a tio n a l tre n d in appealing to m e n fo r cam p aig n co n trib u tio n s. It sou g h t “m en , esp ecially a businessm an,” to serve on th e

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bo ard and inclu d ed in th e cam p aig n “a m e n ’s division.” It hailed a n ew film ,

The Costly Crowd, b eca u se it w as “su itab le for show ing to m any groups, esp e­ cially m en ’s ” W h ile th e p resid ent, execu tiv e d irector, fou r vice p resid ents, and th e secre ta ry rem ain ed w om en, th e board inclu d ed eight m e n and tw en ty n in e w o m en by 1 9 6 2 . O n e R IM H A rep resen tativ e co m m e n te d th a t “w e are n o lo n g er ju s t a lad ies o rg anization . W e are facing an e c o n o m ic p ro b lem w h ich is m o st m ean in g fu l to m e n and w h ich m otiv ates th e m to c o lle ct larger co n trib u tio n s th a n ladies co n c e rn e d w ith w o m en ’s p erso n a l p ro b lem s had b e e n able to e lic it”108 Follow ing th e n a tio n a l strategy o f ta rg etin g m e n and em p hasizing p op u latio n co n tro l qu ieted C a th o lic o p p o sitio n and in crea sed co m m u n ity accep ta n ce . R IM H A w as en terin g a new stage. W h e re a s earlier lead ers fou ght to m a in ta in th e lo c a l c h a ra cte r o f th e clin ic, n ew lead ers trie d to brin g th e clin ic m o re in line w ith n a tio n a l p o licies and ta c tic s.

Conclusion The 1 9 4 0 s and 1 9 5 0 s saw sig n ifican t ch an g es in rep ro d u ctiv e h ealth . The w ar years w itn essed g o v ern m en t en d o rse m en t o f co n d o m s and ind u strial su p p ort fo r co n tra cep tiv es fo r w o m en w ar w orkers. A b o rtio n , w hile illegal u nless th e w om an’s life w as at stake, covertly co n tin u ed w ith little state in ­ te rfere n ce. The p ostw ar p eriod ex p erien ced a crack d ow n th a t p osed b arriers to ab o rtio n , bu t it did n o t d ecrease: d esp erate w o m en co n tin u ed to re so rt to “b a ck alley,” overseas, or self-in d u ced a b o rtio n s. B ec a u se th is issue divided th e m e d ical p rofession , so m e w o m en w ere able to seek care fro m w hat Joffe calls “physicians o f co n scien ce.” W h ile th e baby b o o m m en tality p erm ea ted p opu lar cu ltu re, m any w o m en p o stp on ed or lim ited th e ir child b earin g , ta k ­ ing advantage o f lo c a l b irth c o n tro l clin ics and a b o rtio n to ach iev e th e ir goal. The rise in m id d le-class fertility rates tem p o ra rily alleviated p o p u lation d oom sayers, alth o u g h c o n c e rn s over th e quality o f th e ra ce rem ain ed . To th a t end co n trace p tiv e e x p e rim e n ta tio n b u rgeon ed , w ith te stin g d one p ri­ m arily o n lo w -in co m e w om en o f color, th e very subgroup m o st d isturb ing to p op u latio n co n tro llers. O verall, th e m essage o f previous d ecad es continu ed : w hite m idd le- and u p p er-class fam ilies should p ro crea te, w hile th e re p ro d u c­ tio n o f lo w -in co m e w om en and w o m en o f co lo r should b e cu rtailed . M o st o f th e pressure fo r in terv e n tio n ca m e fro m o rg anization s p re o ccu p ied w ith th e “p op u latio n exp losion ” in th e Third W o rld am o n g p eop le o f color. The postw ar p erio d kept co n tra cep tiv e prog ram s p rim arily in th e hand s o f p ri­ vate individuals and o rg anization s. The fed eral g o v ern m en t em barked in th is aren a on a sm all scale, first w ith w artim e m ilita ry p o licy allow ing co n d o m d istrib u tio n to m ale sold iers and la ter w ith in tern a tio n a l p o licy u nd erw ritin g p op u latio n co n tro l p rog ram s in co u n tries th a t asked for a ssistan ce. O n th e

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d o m estic fro n t, th e fed eral g o v ern m en t rem ain ed a lo o f fro m any a sso c ia ­ tio n w ith co n tracep tiv es. D oo m sa y ers’ p red ictio n s o f th e d eclin in g quality o f th e A m e rica n p op u latio n failed to co n v in ce th e g ov ern m en t to tak e a ctio n . G o v ern m e n t exp en d itu res in th e follow ing d ecad e w ould lead to a d ram atic shift in policy, w ith g ov ern m en t fund ing o f all th re e realm s o f rep rod u ctive co n tro l: ab o rtio n , co n tra ce p tio n , and sterilization.

6

Who Pays? Contraceptive Services and the Welfare State, 1963-1975

The G rea t S o cie ty in tro d u ced n ew p rog ram s th a t in terv en ed in th e private lives o f citizen s, fro m M ed icaid and M e d ica re to co n tra ce p tio n . R a th er th a n a crim e , co n tra ce p tio n b e c a m e a m a jo r in g red ien t o f p u blic policy. W h a t b ro u gh t a b o u t th is tra n sfo rm a tio n ? S o m e groups fou g h t fo r co n tra ce p tio n as an individual rig h t, b u t th e ir in flu en ce w as in co n seq u en tia l. A p p reh en ­ sion over “b reed in g ourselves to d eath” had a sig n ifican t im p a ct on p o p u ­ latio n policy, b u t m an y peop le cared m o re a b o u t who w as b reed in g ra th er th a n th e n u m b ers b red .1 P op u lation co n tro llers co n tin u ed th e ir q u est to lim it th e fertility o f th e lo w -in co m e and ind igent, u n ed u cated , and ra c ia l/e th n ic m in o rities w hile n o lo n g er overtly callin g th e m “u nd esirables.” Em ploying rh e to ric sim ilar to th a t heard during th e D ep ressio n , p o p u latio n co n tro llers a ttra cted fiscal con serv ativ es by calling fo r laws and p rog ram s to d ecrease w elfare d ep en d en ts and cu rta il th e esca la tin g co sts o f ta x -su p p o rte d p ro ­ gram s. N atio n al org anizatio n s and individual lo bby ists to u te d th is popular, co st-e ffectiv e arg u m ent. The press played a dual role, providing supportive coverage th a t swayed p u blic op in io n tow ard g o v ern m en t in terv e n tio n but also re p o rtin g cases o f abuse. P P R I b en efited fro m n a tio n a l a tten tio n to fa m ­ ily plan n in g , p a rticu la rly w ith in c rea sed private and g o v ern m en t fund ing th a t allow ed th e clin ic to expand w hile co n tin u in g to offer com p reh en sive h ealth care. W ith h ea lth and ch o ice its priority, th e clin ic avoided th e g en o ­ cid e accu sa tio n s fa ced by so m e clin ics and co n tin u ed its ra p p o rt w ith th e lo ca l b lack com m unity.

Developments in Contraceptive Research Searle P h arm ace u tica l C om p any m ark eted E n ovid -10, th e n ew oral c o n tra ­ ceptive pill, in late 1 9 6 0 . C heap and reliable, it did n o t disturb th e flow o f sex­ ual in terco u rse bu t prevented a ccid e n ta l p reg n an cies b eca u se o f its h ig h rate o f effectiv en ess. M a n y p op u latio n c o n tro l ad vocates co n sid ered it th e cu reall fo r so cial and e c o n o m ic ills, yet som e w om en co n d em n ed it b eca u se o f th e

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exploitive ta c tic s used in its d evelopm ent. A s P a tricia M ag in n is, an a b o rtio n re fo rm activ ist, stated: “I re sen te d th e pill. I felt th a t th e w o m en w ere guinea pigs used fo r th e pill, and we w ere bein g d en ou nced fo r any failures o f th e pill, [which] m ad e m e b itte r" Dr. C ald ero n e a sserted th a t w hile m o st p eop le in th e p op u latio n c o n tro l m o v em en t “naively th o u g h t th a t if w e could have ‘th e pill,’ all p roblem s relating to o v er-p op u lation . . . w ould au to m atically resolve th e m selv es" she disagreed b eca u se o f “hangover cu ltu ral b elie fs” in th e value o f ch ild ren as free la b o r and a so u rce o f secu rity in old age. M oreover, she co n ten d ed th a t w o m en w ho n eed ed and w anted th e pill w ould n o t have a c ­ cess to it due to la ck o f fu n d s.2 The in itial and an n u al d o c to r’s visits and th e pill’s expense led p rim arily m id d le-class w o m en to u se it. U n eq u al access and safety w as a c o n c e rn at R IM H A . W h ile R IM H A had refu sed to p articip ate in Enovid ex p erim en ts in th e late 1 9 5 0 s , o n ce th e FD A approved it in 1 9 6 0 , th e b o ard allow ed phy sicians to offer it w ith m on th ly m o n ito rin g o f w om en. The board establish ed a pill fund fo r in d igen t p atients and h op ed m an u fa ctu rers w ould develop a lo w er-d o se pill th a t w ould be safer and less expensive.3 Thus, w hen asked to jo in sev eral o th e r affiliates in a five-year study o f a 5 -m illig ra m Enovid pill org anized by S e a rle and PPFA , R IM H A agreed. P a rticip a n ts had to rem a in on th e pill for tw o years o r m o re and b e exam in ed every six m o n th s. B y O c to b e r 1961 4 7 w o m en w ere using it, “m o st successfully,” bu t th e m e th o d o f ch o ice rem ain ed th e diaphragm .4 B y Febru ary 1 9 6 2 1 3 4 w o m en and by y e a r’s end 316 w o m en w ere on it. W h e n n atio n al new s cite d “Enovid in th e d eaths o f so m e w o m en fro m th ro m b o ­ phlebitis,” 131 (41 p e rce n t) o f th e 316 d isco n tin u ed its use. W ith in several m o n th s, how ever, dem and “w as b a ck to n o rm a l” and in crea sed rapidly dur­ ing 1 9 6 3 ; “favorable press and p u b licity ” crea ted an “air o f co n fid e n ce "5 L ate 1 9 6 3 and 1 9 6 4 proved a w atershed in n ew pills. Jo h n so n & Jo h n so n m ark eted O rth o n o v u m , a 2 -m illig ra m pill, in N o v em b er 1 9 6 3 ; th e c o m p e ti­ tio n fo rced Searle to low er E n o v id -5 ’s price. B o th w ere “1 0 0 % ” effectiv e and available at R IM H A . In early 1 9 6 4 S e a rle in tro d u ced O vulin, a 0 .5 -m illig ra m pill, to b e te ste d at R IM H A b eg in n in g in June, as long as p atien ts w ere “m ade aw are” th a t th e drug w as in a n investigative p h a se.6 R IM H A also p a rtic i­ p ated in M ead Jo h n so n & C om p an y ’s M eg estro l study: p atien ts to o k e stro ­ gen fo r fifte en days, follow ed by M eg estro l and estro g en fo r five days. This m eth o d elim in ated p rog estin , th e expensive p art o f th e pill, and co n tin u ed th e m en stru al cycle. M ead provided th e pill free fo r tw o years, w h ich granted ind igent p atien ts a ccess to it, and co n trib u ted $110 a m o n th to th e clin ic to defray th e c lin ic ’s c o sts.7 B y th e su m m er o f 1 9 6 4 th e clin ic could offer an “a la ca rte m enu o f p ills” The sta ff had read L ee R ain w ater’s And the Poor Get

Children and su pported its re co m m en d a tio n to “offer a choice o f m e th o d s” to suit w o m en ’s individual n eed s.8

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

R IM H A still b ristled at PPFA’s “co n sta n t em p h asis” on h ow th e pill could am elio rate “th e in te rn a tio n a l a sp e cts o f th e p o p u latio n p ro b lem ” and th e “overcrow ding, ju ven ile d elinqu ency, etc.” in A m e rica n cities ra th er th a n on how it im proved w o m en ’s h ea lth and ch o ice s. R IM H A re p resen ta tiv es re ­ tu rn ed fro m an an n u al PPFA m e etin g astou n d ed th a t “th e pervading th o u g h t th ro u g h o u t th e session s w as th a t sexu al energy is ju s t as dangerous and pow ­ erfu l in th e m o d ern w orld as a to m ic energy.” PPFA stressed th e “im p o rta n ce o f p op u latio n co n tro l” and th e “e c o n o m ic and bu siness co n se q u e n ce s o f th e p op u latio n exp losion ” m o re th a n th e im p a ct o f n ew co n tra cep tiv es on w o m ­ en’s daily lives.9 B y 19 6 5 physicians cou ld h ail th re e m o d ern co n tra cep tiv e te ch n iq u e s: th e pill, in je cta b le s , and th e IU D . The th ird an n u al m e etin g o f th e A m e rica n A s­ so cia tio n o f P lan n ed P a ren th o o d phy sicians in 1 9 6 5 gave oral co n tracep tiv es “to p h o n o rs for th e m eth o d co n sid ered su rest, safest, and soundest.” S e co n d p lace w ent to “in je cta b le p ro g estin given in tra -m u scu la rly o n ce a m onth.” In 1 9 6 5 P P R I jo in e d fifty -eig h t o th e r affiliates in a tw o -y ea r study o f a m o n th ly in je cta b le called D elad roxate sp o n so red by th e S q u ib b In stitu te fo r M ed ica l R esearch . The th irty -eig h t P P R I w o m en w ere “en th u siastic ab o u t th e shot,” bu t o th ers re je cte d it b eca u se th e y had eith er prolong ed m e n stru a l cy cles or m o n th ly ch ild care and tra n sp o rta tio n difficulties. P P R I also jo in e d an IU D investigation; in on e year 3 2 2 w o m en ch o se IU D s w ith “n o serious co m p lica ­ tions,” alth ou g h tw o p reg n an cies o ccu rred .10 D esp ite o th e r o p tio n s, th e pill rem ain ed p aram o u n t and lau n ch ed a p h ar­ m aceu tica l revolu tion . It rep laced co n d o m s and d ouches as th e m o st used co n tracep tiv e and th e reb y tra n sfo rm e d co n su m erism . Individuals n o lon g er relied p rim arily on d ru gstores or m a il-o rd e r catalog s fo r supplies. W o m e n ’s re a ctio n s to m e d ica l care, esp ecially co n tra cep tiv e care, changed : m an y v is­ ited a p hysician’s office w ith a clea r set o f dem and s. P lacing th e pill, IU D , and in je cta b le s in p hy sician s’ hand s b rou gh t to fru itio n S a n g e r’s plan fo r a m e d i­ cal m o n o p o ly over co n tracep tiv es. A lth o u g h m o st d o cto rs had little train in g in ch e m ical co n tra cep tiv es, A n d rea T on e argues th a t th e se m e th o d s “created w id espread d o cto r p atien t a ccep ta n ce o f m e d ica l b irth control.” P art o f th e re a so n w o m en w ere so know led geable w as th e m ed ia b litz su rround ing th e pill. W h e n it first em erged , th e m ed ia hailed it as th e first significant progress in co n tracep tiv e te ch n o lo g y in h a lf a century. S to rie s extolled its ease o f use. A s th e d ecad e p ro g ressed , so m e q u estio n ed its im p a ct on m orality, w hile o th ers b egan to p ro b e its safety.11 The p ill’s safety had b e c o m e an issue by d ecad e’s end. W h ile m e d ica l p ro ­ fessionals had debated its co n n e ctio n to th ro m b o sis, cancer, and neu ro lo g ical p ro b lem s, n o co n sen su s had b e e n reach ed . The tu rn in g p o in t ca m e in 1 9 6 7 w h en th e British Medical Journal linked th e pill to in crea sed risk fo r b loo d

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clo ttin g . Tw o years later, th e F D A re p o rte d th a t w o m en on th e pill w ere 4 .5 tim e s m o re likely to ex p erien ce th ro m b o e m b o lism . S c ie n tis ts d o cu m en ted o th e r risks, alth ou g h a clea r c o n n e c tio n to c a n c e r w as d ifficult to d iscern ; S e n ate investigations in 1 9 7 0 fou nd th e pill had b e e n m ark eted w ith ou t ad­ eq u ate te stin g o f its lo n g -te rm im p act. A lth ou g h th e S e n a te acknow led ged th e im p ra ctica lity o f b a n n in g th e pill, it m an d ated full d isclosu re b eca u se 6 6 p e rce n t o f w o m en had n o t b e e n in fo rm ed o f p o ssib le side effects. The resu lting p acket in se rts, acco rd in g to E liz a b eth Sieg el W a tk in s, m ad e th e pill “th e first orally ad m in istered drug to ca rry a d etailed w arning d irected at p a ­ tie n ts " W ith w idespread coverage o f S e n a te h earin g s, 8 7 p e rce n t o f w o m en b e ca m e aw are o f safety co n c e rn s; 18 p e rce n t stopp ed ta k in g th e pill. Physi­ cian s co n tin u ed to p re scrib e it b eca u se it w as easier th a n fittin g an IU D or diaphragm and w o m en co n tin u ed to dem and it.12 C on g ressio n al hearin g s o n th e pill’s safety spu rred re sea rch in to n ew c o n ­ tracep tiv es. R esea rch ers te ste d a p o stc o ita l vacu u m ta m p o n th a t w ould stim ­ ulate th e Fallopian tu b es to clo se as w ell as a skin im p lan t and a ta m p o n , b o th o f w hich co n tain ed a sy n th etic steroid co m p ou n d th a t w ould provide a year o f co n trace p tio n . “Sunday p ills" a w eekly stero id d ose, d isrupted th e n o rm al p atte rn o f th e en d o m e triu m and preven ted nid ation . A n ew fem ale steriliz a ­ tio n p ro ced u re used “tran sv ag in al in je c tio n s o f Q u in a crin e o f ca rb o lic acid ” to “o b literate th e tu b e s " b u t it w as “n o t as effectiv e as [the] su rgical p ro c e ­ dure.” The m o rn in g -a fte r pill w as effective b u t req u ired p h y sician su p ervi­ sion. P P R I staff m ad e it clea r th a t w o m en cou ld only u se it tw ice; ch o ice had its lim its. By 1 9 7 3 PPFA re co m m en d e d th a t all affiliates d isco n tin u e its use b eca u se m alp ra ctice in su ra n ce refu sed to co v er it due to la ck o f FD A approval. P P R I com p lied . In a n ew ab o rtio n m eth o d , physicians gave p ro sta ­ gland in intravenou sly to “in c rea se u terin e and tu b a l m o b ility " w h ich w orked w ell in th e eighth to tw elfth w eeks o f pregnancy. R esea rch ers also pursued th re e form s o f m ale co n tra ce p tio n . A n in trav asatio n al device provided te m ­ p o rary sterilizatio n ; it ren d ered sp erm atozoid s in effectiv e. A “sy lastic im ­ p lant o f an d ro gen s” stopp ed sp erm p ro d u ctio n bu t p oten tially dam aged th e p ro state gland and in crea sed ch o lestero l levels. Lastly, a su b stan ce preven ted th e “m atu ra tio n o f th e sp erm atozoid s on th e ep id id y m is"13 R e se a rch in to m ale m eth o d s w as h a lf-h ea rted at b est, leaving p h a rm a ceu tica l c o n tra ce p ­ tives a fem ale responsibility. N o n ew m eth o d s challenged th e p rim acy o f th e pill. D esp ite safety co n cern s, m any w o m en co n tin u ed to rely o n it b eca u se o f its effectiv en ess.

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

Contraception and the Federal Government D u rin g th e 1 9 4 0 s and 1 9 5 0 s waves o f ru ral so u th ern b lack s and P u erto R ican s in search o f b e tte r jo b s and living co n d itio n s m igrated to u rb an cen ters in th e N o rth ea st and M id w est. Jo b co m p etitio n , overcrow ding, and ra cia l te n sio n s led to u n rest and a rise in w elfare rolls, m ak in g th e lo w -in co m e and ind igent m o re visible to society. C ritic s a sserted th a t high fertility co n trib u ted to th e cycle o f poverty. M an y o f th e sam e groups involved in in tern a tio n a l pop u la­ tio n co n tro l p rog ram s in th e 1 9 5 0 s and 1 9 6 0 s b eg an to lobby fo r a d o m estic agenda. Fed eral and state officials’ sea rch fo r a m eans o f co n tro l helped lead to th e d isp ersal o f g ov ern m en t-su b sid ized co n tracep tiv es. Fed eral actio n s b eg an in th e early 1 9 6 0 s . C on g ress approved th e D istric t o f C o lu m b ia H ealth D e p a rtm e n t bu dget in 1 9 6 2 ; it inclu d ed $ 2 5 ,0 0 0 to p ro ­ vide co n tra ce p tio n to p u blic h ea lth m a tern ity p a tie n ts and p u blic w elfare clie n ts.14 W h e n Lyndon B. Jo h n so n assu m ed office, he d eclared a “W a r on P ov erty” and crea ted a n u m b er o f n ew ag en cies. T he E co n o m ic O p p o rtu n ity A ct o f 1 9 6 4 estab lish ed th e O ffice o f E co n o m ic O p p o rtu n ity (O E O ) to a l­ leviate p ro b lem s am o n g less advantaged groups. In resp o n se, th e New York

Times ed itorialized th a t th e only way to w in th e b attle w ould b e “to ta ck le a ro o t cau se o f p overty — th e p resen t explosive g row th o f population.” S ta tistics on in creasin g n u m b ers o f d ep en d en ts in d icated th a t “th e co st o f m aintain in g su ch an enlarged bu rd en o f n o n p ro d u cers cou ld o f its e lf add m illion s o f fa m i­ lies to th o se w h ich tod ay are u nable to ad equ ately su p p ort th e m selv es”15 The Jo h n so n a d m in istra tio n co n sid ered b ro ad en in g g ov ern m en t invest­ m e n ts in d o m estic co n tra ce p tiv e p rog ram s. Tw o ca b in e t officials pu blicly su p p orted co n tra ce p tio n b eca u se o f its e c o n o m ic advantages: S e c re ta ry o f L a b o r W illard W irtz and S e c re ta ry o f th e In te rio r S tew a rt U dall, w ho over­ saw h ealth care fo r N ative A m e rica n s and th e P acific te rrito ria l island s, tw o g roups ta rg e ted by p o p u la tio n c o n tro llers. The p o p u la tio n lobby, sp e a r­ head ed by th e P op u lation C o u n cil and PPFA , w orked to co n v in ce Jo h n so n to in co rp o ra te fam ily p lanning in his W a r on Poverty and to ad d ress th e gravity o f ov erp op u lation in his S ta te o f th e U n io n ad d ress.16 In fou r sep arate sta te­ m e n ts during 1 9 6 5 h e p ro claim ed th a t th e g o v ern m en t w ould seek to solve p op u latio n p roblem s. G o v ern m e n ts, he a sserted in an address to th e U n ited N ation s, should “a c t on th e fa ct th a t less th a n $ 5 .0 0 invested in p o p u lation co n tro l is w o rth $ 1 0 0 .0 0 invested in e c o n o m ic g ro w th ”17 A lth o u g h in M ay 1 9 6 5 th e N atio n al A cad em y o f S c ie n ce s called b irth co n tro l a “b a sic h um an right,” e co n o m ics, n o t w o m en ’s righ ts, sparked th e Jo h n so n a d m in istra tio n ’s en d o rsem en t o f con tracep tiv es. Jo h n so n w anted to m ove quickly bu t w ithou t elicitin g C ath o lic o p p o sitio n , w h ich p rev en ted th e p o p u latio n lobby from co n v in cin g h im to cre a te a p re sid e n t’s co m m issio n on p o p u latio n .18 D o n ­

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ald C ritch lo w argues th a t Jo h n so n bu ried fam ily p lan n in g w ith in existin g a g en cies, esp ecially h ea lth and w elfare p ro g ram s, ra th e r th a n estab lish a cen tralized ag en cy solely fo r co n tra ce p tio n . The lack o f an effective n atio n al d istrib u tio n m eth o d , exacerb ated by th e lack o f natio n alized h ea lth care, left th e g ov ern m en t d ep en d en t o n private org anizatio n s fo r co n tra ce p tiv e d isp ersal.19 In D e c e m b e r 1 9 6 4 th e g o v e rn m en t ca u tio u sly b eg an to u n d erw rite co n trace p tiv e p ro je c ts. The O E O provided th e first fed eral fund s d irected solely at co n tra ce p tio n w ith a n in e -th o u sa n d -d o lla r g ran t to C orp u s C hristi, Texas, a site ch o sen , acco rd in g to co n g ressio n al testim ony, b eca u se o f its new c lin ic ’s su ccess in red u cin g “u nw anted b irth s and bu ngled a b o rtio n s am ong ch arity p a tie n ts " M o s t ob serv ers o f th is p ro g ram h o p ed th a t “lo w -in co m e p o o rly ed u cated ad u lts” w ould use co n tra ce p tio n “to lim it th e ir fam ilies to su p p o rtab le sizes and ach iev e in d ep en d en ce o f th e w elfare s y ste m "20 The O E O approved sim ilar p rog ram s in A ustin, S t. L ou is, B uffalo, N ashville, and O aklan d .21 A lead ing O E O deputy conclu d ed : “I f all th e p o o r had th e sam e n u m b er o f kids as th e n o n -p o o r, w e w ould have fifte en to tw en ty p e rce n t o f p overty licked rig h t th ere. B irth co n tro l could do m o re th a n any o th e r single p overty p r o je c t" The C o u n cil o f E co n o m ic A dvisers estim ated th a t for 1 9 6 4 m o re th a n on e m illio n ch ild ren lived in fam ilies w ith m o re th a n six siblings and an an n u al in c o m e less th a n $ 2 ,0 0 0 ; 2 5 p e rce n t o f all ch ild ren (abou t fif­ te e n m illion ) lived in poverty. In 1 9 6 5 alo n e A id fo r Fam ilies w ith D ep en d en t C hild ren (A FD C ) ra n up a bill o f $1.5 b illio n .22 That year saw a rapid su ccessio n o f fed eral activ ities. In Jan u ary th e C h il­ d ren’s B ureau, a b ra n c h o f th e D e p a rtm e n t o f H ealth , E d u cation and W elfare (D H E W ), allo tted $ 5 .5 m illio n to clin ics th a t d isp ensed co n tra ce p tiv es to lo w -in co m e and in d igen t m arried w om en. The O E O targ eted fund s fo r fa m ­ ily p lanning to fight p overty in early 1 9 6 5 . S o o n after, th e N atio n al A cad em y o f S c ie n c e s ’ C o m m itte e on P op u lation suggested th e g o v ern m en t “p ro m p tly ” in cre a s e its p o p u latio n co n tro l efforts. The W h ite H ou se C o n fe re n ce on H ealth in N o v em b er 1 9 6 5 co n cu rre d , callin g fo r g o v ern m en t serv ices to in ­ digent w om en. C on g ress am end ed th e S o c ia l S e cu rity A c t to req u ire state h e a lth d ep artm e n ts to exten d fa m ily -p la n n in g serv ices w ith in te n years and to au th o rize fed eral g rants fo r d istressed areas th a t cou ld n o t m e e t th is goal.23 A t th e sam e tim e, th e S u p rem e C o u rt stru ck dow n th e a n tiq u ated C o n ­ n e c ticu t C o m sto ck Law in Griswold v. Connecticut, 381 U .S. 4 7 9 (1 9 6 5 ). In N o v em b er 1961 th e C o n n e c tic u t P lan n ed P a ren th o o d League, w ith E stelle G risw old as execu tiv e d ire cto r ( 1 9 5 4 - 6 5 ) , challenged th e statu te by opening a clin ic. The p o lice arrested G risw old and Dr. C. L ee B u x to n o f Yale M ed ica l

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

S ch o o l; th e circu it co u rt fou nd th e m guilty, as did th e su p erior co u rt and th e state su p rem e co u rt. In a sev en -to -tw o d ecisio n th e U n ited S ta te s Su p rem e C o u rt d eclared th e C o n n e c tic u t law u n c o n stitu tio n a l.24 T he “zon e o f p ri­ v acy ” establish ed by th e C o u rt to p ro te c t individual a ccess to co n tracep tiv es, how ever, exten d ed to m a rried cou ples only. Ju stices w ere unw illing to sa n c­ tio n p rem arital sexuality. This re s trictio n to m a rried w o m en did n o t re flec t pu blic opinion. A 1 9 6 5 n atio n al p oll fou nd 8 0 p e rce n t approved o f b irth co n tro l for “anyone w ho w ants it,” 13 p e rce n t disapproved, and 7 p e rce n t did n o t know. B y religion, 8 3 p e rce n t o f P ro te sta n ts, 7 0 p e rce n t o f C a th o lics, and 8 8 p e rce n t o f “all o th e r” approved. A P op u lation C o u n c il-in itia te d G allup p o ll th e sam e year fou nd th a t 6 3 p e rce n t favored fed eral fund ing o f state and city c o n tra ce p ­ tive p rogram s; 2 8 p e rce n t opposed . In an O c to b e r 1 9 6 5 p o ll 59 p e rce n t o f C ath o lics approved o f fed eral aid to fam ily-p lan n in g clin ics. Dr. W illia m V. D ’A n ton io , asso cia te p ro fesso r o f so cio lo g y at N o tre D am e, estab lish ed th e C a th o lic C o m m itte e o n P op u lation and G o v ern m e n t P olicy to in fo rm th e g o v ern m en t th a t n o t all A m e rica n C a th o lics ag reed w ith ch u rch d o ctrin e on b irth co n tro l.25 W ith in creasin g su pport fo r gov ern m en t funding, som e p olitician s drafted legislation . R ep resen ta tiv e Jam es S c h e u e r (D -N Y ) in tro d u ced tw o bills in 1 9 6 5 to rep eal C o m sto ck ; n eith e r passed u n til 1971, w hen th e y w ere c o m ­ b ined in to P u blic Law 9 1 -6 6 2 . S ev era l o th e r 1 9 6 5 bills called fo r th e crea tio n o f O ffices o f P op u lation P ro b lem s in th e D H E W and S ta te D ep a rtm en t, th e org anizatio n o f a W h ite H ou se C on fere n ce o n P op ulation, and th e a llo ca tio n o f funds fo r co n tra cep tiv e d istrib u tio n to clin ics acro ss th e cou ntry .26 H ea r­ ings on S 1 6 7 6 ca m e b efo re a su b co m m itte e ch aired by S e n a to r E rn est G ru ening in th e su m m er o f 1 9 6 5 . H e observ ed th a t th e g ov ern m en t w as m oving to o slowly: th e U n ited S ta tes had th e “h ig h est rate o f p op u latio n grow th, th e h ig h est rate o f u n em p loy m en t, and th e h ig h est ra te o f p u blic d ep en d en cy o f any ind u strialized n a tio n in th e world.” P art o f th e p ro b lem , he argued, w as th a t th e g ov ern m en t, th rou g h its w elfare reg u latio n s, had “u nw itting ly ” im p lem en ted a “p ro n a ta list” policy. H e con clu d ed th a t th e fa cts had b eco m e “so overw helm ing and th e n eed so ap p a ren t” th a t th e g ov ern m en t m u st r e ­ evaluate its p o licies and m ake co n tra ce p tiv es available to lo w -in co m e and ind igent p eop le.27 T estim on y at th e hearin g s co n firm ed th a t th e g o v e rn m en t’s slow resp o n se w as a lead ing cau se o f m ou n tin g w elfare expend itu res and p roblem s a s s o c i­ ated w ith poverty. S e n a to r M ilw ard S im p so n (R -W Y ) argued th a t all levels o f g o v ern m en t “m u st tak e a m o re active ro le . . . to p ro m o te p o p u latio n c o n tro l” b ecau se th e situ atio n had re a ch ed a critic a l im passe:

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W e are all fa m ilia r w ith th e p ro b lem s cau sed by th e n eed y fam ilies w ho have to o m any u nw anted child ren. O u r w elfare d ep artm en ts are plagued w ith th e p o o r w ho co n tin u e to have ch ild ren w h en th e y ca n ’t afford to feed th e o n es th e y have. A nd m any o f th e se, unfortu nately, are b o rn o u t o f w ed lock. The co st o f m ain tain in g ch ild ren o f th e p o o r has clim b ed to m o re th a n a billion dollars a year in w elfare funds. O n e child in every tw enty-five receiv es w elfare aid, and th e n u m b er m ay double in th e n ex t 10 years. H e con clu d ed th a t “a d ire ct co rrela tio n b etw een poverty and u n co n tro lled b irth s” existed .28 S e n a to r R o b e rt B yrd (D -W V ) p o in ted to th e la ck o f c o n tra ­ ceptives to explain th e leap in A F D C re cip ien ts: “The p ro b lem is th e spiraling b irth rate am o n g th o se w ho are incap ab le o f ad equ ately providing fo r th e ir o ffsp rin g ” Byrd claim ed th a t every dollar sp en t o n fam ily planning saved $ 2 5 in A F D C b en efits. Jam es R. D u m p so n , N ew Y ork C ity w elfare co m m ission er, te stified th a t only fed eral aid w ould help in “red u cin g w elfare costs.” W a lter K u ralt o f th e N o rth C arolin a P u blic W elfare D ep a rtm en t te stified th a t su b­ sidized co n tracep tiv es cou ld red u ce m ale fam ily d esertio n by allow ing co u ­ ples to lim it th e ir offspring; if husbands rem ain ed and co n trib u te d to fam ily in co m e, A F D C exp en d itu res w ould d ecrease. F. A . S c h u m a c h e r o f P lanned P aren th oo d asserted th a t g o v ern m en t a ssista n ce to clin ics w ould “u ltim ately red u ce illegitim acy, a b o rtio n s, d elinquency, w elfare co sts, [and] ta x e s ”29 D e ­ spite su p p ort, th e b ill failed to b e re p o rte d o u t o f co m m ittee , p rim arily due to th e te stim o n y o f Jo h n G ardner, D H E W secretary . G ard n er argued th a t it w as u n n e ce ssary b eca u se fund ing w as available for co n tra cep tiv es fro m th e D H E W , th e O E O , and th e am end ed S o c ia l S e cu rity A ct. G ru e n in g c o u n ­ te red th a t his p ro p o sal n o t only earm arked sp ecial funds b u t d em o n strated co n g ressio n al co n cern . G ard n er rem ain ed u nco n v in ced , leaving D H E W and O E O in th e fo refro n t o f fed eral p ro g ra m s.30 These tw o ag en cies lau n ch ed th e first m a jo r fed erally fund ed cam p aig n in 1 9 6 5 . G ran ts fro m D H E W , O E O , and th e Ford and R o ck efeller fou nd ations establish ed a fam ily-p lan n in g clin ic in p o v erty -strick e n ru ra l L in c o ln P arish in n o rth e rn L ou isiana. O n e in th irte e n L ou isian a resid en ts w as on relief, and th e ille g itim acy rate a m o n g th e in d igen t had re a ch ed 3 0 p e rce n t versus a n atio n al average o f 21.3 p e rce n t. O f th e w o m en w ho used th is n ew clin ic, 85 p e rce n t w ere black . W h ile L ou isian a had m o re p o o r black s th a n w h ites, o f­ ficials found w h ites re lu cta n t to u se a n in teg rated facility. This p ro g ram m e t w ith su ccess d espite high n u m b ers o f C ath o lics. In on e year, b irth s am ong lo w -in co m e fam ilies d eclin ed 3 2 p e rce n t, illeg itim ate b irth s 4 0 p e rce n t, and seco n d illeg itim a te b irth s 4 1 .5 p e rce n t. W h e n so m e pu shed to m ake th is p ro je c t com p ulsory, Dr. Jo sep h D. Beasley, d ire cto r o f th e L o u isian a Fam ily

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

P lan n ing P ro gram , criticiz e d “ta x -p a y er v ig ilan tism ” th a t favored co erciv e co n tra ce p tio n to red u ce w elfare and illegitim acy .31 P ress acco u n ts o f su ch su ccesses led to pressu re fo r in c rea sed g o v e rn ­ m e n t activity, and th e g o v ern m en t resp ond ed . In Jan u ary 1 9 6 6 G ard n er is ­ sued a D H E W po licy allow ing co n tracep tiv es to b o th m arried and u nm arried w om en. O E O D ire c to r R . S a rg en t Shriver, how ever, resta ted his lim ita tio n o f fed eral su bsidies to m a rried w o m en living w ith husbands. W h y did divergent p o licies exist? D H E W provided funds th ro u g h its m a tern a l and child h ealth plans, w hich serviced m o th e rs, b o th m arried and single, w hile O E O fu nneled aid th ro u g h co m m u n ity a ctio n prog ram s. Sin g le m o th e rs and single w o m en w ere tw o very different groups. B e c a u se O E O w as n ew and so m etim es c o n ­ trov ersial, S h riv er m ay have d ecid ed to follow a con serv ativ e path. In th e spring o f 1 9 6 6 , how ever, O E O raised th e am o u n t available fo r co n tracep tiv es fro m tw elve to tw en ty dollars fo r ea ch w om an and elim in ated th e o n e-y ea r eligibility lim it. C o m m e n tin g o n grow ing g ov ern m en t involvem ent, Sh riv er observ ed th a t u n til th e m id -1 9 6 0 s , co n tra ce p tio n w as “like syphilis— p o liti­ cally you cou ld n’t ta lk a b o u t it ” In 1 9 6 6 th e g ov ern m en t spent $ 2 5 m illion on co n trace p tiv e serv ices, y et w ith n early five m illio n in d ig en t w o m en o f ch ild b earin g age, th is m o n ey m ad e only a sm all d e n t.32 The w elfare co sts co n tin u ed to grow. C ritics failed to acknow led ge th a t in crea ses resu lted in p art fro m expanded serv ices and eased eligibility re q u irem e n ts, em phasizing in stead th e large fam ilies o f w elfare m o th e rs. O E O re sea rch d eem ed c o n tra ­ ce p tio n th e m o st “co st-e ffectiv e” an tip overty m easu re available. Sim ilarly, th e P u blic H ealth S e rv ice a sserted th a t a co n tra cep tiv e p ro g ram fund ed at $ 9 0 m illio n over five years w ould d ecrease in fan t m o rta lity and b e seven tim es m o re effectiv e th a n th e expensive m a tern ity p ro g ram s.33 In 1 9 6 6 S e n a to r Jo sep h D. Tydings (D -M D ) along w ith G ru en in g and o th ­ ers in tro d u ced a b ill calling fo r co n g ressio n al funds sp ecifically earm arked fo r co n trace p tio n . It ap p rop riated $15 m illio n for fiscal y ear ending 3 0 June 1 9 6 7 , $ 3 0 m illio n fo r 1 9 6 8 , $ 4 5 m illio n for 1 9 6 9 , $ 6 0 m illio n for 1 9 7 0 , and $ 7 5 m illio n fo r 1971. The b ill inclu d ed g u aran tees against co e rc io n o r loss o f serv ices in o th e r fin a n cia l or m ed ical prog ram s. A lth o u g h T ydings’s p rop osal gained w idespread su p p ort, it failed b eca u se G a rd n er d eem ed it u n n e c e s ­ sary. H e pu shed fo r m easu res th a t fit his agenda. First, G ard n er su pported a S e n ate bill th a t w ould in c rea se fund ing fo r p u blic h ea lth p rog ram s, w hich in d irectly w ould fund co n tra cep tiv e serv ices. W h ile his ap p roach could have b e e n a m eans to disguise g o v ern m en t’s o u trig h t involvem ent in b irth co n tro l, it could also have b e e n an attem p t to ensu re th a t co n tra ce p tio n rem ain ed part o f com p reh en sive h ea lth serv ices. S e co n d , C on g ress passed his C o m p reh e n ­ sive H ealth P lanning and P u blic H ea lth S e rv ices A m en d m en ts, giving state and lo ca l gov ern m en ts au th o rity to fin an ce fam ily -p lan n in g serv ices. Third,

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G ard n er estab lish ed a new p o st in D H E W — deputy a ssista n t s e c re ta ry fo r scien ce and p o p u la tio n — to au gm en t th e fed eral g o v ern m en t’s role in fam ily p lan n in g . P op u lation co n tro l ad vocates believed co n tra ce p tio n w arran ted a p o st o f its ow n. G a rd n er disagreed. F ou rth, he evaluated reg ion al and state clin ic serv ice re q u irem e n ts and train in g n eed s. L ast, h e set up a d ep a rtm e n ­ ta l co m m ittee to co o rd in a te all fed eral fam ily-p lan n in g p ro g ra m s.34 P ro gram bu dgets also in creased . A p p rop riation s fo r T itle V o f th e S o cia l S e cu rity A ct fo r fiscal y ear 1 9 6 6 eq u aled $ 4 5 m illio n and, fo r 1 9 6 7 , $ 5 0 m il­ lion. The C h ild ren ’s B u reau a llo ca ted $ 3 0 m illion (fiscal year 1 9 6 6 ) to m e et up to 75 p e rce n t o f p ro g ram co sts fo r w o m en in lo w -in co m e areas. Yet PPFA studies in d icated th a t a b o u t 5 m illio n m ed ically ind igent w o m en w anted a s­ sistan ce; only ab o u t 5 0 0 ,0 0 0 received serv ices. S u ch data led Tydings to p ro ­ m o te legislatio n fo r ad d ition al g ov ern m en t a ssista n ce .35 H e and G ru en in g co sp o n so re d a b ill in 1 9 6 7 to expand d o m estic fa m ­ ily-p lan n in g services. They b elieved th a t “at least $ 1 0 0 m illio n ” p er year was n ecessa ry and w ould b e “th e w isest in v estm en t . . . in co m b a tin g p o v erty ” b ecau se “each dollar sp en t for p rovision o f fam ily p lanning services repays its e lf m any tim e s over in savings fo r w elfare costs.”36 As w ith th e tw o earlier bills, th e 1 9 6 7 p ro p o sal receiv ed w ide su pport. R ep resen tativ e G eo rg e B u sh (R -T X ) told th e S e n a te su b co m m itte e th a t h e was “strongly in favor o f a m o re active p ro g ram in th is field ” In his opinion, th is C on g ress should press vigorously fo r th e m o st d ire ct ap p roach possible. W h e n th e Salk v a ccin e w as discovered and approved, it was w idely d issem inated by P u blic H ealth O fficials. W ith th e pill and o th e r d evices, w e have m ad e g reat strid es in th is field. B u t even th o u g h all G o v ern m e n t p rog ram s in th is field, to m y know ledge, are voluntary, I get th e feelin g th a t w e are still tip to e in g cau tiously around th e edge o f th e p roblem . . . . B irth co n tro l, o ften m isu n d ersto o d , is an answ er to an in creasin gly im p o rta n t p u blic p ro b lem .37 B u sh seem ed to call fo r a q u a si-co m p u lso ry p ro g ram o r at least m o re vigor­ ous advocacy. H is eq u a tio n o f th e pill w ith th e p olio v accin e as a so lu tio n to p overty was a u niqu e co n ten tio n , on e th a t seem ed to liken in d igen t ch ild ren to a d isease in n ee d o f erad ication. These hearin g s exposed th e rift betw een b ill sp on sors and G ardner. The fo rm er criticiz e d D H E W fo r n o t “reco g n iz in g th e n eed fo r greatly expanded Fed eral a ssistan ce in th e delivery o f fam ily p lanning services.” Tydings c o n ­ ten d ed th a t G ard n er was ig n o rin g Jo h n so n ’s calls for a ctio n ; by 1 9 6 7 , L B J had m ad e fo rty -o n e su ch statem en ts. R ep resen tative S ch e u e r co n clu d ed fro m th e re co rd o f th e “p u sillanim ou s and fa in t-h ea rted a d m in istra tio n ” th a t D H E W lacked “effectiv e lead ership , drive, d ire ctio n , and forw ard th ru st in g etting

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

T a b le 6 .1 . E s t im a t e d N u m b e r o f Ille g itim a t e B ir th s a n d I lle g it im a c y R a t io s , U n it e d S ta te s, 1 9 2 0 - 1 9 6 8 Year

I ll e g it im a t e b ir t h s

Total 1920 1930 1940 1945 1950 1955 1960 1965 1968

86,365 90,800 102,996 128,190 148,372 189,733 230,428 297,055 343,815

White 38,490 42,296 43,473 58,670 54,353 64,812 83,333 124,196 155,200

R a t io p e r 1 , 0 0 0 b ir t h s

Nonwhite

Total

White

Nonwhite

47,875 48,504 59,523 69,520 94,019 124,921 147,095 172,859 188,615

29.3 34.7 40.3 44.8 40.9 46.2 53.4 78.6 97.8

15.0 18.6 19.8 23.6 17.5 18.6 22.9 39.7 53.3

125.0 141.1 166.4 179.3 179.5 202.4 215.8 263.2 312.0

Source: Phillips Cutright, '"Illegitimacy in the United States: 1920-1968," in D em ographic a n d S ocial Aspects o f P opulation G row th, ed. Charles F. Westoff and Robert Parke, Jr. (Washington, D.C.:

Government Printing Office, 1972), 383.

th e serv ices to w here th e a ctio n is in th e n eig h b o rh o o d s o f A m erica.” O th ers reproved its slow resp o n se to co m m u n ity n eed s, its la ck o f flexibility in fu n d ­ ing, and th e d earth o f funds a llo ca ted sp ecifically fo r fam ily planning. The p anel agreed th a t th e op tim u m fed eral fund ing cam e fro m O E O , n o t D H EW . O E O d esignated fam ily p lanning a “N a tio n a l E m phasis,” w hile D H E W ex ­ pand ed its role, perhaps in resp o n se to th e p an el’s sharp criticism . G ard n er elevated fam ily p lanning to on e o f six sp ecial p rio rities and finally crea ted a p o st to deal sp ecifically w ith th is area, ap p oin ting K ath erin e B. O e ttin g e r to fill it. Perhaps th e m o st co n tro v ersial 1 9 6 7 p o licy w as co n g ressio n al rem ov al o f th e re strictio n ag ainst fed eral fund s for u n m arried w o m en .38 Illeg itim acy rates am on g w o m en on w elfare had co n sisten tly risen during th e 1 9 6 0 s (see tab le 6.1). O n e m eans to red u ce th e se n u m b ers was to give single w o m en free devices. To save A F D C m oney, C on g ress p ro p o sed chang es in th e w elfare system in 1 9 6 7 . H R 1 2 0 8 0 obliged m o th e rs and teen a g ers over th e age o f sixtee n on A F D C to tak e jo b s offered th e m , regard less o f w ages, w orking co n d itio n s, or th e n eed s o f th e ir ch ild ren or o th e r d ep en d en ts. It also refu sed pay m ent for ch ild ren b o rn a fter an unw ed m o th e r had en rolled fo r b en efits. W h e n th e H ou se p ro p o sal re a ch ed th e S e n a te F in an ce C o m m ittee , tw o b la ck w o m en — M rs. Jo h n n ie T illm on o f W a tts and M rs. A lice N ixo n o f P ittsb u rg h — led sixty w o m en u nd er th e au sp ices o f th e P overty R ights A c tio n C en te r to W a sh in g ­ to n . W h e n th e S e n a te F in an ce C o m m ittee refu sed to h ea r th e m , th e y tu rn ed to th e m e d ia.39 In th e end, th e S e n a te did n o t pass th e p roposal, bu t H ou se a ctio n d em o n strated th e p o p u larity o f prog ram s designed to red u ce w elfare, regard less o f th e im p a ct o n recip ie n ts. A m en d m en ts to th e S o c ia l S e cu rity

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A ct did pass in 1 9 6 7 . In tro d u ce d by B u sh and H erm an S c h n e e b e li (R-PA ), b o th o f th e H o u se W ays and M ea n s C o m m ittee , th e se a m e n d m e n ts m a n ­ dated n o less th a n 6 p e rce n t o f funds ap p rop riated fo r M a te rn a l and C hild H ealth serv ices and M a te rn a l and In fa n t C are b e devoted to fam ily planning. They req u ired state h ea lth d ep artm en ts to inclu d e co n tra cep tiv es and m ake th e m available to w elfare re cip ie n ts and th e in d ig en t.40 C on g ress to o k fu rth e r a c tio n on th e in tern a tio n a l fro n t. Jo h n so n ’s 1 9 6 7 S ta te o f th e U n io n m essage claim ed : “N ext to th e pu rsuit o f p eace, th e really g reat ch allen ge to th e h u m an fam ily is th e ra ce b etw een food supply and p o p u latio n in crea se. T hat ra ce to n ig h t is b ein g lost. T he tim e fo r rh e to ric has clearly passed. The tim e fo r co n c e rte d a c tio n is h ere, and w e m u st get on w ith th e jo b " In M a rc h S e n a to r Fulbrig ht in tro d u ced T itle X to th e F or­ eign A ssistan ce A ct, w h ich earm arked $ 3 5 m illio n annually fo r th re e years to overseas co n tracep tiv e prog ram s. T itle X allow ed th e p resid en t to subsidize g ov ern m en t, U n ited N ation s, and in tern a tio n a l private n o n p ro fit p o p u lation p ro g ram s, in clu d in g th e p ro d u ctio n and d istrib u tio n o f co n tra ce p tiv es. In M ay C on g ress allow ed A ID to fin an ce co n tracep tiv es. By late 1 9 6 7 p op u la­ tio n co n tro l w as an in teg ra l goal o f U .S. e c o n o m ic p rog ram s ab road .41 P u blic resp o n se affirm ed fed eral efforts to d ecrea se p overty and w elfare co sts. In a 1 9 6 7 H arris p oll on L B J’s G rea t S o cie ty p rog ram s, w elfare and re ­ lie f paym ents h ead ed th e list o f d esired cu tb a ck s alon g w ith farm subsidies. The sam e year a PPFA n a tio n a l survey found th a t m o st resp o n d en ts approved o f pu blicly fund ed co n tra ce p tio n to co m b a t p overty and cu rb w elfare ex p en ­ d itu res.42 Yet serv ices to low - or n o -in co m e w o m en rem ain ed inad equate. A 1 9 6 8 O E O survey found th a t n early 8 5 p e rce n t o f th e 5 .4 m illio n A m e rica n w o m en estim ated to n eed subsidized serv ices receiv ed non e. Less th a n o n eth ird o f lo ca l h ea lth d ep artm en ts and o n e -fifth o f ho sp itals w ith large m a ter­ n ity services provided any fam ily p lanning for ind igent p a tie n ts.43 R ad ical p op u latio n co n tro llers ran ted th a t th e g ov ern m en t w as n o t doing enough. A t a w elfare h ea rin g in N ew Y ork in early 1 9 6 8 so m e suggested th a t th e g ov ern m en t pay every im p o v erish ed w om an o f ch ild b ea rin g age $ 5 0 0 a year n o t to have a baby. A n a rtic le in Redbook argued th a t if th e ind igent could n o t d ecid e w h eth er th e y could afford ch ild ren , th e state should esta b ­ lish a licen sin g bo ard fo r th e m .44 S u ch se n tim e n t m ay have led individual w elfare w orkers to co e rciv e m easu res. A lth ou g h fed eral and state fam ily ­ p lanning p o licies w ere voluntary, so m e so cia l w orkers apparently told clien ts to u se co n tracep tiv es or lose th e ir b en efits. Th ese re p o rts are su sp ect: th ey o rigin ate in a C ath o lic p erio d ica l and could have b e e n an attem p t to d iscred it fed eral involvem ent in co n tra ce p tio n . Still, re p o rte d in cid e n ts p ro m p ted th e g o v ern m en t to re a ssert its o p p o sitio n to co m p u lsio n and to estab lish a g riev ­ an ce bo ard to w ard o ff co e rc io n .45

W ho Pays? Contraceptive Services and the Welfare State, 1963-1975

Table 6.2. Percent Pregnant, 1968, by Age and Race Age 15 16 17 18 19

Black

White

2.1 3.9 5.8 7.2 5.0

0.2 0.3 1.4 0.3 0.5

Source: Melvin Zelnik and John F. Kantner, “Sexuality, Contraception and Pregnancy among Young

Unwed Females in the United States," in D em og rap h ic a n d S ocial Aspects o f P opulation G row th, ed. Charles F. Westoff and Robert Parke, Jr. (Washington, D.C.: Government Printing Office, 1972), 372.

B y th e late 1 9 6 0 s p op u latio n co n tro llers w ere co n tin u in g to propagand ize th a t p u blic co n tra cep tiv e fund ing w ould solve a h o st o f so cia l and ec o n o m ic p ro b lem s th a t sw elled th e w elfare rolls, nam ely, u nw anted pregnancy, te e n ­ age p regn an cy, and illegitim acy. Stu d ies show ed th a t abu sed ch ild ren later abu sed th e ir ow n offsp ring and th a t lo w er-in co m e cou p les had m o re u n ­ w anted ch ild ren th a n m id d le- and u p p er-class cou ples. U nw anted ch ild ren o ften end ed up in fo ster care at an average an n u al co st o f $ 2 ,4 0 0 to $ 8 ,0 0 0 a year.46 T een ag ed ch ild b irth also in c rea sed state co sts. In 1 9 6 8 6 0 0 , 0 0 0 b irth s, or 17 p e rce n t o f all b irth s, o ccu rred to w o m en u nd er age tw enty ; m o re th a n 2 0 0 ,0 0 0 w ere sev en teen years old or younger. B la ck te e n s w ere m o re likely to b e co m e p reg n an t th a n w hites (see tab le 6 .2 ). M an y ch ild ren b o rn to te e n m o th e rs u ltim ately end ed up on A F D C .47 A h ig h p ercen tag e o f te e n p regn an cies w ere also illegitim ate. The illeg itim acy rate had b e e n in creasin g steadily fro m 7.1 in 1 9 4 0 to 2 4 .1 in 1 9 6 8 . Stud ies con clu d ed th a t 7 5 p e rce n t o f n on w h ite and 31 p e rce n t o f w hite in c rea ses in illeg itim acy b etw een 1 9 4 0 and 1 9 6 0 resu lted fro m im proved h ea lth co n d itio n s th a t red u ced m iscarriag e. Young, u n m arried , w hite w o m en leg itim ated th e ir c o n c ep tio n s m o re th a n th e ir n on w h ite co u n te rp a rts, a cco u n tin g fo r th e h ig h er rate o f b la ck illeg iti­ m ate ch ild ren on A F D C — a d ifference th a t in crea sed during th e 1 9 6 0 s (see tab le 6.3 ). In 1961 2 4 p e rce n t o f A F D C ch ild ren w ere illeg itim ate, o f w hom 3 8 p e rce n t w ere b lack ; by 1 9 6 9 th e co rresp o n d in g figures w ere 31 p erce n t to ta l, o f w h om 4 6 p e rce n t w ere b lack . A F D C ’s estim a ted exp en d itu re on illegitim ate ch ild ren in 1 9 6 9 w as $1.1 billion, o n e-th ird o f th e en tire A F D C b ill fo r 1 9 6 9 .48 P op u lation co n tro llers used su ch d ata to ju stify th e ir pu sh for clin ics in pred om in an tly b la ck neig h b o rh o o d s and fo r te e n a ccess to g ov ern ­ m en t-su b sid ized co n tra cep tio n . S o m e m e m b ers o f th e b la ck co m m u n ity saw ille g itim a cy in a different light. M an y b la ck te e n s did n o t co n sid er p re g n a n cy as ru in in g th e ir life ch a n ce s; th e y alread y lived in p o v erty and felt tra p p ed th e re. R aising ba-

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T a b le 6 .3 . L e g it im a t e , I lle g it im a t e , a n d T o t a l O u t - o f- W e d lo c k C o n c e iv e d B ir t h r a t e s p e r 1 ,0 0 0 U n m a r r ie d W o m e n b y C o l o r a n d A g e , U .S . 1 9 6 4 - 1 9 6 6 A n n u a l A v e r a g e A g e o f m o th e r

A ll m o th e rs

W h it e

N o n w h ite

L e g it im a t e

1 8 .7

1 7 .3

2 7 .4

I lle g it im a t e

2 2 .4

11.3

88.2

T o tal O W C B

4 1.1

2 8 .5

115 .6

L e g it im a t e

20.2

18 .8

2 9 .4

I lle g it im a t e

16 .4

7 .8

7 2 .4

T o tal O W C B

3 6 .6

2 6 .6

101.8

L e g it im a t e

3 3 .3

2 8 .9

5 8 .6

I lle g it im a t e

3 8 .4

2 1 .5

13 7 .3

T o tal O W C B

6 9 .6

5 0 .5

19 5 .9

15 -4 4

15 -19

2 0 -2 4

2 5 -2 9 L e g it im a t e

7 .5

8.6

2 .7

I lle g it im a t e

4 6 .7

2 3 .4

14 6 .2

T o tal O W C B

5 4 .2

3 2 .0

1 4 8 .9

30 -34 L e g it im a t e

1.8

1 .5

3 .7

I lle g it im a t e

3 5 .6

16 .1

121.6

T o tal O W C B

3 7 .4

1 7 .6

1 2 5 .6

35 -4 4 L e g it im a t e

0 .5

0.6

0.0

I lle g it im a t e

9 .7

4 .8

3 4 .9

T o tal O W C B

10.2

5 .4

3 4 .9

Source : Phillips Outright, “Illegitimacy in the United States: 1920-1968,” in D em ographic a n d S ocial Aspects o f P opulation G row th, ed. Charles F. Westoff and Robert Parke, Jr. (Washington, D.C.:

Government Printing Office, 1972), 404.

bies as te e n s allow ed th e m to draw on th e ir m o th ers and g ran d m oth ers for su pport. M oreover, jo b op p o rtu n ities w ere m in im a l fo r b la ck te e n s; staying h o m e to raise a ch ild did n o t in terfere w ith th e ir e c o n o m ic a d v an cem en t. P reg n an cy did n o t d eter th e ir co n tin u a tio n o f h ig h sch o o l; m o st b la ck te en s w ho b e ca m e p regn an t had already dropped out o f sch o o l.49 N o n e o f th is is to say th a t b la ck te e n s pu rp osely b e c a m e p regn an t. B u t if p reg n a n cy did o c ­ cur, th e y did n o t see it as th e p ro b lem d ecried by p o p u latio n co n tro llers and e co n o m ic con servatives. Teens desiring b irth co n tro l could face d ifficu lties p ro cu rin g it. Planned P aren th o o d , fearin g fo r its p u blic im age, refu sed co n tra cep tiv es to w om en u nd er eigh teen w ith ou t p aren tal co n sen t. Dr. S a d ja G o ld sm ith o f S a n F ra n ­ c is c o ’s P lan n ed P a ren th o o d fou nd th is p o licy absurd. S h e saw th ou san d s o f te e n s w ho n ee d ed co n tra ce p tiv e ca re flo ck in g to H aigh t-A sh bu ry , yet P lan n ed P aren th o o d tu rn ed th e m away. In 1 9 6 7 G o ld sm ith o p en ed a clin ic fo r teen ag ers th a t served as a n a tio n a l m o d el by th e late 1 9 6 0 s .50

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

P op ulation co n tro llers h ailed th is d evelopm ent bu t called fo r m o re gov­ ern m e n t actio n . They lam en ted th a t by early 1 9 6 9 m o re th a n tw o m illio n A F D C re cip ie n ts w ere eith e r single m o th e rs o r th e ir illeg itim ate ch ild ren , and 7 9 .6 p e rce n t, or 4 .3 m illio n w om en, still had n o a ccess to pu blicly funded d evices. D H E W and O E O officials ad vocated th e ex ten sion o f co n tracep tiv e services. In 1 9 6 9 th e N atio n al A cad em y o f S c ie n c e s in Resources and Man urged th a t “efforts to lim it p op u latio n in crea se in th e n a tio n and th e w orld be in ten sified by w h atever m ean s are p ra c tica b le ___ U ltim ately th is im plies th a t th e co m m u n ity and so ciety as a w hole, and n o t only th e p aren ts, m u st have a say a b o u t th e n u m b er o f ch ild ren a cou ple m ay h a v e"51 This last sta tem en t im plied co e rcio n or licen ses fo r p aren th o o d , b u t D H E W and O E O re je c te d su ch ta c tics. W h e n R ich ard M . N ixo n assu m ed th e presidency, he expanded th e fed eral ro le in p o p u latio n co n tro l. O n 2 8 Jan u ary 1 9 6 9 th e g o v ern m en t called for a plan “to p rev en t or red u ce th e in cid e n ce o f b irth s o u t-o f-w e d lo ck " S u ch a p ro g ram “m u st b e exten d ed p rogressively to all ap p rop riate ad ults and you th s, w ith in itia l p rio rity fo r m o th e rs w ho have had ch ild ren b o rn ou to f-w ed lo ck . . . and fo r you th s living in co n d itio n s im m ed iately cond u civ e to b irth s o u t-o f-w e d lo ck " L a te r th a t year N ixo n delivered th e first p resid en ­ tia l address solely d irected at th e “p ro b lem o f p o p u la tio n " C laim in g th a t th e W h ite H ou se con sid ered th e p o p u lation dilem m a “perhaps th e m o st singular p ro b lem w e face to d a y " ex cep t d isarm am en t, h e called fo r expand ed p ro ­ gram s: “U nw anted and u ntim ely child b ea rin g is o n e o f th e sev eral forces w h ich are driving m any fam ilies in to p overty or k eep in g th e m in th a t co n d i­ tio n ___ [I]t need lessly adds to th e bu rd ens placed o n all o u r reso u rces by in ­ creasin g p o p u latio n ___ The fed eral g ov ern m en t m ak es only a m in im al effort in th is area. The efforts o f state and lo c a l g ov ern m en ts are also in a d e q u a te" N ixo n set a goal to m ake co n tra ce p tiv es available to all lo w -in co m e fa m i­ lies by 1975. The sh o rt-te rm co st o f $ 3 0 m illio n a year, acco rd in g to N ixon, w as w o rth th e lo n g -te rm savings in w elfare. H e w as carefu l to tip his hat to th e C ath o lic C h u rch by g u aran teein g th a t his p ro g ram w ould n o t “infringe u p on . . . religiou s c o n v ic tio n s "52 To fulfill his goal, th e N ixo n a d m in istra tio n im p lem en ted n ew p o licies. In th e fall o f 1 9 6 9 D H E W answ ered N ixo n ’s ca ll fo r a N atio n al C en te r for Fam ily P lanning S e rv ices, qu ite a change fro m its earlier slow resp o n se to th e ap p o in tm en t o f a deputy sec re ta ry fo r fam ily planning. O n 2 Febru ary 1 9 7 0 th e ad m in istratio n passed an in c rea se o f $13 m illio n in th e bu dget fo r c o n ­ tracep tiv e re sea rch , to ta lin g $ 2 8 .5 m illio n .53 L a te r th e sam e y ear C on g ress finally passed and N ixo n signed in to law th e Fam ily P lanning S e rv ices and P op ulation R esea rch A ct to provide serv ices to all lo w -in co m e and ind igent w om en; it w as th e first o f its kind to deal solely w ith fam ily planning. It a l­

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lo ca te d $ 3 8 2 m illio n over th re e years to n o n p ro fit o rg anizatio n s to esta b ­ lish and expand su ch serv ices as pill d istrib u tio n , co n su lta tio n s, su pervision, in stru ctio n , and re fe rra l to o th e r m e d ica l services. T he a ct also establish ed th e O ffice o f P op ulation A ffairs and provided g rants for “a cc e p ta b le ” form s o f co n trace p tio n ; a b o rtio n w as n o t inclu d ed .54 C on g ress expand ed c o n tra ­ ceptive services w ith th e S o c ia l S e cu rity A m en d m en ts o f 19 7 2 , w h ich re im ­ b u rsed 9 0 p e rce n t o f state c o n tra ce p tio n ex p e n ses.55 W h ile N ix o n hailed th is “lan d m ark legislation,” P P R I w as critica l. The 1 9 7 0 a c t w as a “w atered dow n” version: th e o rig inal S e n a te b ill a llo ca ted $ 9 6 7 m illio n over five years; th e H o u se allo ca ted only $ 2 6 7 m illio n over th re e years. N o n eth eless, th e co m p ro m ise b ill o f $ 3 8 2 m illio n w as “still a long step in th e right d irection.” A lth ou g h g ratefu l fo r fed eral fu nd ing , P P R I q u estio n ed th e c o n sta n t c r iti­ cism o f in d igen t w o m en as resp o n sib le fo r overp op ulation, arguing th a t th e “m o re affluent in th is co u n try ” should p ra ctice fam ily p lanning b eca u se th e “g reatest grow th o f p op u latio n is fro m th is seg m en t o f our society.”56 Fed ­ eral officials w ere n o t co n c ern e d w ith overp op u lation p e r se, only w ith large fam ilies w ho fin an cially bu rd en ed th e state. The 1 9 6 0 s w itn essed a re v o lu tio n in fed eral policy. A to p ic co n sid ered ta b o o in th e early p a rt o f th e d ecad e, b irth c o n tro l d isp ersal and re se a rc h b e ca m e an in teg ral p a rt o f g ov ern m en t a ttem p ts to co m b a t poverty, illeg iti­ m acy, and, m o st im p o rta n t, m o u n tin g exp end itu res. T o u tin g co n tracep tiv es as th e cu re -all allow ed th e g o v ern m en t to push easy and pu blicly a ccep ted so lu tio n s to m u ch m o re co m p lex s o c io e c o n o m ic p ro b lem s plagu ing s o c i­ ety.

State and Local Actions L o ca l gov ern m en ts ex p erim en ted w ith co n tra cep tiv e p rog ram s in poverty strick e n areas in th e early 1 9 6 0 s . In C h icag o in n e r-city p rog ram s resu lted in a 2 5 p e rce n t d eclin e in th e b irth ra te b etw een 1 9 6 0 and 1 9 6 4 . Dr. E lizab eth C ork ey in itiated on e o f th e first m ass pill p rog ram s in 1 9 6 0 in M eck len b u rg C ounty, N o rth C arolin a. W elfare officials re p o rte d th a t th e n u m b er o f ch il­ d ren on A F D C rolls had n o t in crea sed sin ce im p lem en ta tio n .57 A p rog ram in W o lfe C ounty, K entucky, b rou gh t a 5 0 p e rce n t d ecrea se in th e b irth ra te by 19 6 5.58 S u ch su ccess in crea sed pressu re fo r m o re g ov ern m en t involvem ent. S im ilar to fed eral efforts, th e driving force b eh in d state and lo c a l a ctio n s was eco n o m ic: co n tracep tiv es w ere an easy way to red u ce exp en d itu res on low in co m e and in d igen t p opu lations. S ta te fund ing in crea sed in th e early 1 9 6 0 s . N o rth C a ro lin a h ea lth and w el­ fare d ep artm en ts co m b in ed forces in 1 9 6 0 to supply oral co n tracep tiv es to ind igent w om en. To avoid a ccu satio n s o f g ov ern m en t-sp on so red im m orality,

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

an u n m arried w o m an had to have already given b irth . W allace K u ralt, M e c k ­ lenburg C ou n ty w elfare d irector, estim ated th a t his co u n ty saved $ 2 5 0 ,0 0 0 in A F D C grants b etw een 1 9 6 0 and 1 9 6 4 . A lthou g h h e su p p orted b irth c o n ­ tr o l as a w o m an ’s rig h t, h e in stead to u te d e c o n o m ic savings in h is p u blic sp eech es. P u blicly fund ed clin ics in S o u th C arolin a re p o rte d sim ilar w elfare savings.59 N e ith er N o rth n o r S o u th C a ro lin a en co u n tered re sista n ce to p u b ­ licly funded co n tra ce p tio n , perhaps b eca u se th e m o st in flu en tial o p p osition , th e C ath o lic C hu rch , exerted little in flu en ce in m o st so u th ern states. S im ilar program s in Illin ois, on th e o th e r hand, en co u n tere d op p osition. Dr. L on n y M yers, an a n esth esio lo g ist at M ic h a e l R esse H osp ital in C hicag o, discovered th a t m o th ers on re lie f cou ld n o t b e given co n tra cep tiv es at pu blic h ealth facilities in C o o k C ou nty: she had “h eard all th e se co m p lain ts abou t high w elfare co sts and how th e A D C ’s going way up, and at th e sam e tim e th o se very sam e p eop le deny th e se p eop le th e righ t to have b irth c o n tro l" Sh e argued th a t ta x d ollars should b e used to help “p o o r peop le w ho don’t want b ab ies” and to relieve th e ta x bu rd en on citiz en s w ho did n o t w an t to su pport th e se child ren. A s a resu lt, M yers fou nd ed th e Illin ois C itizen s fo r th e E x te n ­ sion o f B irth C o n tro l in 1961 in co o p e ra tio n w ith D o n Shaw , an E p iscop al p riest, R alp h B row n , a lawyer, and N o rm a n L azaru s, a C h icag o b u sin ess­ m an .60 Sin ce th e plan had b e e n privately funded, pu blic re a ctio n w as m uted. The sam e w as n o t tru e w hen A rn old H. M a rem o n t, ch a ir o f th e state public aid co m m issio n , and H arold O. Sw ank, d ire cto r o f th e Illin ois D e p a rtm e n t o f P u blic Aid, w orked to cu t th e sta te ’s w elfare bu dget. M a re m o n t id entified th e cau se o f th e ju m p fro m $ 2 8 5 m illio n in 1 9 5 5 - 5 7 to $ 6 2 8 m illio n in 1 9 6 1 - 6 3 as an “o u t-o f-c o n tro l” b irth rate. Fifty p e rce n t o f th e w elfare bu dget w en t to A F D C ; th re e out o f fou r re lie f re cip ie n ts in Illin ois w ere b lack . M an y ta x ­ payers resen ted th is exp ense, esp ecially in view o f h ig h illeg itim acy am ong w elfare fam ilies. W ith in a six -m o n th period , for exam ple, 7 8 p e rce n t o f b irth s to A F D C m o th ers at C o o k C ou n ty H o sp ital w ere illegitim ate. M a rem o n t and Sw ank p ro p o sed to supply co n tra cep tiv es at state exp en se to b o th m arried and single w o m en on relief; $ 6 0 0 , 0 0 0 for co n tracep tiv es cou ld save $1.2 m il­ lio n a year in A F D C p ay m en ts.61 R e a ctio n w as m ixed. The board o f h ea lth co n ten d ed th e re w as n o m e d i­ cal n ee d fo r co n tracep tiv es, and, a cco rd in g to M yers, th e A M A , th e C hicag o M e d ica l So ciety, and th e Illin ois M e d ica l S o c ie ty “ju s t stoo d b y ” b eca u se o f C ath o lic o p p osition . O th ers argued th a t th e leg islatio n p ro m o ted im m oral behavior. A tto rn ey G en e ra l W illia m G . C lark , fo r exam ple, argued th a t it w ould m ake th e state “an a c c e sso ry to sexu al p ro m iscu ity and p ro stitu ­ tion.” B e n ja m in S. A dam ow ski, R ep u b lican cand id ate fo r m ay or o f C hicag o, claim ed it “subsidized im m orality w ith th e tax p ay ers’ m oney.” Dr. M yers re ­ sponded: “W e all ag ree th a t th e ideal w ay fo r w o m en w ho do n o t live w ith

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th e ir spou ses to avoid p reg n a n cies is to a b sta in fro m sex and d ivert th e ir sexu al drive in to m o re co n stru ctiv e and socially a ccep ta b le ch a n n els, such as bridge p arties, te a s, and great b o o k clubs. B u t w hat ch a n ces has an A F D C m o th e r to a ttain th is ideal? The resu lt o f ou r naive d esire to settle fo r n o th in g less th a n ab stin en ce is ran d o m re p ro d u ctio n and irresp o n sib le p a re n th o o d " H er arg u m en t failed to o v erco m e o b je c tio n s .62 In th e su m m er o f 1 9 6 3 th e Illin ois legislature establish ed a co m m itte e to d eterm in e w h eth er th e d ep artm en t o f p u blic h ea lth should fund c o n tra ce p ­ tive serv ices fo r all clien ts; th e co m m itte e voted “yes, 1 0 0 % " Y et w hen th e bill passed it re stricted state-fu n d ed co n tra ce p tio n to m arried w o m en living w ith th e ir husbands. By elim in atin g single fem ales th e n ew p ro g ram disqualified 8 0 p e rce n t o f w o m en receiv in g A F D C and u nd erm in ed th e g oal o f red u cin g illegitim acy and w elfare. It also forbad e so cia l w orkers to in itia te th e to p ic o f co n trace p tio n . M yers blam ed th e C a th o lic C hu rch , w h ich “sim ply w anted to show how m u ch pow er it had," and p o liticia n s w ho w ould ra th er “put up w ith h und red s o f th ou san d s o f u nw anted kids and com p lain and com p lain ab o u t giving th e m su p p ort m o n e y ” th a n acknow led ge p rem arital sex and risk C ath o lic cen su re.63 N ew s o f th e Illin ois plan traveled. W h e n M a rem o n t and Sw ank p rop osed th e ir in itial plan, th e New York Times called fo r a sim ilar plan in N ew York. The state legislature, how ever, passed a co m p ro m ise bill in 1 9 6 4 th a t a u th o ­ rized th e state to fund co n tracep tiv es fo r m arried re lie f re cip ie n ts only. S o c ia l w orkers cou ld n o t in itia te th e to p ic. L ittle o p p o sitio n em erg ed b eca u se o f th e se re strictio n s.64 B y 1 9 6 5 tw en ty -n in e states and th e D istric t o f C olu m bia provided pu blicly fund ed co n tra cep tiv e serv ices th ro u g h eith e r th e ir w elfare or th e ir p u blic h ea lth d ep a rtm e n ts.65 The issue o f fo rce versus ch o ice em erg ed as so m e states allow ed so cia l w orkers to in itia te th e to p ic o f co n tra ce p tio n w ith w elfare clien ts. M arylan d ad opted su ch a p o licy in S e p te m b e r 1 9 6 2 . Privately fund ed clin ics had ex ­ isted th e re fo r d ecad es. The state b o ard o f w elfare ad op ted an affirm ative p o sitio n on fund ing and referrals b eca u se birth s to ind igent w o m en had b ee n steadily in creasin g since 1 9 5 0 . W id esp read a cc e p ta n ce o f th is policy, a cc o rd ­ ing to Dr. Jo h n W h itrid g e o f th e M ary lan d D e p a rtm e n t o f H ealth , re flected a “rapid sh ift in p u blic a ttitu d e" due to grow ing irrita tio n w ith m o u n tin g w el­ fare exp en d itu res. A fte r th re e years o f pu blic co n tra cep tiv e fund ing, b irth s d ecreased significantly. A lth ou g h a n a tio n a l 6 p e rce n t d eclin e in fertility o c ­ cu rred at th e sam e tim e, th e B a ltim o re rate d ecreased by 9 p e rce n t.66 O th e r states follow ed M ary lan d ’s exam p le— O h io in 1 9 6 5 and N ew Y ork in 1 9 6 6 . N o rth C aro lin a in crea sed its p ro g ram fou rfold b etw een 1 9 6 3 and 1 9 6 5 . The im p etu s fo r expansion, acco rd in g to K u ralt, was “th e ev er-in creasin g nu m b er o f ch ild ren . . . th e p u blic did n o t w ish to su p p o rt"67 B y late 1 9 6 7 th irty -fo u r

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

states n o t only paid co n tra cep tiv e co sts fo r A F D C fam ilies bu t also allow ed p u blic w elfare d ep a rtm en t sta ff to in itia te d iscussion, cou n selin g , and refer­ rals fo r fam ily p lan n in g .68

Catholic Opposition The Jo h n so n ad m in istratio n ’s en d o rsem en t o f fam ily planning left th e C a th o ­ lic C h u rch in an aw kw ard p o sitio n . C ritch lo w analyzes th e n u an ces o f th e b e h in d -th e -s ce n e s w rangling a m o n g h a rd -lin e rs, lib era ls, and m o d era tes w ith in ch u rch lead ership to devise an a cc ep ta b le p o sitio n w ith regard to fed eral in volvem en t in co n tra ce p tio n . In th e end th e y ag reed n o t to ad opt an official p o licy o f o p p o sitio n as long as all prog ram s w ere volu n tary and offered in stru ctio n in th e rh y th m m eth od . Ind ivid ual p riests could tak e any a ctio n th a t suited th e ir c o n sc ie n ce s.69 S o m e criticiz ed fed eral involvem ent. In N o v em b er 1 9 6 5 M o n sig n o r G eo rg e C. H iggins o f C h icag o co n ten d ed th a t th e W a r on P overty trie d to solve p overty and grow ing re lie f rolls by u rg ­ ing th e ind igent to have few er ch ild ren — a p o licy o f “d efeatism and d esp air” aim ed p rim arily at p o o r b la ck s.70 Follow ing a fall 1 9 6 6 m e etin g in W a sh in g ­ to n , D .C ., C ath o lic b ish op s d en o u n ced th e fam ily -p lan n in g a ctio n s o f th e Jo h n so n ad m in istratio n . “Far fro m m erely seeking to provide in fo rm a tio n in resp o n se to req u e sts fro m th e needy,” th e y co n ten d ed , “g o v ern m en t activ i­ ties in creasin g ly seek aggressively to persu ad e and even co e rce th e u n d er­ privileged to p ra ctice b irth co n tro l” This tren d th rea te n ed “th e free ch o ice o f sp ou ses” to d eterm in e fam ily size and seriously end ang ered th e “inviolability o f th e righ t o f h u m an privacy”71 R a th er th a n re tre a t to a m o ra l co n d em n atio n b ased on C ath o lic d o ctrin e , th e y harp ed o n tra d itio n a l fears o f g ov ern m en t in frin g e m en t on individual rights. N ew state p rog ram s th a t allow ed so cia l w orkers to in itia te th e to p ic o f co n tra ce p tio n ig n ited ad d ition al c riticism fro m som e C a th o lic lead ers. They in sisted th a t th e ca sew o rk e r’s m en tio n in g o f co n tracep tiv es could in flu en ce p eop le and elim in a te th e ir free d o m o f ch o ice. A s America argued: “The State, o n w h om [the w elfare recip ien t] d epends fo r his su b sisten ce, tells h im th rou g h a so cial w orker th a t he has ‘to o m an y ’ ch ild ren and ‘ad vises’ h im to get co n tracep tiv e in fo rm atio n . N o on e th rea te n s h im w ith legal p en alties, it is tru e. B u t h ow free is he, psychologically, to refu se to a cc e p t th e ad vice?” A sim ilar arg u m en t appeared in Commonweal.72 T he ed ito rial staffs o f th ese tw o C ath o lic jo u rn a ls feared th a t as w elfare expend itu res m o u n ted , th e p re s­ sure to co n v in ce th e in d igen t to use co n tra ce p tio n w ould also in crease. This fear w as legitim ate in light o f in crea sin g pressure to solve grow ing g ov ern ­ m e n t exp en d itu res w ith th e d istrib u tio n o f th e pill. M o st o th er religiou s groups su p p orted g ov ern m en t a ctio n s, h ailing th e m

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as a h u m ane resp o n se to dire fam ily situ ation s. In a le tte r to Joh n so n , G ard ­ ner, and Shriver, in flu en tial P ro te sta n t lead ers lab eled th e b ish o p s’ charge o f co e rcio n “com p letely u n fo u n d ed " Even so m e p ro m in en t C a th o lics criticiz ed th e b ish op s’ statem e n t.73 M an y C a th o lics ig n ored th e ir lead ers’ critic ism and used co n tracep tiv es, hoping th a t th e V atican ’s silen ce signaled an easing o f th e ch u rch ’s p osition . They w ere m istak en. In 1 9 6 8 th e papal en cy clica l Hu-

manae Vitae ag ain d en o u n ced all artificia l m ea n s o f co n tra ce p tio n .74 This p ro n o u n cem e n t did little to cu rb co n tracep tiv e use am o n g A m e rica n C a th o ­ lics.

Birth Control and the Black Community S o m e b lacks b e c a m e sk ep tical o f th e in crea sin g pu sh fo r co n tracep tiv e d is­ p ersal in in n e r-city n eig h b o rh o o d s. A lth ou g h th e b la ck co m m u n ity had g en ­ erally su p p o rted b irth c o n tro l sin ce th e 1 9 3 0 s , so m e m e m b ers re je c te d it as a w h ite p lot to d ecim a te th e b la ck race. This co n tro v ersy co n tin u ed in a low -key m an n er th ro u g h th e 1 9 4 0 s and 1 9 5 0 s .75 By th e 1 9 6 0 s th e fea r o f g en o cid e had h eig h ten ed , m u ch o f it ro o te d in cen tu ries o f abuse. Slave rape, breed in g , and g en ital m u tila tio n provided a stron g basis fo r m istru st o f any p ro g ram dealing w ith b la ck sexuality. A lth ou g h m o st b lack s, esp ecially black w o m en , re je c te d th e n o tio n o f b irth co n tro l as g en o cid e, b la ck su sp icion s w ere n o t unw arranted. In general, b la ck n a tio n a lists and rev olu tio n aries raised g en o cid al fears. The m o re estran g ed fro m th e g ov ern m en t black s felt, th e m o re likely th e y w ere to d istru st sta te -sp o n so re d co n tra ce p tio n . W h itn e y Young, lead er o f th e N atio n al U rb a n League, revok ed his g rou p ’s su p p ort o f co n tra ce p tio n in 1 9 6 2 . Sev eral lo c a l N A A C P ch ap ters follow ed suit. M a rv in D avies, head o f th e F lorid a NA ACP, argued th a t b la ck w o m en n eed ed to have large n u m b ers o f b abies u n til th e b la ck p o p u latio n co m p rised b etw een 3 0 and 3 5 p erce n t o f A m e rican s. O n ly th e n w ould black s b e able to a ffe ct th e pow er stru ctu re. A t a m e etin g o f th e C o u n cil o f Philadelp hia A n ti-P o v erty A c tio n C o m m ittee in 1 9 6 5 , C e cil M o o re, p resid en t o f th e lo c a l N A A C P chapter, co n d em n ed a P lan n ed P aren th oo d p ro g ram for n o rth e rn Philadelp hia b eca u se 7 0 p erce n t o f th e p op u latio n w as b lack . L ab elin g th e plan “re p le te w ith every th in g to help th e N egro es co m m it race su icid e" M o o re co n v in ced th e co m m ittee to tab le th e p roposal. Th ese d ecisio n s show a key tra n sfo rm a tio n fro m p rio r d ecad es, w hen th e se o rg anization s h ailed b irth c o n tro l as a v eh icle for racial im p rov em en t. A rou n d th e sam e tim e, D on ald A. B og u e, a C h icag o activ ist, re p o rte d th a t th e b la ck b irth ra te in C hicag o had fallen fro m 3 9 .4 p er 1 ,0 0 0 in 1 9 6 0 to 29.1 p er 1 ,0 0 0 birth s in 1 9 6 5 . A lth ou g h B o g u e d eem ed th is d ecline

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

a b reakth ro u g h in fam ily planning, so m e b lack s con sid ered it evid ence th a t co n tra ce p tio n w as a fro n t to elim in ate th e b la ck p o p u latio n .76 O p p o sitio n am o n g som e black s escalated as th e 1 9 6 0 s p rogressed . M o st o b je ctio n s cam e fro m in n e r-c ity low er cla sses; th e m idd le class generally a ccep ted fam ily p lan n in g to in c rea se th e ir m obility. T he tw o groups a sso ­ ciated w ith g en o cid e w ere th e B la c k P an th ers and th e B la c k M u slim s. The B la ck P an th er Party co n sid ered co n tra ce p tio n only on e p a rt o f a g ov ern m en t sch e m e: drugs, v en ereal disease, p ro stitu tio n , co erciv e steriliz a tio n bills, re ­ strictiv e w elfare legislation , in h u m an living co n d itio n s, “p o lice m u rd ers" rat b ites, m aln u tritio n , lead p o ison in g , freq u en t fires and a ccid e n ts in ru n -d o w n h o u ses, lack o f a co m p reh en siv e sick le-ce ll a n em ia p rog ram , and o v errep ­ re se n ta tio n am o n g V ietn a m sold iers all co n trib u te d to a m alicio u s plan to an n ih ilate th e b la ck ra c e .77 B la ck M u slim s op p osed co n tra ce p tio n fo r th re e reason s. First, th e K o ran co n d em n s it. Se co n d , w o m en ’s p rim ary ro le w as to breed . A s M u slim lead er E lijah M u h am m ad stated: “The w om an is m an ’s field to p ro d u ce his n a tio n " Third, co n trace p tiv es w ere a g en o cid a l p lot devised by th e “w hite d evils" M u h am m ad w arned ag ainst th e “disg raceful b irth co n tro l laws n ow aim ed exclusively at poor, helpless b la ck peop les w ho have n o on e to rely o n " He com p ared th e co n tra cep tiv e cam p aig n to P h arao h m u rd erin g th e first-b o rn boys o f Israel. M a lc o lm X also su sp ected g enocid e: “I t’s easy to see th e fea r in th e ir m in d " h e d eclared , “th a t th e m asses o f dark p eop le . . . w ill co n tin u e to in crea se and m ultiply and g row u n til th e y eventually o verru n [other peoples] like a h u m an sea, a h u m an tid e, a h u m an flo o d " Muhammad Speaks, th e M u slim w eekly, p u blish ed sto ries o n th e “deadly" and “d iab o lic" n atu re o f b irth co n tro l.78 A p rim ary g en o cid e th e o rist w as Dr. C harles G ree n le e, a re sp ec te d b lack p h ysician fro m P ittsb u rg h w ho opp osed th e state co n tra ce p tiv e prog ram . In D e ce m b e r 1 9 6 5 P ennsylvania a llo ca ted p u blic fund s fo r co n tra ce p tiv e d isp ersal and allow ed so cia l w orkers to in itia te th e to p ic w ith clien ts. This policy, how ever, w as co n tro v ersial am o n g state legislators. W h ile m any ap­ proved, o th e rs feared it w ould en cou rag e im m orality a n d /o r accu sa tio n s o f co e rcio n . A fter m o n th s o f battlin g , th e n ew law pro h ib ited casew orkers fro m in itiatin g th e su b je c t and lim ited p u blic funds to m a rried w om en .79 P ublic re a ctio n varied. P lan n ed P a ren th o o d C en te r o f P ittsb u rg h (P P C P ) criticiz ed it, arguing th a t states th a t allow ed ca sew o rk e r in itia tio n show ed “co n c e rn and p rogress for h u m an ity "80 G ree n le e, o n th e o th e r hand, believed th e law provided in su fficien t g u aran tees ag ainst casew o rk er c o e rc io n .81 G ree n le e raised th e issue o f b la ck g en o cid e in 1 9 6 6 and k ep t it alive in th e press. A lth ou g h he did n o t opp ose b irth co n tro l p er se, he o b je cte d to th e

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“p ill-p u sh in g in b la ck n eigh borh ood s,” arguing th a t p u blic a ssista n ce w ork ­ ers carrie d co n tra ce p tiv e “prop ag and a” in to p o o r b la ck h o m es and forced p eop le to u se co n tra cep tiv es or risk losin g b en efits. H e co n ten d ed th a t free clin ics co n stitu ted “g en o cid e”— a co n scio u s co n sp ira cy by w hites to achieve a H itlerian so lu tio n to th e “b la ck p ro b lem ” in th e U n ited S ta tes. The b est way to im prove th e plight o f p o o r b lack s w as to m ultiply in to a p ow erful arm y and d em and a fair share o f th e A m e rica n pie. A s h e to ld Ebony, “O u r b irth rate is th e only th in g w e have. I f w e keep on p rod u cin g , th e y ’re going to have to eith e r kill us or g ran t us full citizenship.” In a P ittsb u rg h telev isio n panel he accu sed th e w hite pow er stru ctu re o f using clin ics to “d ecim ate th e b lack p op u latio n in A m e ric a w ith in a generation.” The only answ er to th is g en o ­ cide, he argued, w as to co n v in ce b la ck w o m en to have m o re b a b ies.82 In July 1 9 6 6 O E O a llo ca ted funds to P P C P to expand its serv ices in eight p overty areas, six o f w h ich w ere p red om in an tly b la ck .83 P P C P in itia te d a “h o m e v isito r” p ro g ram to acq u ain t w o m en w ith available serv ices and O E O co n tra ce p tiv e fu n d s.84 G re e n le e ’s o p p o sitio n a ttra c te d W illia m “B o u ie ” H ad en, a co n tro v ersial civil rig h ts m ilita n t w h om th e Pittsburgh Post Gazette regard ed “as th e m o st violen t o f P ittsb u rg h ’s b la ck leaders.”85 H e b e c a m e a lead er o f th e H o m e w o o d -B ru sh to n A llian ce, fou nd ed in 1 9 6 7 , to “co n so li­ date th e laten t stren g th o f th e N egro co m m u n ity in to an effective fo rce for th e b e tte rm e n t o f th e com m unity.”86 A n o th e r su p p o rter w as th e R everend C harles O w en R ice, a w hite C a th o lic p riest at th e p red om in an tly b la ck H oly R o se m ary parish in H o m ew o o d -B ru sh to n . O n 17 N o v em b er 1 9 6 6 R ice ap­ peared w ith G ree n le e on W Q E D , P ittsbu rgh ’s p u blic b ro ad cast telev isio n sta­ tio n ; b o th m e n vo iced th e ir o p p o sitio n to O E O co n tra cep tiv e fu n d in g .87 R ice seld om em ployed tra d itio n a l C a th o lic rh e to ric in his p u blic sta te ­ m e n ts, relying in stea d o n g en ocid e. In his Pittsburgh Catholic co lu m n he criticiz e d g o v ern m en t a ttem p ts to m ing le c o n tra ce p tio n w ith w elfare: th is “tie -in is n o t only an u nw arranted in tru sio n o f pu blic pow er in to private life bu t it is also subtly anti-N eg ro.”88 H e lam b asted th e Village Voice fo r an a r­ ticle th a t su p p orted co n tra cep tiv e su bsidies fo r th e poor. “D o you n o t realize th a t th e P ill is p u shed in b la ck & P u erto R ica n areas in a m a n n e r entirely different fro m its p ro m o tio n in o th er a reas?” he asked. “H ere in Pittsburgh,” he co n tin u ed , “P lan n ed P a ren th o o d & th e O E O have a h u m m in g Pill M ill in N egro p overty areas. They send lay peop le around w ith all m a n n er o f c o n tra ­ ceptives fro m d o or to d o or to N egroes.” H e m a in ta in ed th a t b lack s su ch as G ree n le e and H ad en w ere “ju s t w aking up” to th e reality o f th e situ atio n .89 The P ittsb u rg h N A A CP, w ith G ree n le e ch airin g th e M ed ica l C o m m ittee , co n d em n ed th e P P C P h o m e v isitors as w orse th a n arm y re cru iters b ecau se th e y “invade[ed] th e privacy o f th e individual” w ith ou t an in v itatio n and in ­ augurated a “sessio n o f brain-w ashing.” It alleged th a t P P C P had p ro m ised

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

O E O officials to “re c ru it” clien ts fo r th e se fed erally fund ed clin ics. “T he evi­ d en ce in d icates th a t th e y n o t only kept th e ir p ro m ise to th e O EO ,” claim ed th e N A A CP, “b u t im proved th e ir m e th o d s by adding a ‘go out and g et th e m b a c k ’ arm to th e ir o p era tio n ” P P C P so licited “w om en fro m every h o u se in every p red om in an tly b la ck n eig h b o rh o o d w here th e O .E .O . o u t-rea ch clin ­ ic s ” w ere lo cate d and op erated a “m ilita ry p o lice fo r th e p u rp o se o f k eep ing th e fem ales in th e ir a n ti-p a ren th o o d c lin ic s ” This “b irth c o n tro l o p era tio n is b lack g en o cid e” The lo ca l stand co n flicted w ith th e n a tio n a l org anizatio n ’s su p p ort o f b irth co n tro l, b u t G ree n le e ch aired b o th th e b o ard and th e h ealth co m m itte e o f th e P ittsb u rg h N A A CP.90 These p u blic d en u n ciation s o f P P C P -O E O prog ram s led to investigations. The H ealth A d visory C o u n cil o f C om m u n ity A c tio n P ittsb u rg h (C A P ), a lo ­ cal ag en cy th a t w orked w ith o th e r private and p u b lic ag en cies to co m b a t poverty, u nan im ou sly gave P P C P a clea n re co rd .91 F or u nk n ow n re a so n s, th e re p o rt w as n o t m ad e pu blic. In ad d ition, P lan n ed P a ren th oo d flew Dr. D ou glas S tew art, its n a tio n a l d ire cto r o f co m m u n ity rela tio n s, to P ittsbu rgh to investigate th e m atter. S tew a rt, a b la ck m an , a ccu sed G ree n le e o f doing “nationw id e h a rm ” w ith false a ccu sa tio n s o f genocid e. P P C P also exam ined th e p ro g ram and d enied all charges, assertin g th a t 8 0 p e rce n t o f P P C P clien ts w ere w hite and th a t b o th ra ces receiv ed id en tica l tre a tm e n t.92 D esp ite criticism by b lack m ilita n ts and R ice, th e clin ics co n tin u ed to o p er­ ate. The bo ard o f th e H o m e w o o d -B ru sh to n C itizen s R enew al C ou n cil, on e o f eight targ et n eig h b o rh o o d s, approved th e ren ew al o f O E O fund ing for P P C P program s in M ay 19 6 7 .93 By th is p o in t P P C P op erated sev en teen b ra n ch clin ­ ics. B etw een 8 0 and 9 0 p e rce n t o f clin ic fund s in p o v erty n eig h b o rh o o d s cam e fro m O E O .94 B y 1 9 6 8 H ad en w as d eterm in ed to elim in ate O E O fu n d ­ ing in th e H o m e w o o d -B ru sh to n n eig h b o rh o o d , inclu d ing “blow ing up” clin ­ ics. To aid his cau se, R ice co n v in ced th e C a th o lic D io ce se o f P ittsb u rg h in July 1 9 6 8 to fund H ad en’s U n ited M o v em en t fo r P ro g ress, a n o rg anization to brin g “a m o re m ilita n t p o sitio n in to th e civil righ ts a re n a ”95 T he d iocese gave th e U n ited M o v em e n t fo r P rogress a g rant o f $ 1 2 ,0 0 0 , $ 1 0 ,0 0 0 o f w hich w as earm arked fo r H ad en’s salary.96 P u blic resp o n se w as fast and furious: th e

Pittsburgh Courier lab eled H ad en a “Salaried M ilita n t”; h ate m ail and abusive calls p ou red in to H oly R o se m a ry recto ry . O n e p a rish io n er su m m ed up: th e ch u rch su p p orted a “crim in a l m ilita n t” fo r n o re a so n o th e r th a n th a t h e op ­ p o sed “th e giving out o f b irth co n tro l p ills” C h u rch co n trib u tio n s fell, and B ish op Jo h n J. W rig h t w as h anged in effigy at S a in t Paul’s C ath ed ral w ith a sign reading “B ish op W rig h t, p u ppet o f B o u ie H ad en ”97 M an y H o m e w o o d -B ru sh to n resid en ts w ere n o happier. H ad en w as fro m G arfield and used his new ch u rch m o n ey to re lo ca te to H o m e w o o d -B ru sh ­ to n . D avid E p p erson, execu tiv e d ire cto r o f CAP, lab eled H ad en an “outsid er”

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The “sta n d a rd -b e a re rs” o f th e co m m u n ity lo o k ed u p o n h im as a “rab b le rou ser” Sarah Brad ford C am pbell, a H o m e w o o d -B ru sh to n co m m u n ity leader th rou g h th e 1 9 5 0 s and 1 9 6 0 s , claim ed th a t H ad en cam e to h er n eig h b o rh o o d “seeking pow er” S h e believed th e ch u rch re lo ca ted h im so he cou ld challenge th e “status quo,” w h ich , in th is in sta n ce, w as th e H o m e w o o d -B ru sh to n C iti­ zens R enew al C ou n cil, on e o f th e lo n g est-ru n n in g n eig h b o rh o o d org aniza­ tio n s in P ittsbu rgh. M em b e rs o f th is com m u nity, acco rd in g to E pp erson, had a “stron g, solid, very resp o n sib le n eig h b o rh o o d -b a se d o rg a n iz a tio n ___ They w orked hard and th e y did g ood th in g s” T h en “o u t o f th e w ood w ork ” cam e H aden, w ho end eavored to challenge th e “old er folks w ho had b e e n in power.” R ice, G ree n le e (w ho w as also n o t fro m H o m e w o o d -B ru sh to n ), and H aden, acco rd in g to C am p bell, “felt th a t th e y could w rest pow er fro m us by using th is gen o cid e issu e” They sought “any issue to try to divide th e group and th a t w as w hy th e g en o cid e issue ca m e u p”98 H ad en ’s ta rg e t d uring th e su m m er o f 1 9 6 8 w as th e n ew H o m ew o o d B ru sh to n M ed ica l C enter, fin an ced w ith th e help o f $1.5 m illio n fro m O EO . PPCP, w ith b o th O E O and private fund s, planned a p e rm a n en t clin ic th ere. H ad en th rea te n ed P P C P rep resen tativ es w ith bod ily v iolen ce if th e y did n o t ce ase activ ities in H o m e w o o d -B ru sh to n and w arn ed th e re w ould b e riots and fire b o m b in g s “if anyone trie s to op erate a b irth co n tro l p ro je c t in th e a re a ”99 H ad en ’s te rro r ta c tic s w ere w idely criticiz ed . O n e citiz en b erated h im fo r lab elin g b irth c o n tro l g en o cid e b u t, in th e n ex t b rea th , th rea te n in g to b o m b a b lack n eig h b o rh o o d clin ic. A n o th e r w rote th a t “th is seem s to m e to b e th e m o st b o ld -fa ced a ffro n t to o u r b la ck n eig h b o rs’ intelligence,” b ecau se H ad en w as essen tially saying th a t “‘you p eop le d on’t have sense enou gh to th in k o r ch o o se fo r y o u rself so I w ill ch o o se fo r you.’” U n d er su ch th rea ts, P P C P tem p o rarily su spend ed o p era tio n in H o m e w o o d -B ru sh to n .100 M an y H o m e w o o d -B ru sh to n w om en, how ever, p ro tested th is su spension. A d m o n ish in g H ad en to “m ind you r ow n business,” sev enty pred om in an tly b la ck w o m en , led by G eo rg ia n a H en d erso n , re q u e ste d P P C P to co n tin u e. H en d erso n stated , “W e ’re g ettin g tired o f sta tem e n ts by M r. H aden. . . . H e is only on e p e rso n — and a m an at th a t— and he ca n ’t speak for th e w om en o f H o m ew oo d ___ B irth c o n tro l is n o n e o f his b u sin ess” A n o th e r w om an asked, “W h y should I le t on e lo u d m o u th te ll m e ab o u t having ch ild ren ?” W ith re ­ gard to H ad en, G reen lee, and R ic e ’s in d ictm en t o f th e h o m e v isito r p rog ram as b lack gen ocid e, B e tty M o rris, th e n urse in charge o f co n tra cep tiv e services in H om ew ood , answ ered th a t P P C P p e rso n n el visited p o o r w hite areas bu t w ith little su ccess b eca u se th e m a jo rity w ere C a th o lic. M o rris explained th a t v isito rs avoided w ealthy areas w h ere w o m en cou ld afford a private physician .101 W o m en gained su p p ort fro m th e session, th e governing bod y o f th e

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

b la ck co n g reg atio n , B e th e sd a U n ited P resb y te ria n C hu rch . P P C P serv ices w ere n o t genocid e: “To lab el su ch a p ro g ram o f fam ily p lanning ‘g en o cid e’ is patently false. . . . N o strictu res are to o h arsh in callin g to ta sk th o se p erson s w ho w ould th u s m islead and in flam e th e p u blic on th is im p o rta n t issue.” The sessio n affirm ed co u p les’ right to b irth c o n tro l and P P C P serv ices.102 The H o m e w o o d -B ru sh to n C itizen s R enew al C o u n cil held a m e etin g on 14 A ugust 1 9 6 8 to d iscuss n eig h b o rh o o d co n tra cep tiv e services. G ree n le e and H ad en co n tin u ed to claim th a t g o v e rn m en t-sp o n so re d c o n tra ce p tio n p er­ p etu ated “b lack genocide.” H en d erso n , lead ing sev enty w om en, m ain tain ed th a t th e se m e n had n o right to d ictate th e n eed s o f w om en, w ho could speak fo r th em selv es, and th e y d em and ed th e co n tin u a tio n o f services. T he w o m en prevailed: th e m o stly m ale co u n cil u nanim ously su pported th e ir d em and s.103 H ad en refu sed to a ccep t th is d ecision. W h ile th e “status qu o” lead ers o f th e H o m e w o o d -B ru sh to n co m m u n ity co n sid ered H ad en a n outsider, th o se o u t­ side th e establish ed circle o f pow er saw H ad en as a “folk h e ro ” M an y o f his follow ers w ere lo w -in co m e, young b la ck m ales, heavily in flu en ced b y B la ck Pow er ideology, and so m e young fem ales w h om th e “stand ard org anizatio n ” view ed as “really on th e ou tsid e b eca u se o f dress and behavior” H ad en ’s sup­ p o rt b ase w as in th e ea stern se c tio n o f th e com m u nity, w here m o st peop le w ere on w elfare. H e a ttra c ted y ou nger p eop le w ho “w ere desirous o f lead er­ ship roles bu t had n o n o ta b le cred en tials fo r them .” Basically, th e d isen fran ­ ch ised gravitated tow ard h im .104 T h rou gh ou t th e fall o f 1 9 6 8 and early 1 9 6 9 H ad en m ain tain e d a stead y barrag e o f p ropagand a ag ainst co n tra ce p tio n . N o t only did he lab el b la ck su p p orters o f th e p rog ram “U n cle T o m s” b u t he accu sed b lack C A P b o ard m e m b ers o f “selling o u t” to keep th e ir p o sitio n s w ith in th e fed eral bu reau cracy. G ree n le e esp ou sed sim ilar arg u m en ts during a telev isio n ap p earan ce in early 1 9 6 9 , w hile R ice kept th e debate alive in his w eekly co lu m n .105 This p e rsisten t pressu re led th e C A P bo ard to co n sid er th e issue at th e ir m eetin g s in Febru ary and M arch . Byrd B row n, p resid en t o f th e lo c a l N A A C P and ch air o f th e C A P su b co m m itte e on p lan n ed p aren th o o d , “flip flop p ed ” on th e issue, acco rd in g to C am pbell, and “re lu cta n tly ” in tro d u ced th e p ro ­ p osal to m ain tain funding. M em b e rs o f th e W elfare R ig hts O rg an ization s o f A llegheny C ounty, w h ich inclu d ed b o th b la ck and w hite w om en, su pported fund ing, in fo rm in g th e press: “W e ca n n o t help b u t n o tice th a t m o st o f the a n ti-b ir t h co n tro l pressu re is co m in g fro m m en , m e n w ho do n o t have to b e a r child ren. W e ’re speaking for th e w o m en and w e w ant th e P lan n ed P ar­ en th o o d C en ters to stay in our n eig h b o rh o o d s”106 D u rin g th e C A P m eetin g s H ad en reiterated th a t co n tra ce p tio n w as “b la ck g enocide.” G ree n le e called it an “in tern a tio n a l co n sp ira cy ” to d im in ish th e “d arker ra c e s ” in th e w orld.

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A n o th e r H ad en su p p o rter qu estio n ed th e lack o f facilities in w hite p overty n eig h b o rh o o d s; P P C P answ ered th a t stron g C a th o lic o p p o sitio n k ep t clin ics o u t.107 The o p p o sitio n quickly lo st steam . A d vocates fo r fund ing appeared b efo re C A P in full force. A pp roxim ately tw o hund red m o stly bla ck w om en, org anized by S a ra h C am p bell, dem and ed th e co n tin u atio n o f P P C P serv ices. P rio r to th e h earin g C am p b ell and h er su p p orters had “collared B o u ie H ad en” and in fo rm ed h im th a t th e y “w ere n o t going to accep t th is bu siness o f g en o cid e” A t th e m e etin g he attem p ted to d iscred it th e m by claim in g th e y spoke only fo r th e m iddle class. In stead , th e y u n d erm in ed his sta n ce by in sistin g on th e ir rig h t to d ecid e b irth c o n ­ tro l issues w ith ou t th e in terv e n tio n o f d o m in eerin g m en. O th ers p o in ted out th a t P P C P op erated serv ices b esid es co n tra ce p tio n , su ch as in fertility clin ­ ics and m arriage and ch ild -sp a cin g clin ics, w h ich ben efited large n u m b ers o f w om en. Th ese w om en, acco rd in g to E pperson, believed fam ily planning co n stitu ted a positive ad d ition to h ea lth care services in ad d ition to secu rin g th e ir righ t to co n tro l th e ir fam ily size.108 In th e end, th e w o m en persuad ed C A P to re in state fed eral funds. H ad en ch o se th e w rong co m m u n ity to ta rg et, yet E p p erson argued th a t H ad en did raise “ce rta in p o in ts o f view th a t w ere valid.” The only w ay to g u aran tee ag ainst co erciv e or g en o cid a l plans w as to have b lack citizen s, p articu larly w om en, d irect fam ily -p lan n in g p rog ram s in b lack co m m u n itie s.109 The issue o f g en o cid e also em erg ed on th e n a tio n a l level. In th e su m m er o f 1 9 6 7 th e m ale-d o m in ated B la c k Pow er C o n fere n ce in N ew ark, N ew Je r­ sey, passed an a n ti-b ir th co n tro l re so lu tio n th a t eq uated b irth c o n tro l w ith “b lack genocide.”110 The follow ing y ear th e Third A n n u al N a tio n a l C o n fer­ en ce on B la ck Pow er in Philadelp hia called on b lack s to “re sist th e in creasin g g en o cid al te n d en cies o f A m e rica n so ciety ” R esista n ce ranged fro m a sm all C alifo rn ia group called E ffo rts to In c re a se O u r Size to groups in P ittsbu rgh and C leveland th a t p ro tested P lan n ed P aren th oo d p rog ram s to th e u ltra m ili­ ta n t group in N ew Y ork know n as th e Five P ercen ters. T h ese o rg anization s asked tw o q u estio n s: “Is b irth c o n tro l ju s t a ‘w h ite m an ’s p lo t’ to ‘co n ta in ’ th e b lack p op u latio n ?” and “Is it ju s t a n o th e r sch em e to cu t b a ck on w elfare aid or still a n o th e r m eth o d o f ‘keep in g th e b lack m an dow n’?”111 T he Thrust qu estio n ed w hy b lack s could n o t g et a free asp irin fo r a h ead ach e, “y et w hen y ou ’re a B la ck w o m an old enou gh to lo o k sexy you ca n g et a tru c k loaded dow n w ith [birth] co n tro l pills free. . . . The w hole p lot m ak es H itler lo o k like a B o y S c o u t”112 B y th e late 1 9 6 0 s a survey fou nd 2 8 p e rce n t o f b lack s agreed th a t “en co u rag in g b lack s to u se b irth c o n tro l is co m p arab le to tr y ­ ing to elim in ate th is group fro m so ciety ” In C leveland , O h io , m ilita n t black s b u rn ed dow n a co n tra cep tiv e clin ic a fter labeling its activ ities “b la ck g en o ­

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

cid e "113 G en o cid e arg u m en ts a ttra c te d m ostly n o rth e rn , u rb a n young m en, n o t w om en. A 1 9 7 3 study found y ou nger b lack s feared g en o cid e m o re th a n old er black s, n o rth e rn m o re th a n so u th ern black s, le ss-ed u ca te d m o re th a n h ig h er-ed u cated b lack s, and m ales m o re th a n fem ales. T he study con clu d ed th a t d espite g en o cid e fears am o n g young b la ck m en , th e re w as “consid erable evid ence th a t b la ck w o m en . . . are even m o re p ositively in clin ed tow ard fa m ­ ily p lanning th a n w hite w o m e n "114 M an y b lack w o m en criticiz e d B la c k P ow er id eology regard ing w om en. They esp ecially o b je c te d to th e co n clu sio n n o t only th a t w hite so ciety had castrated b lack m e n bu t th a t b la ck w om en had “co n trib u ted to th is em ascu la­ tio n " F ran ces B eal, N ew Y ork co o rd in a to r o f th e Stu d en t N o n v iolen t C o o rd i­ natin g C o m m itte e B la ck W o m en ’s L ib e ra tio n C o m m ittee , argued th a t b lack w o m en “are n o t resen tfu l o f th e rise to p ow er o f b la ck m e n ___ N ev erth eless, th is does n o t m e a n th a t you have to neg ate one fo r th e other. . . . It is fallaciou s reason in g th a t in ord er for th e b la ck m an to b e stron g , th e b la ck w om an has to b e w eak " The ap p aren t “n ee d to affirm m a n h o o d ” a m o n g B la c k Pow er m e n led m any to assign seco n d ary roles to w om en. A s A ngela D avis stated in 1 9 6 7 : “I w as criticiz ed very heavily . . . fo r d oing a ‘m an ’s jo b ’ W o m e n should n o t play lead ership ro les, th e y insisted ; a w om an w as to ‘in sp ire’ h e r m an and ed u cate his ch ild ren ” and, as b la ck co m m e n ta to r L ind a L aR u e n o ted , rear “w arriors for th e re v o lu tio n "115 M o st b la ck w o m en re je c te d th is assign ed ro le as rev olu tio n a ry w om b. They d isagreed w ith th e “b ro th e rs" over b irth c o n tro l and genocid e. LaR ue asked th e se m e n ab o u t th e “p o te n tia l rev olu tio n ary w arriors . . . aband oned in o rp h an ag es" Sim ilarly, au th o r T o n i C ade co u n tered g en o cid a l a ccu satio n s by asking b lack m en , “W h a t plans do you have fo r th e care o f m e n and th e child? . . . H ow do w e b re a k th e cy cle o f ch ild -a b a n d o n m e n t-A D C -ch ild ?" A lth ou g h she su p p orted th e “n eed to produce," she re je c te d th e “irre sp o n ­ sible, p oorly th o u g h t-o u t call to young girls, o n -th e -m a rg in scufflers, every S iste r at large to aban d on th e pill." The pill w ould allow cou ples to co n tro l th e spacing and n u m b er o f ch ild ren b o rn to ca rry on th e fig h t.116 The B la ck W o m e n ’s L ib e ra tio n G rou p claim ed th a t w o m en to o k th e pill “b eca u se o f p o o r black m en" w ho refu sed to “su p p ort th e ir fam ilies" and w ould n o t “stick by th e ir w o m en " The group realized th a t “a lo t o f b la ck b ro th e rs" w ere ask ­ ing w o m en n o t to p ra c tice co n tra ce p tio n b eca u se it w as “a fo rm o f W h ite y ’s co m m ittin g gen o cid e on b la ck p e o p le " F or w om en, how ever, th e pill sy m b o l­ ized “th e free d o m to fight g en o cid e o f b la ck w o m en and ch ild re n ___ H aving to o m any b abies stops us fro m su p p ortin g our ch ild ren . . . and fro m fighting b lack m e n w ho still w ant to use and exploit u s " D ara A bu bakari, v ice p resi­ d ent o f th e R ep u b lic o f N ew A fric a — a sep aratist m o v em en t to estab lish a

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n ew b lack n a tio n in M ississip p i, L o u isian a, A lab am a, G eo rg ia , and S o u th C aro lin a— w rote, “W o m e n should b e free to d ecid e if and w hen th e y w ant child ren. . . . M en should n’t te ll us. N o b o d y should te ll u s " 117 This attitu d e prevailed in th e b la ck com m u nity. In a 1 9 7 0 C hicag o study D on ald B o gu e found th a t 8 0 p e rce n t o f b la ck w o m en approved o f b irth c o n ­ tro l and 75 p e rce n t used it. A 1971 pu blic op in io n p o ll found th a t th e m ajo rity o f b lack s, b o th m e n and w om en, su p p orted g o v ern m en t subsidy o f c o n tra ­ ceptives. In Genocide? R o b e rt W eisb o rd con clu d ed th a t “th e b la ck m asses are n o m o re resp onsive to th e g en o cid e n o tio n th a n A m e rica n C a th o lics are to papal en cyclicals on a rtificia l c o n tra c e p tio n "118 M a rtin L u th er K ing, Jr., sup­ p o rted fam ily p lanning and received th e M a rg a ret S a n g er Award in H u m an R igh ts in 1 9 6 6 fo r his efforts. H e argued th a t “in tellig en t guides o f fam ily p lan n in g ” w ere a “profound ly im p o rta n t in g re d ien t” in th e b la ck q u est for “secu rity and a d ecen t life " Stab ility for a b la ck m an w ould resu lt fro m “easy access to th e m eans to develop a fam ily related in size to his co m m u n ity e n ­ v iro n m e n t and to th e in c o m e p o te n tia l he ca n c o m m a n d " W a lte r R. C hivers, ch air o f th e D ep a rtm en t o f S o cio lo g y at M o reh o u se C ollege, em barked on a speaking to u r to p ro m o te co n tra ce p tio n as a m eans to stren g th en , n o t de­ stroy, b lack fam ilies. O th e r p ro m in en t b lack s also su pported fam ily planning, in clu d in g C arl R ow an, fo rm e r U .S. a m b assad o r to Finland and sy ndicated co lu m n ist; Jam es Farm er, n a tio n a l d ire cto r o f th e C on g ress o f R a cia l Equ ality (C O R E ); Bayard R u stin, c h ie f org anizer o f th e 1 9 6 3 M a rch on W ash in g to n ; Jero m e H olland , d istinguished b la ck so cio lo g ist and ed u cator; R o n D ellum s, C alifo rn ia D e m o c ra t and m e m b e r o f th e co n g ressio n a l b la ck cau cu s; and R ep resen tativ e B a rb a ra Jord an o f Texas. In ad d ition, th e N A ACP, C O R E , and th e N atio n al M ed ica l A sso c ia tio n en d orsed fam ily p lan n in g .119 A lth ou g h th e m a jo rity o f b lack s su p p orted b irth co n tro l, so m e w ond ered if th e only m o tiv a tio n beh in d th e w hite pow er stru ctu re w as to help black s im prove. Jesse Ja ck so n did n o t op p o se b irth co n tro l, y et h e did q u estio n th e “tim in g ” o f th e p o p u latio n c o n tro l hy steria in th e 1 9 6 0 s : “T hat th is is ­ sue should su rface sim u ltan eou sly w ith th e em erg en ce o f b lack s and oth er nonw hites as a m ean in g fu l fo rce in th e n a tio n and th e w orld appears m o re th a n coin cid en tal.” L an g sto n H ughes, A m e rica n p o e t and n ovelist, w ondered w hy th e gov ern m en t suddenly had m illio n s o f dollars fo r co n tra cep tiv es for p eop le o f co lo r in In d ia, C h in a, A frica, and H arlem . U relia B row n, a b lack so cial w orker, told th e Reporter th a t “N egroes don’t w ant ch ild ren th e y ca n ’t take care of, bu t we are afraid to tru st you w hen you r offered help has so o ften tu rn ed out to b e e x p lo ita tio n "120 S o m e fam ily -p la n n in g activ ists ack n ow led g ed th a t m an y co n trib u to rs w ere racist. B e a tric e B la ire w orked to estab lish a clin ic in R o c h e s te r’s B ad en S tre e t n eig h b o rh o o d , a p red om in an tly b la ck area, and she “k new d am n w ell

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

th a t m any p eop le, in th e ir m ind s, m ad e th e c o n n e ctio n , w ell, w e’re going to keep th e black s d ow n" B la ire “to o k th e m o n ey anyw ay” b eca u se she believed w o m en n eed ed and w an ted a clin ic. S h e and h e r su p p o rters w ere “se n si­ tive enou gh to m ake sure w e had a b la ck p erso n to w o rk w ith b la ck p e o p le " L o n n y M yers had a sim ilar ex p e rie n ce in C hicag o. W h e n asked if she w as b o th e re d th a t so m e m o n ey ca m e fro m ra c ists, she said yes bu t co n clu d ed th a t “any cau se has strange bedfellow s.” The fin a n cia l b acking and th e “votes o f th e ra c ists” w ho su pported co n tra cep tiv es “ju s t to d ecrea se th e n u m b er o f b lacks in th e city ” w ere cru c ia l to brin g ab o u t ch an g e to b en efit w o m en .121

Events in Rhode Island The R IM H A ex p erien ced rapid clien t grow th fro m 2 ,8 7 3 p atien ts in 1961 to 4 ,9 3 2 in 1 9 6 4 . Sev eral fa cto rs explain th is in crea se. F irst w as th e m ailing o f “D e a r M o th e r and F a th e r” le tters to new paren ts; th e se le tters b rou gh t abou t 15 p e rce n t o f new clien ts. S e co n d w as th e h ea lth p rogram . T he R h od e Island F ou n d ation fo r th e d etec tio n o f u terin e c a n c e r gave R IM H A a n an n u al grant o f $ 3 ,0 0 0 beg in n in g in 1 9 6 0 and in crea sed it to $ 5 ,0 0 0 in 1 9 6 5 . The M e d i­ cal A d visory C o m m ittee exten d ed Pap sm ears to all p atien ts, and th e clin ic sen t m o re slides to b e p ro cesse d “th a n any o th e r single so u rce inclu d ing th e ca n ce r clinic.”122 Third w as th e “trem en d o u s am o u n t o f p u blic in fo rm a tio n on th e p o p u latio n p ro b lem and o n . . . th e P ill” A s th e sta ff conclu d ed , “Su d ­ denly th in gs have changed and very rapidly.” C a th o lic clien ts in crea sed fro m 52 p e rce n t in 1 9 6 2 to 61 p e rce n t in 1 9 6 3 , w h ich paralleled th e 6 0 p e rce n t C ath o lic rep rese n ta tio n in th e state. B y 1 9 6 3 “th e new s b lack ou t w h ich had always su rrou nd ed us b eg an to co m e to an en d ” By 1 9 6 4 sta ff m e m b ers w ere giving telev isio n and radio in terview s and receivin g fro n t-p a g e coverage in th e Providence Journal. W h ile ap p reciativ e o f “rem ark ab le free publicity,” so m e staff m e m b ers w ere w orried th a t som e w o m en w ould n o t realize th a t R IM H A serv ices in clu d ed b irth co n tro l. A fte r years o f defying PPFA , th e execu tiv e co m m ittee voted in July 1 9 6 4 to b e c o m e P P R I in ord er to b en efit fro m n atio n al p u blicity in fu n d -raisin g and p atien t load s.123 D esp ite in crea sin g p u blic a cc e p ta n ce , R h od e Island did n o t jo in o th e r states in using pu blic funds fo r co n tra ce p tio n . C lin ic re p o rts claim ed th a t th e 6 0 p e rce n t C ath o lic p op u latio n prevented su ch im p lem en ta tio n . E xecu tive D ire cto r A n n e W is e trie d in 1 9 6 3 to co n v in ce A u gu stine W . R iccio , d ire cto r o f th e D e p a rtm e n t o f S o c ia l W elfare, th a t th e sta te ’s failure to pay fo r c o n tra ­ ceptives fo r ind igent and w elfare re cip ie n ts co n stitu ted class d iscrim in atio n : “G iving citizen s th e rig h t to plan ch ild ren is ju s t as valid a h ea lth serv ice as any o th e r leg itim a te p u blic h ea lth serv ice. Fam ily p lan n in g is a m a tte r o f p erso n al ch o ice and th o se w ho m u st receive th e ir m e d ica l care th rou g h p u b ­

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lic aid should have th is sam e rig h t o f ch o ice as our m o re fo rtu n a te citiz e n s" W h e n th is lin e o f re a so n in g failed, W is e ad op ted th e e c o n o m ic arg u m en t m o re p alatable to m any a d m in istra to rs: “Su rely th e co n sta n tly risin g co sts o f A D C and o th e r aid p ro g ram s, to say n o th in g o f th e to ll in h u m an m is ­ ery o f u nw anted ch ild ren m ake it n ecessa ry th a t a ca refu l evalu ation o f th is p o licy . . . b e u n d e rta k en " This arg u m en t su cceed ed : R iccio invited th e clin ic to provide an ex h ib it at th e R h od e Island C o n fere n ce o f S o c ia l W o rk , and in 1 9 6 5 th e D e p a rtm e n t o f S o c ia l W elfare allow ed casew orkers to refer clien ts to P P R I on re q u e st.124 C o st-c u ttin g ra th er th a n class d iscrim in a tio n argu ­ m e n ts tran sfo rm e d state policy. The im p a ct o f th is d ecisio n w as im m ed iately evid ent: in 1 9 6 3 only 5 3 p atien ts w ere o n w elfare; in 1 9 6 5 2 8 6 w ere.125 W h ile th e state allow ed re ferra ls, it did n o t provide P P R I funds to defray th e co st o f w elfare clien ts. In search o f new reven u es, P P R I co u rted th e b u sin ess com m u nity. F or th e first tim e, tw o o f th e five vice p resid en ts w ere m e n in 1 9 6 4 .126 The sta ff org a­ nized a series o f “B u sin ess M e n ’s D in n e rs” and a “M e n ’s T eam o f s o licito rs” and b ro u gh t in Jo h n N uveen, ch air o f th e n a tio n a l cam p aig n fund, to speak to m e n ab o u t th e “ec o n o m ic co n se q u e n ce s o f th e p op u lation ex p lo sio n " They co n sciou sly em ployed d ifferent rh e to ric w h en dealing w ith th e bu siness c o m ­ m unity, em phasizing p o p u lation co n tro l ra th er th a n h ea lth and ch o ice. For som e, th e rh e to ric w as n o t im p o rta n t; th e m ain p o in t w as to raise m oney. It b o th e red o th ers th a t p eop le w ould a sso cia te P P R I w ith PPFA’s p o p u latio n co n tro l obsession . They argued th a t PPFA should “w ork on p olishing its im ­ age. . . . T oo m any p eop le b elieve th a t P.P. esp ou ses a negative p hilosophy o f to o m any ch ild ren in th e w orld to m ake it an evil p la c e " D esp ite strateg ic d ifferences, m o n ey flow ed fro m bu sin essm en . C o m b in ed w ith o th e r c o n tri­ b u tio n s, th e bu dget ju m p ed fro m $ 6 2 ,2 7 3 .4 6 in 1 9 6 3 to $ 1 4 4 ,5 4 8 .4 0 in 1 9 6 6 . A lth ou g h th e clin ic enjoyed in crea sed a ccep ta n ce , esp ecially in th e w ake o f

Griswold, th e U n ited Fund re je c te d P P R I, fearin g re p risa l fro m th e sta te ’s C ath o lic hierarchy.127 W ith Griswold, clin ics o p en ed in M a ssa ch u setts and C o n n e c tic u t, y et m any w o m en co n tin u ed to co m e to P P R I, co m p lain in g th a t “th e serv ices o f­ fered w ere n o t w hat th e y had co m e to ex p e ct a fter co m in g to [P P R I]" C a n cer d etectio n rem ain ed “on e o f th e m o st valuable" serv ices at P PR I; th e R h od e Island F ou n d ation doubled its an n u al co n trib u tio n in 1 9 6 7 to $ 1 0 ,0 0 0 , and th e C o u n cil o f C om m u n ity S e rv ices finally a ccep ted P P R I th e sam e year. The staff lau n ch ed a p u b licity cam p aig n “to find m o re p a tie n ts fro m hard core p overty areas, w here th e g reatest need s n o t only for b irth c o n tro l bu t c o m ­ prehensive h ea lth serv ices re m a in " P P R I expand ed h ea lth serv ices to inclu d e b loo d p ressure tra ck in g fo r all, n o t ju s t pill ta k ers, as w ell as v itam in th erap y and diet advice. They also hand led m in o r vaginal p roblem s b eca u se p atients

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

fou nd referrals h ard to fulfill w hile ju g glin g jo b s , child care, and o th e r r e ­ sp o n sib ilities.128 In 1 9 6 7 R h od e Island jo in e d th e m a jo rity o f states in fund ing c o n tra ce p ­ tives. The R h od e Islan d C o n fere n ce on S o c ia l W o rk ag ain invited P P R I to exh ib it at th e 1 9 6 6 co n v en tion and held a sessio n o n fam ily p lanning at its Sp rin g In stitu te. In Ju n e 1 9 6 7 th e D e p a rtm e n t o f P u b lic W elfa re follow ed n ew fed eral S o cia l S e cu rity am en d m en ts to pay fo r co n tra cep tiv e p re scrip ­ tio n s, “an im p o rta n t step,” a cco rd in g to P P R I, b eca u se it p laced “b irth co n tro l in th e sam e p o sitio n as o th e r vital h ea lth serv ices in th e sta te” The follow ing year th e pu blic w elfare d ep artm en t allow ed casew orkers to in itiate b irth c o n ­ tro l d iscu ssions w ith clie n ts.129 These chang es affected P P R I’s p atien t load: w elfare clien ts in crea sed by 31 p e rce n t, and n o -fee , nonw elfare p atien ts in ­ creased by 17 p e rce n t.130 The p atien t load strain ed th e clin ic, still th e only on e in th e state. To ease access, P P R I op ened a supply ce n te r in S o u th P rovid en ce in Ju ne 1 9 6 6 . R eg u ­ lar P P R I p atien ts could p ick up co n tra cep tiv es h ere ra th er th a n travel to th e dow ntow n clin ic. In its first six m o n th s m o re th a n 2 5 0 w o m en to o k advan­ tage o f th e “co n v en ien ce o f a n eig h b o rh o o d office” W o m e n also ben efited w h en P rovid ence L ying-In H o sp ital op ened a clin ic in Jan u ary 1 9 6 7 to serve w ard p atien ts. A g ran t o f $ 3 5 ,0 0 0 fro m D H E W in 1 9 6 8 allow ed L yin g-In to expand th e clin ic to n o n p a tien ts. S o u th C ou n ty H osp ital ag reed to o p en a clin ic u nd er P P R I su p ervision in 1 9 6 7 , and P P R I estab lish ed a clin ic in N ew ­ p o rt. So u th C ou nty had a steady caseload , b u t th e N ew p ort facility co m p eted w ith a n ew IU D p ro g ram ru n by th e navy fo r sailo rs’ w ives.131 B y th e late 1 9 6 0 s P P R I ca rrie d an an n u al caselo ad o f 6 ,6 0 0 clie n ts— an in crea se o f 1 ,0 0 0 sin ce 1 9 6 6 , d espite th e d ro p -o ff o f o u t-o f-sta te clien ts and th e opening o f o th e r clin ics. A pp roxim ately 2 7 p e rce n t cou ld pay n o fee, and 18 p e rce n t o f th e se w ere w elfare clien ts. C a th o lics co n stitu ted th e m ajority, d espite th e 1 9 6 8 papal en cyclical. N ew and old clien ts ben efited fro m h ealth care serv ices, w ith 10 p e rce n t re fe rred fo r fu rth e r tre a tm e n t. M o st clien ts w ere b etw een tw enty and fo rty years old, a lth ou g h so m e w ere in th e ir fifties, and so m e p aren ts b ro u g h t in te en s. B y th e late 1 9 6 0 s th e clin ic saw in crea sed S p an ish - and P ortu g u ese-sp eak in g clie n ts, re flectin g im m ig ra tio n p attern s in th e state.132 A lth ou g h th e clin ic offered variou s co n tra cep tiv e o p tio n s, th e re w as “no q u estio n ab o u t th e su p rem acy o f th e ‘P ill’” W ith tw elve pills fro m w h ich to ch o se, 7 9 p e rce n t o f n ew clien ts w ent w ith oral co n tracep tiv es. D o c to rs often sw itched pills to find th e least side effects; th e y did n o t dism iss w o m en ’s c o m ­ p laints as p sy ch o so m atic. Dr. Slab ey re p o rte d five serious p ro b lem s am ong p atien ts in 1 9 6 7 . O n e w om an died, b u t she had b e e n trea te d fo r h y p erten ­ sion, re n al n ecro sis, and d issem in ated vascu lar th ro m b o sis. The o th e r fou r

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w ere th ro m b o e m b o lic ep isod es; th e y reco v ered and w ere p laced o n different co n tracep tiv es. In all five cases “th e re w as d iscrep a n cy in th e h isto ry th e y gave and in th e re p o rtin g o f sy m p to m s" S o m e p a tie n ts w ere “re lu cta n t to ad m it th e p re sen ce o f side re a ctio n s fo r fea r th a t th e d o c to r w ill n o t pre­ scrib e th e p ill"133 A s in fo rm ed co n su m ers, th e se w o m en k new w hat ty p e o f b irth co n tro l th e y w anted , and th e y k new th e m e d ica l co m p lica tio n s th a t co n train d icate d its use. IU D s w ere seco n d beh in d th e pill; 5 5 2 used it, w ith only 4 cases o f pelvic in flam m ation . In “ea ch o f th e se p a tie n ts" how ever, “a h isto ry o f p rio r in fla m m a tio n w as finally elicited and a d m itte d " Just as w ith th e pill, p atien ts w ithheld in fo rm a tio n to en su re th e ir ch o ice o f c o n tra ce p ­ tio n . B a rrie r m e th o d s su ch as co n d o m s, diaphragm s, jellies, and foam s w ere “lim ited ” in use. The o n ce -so u g h t-a fte r diaphragm d ecreased in popu larity excep t w hen adverse p u b licity on th e pill o ccu rred . Follow ing S e n a te h ea r­ ings in 1 9 7 0 , fo r exam ple, 13 p e rce n t o f P P R I w o m en stopp ed ta k in g th e pill (versus 18 p e rce n t n atio n ally ).134 A fte r a “co o lin g o ff p e rio d ” 6 5 .3 p e rce n t re tu rn ed to th e pill.135 By 1 9 6 8 7 0 p e rce n t used th e pill, 13 p e rce n t IU D s, 14 p e rce n t d iaphragm s, and 3 p e rce n t so m e o th e r m eth od . Dr. Slab ey clo sed th e rh y th m clin ic fo r la ck o f u se.136 The availability and te stin g o f cu ttin g -ed g e co n tra cep tiv es at P P R I m ade it an ed u catio n a l center. The clin ic had tra in ed 4 2 6 individuals by th e late 1 9 6 0 s : 5 0 p e rce n t w ere stu d ent n u rses; oth ers inclu d ed sixth -y ear m ed ical stud ents at B ro w n U niversity, stud ents m a jo rin g in so cia l w ork or h ea lth and ed u catio n fro m seven area co lleg es, so cia l and w elfare w orkers fro m state ag en cies, and area physicians. The classes fo r w h ich stud ents gained college cred it filled “a gap in th e n u rsin g and m e d ica l ed u ca tio n in th is area." A l­ th o u g h 3 9 states a ccep ted fed eral funds fo r b irth -c o n tro l ed u ca tio n a l p ro ­ gram s, R h od e Island refu sed th em . P P R I’s p ro g ram th e refo re fulfilled a n im ­ p o rta n t fu n ctio n in th e state.137 Still, clien ts exposing th e ir in tim ate lives and bod y p arts m u st have felt so m e em b a rra ssm en t at th e p oking and prodding o f stu d en ts.138 P u blic fund ing co n tin u ed to in c rea se in th e late 1 9 6 0 s . In 1 9 6 9 P P R I re ­ ceived fro m th e state h ea lth d ep a rtm e n t $ 1 0 ,7 0 0 , w h ich covered ap p roxi­ m ately o n e-th ird o f P P R I’s co st fo r lo w -in co m e w om en. The h ea lth d ep art­ m e n t in crea sed its p ay m en ts over th e n e x t sev eral y ears, bu t th e w elfare d ep artm e n t refu sed u n til 1 9 7 3 , w hen, a fte r sev en y ears o f n eg o tia tio n , it agreed to pay $13 p er visit fo r w elfare clie n ts.139 P P R I received fed eral m o n ey as well, bu t, as C ritch lo w has show n, th e relation sh ip betw een private org a­ n izatio n s and fed eral b u rea u cra cies w as n o t always sm o o th . A n u n ex p ected freeze in fed eral fam ily-p lan n in g p ro je c ts in 1 9 7 3 raised co n c ern s am on g th e staff: “The p rop osed fed eral bu dget m ay resu lt in a sk y -ro ck etin g case load

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

fo r us if o th e r clin ics are u nable to keep fu n ction in g.”140 S ta te w elfare pay­ m e n ts kicked in ju s t as fed eral fund ing b e c a m e less assured. Fed eral fund ing stirred co n tro v ersies, as it had in P ittsbu rgh. In th is case, religiou s, n o t racial, te n sio n h it P aw tu cket, R h od e Island , w hen n eig h b o r­ h o o d groups re q u e ste d th a t O E O offer co n tra cep tiv e serv ices, specifically, a m o b ile u n it to serve th e B la c k sto n e V alley area, in clu d in g P aw tu cket, C um b erlan d , L in co ln , and C en tra l Falls. The bo ard o f th e B la c k sto n e V al­ ley C om m u n ity A c tio n P ro g ram (B V C A P ), in clu d in g so m e C a th o lic clergy, u nan im ou sly approved th e p rog ram , and th e g o v ern m en t aw arded a grant o f $12,791. B eca u se P P R I’s A n n e W is e w as to oversee th e p rog ram , w o m en served in th e m o b ile u nit w ould receive to ta l exam s, in clu d in g a u terin e c a n ­ ce r te st. P aw tucket M a y o r R o b e rt F. B u rn s, how ever, pu blicly op p osed th e p ro g ram b eca u se b irth co n tro l w ould b e available to single w o m en and b e ­ cau se he did n o t “believe a m u n icip ality should be as closely id entified w ith a b irth co n tro l p ro g ra m ” H e in sisted th a t th e B V C A P board re tu rn th e grant or v acate th e ir offices in city hall. C ity C o u n cilm a n Jo h n J. C o lem a n backed B u rn s, vow ing to re scin d B V C A P ’s d esign ation as th e an tip overty ag en cy for P aw tucket if it did n o t re tu rn th e grant. C en tra l Falls’ m ay or and C u m b e r­ lan d ’s to w n ad m in istra to r back ed B u rn s and C olem an . B V C A P voted tw enty to n in e w ith tw o a b sten tio n s to com p ly w ith B u rn s and C o lem a n b eca u se failure to do so w ould jeo p a rd iz e o th e r im p o rta n t an tip o v erty p rog ram s for B la ck sto n e Valley.141 This d ecisio n d rew sharp criticism . The Providence Journal la m b a sted B urns: W h e n M ay o r R o b e rt F. B u rn s ca n issue u ltim atu m s d em and ing c o n ­ fo rm ity to his view s on th re a t o f ev ictio n fro m city p rem ises and thu s su ccessfu lly co e rce th e B la c k sto n e Valley C om m u n ity A c tio n P rogram , In c. in to alleg ian ce to h im ra th er th a n to th e p o o r for w h om th e p ro ­ g ram is set up, th e fu tu re seem s an yth in g b u t p rom isin g . . . . In our view, M ay o r B u rn s’ heav y -h and ed a c tio n to k ill n o t only a valid bu t a m u ch n eed ed p ro g ram o f fam ily p lanning fo r im p ov erish ed peop le w as im proper. H e has exp loited his p o sitio n as m ayor to ex ert p ow erful p erso n al in flu en ce w here n o n e w as called for, by use o f th re a t ra th er th a n reason , and w ith ou t due regard to th e b est in tere sts or th e rights o f P aw tu cket’s poor. P P R I officials believed B u rn s engaged in a pow er struggle. U n d er O E O leg is­ lation, p overty prog ram s rem ain ed outsid e lo ca l govern m en ts. T he la tte r “can b e co m e sensitive to th o se p overty p rog ram s w h ich are su ccessfu l in th a t th e y m ay re flect a lack o f p ro g ram m in g fo r th e p o o r u nd er regu lar g ov ern m en t

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fu n ctio n s.” The G re e n A m e n d m en t to O E O leg islatio n gave lo c a l g o v e rn ­ m e n ts th e o p tio n to co n tro l co m m u n ity a c tio n p rog ram s, b u t th e P aw tucket city co u n cil voted th a t C A P rem a in separate. B u rn s re sen te d th is d ecision: th e city co u n cil “vote im m ed iately p reced ed th e m ay or’s v iolen t re a ctio n to th e b irth co n tro l p ro g ra m ”142 N o lo ca l p ro test to B u rn s’s a ctio n s ensued. T he fa ct th a t th e grant w ould have establish ed a new serv ice m ay explain th e silence. H ad B u rn s d ism an ­ tled a lo n g -stan d in g serv ice, th e re a c tio n w ould have b e e n different. The co m m u n ity m ay also have feared losing o th e r n ew p rog ram s b en efitin g th e poor. M oreover, w o m en in th is co m m u n ity had m e t W is e and oth ers fro m P P R I during th e p ro p o sal p ro cess. B la c k sto n e V alley is in n o rth e rn R h od e Island , n o t far fro m P rovid ence. W h ile a m o b ile clin ic w ould have b e e n m o re con v en ient, B lack sto n e V alley w o m en could m ake th e trip to P P R I w ithou t to o m u ch difficulty. T hat th e o u tco m e in P aw tu ck et w as so d ifferent fro m th e co n tro v ersy in P ittsb u rgh ca n b e a ttrib u ted to th e lo n g -sta n d in g a ctiv ism o f w o m en in H o m e w o o d -B ru sh to n w ho had b e e n fighting for years fo r b e tte r c o n tra ce p ­ tive serv ices. N o m a tch in g g roundsw ell o ccu rred in P aw tucket, w here m any C ath o lics m ay have b e e n u nw illing to co m e out pu blicly to fight fo r b irth co n tro l. V isiting a n establish ed clin ic w as m u ch less b ra z en th a n p ro testin g fo r n ew services. W o m e n in H o m e w o o d -B ru sh to n had th e p u blic b ack in g o f n eig h b o rh o o d ch u rch es, w hile P aw tucket w o m en did not. The co n tro v ersy in P aw tu cket co n stitu ted th e only upheaval over b irth co n tro l in th e state. U n lik e th e ra c ia l p o litics th a t re v erb e ra te d th ro u g h P ittsbu rgh , P rovid en ce rem ain ed u nscath ed . In th e m id -1 9 6 0 s P P R I w orked w ith C O R E and th e U niversity o f R h od e Island to estab lish C itizen s o f C o n ­ ce rn p ro g ram s to assist re sid en ts in th e R o g er W illia m s h ou sin g p ro je c t. The “in te re st w as g re a t” en o u g h to e sta b lish fam ily -p lan n in g serv ices in S o u th P rovid ence, a p red om in an tly b la ck area, to save clien ts th e trip d ow n­ tow n. U L R I staff con clu d ed th a t “th e id ea o f o p en in g th is b ra n c h office was sound; . . . p articip a tio n w as h ig h and in tere st w as k e e n ”143 W h e n PPFA told P P R I th a t n atio n a l had to w ork to co m b a t “th e feeling am o n g som e N egroes th a t P lanned P aren th o o d activ ity has ra cia l overtones,” P P R I sta ff resp ond ed th a t th e y faced n o su ch p roblem . The U L R I co n tin u ed to invite P P R I to open h o u ses, and “C O R E invited us to set up a supply sta tio n o n C am p S treet,” w h ich served “to in d icate a rep u d iation lo cally o f th o se groups w ho claim P lanned P aren th o o d has ra cia l o v erto n es” The bo ard d iscussed g en o cid e and u n d ersto o d th e d epths o f d esp air th a t so m e m in o rity groups felt: “M in o r­ ity groups have in ad eq u ate hou sing, ed u catio n , are hungry, poor, and o ften ill— th ey lack e co n o m ic, so cia l and p o litica l p ow er— th e y are advised to have

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

few er ch ild ren w hen around th e m o n all sides are affluent, w ell ed u cated , well fed and p olitically p ow erfu l p eop le w ho are raising large fam ilies.” H oping to in still th is em pathy in th e p eop le tra in ed at P PR I, th e y provided a q u es­ tio n n a ire for tra in ee s: “Y ou’re o n duty at [Provid ence L ying-In]. N egro post p artu m p atien t . . . You m e n tio n th e availability o f fam ily p lanning services and are accu sed o f p reach in g b la ck g en ocid e. H ow w ould you h and le th is u p set p atien t and th is a ccu sa tio n ?”144 A lth ou g h no answ ers w ere provided, th e q u estio n is telling . P P R I w as aw are o f g en o cid e fears and w anted to e n ­ sure th a t its tra in ee s w ould hand le th e m in a m a n n er co n g ru en t w ith P P R I’s em phasis o n w o m en ’s h ea lth and choice. This p rio rity d om in ated P P R I th rou g h th e early 1 9 7 0 s. N ew lead ers cam e and w ent, in clu d in g th e first m ale v ice p resid en t in 1 9 6 8 and th e n first m ale p resid en t in 1 9 6 9 and 1 9 7 0 ; w o m en resu m ed th e p resid en cy for 1971, 1 9 7 2 , and 1 9 7 3 .145 Th rou gh th e se ch an g es th e m e d ica l d ire c to r’s re p o rts show ed th e “kind o f c o n c e rn fo r th e ind ivid ual fo r w h ich our m e d ica l p ro g ram is k n o w n ” By 1 9 7 0 W is e w as d isgusted w ith “th e rh e to ric co m in g fro m th e ov erp op u lation p ro p h e ts” w ho played a “n u m b ers gam e.” P P R I refu sed to play, re je ctin g n a tio n a l em phasis on a tw o -ch ild fam ily: “N o p o licy on fam ily size b e s t” The sta ff w orked w ith B row n m ed ical stud ents to rem in d th e m th a t “clin ic p atien ts are also h u m an b e in g s”146 In th e early 1 9 7 0 s R h od e Island w om en ben efited fro m expand ed clin ics, partly as a resu lt o f fed eral funds. B y 1 9 7 2 th e re w ere eight clin ics outsid e P rovid en ce; jo in in g P P R I w ith in th e city w ere te n P rogress fo r P rovid ence H ealth C en ters and th e L yin g-In clin ic. P P R I n o lo n g er served th e m a jo rity o f state citizen s, and th e c h a ra cte ristic s o f w o m en co m in g to P P R I changed. M o st n ew clien ts in 1 9 7 0 had in c o m es o f $ 4 9 or less p er w eek (versus $ 7 5 to $ 1 0 0 in 1 9 6 6 ); th e y w ere betw een tw enty and tw en ty -fo u r years old (versus tw en ty to tw en ty -n in e in 1 9 6 6 ); 4 9 p e rce n t had n o ch ild ren (versus fou r ch il­ d ren in 1 9 6 6 ); and only 6 p e rce n t had fou r or m o re child ren. By 1 9 7 2 m o st n ew clien ts w ere b etw een th e ages o f eig h teen and tw enty-five; 8 0 p e rce n t o f n ew clien ts and 6 6 p e rce n t o f all clien ts had n o child ren. T he p atien t load in ­ creased to 8 ,6 6 4 , d espite o th e r clin ics. W ith a bu rg eon in g caseload o f clien ts less able to pay, P P R I relied on fu n d -raisers and g ov ern m en t su bsid ies.147 P P R I used fed eral funds to offset th e expanding co sts o f h ea lth services. In 1 9 7 0 th e clin ic b eg an te stin g fo r V D and p reg n an cy and th e follow ing year added granu losa cell (G C ) cu ltu res and urinalyses. In 1 9 7 2 th e sta ff co n sid ­ ered in co rp o ratin g sick le-ce ll an em ia te stin g bu t d ecid ed n o t to only b ecau se “m any o th e r ag en cies do i t ” A lth ou g h th e sta ff no lo n g er re co rd ed c lie n ts’ ra c ia l/e th n ic b ackg rou n d s, th e co n sid era tio n o f sick le-ce ll te stin g affirm s a significant p ercen tag e o f b la ck w om en. The staff also in itiated g en etic sc re e n ­

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ing, in line w ith th e n a tio n a l tren d tow ard g en etic cou nseling . The sta ff b e ­ lieved th e se n ew prog ram s b rou gh t “m o re co m p lete h ea lth ca re ” fo r patients. C om m u n ity su p p ort surged, w ith a 2 5 p e rce n t in c rea se in d on ors, allow ing th e ir o p eratin g bu d g et to ju m p fro m $ 1 9 7 ,5 6 0 in 1 9 7 0 to $ 4 4 4 ,2 6 5 .5 6 by 1 9 7 6 .148 A lth o u g h m o re p eop le sought co n tra ce p tiv e care, m any still exp ressed an x ie ties ab o u t it. “P a tie n ts’ fea rs” in clu d ed “refu sal or d enial o f help; to o costly; illegality or im m orality o f b irth co n tro l; pelvic exam ; jeo p a rd iz e public a ssistan ce status; loss o f sexu al en jo y m en t; bein g sterilized or losing cap acity fo r fu tu re p regnancies.” This list is revealing. D esp ite g o v ern m en t assu ran ces th a t w elfare p ay m ents w ere n o t tied to co n tra cep tiv e use, m ed ia coverage o f co e rcio n con v in ced m any w o m en th e y w ere co n n e cte d . The fears o f steril­ izatio n re flect n a tio n a l coverage o f co e rce d steriliz a tio n o f w elfare clien ts at federally fund ed fam ily-p lan n in g clin ics. F or m en, th e co n c ern s in rank ed o r­ der w ere “loss o f statu re as head o f h ousehold ; loss o f self-esteem , se lf-c o n fi­ d ence; loss o f re sp e c t o f p eer group; cap acity to give sexual pleasu re; sickness or d isease resu lting fro m th e use o f co n tra ce p tiv e; m a te ’s o p p o rtu n ity for infidelity; ta b o o s on d iscu ssion o f sex w ith o u tsid er as to o p e rso n a l a m a tter; ig n o ran ce o f language.”149 The first th re e deal w ith u nd erm in in g trad itio n al m ale authority. A lso n o te w o rth y is th e fea r m e n exp ressed co n c ern in g th e sexual free d o m w o m en could gain fro m co n tracep tiv es; b irth co n tro l equaled sexu al liberation . W ith y ou n ger w o m en seekin g co n tra ce p tiv es, P P R I b u ilt o n th e m o d el set by Dr. G o ld sm ith in S a n F ra n cisco and o p en ed th e T e en A ge C en te r in 1 9 7 0 . “The grow ing n u m b er o f m in o rs referred by ag en cies and individuals or b rou gh t by p aren ts . . . p o in ted out th e n ee d fo r a sp e cia l y ou th serv ices p ro ­ gram,” acco rd in g to W ise, w ho saw it as p art o f a “co m p reh en siv e h ea lth ser­ vice fo r teenagers.” O n ce again, P PR I w as in th e vanguard in its region: “There is no su ch type o f serv ice available in th e sta te — th e re is m u ch ta lk ab o u t th e p o o r situ ation o f m any o f to d a y ’s teen a g ers b u t n o a c tio n — w e should tak e a ctio n , ta k e th e lead in th is field.” As late as 1971, a cco rd in g to E liz a b eth Siegel W atk in s, th e “m a jo rity ” o f clin ics “still req u ired p ro o f o f m arriage.”150 W h ile th e staff w as very en th u sia stic, th e board avoided p u b licity so as n o t to alien ate p o te n tia l co n trib u to rs. B y 1971 3 4 p e rce n t o f p atients w ere n in e te en and u nd er; th e follow ing year saw “in c rea ses n early every m onth.” O n ly one o f 7 2 8 te en s b e c a m e p regn an t. W ise conclu d ed : “It is n o t ju s t th e availability o f co n tracep tiv es w h ich preven ts pregnancy, since drug stores are open to all. W e give ed u catio n and cou nseling . W e n e ith e r co n d em n n o r con d on e. M o st im p o rta n t, w e provide a p lace w h ere young p eop le ca n d iscu ss th e ir c o n ­ cern s ab o u t th e ir sexu ality in a n o n -ju d g m en ta l atm osp here.” The sta ff also

W ho Pays? Contraceptive Services and the Welfare State, 1963—1975

stressed th e im p o rta n ce o f co m m u n ica tio n w ith p aren ts. B y 1 9 7 4 9 2 3 “you th p atie n ts” had b e e n served, and as late as 1 9 7 5 P P R I w as th e only clin ic in th e state th a t allow ed m in o rs a ccess to co n tracep tiv es w ith ou t p aren tal co n sen t. The m ajo rity o f te e n s w ere fro m “m id d le-class, c lo se -k n it fam ilies th a t share m any th in gs excep t ta lk a b o u t sex, w h ich is a n o -n o ” C on fid en tiality and th e ability to relate to te e n s ap p eared to b e keys to th e T een Age C e n te r’s su c­ cess.151

Conclusion The first d ecad e o f g ov ern m en t co o p e ra tio n w ith private o rg an izatio n s in co n tra ce p tio n red u ced so m e so cia l and e c o n o m ic “p ro b le m s” a sso cia te d w ith th e in d igen t and lo w -in co m e clien ts. K a th erin e O e ttin g e r o f D H E W re p o rte d th a t in 1 9 6 4 only th irte e n states allow ed h ea lth d ep artm en ts to p ro ­ vide co n tracep tiv e serv ices, b u t by 1 9 6 7 fo rty -six states did so. B y th e end o f th e d ecad e th e b irth ra te fo r all n in e g eo g rap h ic reg ion s in th e co u n try had d ecreased . M oreover, D H E W w as “en co u rag ed ” th a t th e se d eclin es w ere reg ­ istered “in areas o f th e low est ed u catio n al atta in m e n t— th e h ig h est in cid e n ce o f p o v erty — th e h ig h est rates o f ille g itim a cy — [and] th e largest n u m b er o f ch ild ren p er fam ily” A 1 9 7 0 S e n a te re p o rt claim ed th a t th e “e c o n o m ic effects o f th e o ral co n tracep tiv es on su ch m atters as d ecreased fam ily size, in crea sed disp osable fam ily in c o m e s, [and] d ecreased p u blic w elfare c o s ts ” w ere evi­ d ent in A m e rica n so ciety .152 B y th a t p o in t, b o th state and fed eral g ov ern ­ m e n ts had in co rp o ra te d co n tra ce p tio n as a p rin cip a l co m p o n e n t o f pu blic policy. This evolu tion resu lted p rim arily fro m a d esire to d ecrea se m o u n tin g w elfare expend itu res. B etw een 1 9 6 5 and 1 9 7 5 th e g ov ern m en t saved an e s­ tim ate d m in im u m o f $1.1 b illion due to its in v estm en t in co n tracep tiv es. In 1975 alone, fo r every dollar sp en t on co n tra ce p tio n , th e g o v ern m en t “saved” $ 2 .5 0 in 1 9 7 6 by averting th e b irth s o f ch ild ren w ho p resum ably w ould have depend ed on th e w elfare system fo r survival. The lo n g -te rm savings ranged fro m $ 2 6 to $ 1 0 0 fo r every dollar spent o n co n tra ce p tiv es.153 W h a te v e r th e m o tiv a tio n for g o v ern m en t involvem ent, individual w o m en on th e lo ca l level b en efited fro m expand ed clin ic serv ices and re sea rch into safe and effectiv e m e th o d s o f b irth co n tro l. N a tio n a l re sea rch ers generally rem ed ied th e m e d ica l effects o f th e pill, low ering th e a m o u n t o f estro g en and th u s red u cin g som e side effects. P P R I clien ts esp ecially ben efited fro m to p -n o tc h com p reh en sive h ea lth care. W h ile p o p u latio n co n tro llers h ailed g o v ern m en t efforts in co n tra ce p tio n , m an y pu shed fo r fu rth e r ch an g es. P e rm a n e n t m e th o d s o f co n tro l su ch as sterilizatio n n o t only w ould save m o n ey bu t also could provide a final solu ­

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tio n to th e p erceiv ed p o p u latio n p ro b lem s. T he y ou n ger th e age at w hich w o m en are sterilized , th e m o re ch ild b irth co sts th e g ov ern m en t ca n save. The ap p aren t su ccess o f th e co n tra cep tiv e prog ram s p rom p ted m any so cial critics to p ro m o te ad d ition al p o licy alteratio n s in th e areas o f a b o rtio n and sterilization .

7

Who Pays for What? Abortion and Sterilization, 1960-1975

In th e early 1 9 6 0 s illegal a b o rtio n s co n tin u ed unab ated , w ith u nd ergrou nd serv ices p ro liferatin g as th e d ecad e progressed . A n u m b er o f in flu en tial o r­ ganization s pushed fo r change, inclu d ing N ixon ’s C o m m issio n o n P op ulation G row th. A n u m b er o f fa cto rs trig g ered grow ing a cc e p ta n ce o f a b o rtio n and sterilizatio n : en v iro n m en ta l c o n c e rn s, sca rcity o f w orld reso u rces, g reater op en n ess ab o u t sex and co n tra ce p tio n , and th e availability o f relatively safe and sim ple p ro ced u res. W o m en in creasin g ly called for rep ro d u ctiv e righ ts, a d em and th a t held little sway over state and fed eral legislators. F iscal c o n ­ servatives, p o p u latio n co n tro lle rs, and d em o g rap h ers’ p ressu re to red u ce g o v ern m en t exp en d itu res, esp ecially A F D C , did in flu en ce state and fed eral d ecisio n s n o t only to legalize b u t also to fund a b o rtio n and steriliz a tio n p ro ­ ced ures. S ta te re fo rm provided sta tistics d em o n stratin g th e im p a ct o f legal­ izatio n , nam ely, d eclin es in illeg itim ate b irth ra tes, te en a g e b irth s, m atern al m ortality, and th e fertility rate o f in d igen t w om en. A lthou g h p op u lation c o n ­ tro lle rs hailed th e se sta tistics as p ro o f th a t a b o rtio n cou ld help solve th e p o p ­ u latio n “p ro b le m " N ixo n opp osed a b o rtio n . C o n c e rn fo r th e C a th o lic vote led h im to r e je c t a b o rtio n b u t n o t sterilizatio n , desp ite official ch u rch r e je c ­ tio n o f b o th p ro ced u res. O f th e tw o, C a th o lic o p p o sitio n w as m u ch stron g er to a b o rtio n th a n sterilizatio n . The la tte r provided N ixo n an op p o rtu n ity to keep elite w hite p op u latio n co n tro lle rs’ su p p ort w ith ou t losing th e C ath o lic v o te— a w in -w in situ atio n fo r him . As w ith earlier refo rm , th e rh e to ric used to ju stify lib eraliz a tio n w as n o t as im p o rta n t to individual w o m en as th e re ­ p ro d u ctiv e free d o m m any gained. W h ile m id d le- and u p p er-class w o m en enjoyed m o re ch o ice , m any low er-class and in d igen t w o m en faced co erciv e ta c tic s by w hite officials w ho believed th e y should ch o o se w ho ought to be allow ed to p ro crea te. A s it had during th e g en o cid e accu sa tio n s w ith th e pill, P P R I rem ain ed u n scath ed by th e c o e rcio n controversy. T he clin ic adapted its p rogram s to suit clien t d em and s, offering a b o rtio n serv ices and o p en in g th e first v ase cto m y clin ic in N ew England.

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The Push for Abortion Reform D u rin g th e early 1 9 6 0 s illegal a b o rtio n s ro se 10 p e rce n t, rea ch in g an esti­ m ated 1.5 m illio n annually. A study o f u rb an N o rth C arolin a fou nd 14.9 il­ legal ab o rtio n s p er 1 0 0 co n cep tio n s for w h ites and 3 2 .9 p er 1 0 0 co n cep tio n s fo r blacks. It also fou nd a h ig h ra te o f illegal a b o rtio n s fo r w om en o f b o th races w ho had five o r m o re p re g n a n cie s.1 G row ing n u m b ers o f a b o rtio n s am o n g single w o m en co n cu rre d w ith rising illeg itim acy rates. B o th tren d s d em o n strated in crea sed p rem a rita l sexu al activity. W h ile arguing th a t c o n ­ tra ce p tio n cou ld p rev en t th e se p reg n a n cies, so m e so cia l critic s co n ten d ed th a t a b o rtio n laws should b e re fo rm e d to te rm in a te u nw anted p regn an cies th a t did occur. D em o g ra p h er C harles W e sto ff claim ed th a t b etw een 8 0 0 ,0 0 0 to 1 m illio n u nw anted b irth s to o k p lace annually, m o st am o n g th e ind igent and lo w -in co m e w om en w ho bu rg eon ed w elfare co sts. H e a sserted th a t 2 0 to 2 5 p e rce n t o f all p regn an t w om en ea ch y ear sought a b o rtio n s. In alm ost all cases, th e w ealthy secu red legal op eratio n s (approxim ately 1 0 ,0 0 0 p er year) b ecau se th e y eith e r had a tru sted d o c to r or traveled abroad .2 W h ile ind igent and lo w -in co m e w o m en m ig h t e n c o u n ter a sy m p ath etic d o cto r w illing to help th e m , th e y o ften ex p erien ced u n sa n ita ry co n d itio n s and painfu l, b o tc h e d p ro ced u res. A tw e n ty -fo u r-y e a r-o ld m a rried w om an w ith th re e ch ild ren paid M rs. D o ro th y E. F urtad o o f P rovid en ce $ 1 5 0 fo r an a b o rtio n p e rfo rm e d in F u rtad o ’s ap artm en t. The w om an developed an in fe c ­ tio n and had to b e hospitalized . S u ch stories did n o t p revent o th e r w o m en fro m seeking illegal a b o rtio n s. In fa ct, w o m en p ro te cte d a b o rtio n ists. W h e n th irty -y e ar-o ld A n th on y A ltieri w as a rrested fo r p erfo rm in g an a b o rtio n on a tw en ty -tw o -y ea r-o ld P ro v id en ce w om an , th e la tte r refu sed to co o p e ra te w ith p o lice and te stified in co u rt th a t she did n o t see th e a b o rtio n ist. W ith legislative im m u n ity still in p lace, she stoo d to lo se n o th in g fro m refu sing to id en tify th e m an. H e r te stim o n y fo rced th e state to d ism iss th e charges against A ltieri.3 Sev eral events in th e 1 9 6 0 s b rou gh t th e legal status o f a b o rtio n to a head. First, in 1 9 6 2 Dr. H elen B ro o k e Taussig o f th e F D A investigated th alid om id e, a E u rop ean n a rc o tic m ark eted as a sleep ing ta b let, tran qu ilizer, and m iracle aid to co m b a t m o rn in g sick ness, and fou nd it cau sed feta l m a lfo rm a tio n s, esp ecially in early pregnancy.4 S h e rri F ink bine, a telev isio n p erso n ality and m o th e r o f fou r in A rizo n a, had ta k en th alid om id e a fte r h e r husband brou ght it fro m England to ease h e r m o rn in g sickness. H e r d o cto r re co m m en d e d she te rm in a te th e pregnancy, bu t state officials refu sed ; she traveled to Sw ed en.5 S a ra h W ed d in gton , th e law yer w ho argued Roe, co n ten d ed th a t F ink bine “had a g reat im p a ct” b eca u se she w as a m id d le-class w om an w ho “had oth er ch ild ren she loved very m u ch , and she w as very a rticu la te ab o u t sim ply n o t

W ho Pays for What? Abortion and Sterilization, 1960—1975

w anting th is p articu la r p reg n an cy " The A m e rica n pu blic agreed: 5 2 p erce n t su p p orted her, 3 2 p e rce n t disapproved, and 16 p e rce n t had n o o p in io n .6 Se co n d , a fter fou r y ears’ w ork at th e b eh e st o f physicians co n cern e d w ith am bigu ou s a b o rtio n law s, th e A m e rica n Law In stitu te (A LI) affirm ed a b o r­ tio n w hen th e w om an’s physical or m e n ta l h ea lth w as end angered ; th e fetus w as physically or m entally d efective; or th e p reg n an cy w as th e resu lt o f rape, in cest, or o th e r felon iou s in terco u rse .7 The m e n ta l h ea lth in clu sio n w as im ­ p o rtan t: as m e d ica l ad vances elim in ated co n d itio n s d angerous to pregnant w o m en , physical h ea lth ju stific a tio n s d ecreased . P sy ch iatrists in creasin g ly reco g n ized th e im p a ct on a w om an ’s m e n ta l h ea lth if she w as fo rced to carry an u nw anted p reg n an cy to te rm .8 Third, G erm a n m easles sw ept th e n a tio n fro m 1 9 6 2 to 1 9 6 5 , p osing a 5 0 p e rce n t ch an ce o f fetal d eform ity to in fecte d w om en. M any sought ab o rtio n s. Sy m p ath etic d o cto rs in C alifo rn ia ig n ored th e law and p e rfo rm e d th e m . P a­ tric ia M ag in n is argued th a t th e se d o cto rs cam e u nd er scru tin y b eca u se th e state w as “heavily d om in ated by C a th o lic p o litic ia n s" T he in q u iry suspend ed fu rth e r ab o rtio n s, b u t in d ictm en ts raised a pu blic outcry, and m any physi­ cian s cam e to th e d efense o f th e a ccu se d .9 Fou rth , th e 1 9 6 7 E u rop ean in tro d u c tio n o f vacu u m (or su ctio n ) a sp ira ­ tio n m ad e ab o rtio n m o re a ccep ta b le to m any physicians. Earlier, th e p rim ary m eth o d w as d ilation and cu rettag e (D & C ), a b lood y p ro ced u re m any d o c­ to rs found tro u b le so m e.10 V acu u m asp iratio n d one in th e first trim e s te r was a relatively easy and p ainless p ro ced u re th a t red u ced aversion to a b o rtio n am o n g so m e d o cto rs, ju s t as v a se cto m y had earlier rep laced ca stra tio n as a m o re accep tab le m e d ica l p ractice. A s a b o rtio n d em and s in crea sed , a b o rtio n re fe rra l serv ices em erg ed to help w o m en secu re safe, a lb eit illegal, a b o rtio n s. T he N ew Y ork C lergy C o n ­ su ltatio n S erv ice on A b o rtio n (N Y C C S A ) w as establish ed in 1 9 6 7 u nd er th e lead ership o f th e R everen d H ow ard R. M ood y, p a sto r o f th e Jud son M e m o ­ rial B ap tist C h u rch in G reen w ich Village. The ch u rch a d m in istra to r at Jud ­ son, A rlen e C arm en , b e c a m e N Y C C S A d irector, m o tivated by h e r b e lie f th a t a b o rtio n laws w ere designed to keep w o m en “in th e ir place. It had n o th in g to do w ith our safety or p ro te c tio n at all." A s C a rm en conclu d ed , th e ch u rch affiliation o f N Y C C S A le n t a “c e rta in ap p eal . . . fo r th e p u blic, w h ich I ’m sure th e a u th o ritie s sh a re d " Even th e C a th o lic C h u rc h m ad e n o efforts to “do an yth in g " ab o u t th e N Y C C S A , perhaps b eca u se it w as n o t calling fo r th e legalization o f ab o rtio n . It sim ply assisted w o m en w ho “w ere going to have a b o rtio n s anyway." The N Y C C S A o p erated fro m M ay 1 9 6 7 to July 1 9 7 0 .11 Sad ja G o ld sm ith organized a clergy cou n selin g serv ice at th e S a n F ran cisco P lan n ed P aren th o o d in 1 9 6 7 , b eliev in g th a t th e clergy affiliation gave th e serv ice an “u m b rella o f re sp e c ta b ility " G o ld sm ith en co u n tere d re sista n ce

189

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fro m con serv ativ e P lan n ed P a ren th o o d b o ard m e m b ers w ho argued th a t in volvem en t w ith a b o rtio n w ould dam age fu n d -ra isin g fo r co n tra ce p tio n . W h e n she refu sed to ab an d o n th e p ro je c t, so m e bo ard m e m b ers resigned , and som e fou n d ation s w ith d rew fin a n cia l su pport, bu t th e serv ice co n tin u ed to operate. In L o s A ng eles H ugh A nw yl org anized a sim ilar group, and in C h icag o u nd ergrou nd serv ices w ere available th ro u g h “Ja n e " w ho arrang ed approxim ately eleven th o u san d a b o rtio n s. The N atio n al C lergy C o n su lta tio n S erv ice, fou nd ed in N o v em b er 1 9 6 8 , op erated affiliates in tw en ty states, in ­ volved th o u san d s o f m in iste rs, rab b is, and lay p ersons, and co u n seled over 3 0 0 ,0 0 0 w o m en by 19 7 0 . M o s t N atio n al C lergy C o n su lta tio n S e rv ice clien ts w ere m iddle class.12 L o w -in co m e and in d igen t w o m en o ften faced back -alley a b o rtio n s. W a r­ ren M . H ern, physician and sta ff m e m b er o f O E O ’s fam ily-p lan n in g program , w ro te th a t th e se w o m en suffered and so m etim es died b eca u se th e y could n o t afford safe ab o rtio n s, “o b ta in ed w ith relative ease by th e m o re affluent. . . . A d isp ro p o rtio n ate n u m b er o f th e w o m en w ho die are P u erto R ica n , b lack , M e x ica n A m erica n , o r m e m b ers o f so m e disadvantaged g ro u p " M agazines su ch as th e Christian Century, Pageant, th e Saturday Evening Post, Parents Magazine, Atlantic Monthly, Redbook, and th e New York Times Magazine ran a rticles d ecryin g th e bu ngled crim in a l a b o rtio n s to w h ich lo w -in co m e and in d igen t w om en had to re so rt b eca u se safe, a n tisep tic o p eratio n s w ere available only to th e afflu en t.13 W h ile referra l serv ices and so m e jo u rn a lists w ere co n c e rn e d w ith w o m ­ en’s h ealth and safety, p op u lation co n tro llers and fiscal con servatives pushed fo r re fo rm to m anip u late d em og rap hics and to save m oney. The hazard s o f back-alley a b o rtio n s scared m any lo w -in co m e and in d igen t w o m en in to ca r­ rying a p regn an cy to te rm , o ften resu lting in ad d ition al A F D C expend itu res. W o m e n in p overty acco u n ted fo r 6 0 p e rce n t o f w hite and 8 0 p e rce n t o f n o n ­ w hite illegitim ate b irth s. D em o g rap h ers asserted th a t w ith in eight years legal ab o rtio n s m igh t red u ce illeg itim a cy by 5 0 p e rce n t and elim in ate th e co st o f m ain tain in g d efective offspring.14 P u blic op in ion also su pported refo rm .15 Stud ies in 1 9 6 5 and 1 9 7 0 asked six id en tical qu estio n s regard ing a b o rtio n and fou nd a su b stan tial change (see tab le 7.1).16 The p e rce n t favoring a b o rtio n fo r cou ples w ho could n o t afford a child m o re th a n doubled in every group. The in c rea se w as even g reater for th o se in favor o f a b o rtio n fo r u n m arried m o th e rs and seem ed to co rresp o n d w ith m o u n tin g ille g itim a cy ra tes and A F D C co sts. In 1 9 6 5 , fo r exam ple, A F D C exp en d itu res to ta le d $1.5 b illion ; in 1 9 6 9 th e y re a ch ed $ 3 .3 billion, and 31 p e rce n t o f all ch ild ren on A F D C w ere illegitim ate. C ritics argued th a t legalized a b o rtio n w ould give th e se m ostly young m o th ers an alternativ e and save taxp ay er d ollars.17

W ho Pays for What? Abortion and Sterilization, 1960-1975

Table 7.1. Percent o f W ives W ho Approve Different Reasons for A bortion, 1 9 6 5 -1 9 7 0 Year and reason for abortion M other’s health endangered 1965 1970 Difference Pregnancy result of rape 1965 1970 Difference Probable deformity of child 1965 1970 Difference Mother unmarried 1965 1970 Difference Couple cannot afford child 1965 1970 Difference Couple do not want child 1965 1970 Difference

Total

W hite Black Non-Catholic

W hite Black Catholic

88.7 89.8 1.1

88.7 90.3 1.6

89.3 86.3 -3.0

93.4 93.0 -0.4

76.9 82.2 6.3

52.8 71.0 18.2

54.0 72.1 18.1

43.3 64.3 21.0

58.5 75.3 17.8

43.1 62.8 19.7

50.9 69.4 18.5

52.4 70.6 18.2

37.2 59.5 22.3

57.5 74.3 16.8

40.2 59.2 19.0

12.3 32.1 19.8

12.6 32.6 20.0

10.4 27.4 17.0

14.1 36.1 22.0

9.1 22.3 13.2

11.0 25.3 14.3

11.0 25.3 14.3

12.7 29.4 16.7

12.3 28.4 16.1

7.9 16.5 8.6

7.3 21.6 14.3

7.3 21.6 14.3

7.9 23.9 16.0

8.4 24.2 15.8

4.7 14.0 9.3

Source: Elise F. Jones and Charles F. Westoff, “Attitudes toward Abortion in the United States in

1970 and the Trend since 1965," in D em og rap h ic a n d S ocial Aspects o f P opulation G row th , ed. Charles F. Westoff and Robert Parke, Jr. (Washington, D.C.: Government Printing Office, 1972), 572.

B y th e late 1 9 6 0 s co st-c u ttin g a rg u m en ts, co m b in ed w ith c o n c e rn for w o m en ’s h ealth and safety, led variou s o rg an izatio n s to su p p o rt refo rm . The U n ited P resb y te ria n C h u rch , U n ita ria n -U n iv ersa list A sso c ia tio n , A L I, A m e rica n C ivil L ib e rtie s U n ion , A m e ric a n M e d ica l W o m e n ’s A sso cia tio n , N ew Y ork A cad em y o f M ed icin e , lo c a l affiliates o f PPFA , N atio n al C o u n cil o f W o m en o f th e U n ited S ta te s, and Y W C A called for liberalization . A survey o f 2 ,2 8 5 gyn eco lo g ists in N ew Y ork found th a t 8 7 p e rce n t favored a n ew law.18 The C itiz en s’ A dvisory C o u n cil on th e S tatu s o f W o m en , estab lish ed u nd er K ennedy, argued in its 1 9 6 8 re p o rt th a t th e g o v ern m en t should b e rem ov ed fro m a private d ecisio n and called fo r o u trig h t rep eal ra th er th a n re fo rm b ecau se p roposals th a t “p e rm it a b o rtio n s u nd er ce rta in circ u m sta n ces w hile p enalizing all o th ers deny th e rig h t o f a w om an to co n tro l h er ow n re p ro d u c­ tive life in light o f h e r ow n circ u m sta n ces, in tellig en ce, and c o n sc ie n c e " Yet th e re p o rt sp en t m o re tim e d iscussing o v erp op u lation and th e en v iro n m en t th a n w o m en ’s rig h t to ch o o se .19

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F em inists attem p ted to sh ift th e d iscu ssion to w om en ’s righ ts. R ed sto ck ings, fou nd ed in 1 9 6 9 , defined a b o rtio n as in teg ra l to w o m en ’s au ton om y and called fo r th e d ecisio n to b e in th e hands o f w om en, n o t d o cto rs, law yers, or co u rts.20 The N atio n al O rg a n iz a tion fo r W o m en (N O W ) called fo r “th e righ t o f w o m en to c o n tro l th e ir ow n rep ro d u ctiv e lives” and rem ov al “fro m th e p e n al co d e laws lim itin g a ccess to co n tra ce p tiv e in fo rm a tio n and de­ vices . . . and governing a b o rtio n ”21 N O W ’s attem p t to re d ire c t th e a b o rtio n m o v em en t fro m h ea lth , e c o n o m ic, and p o p u latio n co n c e rn s to individual free d o m w as n o t successful. L u cin d a Cisler, n a tio n a l co c h a ir o f N O W ’s task fo rce on ab o rtio n , ack now led g ed th a t th is line o f rea so n in g w as th e least popular. Sh e criticiz e d “th o se w ho ca u tio n us to play dow n th e w o m en ’srigh ts a rg u m e n t” b eca u se th e fem in ist p ersp ectiv e w as a “really d isturbing id ea” Sh e resen ted th a t th e grow ing p o p u larity o f a b o rtio n re fo rm stem m ed n o t fro m a w o m en ’s righ ts stand p o in t bu t fro m “im proved health, low er b irth and d eath rates, fre e r m e d ica l p ra ctice, th e sep aratio n o f ch u rch and state, hap p ier fam ilies, sexu al privacy, [and] low er w elfare ex p en d itu res”22 F em i­ n ists gained su p p ort w hen th e A m e ric a n C ollege o f O b ste tricia n s and G y­ n eco lo g ists (A C O G ) stated th a t a b o rtio n should n o t b e used “as a m eans o f p op u latio n c o n tro l” In 1 9 6 9 th e G roup fo r th e A d v an cem en t o f Psychiatry, an o rg an izatio n o f 2 8 0 p sy ch iatrists w ith a b o rtio n rig h ts activ ist L aw rence L ad er as on e o f its m a jo r rep resen tativ es, reco m m en d e d rep ea l b eca u se “a w o m an should have th e rig h t to a b o rt o r n o t, ju s t as she has th e rig h t to m arry or n o t”23 S u ch fem in ist arg u m en ts held little sway w ith legislators. F iscal c o n te n ­ tio n s on d ecrea sin g w elfare exp en d itu res w ere m u ch m o re p ersu asive to th e se overw helm ingly w hite m e n th a n any n o tio n o f w o m en ’s rep rod u ctive rights. B u rgeon in g state budgets, n o t fem in ist dem and s, w ere key to a b o rtio n reform .

Reform o f State Laws S o m e states b eg an to alter laws and look ed to leg islatio n in o th e r co u n tries. In 1 9 2 0 th e S o v iet U n io n au th o rized a b o rtio n on re q u e st during th e first trim e ste r. Japan legalized it fo r s o c io e c o n o m ic re a so n s in 1 9 4 8 . B etw een 1 9 5 6 and 1 9 5 8 C zech o slov ak ia, H ungary, Y ugoslavia, Poland, and B u lgaria legalized a b o rtio n on req u est. P op u lation co n tro llers and fisca l co n se rv a ­ tives p o in ted to th e 3 0 to 5 0 p e rce n t d eclin e in th e illeg itim acy rates in th ese n a tio n s.24 A b o rtio n re fo rm in th e U n ited S ta te s, th e y argued, cou ld bring sim ilar resu lts and th e reb y red u ce w elfare exp end itu res. O n e o f th e first states to re fo rm its law w as C aliforn ia. E ffo rts had b eg u n

W ho Pays for What? Abortion and Sterilization, 1960—1975

in th e early 1 9 6 0 s b u t failed, a cco rd in g to M a g in n is, b eca u se o f “C a th o lic C h u rch in flu en ce on le g isla tio n " In 1 9 6 2 M ag in n is fo rm ed th e S o c ie ty for H u m an e A b o rtio n , a ta x -e x e m p t ed u catio n al body, and th e A sso c ia tio n for th e R ep eal o f A b o rtio n Law s as a p arallel fo r lobby in g and o th e r p o litica l activ ities.25 The a sso cia tio n trie d to defeat a re fo rm m easu re, th e B ielen so n B ill, bu t it passed in 1 9 6 7 . It allow ed w o m en to p e titio n a c o m m ittee o f th ree to five physicians fo r an a b o rtio n , b u t ap p lican ts did n o t have th e rig h t to m e e t w ith th is co m m ittee , w h ich could g ran t a b o rtio n s fo r rap e or in c e st or grave im p airm e n t to w o m en ’s physical o r m e n ta l health. To m e e t th e m en ta l h ealth crite rio n a w om an n eed ed tw o p sy ch ia trists’ le tters, a tim e -c o n su m ­ ing and expensive m and ate. M oreover, in su ran ce com p anies o ften d eem ed su ch w o m en su icid al and ca n celed th e ir p o licies. W o m e n in te a ch in g or o th e r sensitive o ccu p a tio n s found th e ir jo b s on th e line b eca u se th e se letters en tered th e ir p e rm a n en t m e d ica l re co rd s as signs o f m e n ta l instability.26 F em in ists re sen te d su ch p a tern a lism . M an y m ale leg islato rs b elieved w o m en should have no say in “w h en th e y should b e bred and n o t b re d " The p ro ced u re to fulfill th e rape or in c e st co n d itio n stru ck m any w o m en as an “ab so lu te, shocking in s u lt" M an y legislators claim ed th a t “g irls” w ould u se th e m e n tal h ealth stip u latio n to “g et even w ith th e ir husbands." T h ere w as a “huge d istru st o f w o m en ” and co n tem p t fo r th e m am o n g th e se legislators. They “alw ays” re fe rred to w o m en as “girls,” and “fetuses w ere, ju s t as now, in co rre ctly called babies." S o m e legislators d escrib ed w o m en desiring a b o r­ tio n s as “sluts . . . irresp o n sib le . . . self-serv in g . . . and selfish.” In th e end, m ale legislators designed th e law “to keep w o m en u nd er c o n tro l” (a sta te ­ m e n t h eard rep eated ly at th e hearings) and to m ake a w om an “craw l on h er belly w ith an im m en se lum p o f ca sh in h e r hand.”27 Illin ois activ ists attem p ted to avoid th e p ro b lem s asso cia ted w ith th e C a li­ fo rn ia law by calling fo r rep eal ra th er th a n refo rm . L on n y M yers established th e Illin ois C itizen s for th e M e d ica l C o n tro l o f A b o rtio n (IC M C A ) in 1 9 6 6 as th e first state group to call fo r rep eal on ground s th a t a b o rtio n w as a p ri­ vate m a tte r b etw een a w om an and h e r d octor. This reason in g a ttra cted c o n ­ servatives as w ell as lib erals b eca u se it p laced a b o rtio n w ith in th e co n tex t o f individual free d o m and responsibility. M yers ch o se th e n am e to a ttra c t physicians, bu t th is ta c tic failed. S h e th e n sought th e su p p ort o f p rofession al m en , “th e m o st p restig io u s people.” A lth o u g h she also a ttem p ted to en list w om en, “th e re ju s t w eren ’t th a t m any prestigiou s w o m en w ho w ere w illing to co m e out fo r a b o rtio n in C hicago.” H ugh H e fn e r en d orsed IC M C A , and

Playboy did all its p rin tin g . The en d o rse m en t o f a m an and m ag azine th a t trea te d w o m en as sex o b je c ts did n o t fill th e cred ib ility gap left by physicians. B etw een 1 9 6 7 and 1 9 6 8 th e IC M C A u nsu ccessfu lly lo b b ied th e legislature

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fo r repeal. W h ile th e C o m m ittee o n P u blic W elfare su pported th e m easu re to red u ce exp en d itu res, G o v ern o r O tto K e rn er veto ed it, fearing stron g C a th o ­ lic o p p o sitio n .28 In o th e r states so m e refo rm s w ere so co m p lex th a t few w o m en could m e et th e criteria. N o rth C a ro lin a allow ed licen sed d o ctors to p e rfo rm a b o rtio n s in ho sp itals fo r life a n d /o r h ea lth en d a n g erm en t; d efo rm ed fetu s; in c e st; and rape, if re p o rte d w ith in sev en days. The law also stip u lated a fo u r-m o n th resid en cy req u irem e n t excep t in case o f em erg en cy and w ritten co n se n t from th re e d o cto rs n o t engaged in private p ra c tic e to g eth er.29 T he la tte r a sp e ct p o sed an in su rm o u n ta b le fin an cial bu rd en fo r m o st w om en. T he re strictiv e n atu re o f th is and o th e r m easu res led IC M C A to sp o n so r th e F irst N atio n al C o n fere n ce on A b o rtio n Law s in C hicag o in 1 9 6 8 , w hich led to th e fo rm a tio n o f th e N atio n al A b o rtio n R ig h ts A c tio n League (N A R A L ) in 1 9 6 9 to pursue legislative rep eal and ju d icia l change. B y 1 9 7 0 A laska, A rk ansas, D elaw are, G eo rg ia, H aw aii, K ansas, M aryland , N ew M ex ico , N ew York, O reg o n , S o u th C arolin a, V irginia, and W a sh in g to n had altered th e ir statu tes. M o st laws ad­ h ered to A L I re strictio n s, b u t legal a b o rtio n s still in crea sed fro m 5 ,0 0 0 in 1 9 6 3 to m o re th a n 2 0 0 ,0 0 0 in 1 9 7 0 .30 The m o st sig n ifican t ch an g e o cc u rre d in N ew York, w here C o n sta n ce C oo k , a R ep u b lican rep resen tativ e, led th e rep eal effort in 1 9 7 0 . S h e re je c te d re q u ire m e n ts th a t w o m en go b e fo re a d o c to rs ’ c o m m itte e and h o sp ita l co m m itte e and co n su lt w ith p sy ch iatrists. C o o k w as “b o th e re d ” th a t “th e sp eech es w ere so o u trageou s, and so m ale-orien ted ,” w ith m e n m aking “th e w hole d ecisio n as to w hat w o m en ’s lives shall b e ” S h e g ained th e su p p ort o f liberals co n ce rn e d w ith w o m en ’s rep ro d u ctiv e righ ts and con serv ativ es w ho believed rep eal w ould red u ce w elfare rolls, esp ecially A F D C . To ensure enou gh v otes, C o o k co m p rom ised , stipu lating th a t a b o rtio n s b e p erfo rm ed by a d o cto r w ith in th e first tw en ty -fo u r w eeks. N ew Y ork h ea lth law already req u ired th a t d o ctors ca rry out th e p roced u re; she back ed dow n “relu cta n tly ” on th e tim e lim it b u t did n o t b elieve she “sacrificed th e b a sic principle.” C oo k refu sed am e n d m e n ts m an d atin g v eto p ow er fo r th e hu sband and p a re n ­ ta l co n se n t fo r m in o rs. G roups w orking fo r th e b ill’s passage inclu d ed th e N ew Y ork b ra n c h o f N O W , N Y C C S A , N A R A L (a group C o o k co n sid ered “rad ical”), and th e A sso cia tio n fo r th e Study o f A b o rtio n , a group form ed by d o cto rs tire d o f “playing G o d ” w hen d eterm in in g if a w om an qualified fo r a th e ra p e u tic ab o rtio n . N ew Y ork ’s A M A did n o t en d orse rep eal b eca u se m any o f its m e m b ers w ere C a th o lic; and, acco rd in g to C oo k , d o ctors feared th a t a b o rtio n s w ould “h u rt th e p ro fessio n e c o n o m ica lly ” by red u cin g p ed ia tric care. P lan n ed P a ren th o o d affiliates in Sy racu se, N ew Y ork City, and e lse ­ w here en d o rsed th e C o o k B ill, bu t PPFA to o k n o stand b e c a u se it feared loss o f its ta x -e x e m p t status if p olitically involved. This c o n c e rn did n o t d is­

W ho Pays for What? Abortion and Sterilization, 1960—1975

suade th e C ath o lic C hu rch . The b ill ca rried by a single vote, su rprising ev­ eryon e bu t C oo k . First, she had dow nplayed fem in ism so as n o t to alienate m ale p o litician s. S e co n d , as C o o k recalled , th e re w as “a w hole group . . . w ho th o u g h t th is w ould b e a g oo d way to cu t w elfare.” Third, as A lan G u ttm a ch er rem arked , th e law passed due “to m o u n tin g co n c e rn ab o u t U .S. p o p u lation grow th and p o llu tio n ”31 The n ew law w as th e m o st lib era l p o licy passed by 1 9 7 0 . N ew Y ork left th e d ecisio n to th e p atien t and h e r doctor. It req u ired n o resid ency, n o p a ­ re n tal p erm issio n fo r te en a g ers, no co n su ltation s w ith o th er d o cto rs, and no ju stifica tio n o f th e proced u re. In th e first six m o n th s 6 9 ,0 0 0 a b o rtio n s w ere p erfo rm ed in N ew Y ork C ity alone: 4 5 p e rce n t o f clien ts w ere city resid en ts, 4 p e rce n t w ere fro m o th e r parts o f th e state, and 4 9 p e rce n t w ere o u t-o f-sta te resid en ts. W ith in th e first year, acco rd in g to d ep artm en t o f h ea lth sta tistics, 181,821 legal a b o rtio n s o ccu rred in N ew Y ork C ity — a figure th a t su rpassed th e ex p e ctatio n s o f re fo rm p ro p o n e n ts.32 The im p act w as clear. B irth ra te s d eclined , and illeg itim ate b irth s dropped fo r th e first tim e sin ce 1 9 5 4 . T een ag ers a cco u n ted fo r 13.8 p e rce n t o f live b irth s b u t 16 p e rce n t o f a b o rtio n s; o f th e se, 3 3 p e rce n t w ere girls sev en teen years old o r younger. “A ll” shelters in N ew Y ork C ity th a t cared for u n m ar­ ried p regn an t girls rep o rted a “sharp d eclin e” in a p p lica n ts.33 This ab atem en t suggests th a t legal a b o rtio n s did n o t m erely rep lace u nd ergrou nd op eratio n s; rather, teen ag ers te rm in a ted p reg n an cies th a t w ould oth erw ise have resulted in birth s. A s R ep resen tativ e Sh irley C h ish o lm (D -N Y ) n oted , N ew Y ork p o l­ icy b efo re 1 9 7 0 , in ten tio n ally or n o t, served “to m a x im iz e ille g itim a cy ”; th e n ew law w ould help alleviate th e p ro b lem o f illeg itim ate ch ild ren , w ho w ere usually “th e m o st u nw anted o f th e u nw an ted ”34 It also red u ced th e fertility rate o f in d igen t w om en. W o m e n difficult to re a ch w ith co n tracep tiv es w ere likely to re so rt to legal ab o rtio n . B etw een 1 July 1 9 7 0 and 31 M a rc h 1971 w ard p atien ts a cco u n ted fo r 4 6 p e rce n t o f live b irth s b u t 5 5 p e rce n t o f a b o rtio n s. In ad d ition to h o sp ita l serv ices, C a rm en and M o o d y estab lish ed th e n o n ­ profit C en te r for R ep rod u ctive and Sexu al H ealth in N ew Y ork C ity in 1 9 7 0 to offer lo w -co st a b o rtio n services. The ce n te r charged only $ 2 5 fo r an a b o rtio n and set aside 2 5 p e rce n t o f a b o rtio n s fo r ind igent w om en. F ifteen m o n th s o f legalized a b o rtio n b rou gh t a 7 .5 p e rce n t d ecline in o u t-o f-w ed lo ck b irth s and cu t th e m atern al d eath rate in N ew Y ork C ity by m o re th a n h a lf to tw o deaths fo r every te n th o u san d live b irth s, th e low est rate in city histo ry .35 B la ck w o m en co m p rise d a sizable p e rce n ta g e o f w o m en seek in g a b o r­ tio n s. N onw hites w ere m o re likely th a n w h ites to a b o rt w h en th e o p eratio n w as legal. N onw hite resid en ts o f N ew Y ork City, fo r exam ple, a cco u n ted for 3 2 p e rce n t o f live b irth s b etw een 1 July 1 9 7 0 and 31 M a rch 1971 b u t 4 2 p er­ cen t o f ab o rtio n s (see ta b le 7 .2 ). In a follow -up study b la ck w o m en acco u n ted

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Table 7.2. Characteristics of W om en Having A bortions, New York City, 1 9 7 0 -1 9 7 1 Characteristics

Legal abortions per 1,000 live births

Poor Nonwhite First births Age nineteen or less White

775 594 590 527 422

Source : Jean Pakter and Frieda Nelson, “Abortion in New York City: The First Nine Months,” Fam ily P lan n in g Perspectives 3 (July 1971): 1-15.

fo r 4 7 .6 p e rce n t o f a b o rtio n s versus 3 9 p e rce n t fo r w hite w om en, althou g h m o re th a n tw ice as m any w hite w o m en lived in N ew Y ork C ity.36 This high in cid e n ce o f a b o rtio n am o n g b lack w o m en renew ed g en o cid e arg u m en ts o f m ilita n t b la ck m ales. C a rm e n co n firm ed th a t so m e w hite elites d onated m o n ey “fo r all th e w rong re a s o n s " b u t th is goal did n o t re flect clin ic sta ff attitu d es, and b la ck w o m en realized th e d ifference.37 M an y b lack w o m en argued th a t illegal, n o t legal, a b o rtio n s w ere ta n ta m o u n t to g enocide. F ran ces B e a l asserted th a t “rigid laws co n c ern in g a b o rtio n s” w ere a m eans o f “ou trig h t murder,” b eca u se 8 0 p e rce n t o f a b o rtio n deaths in N ew Y ork C ity during th e 1 9 6 0 s w ere am o n g b la ck and P u erto R ica n w om en. E d itor R en ee Fergu son o f th e Washington Post co n ten d ed th a t th e N ew Y ork law w ould have a “positive effect on h altin g th e h ereto fo re grow ing ra te o f N ew York h o sp ital em erg en cy cases o f b la ck and o th e r m in o rity -g ro u p w o m en ” w ho self-in d u ced a b o rtio n s.38 Sh irley C h ish o lm w orked actively fo r th e rep eal o f rem ain ing laws fo r th e sam e reason s. S h e argued th a t 4 9 p e rce n t o f pregnant b lack and 6 5 p e rce n t o f p regn an t P u e rto R ica n deaths resu lted fro m crim in a l ab o rtio n s. Sh e co n clu d ed th a t “to lab el fam ily p lanning and legal a b o rtio n p rogram s ‘g en o cid e’ is m ale rh e to ric , fo r m ale ears. It falls flat to fem ale lis­ te n ers and to th o u g h tfu l m ale o n e s " 39 G en o cid e arg u m en ts did n o t stem th e flow o f w o m en seeking a b o rtio n s. In fa ct, a b o rtio n o n d em and gained w ide su pport. T he W o m en ’s N atio n al A b o rtio n C o alitio n su p p orted a b o rtio n as a civil rig h t; 2 ,5 0 0 d em o n strato rs, m o stly w om en, m a rch ed in W a sh in g to n , D .C ., to d em and rep eal o f re s tric ­ tive law s.40 In Ju n e 1 9 7 0 th e A M A H ou se o f D eleg ates voted 103 to 7 3 to a l­ low d o cto rs to p e rfo rm a b o rtio n s fo r so cia l and e c o n o m ic as w ell as m ed ical reason s as long as th e d o c to r w as licen sed , th e a b o rtio n w as p erfo rm ed in an accred ited hosp ital, and tw o o th e r d o cto rs w ere con su lted . In resp o n se, Dr. G in o Papola o f Pennsylvania, p resid en t o f th e 6 ,0 0 0 -m e m b e r N ation al Fed eratio n o f C a th o lic Physicians G uild, resig n ed fro m th e A M A and urged th e 3 5 ,0 0 0 C ath o lic d o cto rs to do th e sam e.41 D esp ite C a th o lic o p p osition , m o st d o cto rs favored a lib eralized policy. The A C O G called fo r a b o rtio n to

W ho Pays for What? Abortion and Sterilization, 1960—1975

b e left to th e w o m an and h e r doctor. In ad d ition, clo se to tw o hund red d o c­ to rs and m e d ica l p ro fesso rs w ro te a frien d o f th e co u rt b rie f to th e Su p rem e C o u rt in A ugust 1971 claim in g th a t a b o rtio n re strictio n s w ere u n c o n stitu ­ tio n ally in terferin g w ith th e ir rig h t to p ra c tice m e d icin e; th e se co n stra in ts led to “a n ti-s o c ia l” resu lts, su ch as u nw anted ch ild ren and d angerous illegal a b o rtio n s.42 P u b lic op in io n also favored refo rm . In a 1 9 6 5 p o ll 91 p e rce n t opp osed lib eralized p o licies, bu t a 1971 survey co n d u cted by N ixo n ’s C o m m issio n on P op ulation G ro w th and th e A m e rica n Future found th a t 5 0 p e rce n t believed th e d ecisio n should b e left to th e w om an and h e r d octor, 41 p e rce n t claim ed a b o rtio n should be p erm issib le in ce rta in circu m sta n ce, 6 p e rce n t stated it w as u n acce p tab le u n d er any co n d itio n s, and 3 p e rce n t had n o op in ion . A fu rth e r breakd ow n fou nd th a t 3 3 p e rce n t o f black s bu t 51 p e rce n t o f w hites approved o f lib eralized p o licies; 4 5 p e rce n t o f w o m en b u t 53 p e rce n t o f m en approved; 4 5 p e rce n t o f th o se over age th irty bu t 5 8 p e rce n t o f th o se u nd er age th irty approved; and 3 9 p e rce n t o f C a th o lics, 4 8 p e rce n t o f P ro te sta n ts, and 91 p e rce n t o f Jew s approved o f reform . A seco n d q u estio n asked if a b o r­ tio n w as accep tab le fo r p aren ts w ho had all th e ch ild ren th e y d esired or could afford: 4 9 p e rce n t approved, 4 2 p e rce n t disapproved, and 9 p e rce n t had no opinion. A n o th e r survey by th e A m e rica n C o u n cil on E d u cation found th a t 8 3 p e rce n t o f first-y ear college stu d ents favored legalized a b o rtio n .43 In early 1 9 7 2 th re e in flu en tial groups added th e ir su pport. First, th e A BA ’s 3 0 7 -m e m b e r H ou se o f D elegates approved a statu te p erm ittin g a b o rtio n s “on d em an d ” during th e first tw en ty w eeks. B ey o n d tw enty w eeks, th e A B A ap­ proved if th e m o th e r’s m e n ta l o r physical h ea lth w as th rea ten ed , if th e fetus w as gravely d eform ed , o r if th e p reg n an cy resu lted fro m rape o r in cest. O nly th irty m e m b ers d issented in th is trad itio n ally con serv ativ e body. T he liberal to n e o f th e ir statu te w as startling : o f laws in effect at th a t tim e, only N ew Y ork’s w as m o re perm issive. Perhaps th e ir stand derived less fro m a liberal b e lie f in w o m en ’s righ ts th a n fro m a conservative, elite c o n c e rn w ith p op u la­ tio n co m p o sitio n , g o v ern m en t exp en d itu res, and g o v ern m en t in terv en tio n in private a n d /o r m e d ica l m atters. S e co n d , th e U N ’s p o p u lation division r e ­ p o rted th a t a b o rtio n “m ay b e th e single m o st w idely used m eth o d o f b irth co n tro l in th e w orld ” and th a t d eath rates am o n g w o m en u nd ergoing legal a b o rtio n s w ere “very low.” Third, N ixo n ’s C om m ission on P op u lation G ro w th and th e A m e rica n Future, w ith Jo h n D. R o ck e fe ller III as chair, m ad e pu blic co n clu sio n s reach ed a fter a tw o -y ea r in v estig atio n o f p op u latio n policy: th e m ajo rity o f th e co m m issio n believed a b o rtio n should b e left to th e w om an and h e r d octor. The co m m issio n called fo r laws “creatin g a clea r and positive fram ew o rk fo r th e p ra ctice o f a b o rtio n on request,” reco m m en d e d g ov ern ­ m e n t fund ing fo r it am o n g th e ind igent, and urged h ea lth in su ran ce co m p a ­

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n ies to cover its co sts. The co m m issio n also a sserted th a t co n tracep tiv es and sex ed u catio n should b e available to m in o rs and th a t state laws im p ed ing full access to th e se serv ices should b e re fo rm e d .44

Abortion and the Federal Government D esp ite N ixo n ’s stron g su p p ort o f co n tracep tiv es for p op u latio n c o n tro l and w elfare savings, h e refu sed to en d o rse ab o rtio n . M in d fu l o f C a th o lic voters, he argued th a t “n o th in g should b e d one on th e Fed eral level”; he preferred a b o rtio n laws “b e con sid ered by ea ch S tate, and . . . a cted u p on by ea ch S ta te depend ing u p on th e op in io n in th a t S ta te ”45 N everth eless, th e early 1 9 7 0 s saw n u m ero u s bills in tro d u ced to C on g ress. S e n a to r R o b e rt P ack w ood (RO R ) sp o n so red S 3 5 0 1 , a b ill to lib eralize a b o rtio n s in th e D is tric t o f C o ­ lu m bia, in Febru ary 1 9 7 0 to serve as “an exam ple to th e re st o f th e co u n try as to w hat th e S ta te s should p a ss” B e c a u se overp op u lation w as th e “m o st im p o rta n t p ro b lem ” facing th e n atio n , he su p p orted a p o licy to “co n tro l, re ­ strain, and plan th e p op u latio n in th is co u n try ” H e also in tro d u ced S 3 5 0 2 to provide ta x in cen tiv es for fam ily lim itatio n : a ta x d ed u ctio n o f $ 1 ,0 0 0 fo r th e first child, $ 7 5 0 fo r th e seco n d , $ 5 0 0 fo r th e third , and n o n e for su b seq u en t child ren. N e ith er p ro p o sal receiv ed m u ch a tten tio n .46 The follow ing year, on 31 July 1 9 7 0 , an ad m in istrativ e m em oran d u m al­ low ed physicians at m ilita ry h osp itals to p erfo rm a b o rtio n s at g ov ern m en t expense. This p o licy m ay have b e e n c o n n e c te d to ch e m ic a l w arfare in th e V ietn am W ar. In 1961 th e m ilita ry lau n ch ed O p era tio n H ades (later ren am ed O p e ra tio n R a n ch H and ), p o ison in g and d efoliating S o u th e a st A sia fo r at least te n years. By 1 9 7 0 th e U n ited S ta tes had d estroyed m o re th a n 5 m illion acres in S o u th V ietn a m by spraying n early 2 3 m illio n gallons o f d efoliants. The U n ited Sta te s assu red S o u th V ietn am th a t th is spraying w as h arm less to an im als and hu m ans, y et n o t u ntil 1 9 6 6 did th e N atio n al In stitu tes o f H ealth study th e im p act on p reg n an t anim als. R esu lts show ed th a t a p reg n an t V iet­ n am ese w o m an w ho d rank w ater fro m a sprayed area had a 9 0 p e rce n t rate o f fetal m alfo rm a tio n .47 In Ju n e 1 9 6 8 S o u th V ietn am ese new spap ers rep o rted a “rem arkab le ris e ” in d eform ed b abies as a resu lt o f A m e rica n d efoliation. In D e ce m b e r an A m e rica n C -1 2 3 w ith eng ine tro u b le je ttiso n e d a th o u san d gallons o f d efoliant on Tanhiep, tw en ty m iles n o rth o f Saigon; th e village la ter re p o rte d m alfo rm ed in fa n ts.48 B y F ebru ary 1 9 6 9 officials k new th a t A g ent O ran ge (2 ,4 ,5 -T ) cau sed feta l d eform ity: it w as 1 0 0 ,0 0 0 tim es m o re p o ten t th a n th alid o m id e as a cau se o f b irth d efects. Yet n o g ov ern m en t ag en cy safe­ guarded A m e ric a n serv icem e n or V ietn a m ese civilians. T hat su m m er, law stu d ents affiliated w ith co n su m er ad vocate R alp h N ad er investigating th e FD A d iscovered a re p o rt th a t fou nd th a t “all dosages, ro u tes, and strains”

W ho Pays for What? Abortion and Sterilization, 1960—1975

o f A gent O ran g e resu lted in a th reefo ld in c rea se in a b n o rm a l fetu ses and an alm ost 8 0 p e rce n t feta l m o rta lity rate. The study w as u nable to ach ieve a “n o -e ffe c t” level— every dosage level p rod u ced d eform ed fetu ses.49 O n 2 9 O c to b e r 1 9 6 9 Dr. L ee D u B rid g e, N ixo n ’s sc ie n c e advisor, a n ­ n o u n ced th a t th e g o v ern m en t w ould re s tric t th e u se o f 2 ,4 ,5 -T in d o m es­ tic food crop s and m ilita ry o p eratio n s. W h ite H ou se officials w ould give no fu rth e r in fo rm a tio n b eca u se th e g ov ern m en t did n o t w an t “w ild sp e cu la ­ tio n ” sim ilar to th a t over th e b irth co n tro l pill, w h ich had “cau sed m illion s o f w o m en to get h y sterical w ith w orry” The follow ing day, how ever, th e P en ­ ta g o n a n n o u n ced th a t m ilita ry use o f 2 ,4 ,5 -T in V ietn a m w ould co n tin u e and refu sed to acknow led ge th a t it cau sed feta l d eform ities. C on tin u ed use o p en ed th e U n ited S ta tes to charges o f “callou s disregard fo r in n o c e n t h u ­ m an life” and w ar crim e s involving g en etic dam age to A m e ric a n G Is and V ietn am ese civilians. B y late 1 9 6 9 b o th W H O and th e U N G en e ra l A ssem bly co n d em n ed A m e rica n u se o f ch em ica ls in V ietnam . N o t u n til 15 A pril 1 9 7 0 did th e deputy s e c re ta ry o f d efense b an A g ent O ran g e use in V ietn am . By th a t p o in t th e m ilita ry had sprayed forty m illio n pounds o f it th ere. T he off­ spring o f A m e rica n s involved in O p era tio n R a n ch H and as w ell as G Is o n th e ground displayed b irth d efects and g en etic dam age.50 K now ledge o f feta l a b n o rm a lities presum ably in flu en ced th e d ecisio n to allow and subsidize a b o rtio n s at m ilitary hospitals. In S a n A n ton io , Texas, th e W ilford H all A ir F orce M ed ica l C en te r p erfo rm ed 135 a b o rtio n s o n service w ives w ith in a fo u r-m o n th p erio d .51 This tren d stirred a b o rtio n o p p o n en ts in C on gress. In O c to b e r R ep resen tativ e Jo h n G. S c h m itz (R -C A ), fo rm er n a ­ tio n a l d ire cto r o f th e Jo h n B irc h So ciety , u n su ccessfu lly in tro d u ced a b ill to reverse th e July p olicy.52 S o m e d o cto rs on b ases refu sed to p e rfo rm th e o p er­ ation. The P en tag o n stipu lated th a t in su ch situ atio n s th e serv icem e n ’s wives could go to a civilian h o sp ita l w ith g o v ern m en t fund s as long as a b o rtio n was legal in th a t state.53 This stan ce outraged S ch m itz , w ho told C on g ress th a t th e “Fed eral G o v ern m e n t should n o t b e in th e fo refro n t o f th e baby elim in atio n m o v em e n t” H e in tro d u ced H R 4 2 5 7 to req u ire m ilita ry hosp itals to abide by state laws in w h ich th e y w ere lo cated , bu t again C on g ress to o k n o a ctio n .54 The co n tro v ersy spilled in to th e 1 9 7 2 p resid en tia l race. In M a rc h 1971 S e n a to r Ed m und M u sk ie, th e leading D e m o c ra tic cand id ate and a C a th o lic, co n ten d ed th a t a b o rtio n w ith in th e first six w eeks o f p reg n an cy w as a cc ep t­ able bu t “beyond th a t p oin t” p osed a m o ra l d ilem m a b eca u se he believed th e fetu s had “quickened.” D esp ite his su p p ort fo r fam ily p lanning , he opposed a b o rtio n as a rem ed y to red u ce w elfare.55 Paul N. M cC losk ey , Jr. (R -C A ), a R ep u b lican challenger, a sserted th a t th e “rig h ts o f a w om an to d eterm in e w h eth er she b ears a ch ild ” d eserved a “h eavier w eight in th e scales o f ju stic e in 1971 th a n th e rig h ts o f th e fetu s to life”56 H is stand co n flicted w ith th e

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m ajo rity o f his fellow R ep u b lican s, esp ecially N ixon. In A pril N ixo n brok e his silen ce, m ain ta in ed sin ce his 1 9 6 8 cam paign. H e re itera ted th a t th e is­ sue w as fo r th e states, n o t th e fed eral g ov ern m en t. “P artly fo r th a t re a so n " he stated , “I have d irected th a t th e p o licy on a b o rtio n s at A m e rica n m ilitary b ases in th e U n ited S ta tes b e m ad e to co rresp o n d w ith th e laws o f th e States w here th o se bases are lo c a te d "57 W ith m o st bases in states w here a b o rtio n w as illegal, N ixo n ’s d irective su bstantially low ered a b o rtio n a ccess fo r m ili­ ta ry w om en. B ella A bzug (D -N Y ) criticiz ed N ixo n fo r invoking sta tes’ rights w h en th e arm ed fo rces had n o ch o ice in th e ir m ilitary a ssig n m e n ts.58 N ixo n to o k th is o p p o rtu n ity to p resen t h is view s. H e stated th a t “fro m p e rso n al and religiou s b eliefs I co n sid er a b o rtio n a n u n a cce p ta b le fo rm o f p op u latio n co n tro l" M oreover, he claim ed th a t “u n re stric te d a b o rtio n p o l­ icie s, or a b o rtio n on dem and, I ca n n o t squ are w ith m y p e rso n a l b e lie f in th e san ctity o f hu m an lif e - in c lu d in g th e life o f th e y et u nb orn . . . . A good and g en erou s p eop le w ill n o t opt, in m y view, fo r th is kind o f alternativ e to its so cial d ilem m as. R ather, it w ill o p en its h ea rts and h o m es to th e u n ­ w anted ch ild ren o f its ow n, as it h as d one fo r th e u nw anted m illions o f o th e r la n d s"59 C ritics p o in ted out th a t N ixo n ’s a b o rtio n view co n flicted w ith th e d o ctrin e o f h is fam ily ’s ch u rch , th e A m e ric a n F riends S e rv ic e C o m m ittee , w h ich stated th a t “n o w om an should b e forced to b e a r an u nw anted child" and th a t “ab o rtio n , p erfo rm ed u nd er p ro p er co n d itio n s, is p referable to th e b irth o f an u nw anted ch ild "60 H is S o u th ea st A sia p o licies also clash ed w ith Q u ak er p acifism and th e “sa n ctity o f h u m an life " N ixo n to o k n o a c tio n to aid th e te n to fifte en th o u san d ch ild ren fath ered by A m e rica n serv icem en in S o u th V ietn am : th e g ov ern m en t had “n o a u th o rity ” over o r “re sp o n sib ility ” to ch ild ren fath ered by G Is. S e rv ic em e n attem p tin g to b rin g th e ir offspring in to th e U n ited S ta tes en co u n tered n u m ero u s o b sta cles, n o t th e “o p en h ea rts and h o m es" to w h ich N ixo n re fe rred .61 E d itorials p roliferated in re a ctio n to N ixo n ’s sp eech. Dr. E. Jam es L ieb erm an o f th e N atio n al In stitu te o f M en ta l H ea lth qu estio n ed N ixo n ’s “selective re v eren ce fo r life": “B y tig h ten in g th e m ilita ry h o sp ital a b o rtio n p o licy w hile so ften in g th e M ylai c o u rt-m a rtia l v erd ict, th e P resid en t appears m o re c o n ­ cern ed w ith th e survival o f th e u nw anted fetu s th a n w ith th e m u rd er o f th o se u nlucky fam ilies w ho had to face L ie u ten a n t C alley ’s g u n s "62 A le tte r to th e

New York Times argued th a t if N ix o n w ould “g en eralize his deep p erso n al co n v ictio n ‘on th e sa n ctity o f h u m an life’ bey on d th e a b o rtio n issue to one o f universal life and limb," th e n h e w ould o rd er a w ithdraw al fro m V ietn am and brin g th e “sen seless carn ag e" to an end .63 A New York Times ed ito rial co n cu rred : “Issu es affectin g th e ‘san ctity o f h u m an life’ are fa r m o re involved in th e V ietn am w ar th a n th e y are in th e rem ov al o f legal ob stacles to ab o rtio n " 64 N A R A L claim ed th a t N ixon “seem ed m o re co n c ern e d w ith th e sur­

W ho Pays for What? Abortion and Sterilization, 1960—1975

vival o f th e u nw anted fetu s th a n w ith th e h ea rtb rea k in g w aste o f A m e rica n and V ietn am ese lives in S o u th ea st A s ia "65 N ixo n also drew critic ism fo r in te rje c tin g h is p erso n a l o p in io n in to th e p u blic arena. S o m e accu sed h im o f playing p o litics by end orsing th e “C a th o ­ lic p o sitio n ” w hen th e Su p rem e C o u rt and state legislators w ere d ecid ing w h eth er th e state had ju ris d ic tio n over a p reg n an t w o m an ’s bod y and h er p h ysician ’s p ro fessio n a l ju d g m e n t.66 The New York Times argued th a t any fed eral o r state a ctio n s to m ake N ixo n ’s p erso n al view s “th e basis fo r pu blic p o licy w ould b e b o th cru el and regressive.” The ed itors also critiq u ed N ixo n ’s claim s regard ing u nw anted child ren: “A sto n ish in g , ind eed , is th e P resid en t’s a sse rtio n th a t A m e ric a ‘w ill o p en its h ea rts and h o m e s’ to th e se unw anted child ren. H e, m o re th a n m o st, has re a so n to b e aw are th a t th e nationw id e con serv ativ e rev olt ag ainst th e co st o f w elfare is cen tered o n th e te n s o f th o u ­ sands o f ch ild ren b o rn o u t o f w ed lock in w elfare hom es.” They con clu d ed th a t “to deny m o th e rs in th e se h o m es th e sam e free d o m o f ch o ice as w ealth ­ ie r w om en . . . is an a c t o f in h u m an ity and so cia l irresp o n sib ility "67 This perceived th re a t to re fo rm ig n ited in crea sed activism . S e n a to r Packw ood in tro d u ced a b ill in M ay 1971 th a t au th o rized a b o rtio n s in th e first tw en ty w eeks if p erfo rm ed by licen sed physicians and a fte r th a t tim e if c o n ­ tin u in g th e p reg n a n cy end ang ered th e w om an’s h ea lth .68 In July 1971 A bzug in tro d u ced a b ill to provide co n siste n t quality m e d ica l care, inclu d ing a b o r­ tio n , to all m ilitary w o m en regard less o f th e state in w h ich th e y resid ed .69 The follow ing M ay A bzug in tro d u ced th e A b o rtio n R ig h ts A c t o f 1 9 7 2 . It w ould “finally and com p letely affirm th e rig h t o f every A m e rica n w om an to ch o o se w h eth er o r n o t she w ill b e th e m o th e r o f a ch ild " A bzug argued th a t re s tric ­ tive po licies d iscrim in ated ag ainst th e ind igent, w ho “m o st o ften ” exp erien ced th e “p ro b lem o f u nw anted ch ild re n " Th ese w o m en had “b e e n com p elled to b e a r th e ir u nw anted ch ild ren and to su b je ct th e m to th e deprived en v iro n ­ m e n t o f p o v erty "70 The W o m en ’s N atio n al A b o rtio n A c tio n C oalitio n , N O W , and Z e ro P op u lation G ro w th p ro m o ted th is a ct. O n ce again, how ever, th e b ill receiv ed little atten tio n . Dr. G eo rg e S. W alter, an ad vocate o f A bzu g ’s bill, claim ed th a t re sista n ce to legalized a b o rtio n w as a hold over o f m ale d esire to d om in ate w om en: “The p reg n an t w om an sym bolized p ro o f o f m ale potency, and if th e m ale lo o se n s his ru le over w o m en and g ran ts th e m th e rig h t to d ispose o f th a t p ro o f w h en they w ant to , th e m e n th e n feel te rrib ly th rea ten ed lest th e w om an can , at will, ro b th e m o f th e ir p o te n cy and m a scu lin ity "71 T h ree days afte r A bzug in tro d u ced h er bill, N ixo n reiterated his aversion to liberalized p olicies. E xp ressing gratitu de to his co m m issio n fo r th e ir popu ­ latio n study, h e repud iated th e ir p rim ary re co m m en d a tio n s: “I w ant to re a f­ firm and reem p h asize th a t I do n o t su p p ort u n restric te d a b o rtio n p o licies" and “u n restricte d d istrib u tio n o f fam ily p lanning serv ices and d evices to m i­

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nors.”72 R u m ors circu lated th a t N ixo n ’s co n c e rn over th e p op u latio n p ro b lem w as supplanted by his fa n a tica l drive to w in re e le c tio n — a goal he b elieved he could ach ieve by appealing to so u th ern con servatives and C a th o lics. W h ite H ou se C h ie f o f S ta ff H. R. H ald em an reca lled N ixo n arguing in fall 1971 th a t “th e p lace fo r us is n o t w ith th e Jew s and th e N eg ro es, bu t w ith th e w hite eth n ics and th a t w e have to go a fte r th e C a th o lic th in g ”73 N ixo n w alked a fine line b etw een paying lip serv ice to th e p op u lation m o v em en t back ed by b u si­ n ess elites, w h ich p ro m o ted b o th co n tra ce p tio n and a b o rtio n , and opposing a b o rtio n and te e n a ccess to co n tra cep tiv e in fo rm a tio n to w oo th e C ath o lic C hu rch. B y 1 9 7 2 a b o rtio n w as a p o litica l football. The N atio n al W o m e n ’s P olitical C aucu s u n su ccessfu lly trie d to p lace a b o rtio n on th e R ep u b lican platform . D e m o c ra tic p re sid e n tia l h o p efu l G eo rg e M c G o v e rn p erso n ally opp osed ab o rtio n , w hile th e cau cu s w anted an a b o rtio n righ ts p lan k in th e platform . G lo ria S te in e m offered a m o d ified re so lu tio n th a t p ro h ib ited g ov ern m en t “in terferen ce in th e sexu al and rep ro d u ctiv e free d o m o f th e A m e ric a n c iti­ z en ” Sh irley M acL a in e, a ctress and liaiso n b etw een M cG o v e rn and w o m en ’s groups, o m itted it b eca u se she believed it u nd erm in ed M c G o v e rn ’s ch an ces. S tein em reviled G ary H art, M cG o v e rn ’s cam p aig n m anag er: “You p ro m ised us you w ouldn’t tak e th e low road, you b a sta rd s”74 W ith a b o rtio n re je c te d by b o th p o litical p arties, so m e fem in ists feared a rep eal o f righ ts already w on in so m e states.

The Supreme Court Legalizes Abortion O n 2 2 Jan u ary 1 9 7 3 th e Su p rem e C o u rt hand ed dow n its d ecisio n in Roe v.

Wade, 410 U.S. 113 (1 973). A tto rn ey S a ra h W ed d in g ton had m e t Jane R oe, an u n m arried p regn an t high sc h o o l d rop ou t, th ro u g h h e r law sch o o l frien d L ind a Coffey. R oe, w ho lived in T exas, had challenged h er sta te’s law p ro h ib ­ itin g ab o rtio n s. In 1 9 7 0 th e case ca m e b efo re a fed eral co u rt in D allas, w hich d eclared th e a b o rtio n sta tu te u n c o n stitu tio n a l b e c a u se it d enied w o m en th e ir N in th A m en d m en t right to d ecid e w hen and if to p ro crea te. T he co u rt failed to in terd ict th e d istrict a tto rn ey fro m in d ictin g p hy sicians, assu m ing th e state w ould com p ly w ith th e co u rt’s d ecision. D is tric t A tto rn ey H en ry W ad e, how ever, a n n o u n ced he w ould pursue su ch p ro se cu tio n s, giving W e d ­ d in gton and C offey th e basis fo r an appeal to th e S u p rem e C o u rt.75 W ith approxim ately tw enty -five a b o rtio n cases p ending, th e C o u rt ch o se th e Texas and G eo rg ia (Doe v. Bolton, 4 1 0 U .S. 179 [1973]) ca ses, p lanning to disp ose o f th e m in on e h earin g. W ed d in g ton argued h er case tw ice, first on 31 D e ce m b e r 1971, b u t th e re tirem e n ts o f Jo h n H arlan and H ugo B la ck left th e C o u rt “h esita n t o n su ch a key kind o f ca se to d ecid e it w ith only seven

W ho Pays for What? Abortion and Sterilization, 1960—1975

ju d g e s" Sh e reargu ed in 1 9 7 2 a fte r N ixo n had ap p oin ted L ew is Pow ell and W illiam R eh n q u ist, m e n he believed w ould r e je c t a lib eralized fed eral a b o r­ tio n policy. W ed d in g to n co n ten d ed th a t th e re a l ju stific a tio n fo r th e delay w as N ixon ’s re e le ctio n co n cern s: “Burger, bein g a N ixo n ap p o in tee, th o u g h t th a t it w ould b e very em b arrassin g to th e P resid en t fo r th e N ixo n co u rt to co m e out w ith a d ecisio n in favor o f th e right to ch o o se during th e tim e he w as cam p aig n in g " Ju stice H arry B la ck m u n ’s n o tes co n firm a sim ilar su spi­ cion. The C o u rt a n n o u n ced its d ecisio n o n th e first M on d ay a fte r N ixo n was inau gu rated to his seco n d te rm .76 In Roe, B lack m u n , also a N ixo n ap p ointee, w ro te th e critica l op in io n estab lish in g w o m en ’s right to ch o o se bu t n o t m a n ­ dating access to a b o rtio n . Doe a sserted th a t th e state ca n n o t in terfere w ith th e exercise o f a w om an’s right by p ro h ib itin g or lim itin g a ccess to ab o rtio n . Follow ing Roe and Doe, state laws allow ed w o m en to p ro cu re a b o rtio n s w ith ­ out th ird -p a rty in terferen ce. W o m e n ’s sovereig nty over a b o rtio n w as n o t absolu te. B la ck m u n placed th e p ow er in th e first trim e s te r in th e “m e d ica l ju d g m en t o f th e p reg n an t w om an’s atten d in g p h y sician " The C o u rt lim ited a b o rtio n in th e seco n d and th ird trim e ste rs, allow ing for state in tere st in p ro m o tin g w o m en ’s h ea lth and fo r “ap p rop riate m e d ica l jud gm ent." In sum , a b o rtio n w as, “prim arily, a m e d ­ ical decision."77 W h ile privacy w as im p o rta n t, m e d ica l sovereignty w as key. M an y ph ysician s tra n sfo rm e d th is sovereig nty in to profit. C a rm en argued th a t, follow ing Roe, “cu tth ro a t co m p etitio n " em erg ed am o n g d o cto rs “out to m ake a buck." They quickly establish ed clin ics su ch as P ark M ed ica l C en te r in N ew Y ork City, w here so m e d o cto rs m ad e $ 5 0 0 ,0 0 0 a y ear p erfo rm in g a b o rtio n s “p a rt-tim e " G o ld sm ith claim ed th a t even co n serv ativ e d o cto rs changed th e ir sta n ce and b eg an to p e rfo rm a b o rtio n s b eca u se “th e y realized th a t a b o rtio n w as going to b e c o m e a very lu crative n ew p art o f th e ir p ractic e " 78 W h ile w om en b en efited fro m safe a b o rtio n s offered by physicians, th e C o u rt re stricte d serv ices to th e d iscretio n and availability o f d o ctors.

Roe rep resen ted th e cu lm in a tio n o f efforts by m an y state legislators and p o litica l lead ers to cu rb large fam ilies am o n g single m o th e rs on w elfare. As h isto rian R osalind P etch esk y conclu d ed , th e state “carefully avoided c o n c e s ­ sion s to fem in ist id eology a b o u t rep ro d u ctiv e freed o m . To a cco m m o d a te p o p u lar pressu re w ith ou t leg itim atin g fem in ism , . . . state and p o p u latio n plan n ers su bsu m ed a b o rtio n p o litics u nd er th e ru b ric o f p o p u lation c o n tro l" The pu sh fo r a b o rtio n refo rm , w hile a fem in ist plank, w as tru ly “spearhead ed by a co alitio n o f private and fam ily planning org anization s, fou n d ation s, and co rp o ra te in te re sts o rg anized arou n d th e p o p u latio n is s u e "79 F ed eral and state gov ern m en ts fin an ced a b o rtio n s fo r ind igent w o m en th ro u g h M e d ic­ aid and o th e r p u blic h ea lth bills, allow ing easy a ccess to serv ices fo r w o m en d eem ed resp o n sib le fo r in crea sin g w elfare exp en d itu res. R eg ard less o f th e

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m o tiv atio n o f po p u lation co n tro llers and th e lim its o f th e d ecision, individ­ ual w o m en at th e lo c a l level b en efited fro m safe a b o rtio n s. Fem ale m o rta lity fro m a b o rtio n d ecreased w ith its leg alization .80

Abortion in Rhode Island R h od e Island failed to lib eralize a b o rtio n in th e 1 9 6 0 s , desp ite attem p ts b e ­ gin n in g in 1 9 6 6 . P P R I su p p orted a b o rtio n re fo rm b u t h eed ed PPFA’s re c o m ­ m e n d atio n th a t any en d o rse m en t co m e fro m sta ff m e m b ers as individuals, n o t as rep resen tativ es o f P P R I.81 The R h od e Island M ed ica l S o c ie ty argued, to no avail, th a t a b o rtio n w as n o t a legislative p ro b lem bu t a m e d ica l on e.82 C ath o lic lead ers b lock ed refo rm and pushed, unsuccessfully, fo r legislation to elim in ate th e cen tu ry -o ld exem p tio n to save th e w om an’s life.83 W ith only th e ra p e u tic a b o rtio n s available, P P R I co u n seled and referred w o m en elsew here. The m e d ica l d ire cto r sp en t 7 5 p e rce n t o f h e r tim e in a b o r­ tio n cou nseling. In 1971 610 w o m en req u ested a b o rtio n s. T he sta ff put clients in to u ch w ith C lergy m en ’s A d visory C o m m ittee s in R h od e Island and M a s ­ sach u setts or re ferred th e m to legal N ew Y ork clin ics. P P R I b o ard m em b ers traveled to clin ics to en su re th e ir safety and w ere o ften disap pointed by th e disp arity am o n g th em : “U n fo rtu n ately th e re is a g ood am o u n t o f fin an cial ex p lo itatio n o f a b o rtio n p atien ts and in cred ib ly high p ro fits bein g m ad e in so m e facilities.” T echnically, P P R I violated state law by p a rticip a tin g in refer­ rals.84 W alk in g th is fine line w as d angerous, esp ecially in light o f a “w o rsen ­ ing clim ate in R h od e Islan d ” as th e C a th o lic C h u rch did all it could to hold b a ck state re fo rm .85 The ch u rch lo st th e battle w ith Roe in 1973. Follow ing Roe, th e P P R I execu tiv e co m m itte e felt a “sense o f u rg en cy ” to estab lish “a free stand ing a b o rtio n clin ic as so o n as is feasible.” A n n e W is e ar­ gued th a t “P P R I ow es its ex isten ce to th e fa ct th a t p eop le risked co m m u n ity cen su re to offer a serv ice in w h ich th e y believed and fo r w h ich th e re w as a d esp erate need. Feeling ag ainst b irth co n tro l in 1931 w as stro n g er and m o re w id espread th a n is feeling ag ainst a b o rtio n in 19 7 3 . W e have th e h ig h est law o f th e land and th e m a jo rity o f A m e ric a n citiz en s b eh in d u s” Even w ith S u ­ p rem e C o u rt sa n ctio n , P P R I realized th a t th e ch u rch ’s p ow er in th e state w ould m ake w idespread a cc e p ta n ce “highly unlikely” B y th e su m m er o f 1 9 7 3 P P R I w as co n scio u s o f in crea sin g o p p o sitio n to th e S u p rem e C o u rt’s d e c i­ sion and “a grow ing m o v em en t in C on g ress tow ard a co n stitu tio n a l a m en d ­ m e n t to p revent a b o rtio n s”86 P P R I co n tin u ed to help w o m en p ro cu re a b o r­ tio n s o u t o f state, b u t th is a ssista n ce b e c a m e difficult. Follow ing Roe, N ew Y ork cu rtailed its a b o rtio n s fo r n o -fe e , lo w -in co m e w o m en b eca u se o f th e d ecreased d em and as o th e r states offered th e p roced u re. B y A pril 1 9 7 3 som e N ew Y ork clin ics re p o rte d a d ecrea se in daily a b o rtio n s fro m 1 3 0 to 3 0 : “For

W ho Pays for What? Abortion and Sterilization, 1960—1975

th is re a so n m o st clin ics ca n n o lo n g er afford to do $ 2 5 .0 0 or free ab ortion s.” A s a resu lt, “R h od e Islan d ’s low in c o m e w o m en have no a ccess to legal a b o r­ tio n and th e refo re are th e v ictim s o f u neq u al p ro te c tio n o f th e law”87 The su m m er o f 1 9 7 3 saw plans b eg in fo r a clin ic. A fter L ying-In op ened a facility in A ugust, Pelham , a N ew Y ork group, in fo rm ed P P R I th a t if it did n o t o p en a clin ic, P elham w ould. The sta ff believed P elham w as in terested only in p rofits. A freesta n d in g clin ic at P P R I w ould offer low er co st and a m o re sy m p ath etic a tm osp h ere, and, m o st im p o rta n t, “it w ould b e fa r less tra u m a tic for p atien ts th a t alread y estab lish ed a relation sh ip w ith P lanned P aren th oo d if th e y w ere able to rem a in h ere a fter counseling.” In S e p te m b e r all bu t o n e bo ard m e m b e r voted to in c o rp o ra te a b o rtio n .88 Yet h ea lth de­ p a rtm en t regu lation s p o sed a b a rrier: an a n esth esio lo g ist m u st b e p resen t, th e o p eratin g ro o m m u st b e equipped fo r ab d o m in al surgery, b loo d m u st be stored , and d eath ce rtifica tes m u st b e filed. W is e o b je c te d to th e la tte r as “an invasion o f privacy” These re strictio n s w ould “m ake o p eratin g an o u t-p atien t clin ic im possible.” In ord er to com ply, P P R I n eed ed a n ew bu ilding.89 D u rin g th e in terim , P P R I n o tice d a shift in th e n a tio n a l d iscou rse regard ­ ing ab o rtio n . “P op u lation seem s to have lo st popu larity as a to p ic; a b o rtio n is th e su b je ct o f m o st c o n c e rn ” Few p eop le co n tin u ed to to u t a b o rtio n as a m eans o f po p u latio n co n tro l and w elfare savings in th e face o f a n tia b o rtio n rh e to ric th a t eq u ated a b o rtio n w ith m urder. The exp losion fro m a n tich o ice groups drow ned out p ro c h o ice ad vocates. PPFA “w arn ed ” P P R I th a t “a n ti­ a b o rtio n forces in th e co u n try are org anizing fo r a spring offensive . . . and have started a grow ing m o v em en t to appeal [Roe]” P P R I believed th e v eh e­ m e n ce o f th e o p p o sitio n “gave us th e o p p o rtu n ity to realize th a t w e ca n n o t rem ain co m p la ce n t”90 B y 1974 a n ew building had b e e n secu red and plans w ere u nd er way for th e clin ic. The sta ff estim ated th a t ea ch year 2 2 p e rce n t o f clien ts (abou t tw o th o u san d w om en) w ould seek a b o rtio n s fro m P PR I, a n u m b er th a t fell w ithin th e PPFA n atio n a l d irective th a t a b o rtio n s “n o t exceed 25% o f th e to ta l pa­ tie n t lo ad ” N o ex p lan ation w as given fo r th is n a tio n a l policy, b u t perhaps n atio n al w as co n cern e d th a t th e p u blic w ould perceive a b o rtio n as a regu lar m eth o d o f b irth co n tro l, a b e lie f th a t could dam age fin a n cia l co n trib u tio n s to th e organization . The sta ff p lan n ed to charge $ 1 5 0 and ex p ected th a t 15 p e rce n t w ould b e u nable to pay. Even w ith th is “bad debt,” th e y p ro je c te d th e a b o rtio n clin ic w ould b e “eco n o m ica lly advantageous,” w ith an an n u al profit o f $1 0 3 ,2 1 2 to defray o th e r h ea lth care c o sts.91 N o on e m e n tio n e d th e irony o f P P R I’s earlier critic ism o f P elham ’s in tere st in profits a sso cia te d w ith ab o r­ tion. In th e spring o f 1 9 7 5 th e a b o rtio n clin ic opened. W ith in tw o w eeks “R ight to L ife” groups p ick eted th e en tra n ce , and C a th o lic p ressu re m ad e finding

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d o cto rs to sta ff th e clin ic difficult. W o m e n and In fa n ts H o sp ita l in fo rm ed P P R I th a t n o n ew resid en ts w anted to w ork at P P R I, and tw o d o cto rs slated to p e rfo rm ab o rtio n s “d ecid ed n o t to do s o " N atio n al polls d em o n stratin g d o cto rs’ approval o f a b o rtio n did n o t n ecessa rily tra n sla te in to th e ir w illing­ n ess to p e rfo rm a b o rtio n s. The sh ortag e o f physicians m e a n t th e clin ic was only able to p e rfo rm 2 5 p e rce n t o f ex p ected a b o rtio n s. M oreover, in crea sed lab fees, a “ju m p in p ro fessio n al fees,” and o th er u n an ticip ated co sts brou ght estim ated p ro fits dow n to $ 2 8 ,0 0 0 .92 By su m m er th e situ atio n look ed “g rim in d eed ” F ran cin e S. S tein , a d m in istra to r o f th e PPFA a b o rtio n lo an and te c h ­ n ica l a ssistan ce p rog ram , visited P P R I and “had th e unhappy feeling th a t in a variety o f w ays, p erhap s u n co n scio u s or u nexam in ed , th e p ro g ram w as n o t fully accep ted by th e A ffiliate. The sta ff v erbalized dread, fear, even nervou s flip p an cy a b o u t a b o rtio n ” S te in fou nd th a t so m e v o lu n teers believed “to o m u ch effort w as b ein g expend ed o n abortion .” S h e re co m m en d e d th a t staff w ho could n o t “w hole h earted ly . . . su p p ort th e p ro g ram ” b e “given a ch o ice o f n ew jo b assig n m en ts . . . or o f resig nation.” S im ila r p ro b lem s o ccu rred w ith college in tern s. A U niversity o f R h od e Island p ro fesso r w ro te th e clin ic co n cern in g an “older, m atu re stu d ent (P ro te sta n t)” seeking a fall in tern sh ip bu t only if she could avoid th e a b o rtio n prog ram . This stu d ent “very m u ch w ants to w ork in a fam ily planning a g en cy — contraception, sex education, et al.— bu t . . . has n o t y et co m e to te rm s w ith h e r feeling s a b o u t a b o rtio n ”93 Su p p o rtin g a b o rtio n in th e a b stra ct w as easier th a n providing a b o rtio n s to w om en. P P R I m anaged to expand its serv ices w hile n o t sacrificin g th e hu m ane a sp e ct ce n tra l to its identity. S tein fou nd th a t th e sta ff spent to o “m u ch tim e w ith each p a tie n t” and th a t “p re -a b o rtio n clin ic p roced u res appeared terrib ly cu m b e rso m e . . . b eca u se every thing is d one individually.” S h e reco m m en d e d p am p h lets to rep lace o n e -o n -o n e cou n selin g w hen p ossible and organizing groups o f fou r o r five w o m en w ith a co u n selo r fo r a “b rie f 2 0 / 3 0 m inu te group d iscu ssio n ab o u t w hat w ill happen.” P P R I re sen te d th is critic ism o f “to o m u ch T L C ” and refu sed to follow h er su ggestion th a t th e sta ff b e “B rief, C o n cise, W rite L ittle, less T L C ” T h eir d ecisio n paid off. As on e p atien t told th e Providence Journal, “This p lace is right. W o m en are trea te d as hum ans here. They are given su pport. They are never in tim id a ted ”94

National Trends in Sterilization In th e face o f a w ell-fu nd ed , w ell-organ ized , and highly visible a n tich o ice m o v em en t, few p o p u lation co n tro llers co n tin u ed to to u t a b o rtio n as a solu ­ tio n to th e so cia l and e c o n o m ic “p ro b lem s o f population.” In stead , em phasis shifted to m o re a ccep ta b le and p e rm a n en t m eans o f g overn m en t-fu n d ed fer­

W ho Pays for What? Abortion and Sterilization, 1960—1975

tility co n tro l, in particular, sterilizatio n . M an y p eop le co n sid ered th is o p era ­ tio n less “offensive” th a n a b o rtio n b eca u se it preven ted ra th er th a n te rm i­ nated pregnancy. A m ark ed in c rea se in co n tra cep tiv e steriliz a tio n o ccu rred in th e late 1 9 6 0 s . By th e early 1 9 7 0 s steriliz a tio n as a m ea n s o f v olu n tary fam ily p lan n in g had b e c o m e popular. U n fortu n ately , co e rce d steriliz a tio n had in creased as well. A n u m b er o f re a so n s exp lain th e p op u larity o f steriliz a tio n . F irst, th e A C O G relaxed its guidelines fo r eligibility in 1 9 7 0 . E arlier, A C O G p re re q ­ u isites re q u ired co n su lta tio n w ith tw o d o cto rs and a p sy ch iatrist. S e co n d , ad vances in m e d ica l te ch n o lo g y m ad e th e p ro ced u re relatively easy and risk ­ free. Third, fo r grow ing n u m b ers o f tw o -in c o m e fam ilies and fem ale-h ead ed h ou seh old s, steriliz a tio n g u aran teed ag ainst w ork in terru p tio n s due to p reg ­ n an cy and ch ild rearin g . F ou rth , C a th o lics in creasin g ly tu rn ed to sterilizatio n b ecau se it co n stitu ted on e “sin” ra th er th a n th e co n sta n t tu rm o il over c o n tra ­ ceptives and ch u rch d o ctrin e. Fifth, p o p u lation co n tro llers to u ted th is o p tion as a m o re reliable an sw er to th e p o p u lation exp losion and m ou n tin g w elfare exp en d itu res th a n c o n tra ce p tio n and a b o rtio n . In d iv id u al p h ilan th rop ists and pu blic officials provided funds to en cou rag e ind igent w o m en to undergo sterilizatio n , h op in g to end p erm an en tly h ig h fertility am o n g th em . Early steriliza tio n bills targ etin g th e ind igent o ccu rred in th e So u th . In th e early 1 9 6 0 s V irginia tw ice a ttem p ted to red u ce w elfare co sts w ith com p u lsory sterilizatio n for w o m en w ith illeg itim ate child ren. A lthou g h b o th attem p ts failed, th e legislature passed a volu n tary steriliz a tio n law in 1 9 6 2 , th e first in th e n atio n to accep t e c o n o m ic hard ship as a p retext fo r th e o p era tio n .95 A M ississip p i b ill in 1 9 6 4 au th o rized ja il te rm s fo r unw ed m o th ers w ith tw o or m o re ch ild ren u nless th e y ag reed to sterilization . T he dual in ten t o f th is p ro ­ p o sal w as to red u ce w elfare and ru n unw ed m o th e rs o u t o f th e state, w hich w ould also save th e state m oney. The u p ro ar fro m civil righ ts leaders over th is “g en o cid e” legislatio n led to its d efeat.96 In C alifo rn ia p o lice a rrested tw en ty -o n e-y ea r-o ld N an cy H ern an d ez on a su p erficial drug charge. S a n ta B a rb a ra m u n icip al co u rt ju d g e F ran k P. K e a r­ n ey sen ten ced h er eith e r to six m o n th s in ja il or im m ed iate p ro b a tio n if she agreed to sterilization . W ith n o a tto rn ey p resen t, she ch o se th e latter. Later, h e r pu blic d efend er lab eled th is a ctio n “u n reaso n ab le, cap ricio u s, illegal, and u n co n stitu tion al.” H ern an d ez revok ed h e r co e rce d c o n se n t and w as freed w ith in th re e h o u rs.97 H ern an d ez had tw o ch ild ren , on e fro m h e r estranged husband and on e fro m h e r cu rre n t p artner, Jo se p h S a n ch ez . K ea rn ey told a press co n fere n ce th a t she w as an “u nfit m o th e r . . . in d anger o f con tin u in g to lead an im m oral, dissolute life end ang ering th e h ealth , safety and lives o f h er ch ild ren ” To charges o f ra cism h e answ ered: “I ’m n o t try in g to b e a N azi. It seem ed to m e th a t she should n o t have m o re ch ild ren b eca u se o f h e r p ro p e n ­

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sity to live an im m o ra l life.” C on servative c ritic W illia m F. B u ck ley co n ten d ed th a t “th e o riginal ru ling o f th e ju d g e ought to rem a in as a p e rm a n en t exh ibit in our ju d icial ch a m b er o f h o rro rs ”98 S teriliz a tio n w as irrelev an t to th e crim e co m m itted . N o t all steriliz a tio n abu se receiv ed as m u ch a tte n tio n as th e H e rn a n ­ dez case. Dr. Julius P au l o f th e W a lte r R eed A rm y In stitu te o f R e se a rch in W a sh in g to n , D .C ., to ld a m e etin g o f th e P op u lation A sso cia tio n o f A m erica in th e spring o f 1 9 6 6 o f his re serv a tio n s regard ing steriliz a tio n o f unw ed m o th e rs o n w elfare or so m etim e s o f b o th p a ren ts o f illeg itim ate child ren. H e w arn ed th a t cu rre n t em p h asis o n co m p u lsory steriliz a tio n as a m eans to p ro te ct th e p u blic fro m its “u n fit” m e m b ers, a te rm n ow used to d enote so cia l and e c o n o m ic u nd esirab les ra th er th a n m e n ta l and p h y sical “d efec­ tives,” ech o ed th e 1 9 3 0 s eu genic m o v em en ts. B etw een 1 9 6 0 and 1 9 6 5 seven sta tes— D elaw are, G eo rg ia, Illin ois, M aryland , M ississip p i, N o rth C arolin a, and V irg in ia— co n sid ered leg islatio n to sterilize p a re n ts o f illeg itim ate off­ spring. A lth ou gh n o n e passed, Dr. Paul w arned th a t th e y in d icated th a t th e co u n try had “co m e full c irc le ” to th e punitive attitu d es o f th e early tw e n tieth centu ry, w h en m any states sterilized crim in als and o th e r “u nd esirables.”99 M o st o f th e se laws rem ain ed in effect: tw e n ty -six states au th o rized steriliz a ­ tio n for th e “m entally ill or m entally defective,” fifte en did so for ep ilep tics, and tw elve fo r c e rta in crim in a ls.100 The 1 9 6 0 s cam p aig n differed in th a t it had racial and e c o n o m ic ra th er th a n phy sical and m e n ta l o v erton es. P art o f th is ch an ge can b e explained by th e risin g level o f co n c e rn fo r th e m entally and physically hand icap p ed , a m o v em en t fueled by fam ily m e m b ers. They estab lish ed th e N atio n al A sso c ia tio n fo r R etard ed C h ild ren ; w ith ch ap ters in each state by th e 1 9 6 0 s , it w as a n in flu en tial pressu re g roup.101 P ro te ctio n fo r th is group previously defined as “u n fit” did n o t extend to th e socially and eco n o m ically “u n fit” o f th e 1 9 6 0 s and 1 9 7 0 s. Dr. Paul even w arned against v o lu n tary steriliz a tio n , b eca u se “co n s e n t” m ig h t b e a p rice paid fo r so m e­ th in g in re tu rn , su ch as release fro m ja il or co n tin u ed w elfare b en e fits.102 Yet volu n tary p rog ram s did em erge. Fauqu ier H osp ital in W a rre n to n , V ir­ ginia, estab lish ed a free steriliz a tio n clin ic fo r in d igen t w om en p rim arily to red u ce th e co u n ty ’s ta x bu rd en. By S e p te m b e r 1 9 6 2 six ty -th re e w o m en had b e e n sterilized , 6 6 p e rce n t o f th e m black . This p ro g ram drew n a tio n a l a tte n ­ tio n ; m any con sid ered it th e b est solu tion to p overty and its co sts to society.103 The o p p o sitio n stem m ed fro m co n c e rn over co e rcio n . T he New York Times believed th is p o licy raised profound qu estion s: “T he alm ost feu dal d isparities b etw een land lord and te n a n t, m illio n aire and p o o r m an ” in Fauqu ier could n o t b e solved w ith “free m e d ica l care fo r th e ind igent o r sterilization.” Amer­

ica criticiz ed th e p ro g ram as “an ad roitly aim ed slap in th e fa ce o f th e p o o r” Its “‘v o lu n tary ’ a s p e c t” w as a “m ere anodyne. . . . It is n o sec re t th a t peop le,

W ho Pays for What? Abortion and Sterilization, 1960—1975

perhaps th e p o o r m o st easily o f all, ca n b e cu n n in g ly trap p ed b etw een th e ir ow n le g itim ate p e rso n a l p rid e and th e ex tern a l fo rces o f so cia l p re ssu re" O n ce an official su ggested sterilizatio n b eca u se o f a w o m an ’s e c o n o m ic sta ­ tu s, h e r free d o m to ch o o se b e c a m e tain ted . N ot surprisingly, so m e w om en had “‘v o lu n tarily ’ k n u ck led u n d er in th e face o f su ch p re ssu re "104 C h u rch officials again em ployed a so cia l critiq u e ra th er th a n m o ra l co n d em natio n . A rch b ish o p P atrick A . O ’B oyle o f W a sh in g to n , D .C ., o b je c te d to p atern alism and racism : th o se tak in g p a rt in th e p ro g ra m — m ainly b la ck s— w ere “trea te d as irresp o n sib le child ren" w ho did n o t p o ssess “enou gh in tellig en ce to lead a n o rm a l e x iste n c e " In ad d ition, h e ch arged th a t th e “crud ely selfish” p u r­ p o se w as “to red u ce th e ta x ra te in Fauqu ier C ou n ty " B a p tist evangelist Billy G rah am and Commonweal co n cu rre d .105 S o m e b la ck w o m en also criticiz ed th is program . F ran ces B ea l co n ten d ed th a t cou n ty officials p ressured “p o o r and helpless b la ck m o th e rs and young g irls" in to u nd ergoin g steriliz a tio n “in exch an ge fo r a co n tin u a tio n o f w elfare b e n e fits " A lth ou g h th e w orld de­ n o u n ced N azi sterilizatio n s, “n o on e seem s to g et u p set by th e re p e titio n o f th e se sam e ra cist p ra ctice s tod ay in th e U n ited S ta tes o f A m e ric a — land o f th e free and h o m e o f th e b ra v e "106 C lin ic officials, how ever, h ailed steriliz a tio n to relieve ind igent co n d itio n s and to red u ce w elfare. O th e r reg ion s follow ed F au q u ier’s exam ple. A 1 9 6 3 N o rth C aro lin a law p e rm itte d a p atien t to ch o o se steriliz a tio n if tw o physi­ cian s agreed it m e t a fam ily need. In B e re a , K entucky, p art o f depressed A p­ palachia, Dr. L ouise G ilm an H u tch in s, long active in providing con tracep tiv es to co m b at poverty, received $ 2 5 ,0 0 0 fro m Jesse H artm an , a M a n h a tta n in ves­ tor, to offer steriliz a tio n to p rev en t th e ch ron ically unem ployed fro m b earin g ch ild ren th e y could n o t afford. W ith H a rtm a n ’s m o n ey H u tch in s sterilized 1 4 0 w o m en and 5 0 m en. O n ce H a rtm a n ’s funds ra n o u t, th e M o u n ta in M a ­ te rn a l H ealth League m ain tain ed th is serv ice b eca u se H u tch in s argued th a t sterilizatio n red u ced w elfare paym ents. B ec a u se th e state paid a fifty -d ollar delivery fee plus h o sp ital exp en ses fo r ea ch b irth to ind igent w om en, officials claim ed th is p ro g ram saved th e state th ou san d s o f dollars in six m o n th s.107 The su ccess in red u cin g w elfare led to in crea sed su p p ort fo r sterilization . A n atio n al p oll in 1 9 6 6 found th a t 6 4 p e rce n t approved o f steriliz a tio n for “w o m en w ho have m o re ch ild ren th a n th e y ca n provide fo r properly " 2 4 p er­ cen t disapproved, and 12 p e rce n t had n o opinion. S o m e groups p ressured th e fed eral g o v ern m en t to fund th is service. The A sso c ia tio n fo r V olu ntary S te r­ ilizatio n literatu re stressed g ov ern m en t-su b sid ized steriliz a tio n as on e a n ­ sw er to th e w aste o f “billio n s m o re o f o u r ta x dollars . . . on re lie f" and to th e “critica l n eed to c o n tro l th e p op u latio n e x p lo sio n "108 T he a sso cia tio n jo in e d th e A m e rican C ivil L ib e rties U n io n (A C L U ) in p ro testin g th e b an o n using O E O funds to sterilize lo w -in co m e m e n and w om en. A lthou g h O E O u nd er­

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w ro te co n tracep tiv es in 1 9 6 6 , steriliz a tio n fund ing seem ed to o risky. A t th e sam e tim e, how ever, fed eral m o n ey p ou red in to th e P op ulation C o u n cil for p ro je c ts bu reau crats believed w ere to o co n tro v ersial fo r fed eral involvem ent, inclu d ing steriliz a tio n .109 B y 1 9 7 0 so cia l a cc e p ta n ce o f steriliz a tio n had g row n consid erably am ong physicians, m ain strea m p erio d ica ls, and fed eral officials.110 Fed eral b u reau ­ crats ad v o cated in c o rp o ra tin g fed erally fu nd ed steriliz a tio n in to clin ics. Eighty p e rce n t o f O E O clin ics w anted it as an option. N ixo n ’s C om m ission on P op u lation G ro w th reco m m en d e d th a t “all ad m in istrativ e re strictio n s on access to volu n tary co n tra cep tiv e sterilizatio n b e elim in ated so th a t th e d e c i­ sion b e m ad e solely by physician and patient.” A lth o u g h N ixo n had re je c te d th is co m m issio n ’s re co m m en d a tio n regard ing a sim ilar m e d ica l co n tex t for ab o rtio n , he su pported its stand o n sterilization . Fed eral funds b e c a m e avail­ able in 1971.111 A s steriliz a tio n b e c a m e an a cc ep ted m e th o d o f fam ily p lan n in g am on g w hite m id d le-class cou p les, so m e d o cto rs sterilized w o m en “w hose fertility p attern s offend ed th e ir valu es” or in d igen t and lo w -in co m e w om en , e sp e­ cially eth n ic and ra cia l m in o ritie s.112 M an y physicians m isled w o m en abou t th e dangers or p e rm a n en ce o f tu b al ligations. H ealth care officials so m etim es co e rce d w o m en during la b o r or a b o rtio n o r co n v in ced th e m th a t th e ir w el­ fare serv ices w ould b e rescin d ed u nless th e y con sen ted . S o m e w o m en did n o t even know th e y had b e e n sterilized. These a cts o f c o e rcio n w ere jo in e d by a ttem p ts to pass a n o th e r wave o f legislatio n to red u ce w elfare. The S e n a te co n sid ered a b ill to sterilize any w om an o n w elfare w ith tw o illeg itim ate child ren. In O reg o n legislators d is­ cu ssed sterilizin g w ards o f th e state. A M arylan d p ro p o sal called fo r th e ster­ ilizatio n o f m o th e rs o f illeg itim ate ch ild ren on re lie f rolls. G eo rg ia w elfare d ire cto r W illia m B e n so n su ggested steriliz a tio n to co n ta in w elfare ex p en ­ ditures. L o u isian a follow ed th e G eo rg ia exam ple. In 1 9 7 0 W illia m Shockley, co w in n er o f th e N o b el P rize fo r P hysics in 1 9 5 6 , stated th a t ra cia l quality w as d eclin in g in p art b eca u se th e average b la ck IQ w as low er th a n th a t o f w hites; he en d orsed a “S teriliz a tio n B o n u s P lan” to pay “in tellectu ally in fe rio r” p e o ­ ples o f b o th races to u nd ergo steriliz a tio n .113 H is plan ech o ed H itle r’s. C lassism and ra cism prevailed in th e se d iscu ssions. B ru ce H ilton , d ire c­ to r o f th e N atio n al C en te r for B io -E th ic s, co n ten d ed th a t ra cism as w ell as p atern alism led to co e rc io n in sterilizatio n . H e stated th a t “o th erw ise d e­ cen t, G o d -fearin g , ch u rch going p eop le still feel th a t G o d has given th e m th e b lack m an as a responsibility. A nd th a t kind o f p atern alism says th a t if th is w om an isn’t sm a rt enou gh to stop having child ren, th e n it is m y re sp o n sib il­ ity to help h er” This ty p e o f “h elp ” w as ju s t an u nsp eak able w ish to co n tro l black s. Su san L a M o n t o f th e W o m e n ’s N atio n al A b o rtio n A c tio n C o a litio n

W ho Pays for What? Abortion and Sterilization, 1960—1975

believed th e steriliz a tio n cam p aig n resu lted fro m h atred o f th e poor, b o th b lack and w h ite.114 D o c to rs ’ attitu d es su b stan tiated th e se arg u m en ts. A sur­ vey o f te a ch in g ho sp itals in th e late 1 9 6 0 s fou nd 5 3 .6 p e rce n t m ad e steriliza­ tio n a co n d itio n fo r o b tain in g an a b o rtio n am on g in d igen t w om en, d eem ing w elfare w o m en in cap ab le o f using co n tra ce p tio n effectively. In tw o surveys in th e early 1 9 7 0 s 6 p e rce n t o f d o cto rs said th e y d iscussed steriliz a tio n w ith private p a tien ts, w hile 14 p e rce n t reco m m en d e d it as th e b est ch o ice to in d i­ gen t w om en. M oreover, 9 4 p e rce n t o f o b ste tricia n -g y n e co lo g ists approved o f co m p u lsory steriliz a tio n o f w elfare m o th e rs w ith th re e illeg itim ate ch ild ren .115 The im p act o f su ch a ttitu d es ca n b e seen in steriliz a tio n tren d s. The N a ­ tio n a l A b o rtio n A c tio n C o m m itte e fou nd th a t fo u rteen states had co n sid ­ ered legislatio n “d esigned to co e rce w o m en receiv in g w elfare to su b m it to sterilization.” In S o u th C arolin a R ep resen tativ e L uciu s N. P o rth p ro p o sed in 1971 to force fem ale w elfare re cip ie n ts w ith tw o ch ild ren to ch o o se steriliz a ­ tio n or forfeitu re o f w elfare p ay m ents b eca u se su ch fam ilies w ere n o t only a th re a t to so ciety bu t an exp ense th e pu blic should n o t have to bear.116 W o m en d ep end ent o n p u blic fund s w ere sterilized m o re th a n o th ers, and m in o rity w o m en on w elfare w ere sterilized m o re th a n w hites in th e sam e situation. Sixty p e rce n t o f b la ck p o stp a rtu m w om en in Su n flow er C ounty, M ississip pi, had b e e n sterilized by 1 9 6 5 w ith ou t th e ir know ledge or co n sen t. In N o rth C arolin a th e p ro p o rtio n o f b lack s sterilized by th e state in crea sed fro m 2 3 p e rce n t d uring th e D ep re ssio n to 6 4 p e rce n t by 1 9 6 6 , m ainly due to new A D C regu latio n s th a t inclu d ed b lack s in w elfare prog ram s. O n ce th e y cam e u nd er th e scru tin y o f so cia l w orkers, th e ir ch a n ces o f in v olu n tary steriliz a ­ tio n in creased . S teriliz a tio n rates inflated for b o th races w ith th e n u m b er o f ch ild ren b o rn to w elfare m o th e rs. W h ile th is in c re m e n t could re fle c t w o m en ach iev in g th e ir d esired fam ily size, m o re likely th e y faced p ressure fro m w el­ fare officials to lim it th e ir fam ilies. W elfare officials ta rg e ted w om en, despite th e fa ct th a t tu b a l ligation is m o re co m p licated and re cu p era tio n m o re d if­ ficu lt th a n vasectom y. Pop ular cu ltu re p ro m o ted fem ale steriliz a tio n u nd er th e guise o f sexu al lib era tio n , bu t co e rce d steriliz a tio n o f w elfare m o th e rs had little to do w ith lib era tio n .117 In v olu n tary steriliz a tio n cam e to a head in th e su m m er o f 19 7 3 . In June new spap ers revealed th a t fed eral funds had b e e n used to sterilize b la ck ch il­ d ren o n w elfare. The M o n tg o m e ry Fam ily P lanning C lin ic, an O E O -fu n d ed facility, had given th e R e lf sisters D ep o P rovera, an ex p erim en ta l c o n tra ce p ­ tive. W h e n th e F D A b an n ed its use fo r b irth co n tro l, th e R e lf fam ily c a s e ­ w orker in sisted th a t th e girls lacked th e “m e n ta l ta le n ts” to tak e c o n tra ce p ­ tive pills. B e ca u se “boys w ere han gin g aro u n d ” th e girls, she reco m m en d e d sterilizatio n . The clin ic p resen ted M rs. R e lf w ith a co n se n t form . B elieving

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th e girls w ere receivin g a re p la cem e n t co n tracep tiv e, th e ir illiterate m o th e r p laced an X on th e signatu re line. A lth o u g h on e sister refu sed to und ergo th e p ro ced u re, th e clin ic sterilized tw elve-y ear-old M in n ie Relf. A S e n a te in ves­ tig atio n found th a t th e R e lf fam ily had n o t asked fo r fam ily -p lan n in g assis­ tan ce. Instead , w elfare officials had sought out th e girls. N ew spapers revealed th a t eleven o th e r girls m ig h t have b e e n involuntarily sterilized at th e sam e clin ic.118 W h ile p o p u latio n co n tro llers look ed favorably on th e se a ctio n s, th e b lack press w as outraged. The Chicago Daily Defender called th e R e lf case “a b la ­ ta n t in frin g e m en t o n h u m an rig h ts” as w ell as “a clea r and rev oltin g in stan ce o f S o u th e rn race p reju d ice in tru d in g its e lf in to th e private lives o f illite r­ ate b lack s b e re ft o f eith e r pow er or in flu en ce” T he Black Panther, th e party new spaper, argued th a t it d em o n strated th e tru e in ten tio n o f th e M o n tg o m ­ ery fam ily-p lan n in g c lin ic— th e p rem ed itated m u rd er o f a race. Muhammad

Speaks co n sid ered th e in cid e n t “a d elib erate a c t o f g en o cid a l steriliz a tio n ” and d eclared th a t th e “d em o n ic ad vocates o f ‘p o p u latio n c o n tro ls’ had e sc a ­ lated th e ir w ar ag ainst th e n on w h ite p e o p le” w ith tw o n ew leth a l w eapons, a b o rtio n and sterilization . The New York Daily Challenger b elieved th e situ ­ atio n d em o n strated “th e low estee m in w h ich B la c k life is held and th e g en o ­ cid al n atu re o f prog ram s su pposedly designed to help B la c k s ” The Pittsburgh

Courier, th e pap er th a t had earlier su p p orted b la ck w o m en ’s a ccess to O E O fund ed co n tracep tiv es, a sserted th a t th e R e lf in cid en t w as “a n o th e r case o f a w hite d ire cto r o f a w h ite-ru n in stitu tio n d ecid ing w hat is ‘b e s t’ fo r b lack s in th e long ru n ” C olu m n ist V ern o n E. Jord o n w ro te in th e Afro-American th a t th e R e lf case was “an a ct th a t m ak es th e b loo d ru n cold in its callou s disregard fo r th e m o st fu n d am en tal righ ts o f th e individual”119 O n e m o n th a fter th e R e lf sto ry brok e, N ial R u th C ox, an unw ed b lack m oth er, charged th a t she had b e e n co e rce d to und ergo steriliz a tio n in N ew B e rn , N o rth C arolin a, at age eighteen. S ta te law allow ed th e p aren t o f a “m e n ­ ta l d efectiv e” u nd er th e age o f tw e n ty -o n e to sign c o n se n t form s fo r th is p ro ­ cedure. S tate officials d eem ed C ox a “m en ta l d efectiv e” b eca u se she had given b irth to a d aughter at age sev en teen , ju s t as C a rrie B u c k ’s m o th e r had b ee n lab eled in th e early tw e n tieth century. S im ila r to th e 1 9 3 0 s , so m e b u reau crats used th e ru se o f te en a g e sexuality, esp ecially th a t resu ltin g in illeg itim ate b irth s, to b e su fficient evid ence o f m e n ta l in stab ility to w arran t sterilization . C o x ’s m other, a w idow w ith n in e ch ild ren , signed th e c o n se n t form s a fter th e casew o rker in fo rm ed h er th a t if she refu sed , h e r fam ily m ight stop receivin g w elfare ch eck s. N o one explained th a t th e p ro ced u re was p erm an en t. A s N ial C o x told a rep orter, “N obod y explained anything. They trea te d us as th o u g h w e w ere an im als”120

W ho Pays for What? Abortion and Sterilization, 1960—1975

That sam e su m m er M rs. C a ro l Brow n, a w elfare m o th e r p regn an t w ith h er fifth child, visited th re e d o ctors in h e r h o m eto w n o f A iken, S o u th C arolin a, to find on e w ho w ould d eliver h e r baby. A ll th re e refu sed u nless she c o n ­ sen ted to sterilizatio n . In th e sam e to w n a n o th e r d octor, C lovis H . P ie rce , refu sed to deliver th e th ird child o f w elfare m o th e rs u nless th e y first agreed to sterilizatio n . In a six -m o n th perio d in 1 9 7 3 P ierce p e rfo rm e d tw en ty -eig h t sterilization s: eig h teen w ere w elfare m o th e rs, o f w h om sev en teen w ere black. Yet his nu rse claim ed , “This is n o t a civil rights th in g , or a ra cia l th in g, it is ju s t w elfare.”121 E vents in A iken b e c a m e con tro v ersial. B la c k n ew sp ap ers criticiz e d th e v iolatio n o f b lack w om en. The Black Panther b elieved th e A iken in cid e n ts w ere p art o f a “ra cist, g en o cid al exterm in a tio n d irected at p o o r B la c k girls and w o m en ” The Afro-American co n ten d ed th a t P ie rce ’s u ltim atu m sounded sim ilar to “so m e sin iste r u n -A m e ric a n h o rro r sto ry unraveling.” Y et m any w hites in A iken su p p orted co e rce d steriliz a tio n o f w elfare m o th ers. The ex­ ecu tive d ire cto r o f th e C h a m b e r o f C o m m e rc e, B ry a n M c C a n le ss, argued th a t b o th b lack and w hite “tra sh . . . should be sterilized.” O th ers circu lated p e titio n s th a t ju stified co m p u lsio n w hen w elfare m o th e rs did n o t volu ntarily use subsidized co n tra cep tiv e devices. O th e r p etitio n s ratio n alized co e rcio n b ecau se taxp ayers m a in ta in ed th e rig h t to d ictate th e m e d ica l tre a tm e n t o f w elfare recip ie n ts. D o c to rs in A iken claim ed th e y did w hat w as “b est fo r society.”122 As elite w hite m en, th e y believed th e y should co n tro l th e re p ro d u c­ tive ch o ices o f ind igent w om en. O th e r groups re a cte d strong ly to co e rcio n . B la c k co n g ressw o m en Sh irley C hish o lm , B a rb a ra Jord on , Y vonne B urke, and C ard iss C ollin s w ro te letters o f ou trage to D H E W se c re ta ry C asp ar W ein b erg er w arning h im th a t steril­ izatio n abuse “raised d oubts in th e m ind s o f m in o rity citizen s co n c ern in g th e volu n tary n atu re o f federally funded fam ily p lanning p ro g ra m s” N A A C P and U rb an League officials also m ad e h eated sp eech es. F ou rteen n a tio n a l groups co n d em n ed fu rth er use o f p u blic funds u n til C on g ress d rafted “co m p reh en ­ sive statu to ry p ro h ib itio n s” fo r th is p ro ced u re.123 S o m e fem in ists con d em ned co e rce d sterilizatio n . G lo ria S tein em told Ebony th a t steriliz a tio n “affects all o f us bu t . . . esp ecially m in o rity w om en. The g ov ern m en t th in k s it n o t only has th e righ t to tap o u r ph on es bu t to in terfere in all areas o f our p erso n al lives, in clu d in g g overning o u r very b o d ie s” S o m e w o m en organized groups against abuse, su ch as th e W e st C o a st C o m m itte e A g ainst F orced S te riliz a ­ tio n and N ew Y ork’s C o m m itte e to End S teriliz a tio n A bu se.124 The fem in ist critiq u e, how ever, w as m u ted and slow in co m in g , perhaps b eca u se p o p u ­ latio n co n tro l groups th a t su p p o rted steriliz a tio n am o n g th e in d igen t had b e e n stron g allies o f th e p ro ch o ice m o v em en t. M oreover, th e issue o f co erced

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sterilizatio n did n o t a ffect th e fem in ist m o v em en t, w h ich w as d om inated by w hite m id d le-class w om en. In fa ct, th e y w ere th e very group p op u lation c o n ­ tro lle rs en cou rag ed to p ro create. M o st o f th e im m ed iate re a ctio n ca m e fro m legal and g o v ern m en t sources. The A C L U b rou gh t ad d itional abu se cases to p u blic a tten tio n . E leven C h ica nas filed suit against th e L os A ngeles C ou n ty M e d ica l C enter, charging th e y w ere eith e r co e rce d or d eceived in to signing co n se n t fo rm s during la b o r or u nd er th e in flu en ce o f m ed icatio n . O n e m o th e r had an esth esia w ithheld u ntil she agreed to sign. O th ers had n o t signed any fo rm at all. Few o f th e se eleven spoke m o re th a n m in im a l E nglish, and all w ere in d ig en t; fou r w ere unaw are th e p ro ced u re had b e e n p erfo rm ed u n til th e y asked for co n tra ce p tiv es; one w om an only fou nd out fou r years la ter during a ro u tin e m ed ical exam . The C h ica n a case w as p articu larly tra u m a tic n o t only b eca u se d o cto rs d ecid ed w ho should n o t rep ro d u ce b u t b eca u se tra d itio n a l M e x ic a n A m e ric a n so ­ ciety o ften ju d ged w o m en on th e ir ability to b e a r ch ild ren . Judge Jesse W . C u rtis w as u nsym p ath etic: he d ecid ed ag ainst th e m in Madrigal v. Quilligan N o. 7 5 - 2 0 5 7 , N in th C ircu it U.S. D istric t C o u rt, 19 7 8 , b eca u se h e believed th e situ atio n w as “essen tially th e resu lt o f a breakd ow n in co m m u n ic a tio n b e ­ tw een th e p atien ts and th e d o c to r s "125 The w hite m ale esta b lish m en t u nited against abu sed w o m en o f color. Follow ing th is case, th e H ealth R esea rch G roup investigated su rgical ster­ ilizatio n in 1973 and co n clu d ed th a t co n se n t form s w ere a “fa rce ” b ecau se h o sp ital staffs p ressu red w o m en to co n se n t w hile in labor. This study also fou nd th a t co e rcio n o f in d igen t w hite and b la ck w o m en w as w idespread, e s­ pecially in th e So u th . R esea rch by B a rb a ra C aress at th e H ea lth P olicy A dvi­ so ry C en te r co n cu rred . “S teriliz a tio n abu se is n o t th e ex cep tio n bu t th e rule,” she w rote. “It is sy stem atic and w idespread. . . . S u ch abu se is th e m o st w id e­ spread exam ple o f m e d icin e as an in stru m en t o f so cia l c o n tro l"126 The lack o f stric t fed eral regu lation s fa cilita ted th e in ju stice s m any ind igent w o m en faced. N ative A m e ric a n and P u erto R ica n w o m en w ere esp ecially v ictim ized . The In d ian H ealth S e rv ice (IH S ), p art o f th e fed eral g ov ern m en t, sterilized so m any w o m en th a t, a cco rd in g to on e observer, it could have elim in ated all p u re-b lo o d trib e s w ith in fifteen years. Every fu ll-b lo o d ed O k la h o m a n Kaw w om an had b e e n sterilized . B etw een 1 9 7 3 and 1 9 7 6 th e IH S sterilized 3 ,4 0 6 N ative w om en. B y th e end o f th e decad e n early 2 5 p erce n t o f w o m en o f ch ild ­ b earin g age had u nd erg o n e tu b a l ligations. O fficials did n o t in fo rm th e m ab o u t th e irrev ersib ility o f th e o p eration . In v estigation s co n clu d ed th a t th e cau se o f abu se w as th e cu ltu ral in sen sitiv ity o f d o ctors: th e y pushed a m id ­ d le-class fam ily n o rm o f tw o ch ild ren and believed single, in d igen t w o m en should n o t p ro create. S im ilar to th e C h ican as, m any N ative A m e rica n w om en

W ho Pays for What? Abortion and Sterilization, 1960—1975

w ere ash am ed th a t th e y could n o lon g er have child ren. This loss u nd erm in ed th e ir sen se o f trib a l identity.127 In P u erto R ico m o re th a n on e in th re e w om en in th e ir child b earin g years w ere sterilized , yet legal a b o rtio n s w ere essentially unavailable.128 A lth o u g h fund ing fo r a b o rtio n s had d ecrea se d su b stan tially sin ce Roe and private in su ran ce com p anies generally refu sed to cover co n tracep tiv es, b o th p u b lic and private funds fo r steriliz a tio n rem ain ed in ta ct. A survey o f th irty -sev e n private in su ran ce co m p an ies fou nd th a t on e paid fo r th e pill and tw o paid for IU D s, b u t th irty -fo u r covered fem ale sterilizatio n , w hile tw en ty seven covered v a secto m ies. S teriliz a tio n w as m u ch m o re co st-e ffectiv e and efficien t th a n co n tra ce p tio n .129 M oreover, it provided a p e rm a n en t solu tion to p op u latio n co n cern s. O u tcry over abu ses led to g ov ern m en t investigations. A 1 9 7 3 survey o f fed erally fu nd ed p ro g ram s revealed th a t tw o -th ird s o f clie n ts w ere w hite and o n e-th ird b lack , y et black s co n stitu ted 4 3 p e rce n t o f th o se sterilized . A D H E W re p o rt con clu d ed th a t fro m th e su m m er o f 1 9 7 2 to th e su m m er o f 1 9 7 3 , 2 5 ,0 0 0 adults w ere sterilized in fed erally fund ed clin ics. O f th e se, 153 fem ales w ere u nd er eighteen. A n o th e r re p o rt fou nd th a t o f 1 ,6 2 0 steriliz a ­ tio n s in N o rth C arolin a betw een 1 9 6 0 and 1 9 6 8 , 6 3 p e rce n t w ere p erfo rm ed on black s, 5 5 .9 p e rce n t o f w h om w ere te e n s. In A labam a m o re th a n 5 0 p er­ cen t o f in v olu n tary sterilizatio n s au th o rized by th e state h ea lth d ep artm en t in 1973 w ere p erfo rm ed on b la ck w o m en .130 W h ite m id d le-class h ea lth o f­ ficials u sed th e ir p ow er to shape th e p o p u latio n alon g lin es th e y d eem ed accep tab le. A sm all p art o f th e blam e fo r th e se abu ses rested w ith th e fed eral b u rea u ­ cracy. O fficials d rafted guidelines in 1 9 7 2 fo r federally funded sterilization s. A lth ou g h O E O had 2 5 ,0 0 0 cop ies ready fo r d istrib u tio n , th e W h ite H ou se “su ppressed ” th e m : 1 9 7 2 w as an e le c tio n year, and N ixo n did n o t w ant his a d m in istratio n openly linked w ith steriliz a tio n fo r fea r o f lo sin g C a th o lic v otes. The guidelines sat on th e shelf, w hile th e fed eral g ov ern m en t fin an ced sterilizatio n w ith o u t safeguards u n til 1974. B y th a t p o in t th e m o st b latan t abu ses had o ccu rre d .131 W h e th e r guidelines w ould have p rev en ted abuse is debatable: officials cou ld have ig n ored th e m th e way d o ctors ig n ored th e N u rem b erg C od e in m e d ica l ex p erim en ts. Th ese abu ses violated w o m en ’s co n stitu tio n a l righ ts. They w ere n o t allow ed to ch o o se a m e th o d o f fam ily planning; o th ers ch o se fo r th em . B e c a u se officials did n o t apply th e sam e c o ­ e rcio n to self-su p p o rtin g w om en, R elf, C ox, and oth ers in th e sam e situ ation w ere d enied eq u al p ro te ctio n u nd er th e law. W h a t a ctio n did th e se w om en tak e? C o x sued N o rth C arolin a fo r $1 m il­ lion. The R e lf fam ily reta in ed p ro m in en t a tto rn ey M elv in B elli to sue clin ic officials and fed era l h ea lth officials fo r $ 5 m illion . T he civil su it ag ainst

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th e n -D H E W se c re ta ry C a sp er W ein b erg er alleged th a t th e “in tru sio n in to th e p lain tiffs’ bod ies and p erso n a l lives” w as a n in frin g e m en t o f th e ir b asic co n stitu tio n a l righ ts. W h e n investigators discovered th e W h ite H ou se c o n ­ n e ctio n , B elli am end ed th e suit to inclu d e fo rm e r W h ite H ou se aides Joh n W . D ea n III and Jo h n D. E h rlich m a n .132 The N atio n al W elfare R ig h ts O rg a n i­ zatio n also b rou gh t suit ag ainst W ein b erg er fo r failing to estab lish clea r-cu t guidelines w ith in D H E W fo r fed erally fund ed steriliz a tio n s.133 In M a rch 197 4 Judge G erh ard G esell o f th e U n ited S ta tes D istric t C ou rt fo r th e D istric t o f C olu m b ia h and ed dow n Relf et al. v. Weinberger et al. He stated: O v er th e last few years, an estim ated 1 0 0 ,0 0 0 to 1 5 0 ,0 0 0 lo w -in co m e p erso n s have b e e n steriliz ed an n u ally u n d er fed erally fu nd ed p ro ­ g ram s___ A lth ou g h C ong ress has b ee n in sisten t th a t all fam ily planning p rogram s fu n c tio n on a purely volu n tary basis, th e re is u n co n tro v e rte d evid ence in th e reco rd th a t . . . an in d efin ite n u m b er o f p o o r peop le have b e e n im p rop erly co e rce d in to a ccep tin g a steriliz a tio n o p era tio n u nd er th e th re a t th a t variou s federally su p p orted w elfare b en efits w ould be w ithdraw n u nless th e y su bm itted to irrev ersib le sterilization . G ese ll observ ed th a t th e “dividing line b etw een fam ily planning and eu genics is m u rky ” and ru led th a t th e la ck o f guidelines to p ro te ct p atients w as “b o th illegal and arb itra ry b eca u se th e y au th o rize in v olu n tary sterilizatio n s, w ith ­ out statu to ry or co n stitu tio n a l ju stificatio n .” Federally funded sterilization s w ere p erm issib le only w ith th e “voluntary, know ing and u n c o erc ed co n sen t o f individuals co m p ete n t to give su ch consent.” W h a t had o cc u rred in A la­ bam a, acco rd in g to B elli, w as “th e kind o f th in g H itler did.” N o t only ra cism bu t p atern alism played a role, acco rd in g to H ow ard P hillips, ex -d ire cto r o f O E O : “This is a classic exam ple o f th e m en tality th a t ‘th e so cia l w orker know s w h at’s best.’”134 A lthou g h P hillips excluded d o ctors fro m his co n d em n atio n , th e y to o believed th e y w ere in a p o sitio n to m ak e su ch life-a lterin g d e c i­ sions. O n 6 Febru ary 1 9 7 4 D H E W issued guidelines fo r fed erally fund ed steril­ ization s. They im p o sed a m o ra to riu m on sterilizin g p atien ts u nd er th e age o f tw en ty -o n e, p ro h ib ited ob tain in g co n se n t during labor, m and ated a w aiting p eriod , and o rd ered w o m en b e in fo rm ed th a t n o b en e fits w ould b e lo st if th e y refu sed sterilizatio n . D H E W also req u ired a review co m m itte e o f five to approve th e o p era tio n and in sisted u p on a co u rt ru ling th a t steriliz a tio n was “in th e b est in tere st o f th e patient.” M oreover, D H E W d ecertified Dr. P ierce o f A iken and barred h im fro m providing o b ste tric services fo r M ed icaid m oney. H is private p ractice , how ever, co n tin u ed to flourish.135 T h ese guidelines drew criticism . S o m e groups w anted all fed eral fund ing o f steriliz a tio n elim inated .

W ho Pays for What? Abortion and Sterilization, 1960—1975

O th ers believed th e guidelines did n o t p ro te c t individuals ag ainst co e rcio n b ecau se th e g ov ern m en t provided n o en fo rce m en t m e ch a n ism . A s R ichard B a b co c k , Jr., o f th e C en te r fo r L aw and S o c ia l P olicy in W a sh in g to n , D .C ., stated , “The H .E.W . regu lation s are . . . w holly in ad eq u ate___ A s th e in cid en ts w h ich w ere exposed last su m m er illu strate, w elfare re cip ie n ts in th is co u n try can b e th reate n ed , lied to , or m isin fo rm ed u ntil th e y co n se n t to b e sterilized. The H .E.W . regu latio n s . . . in fa ct do n o th in g to p revent su ch co erciv e ta c ­ tics.” The g u aran teed volu n tary n atu re o f all fam ily -p lan n in g services b efo re

Relf did n o t p rev en t th e abu ses re p o rte d in th e su m m er o f 1 9 7 3 . W ith o u t ad equ ate p o lice pow er, th e n ew stip u lation fo r a signed co n se n t w ould do little to stop fu rth er abuse. “O bviously, ag reeing to so m eth in g w ith a gun at you r head is n o t really ag reeing at all,” argued B a b co c k . Sim ilarly, a ccep tin g an offer “you ca n n o t re fu se” w ould b e equally involuntary. T h ese o b je ctio n s, how ever, b rou gh t n o chang e in D H E W g u id elines.136 Stud ies co n firm ed th e p e rsisten ce o f abuse. O n e in vestigation d iscovered th a t 7 6 p e rce n t o f ho sp itals did n o t com p ly w ith D H E W guidelines, w hile a n ­ o th e r claim ed 9 4 p e rce n t w ere n o n co m p lia n t. O n e -th ird did n o t even know g u id elines existed . A follow -u p study in 1 9 7 9 d iscovered th a t 7 0 p e rce n t o f ho sp itals involved w ith M ed ica id steriliz a tio n s co n tin u ed to b re a ch th e 1 9 7 4 regu latio n s.137 P art o f th is n o n co m p lia n ce w as a resu lt o f d o cto rs’ a tti­ tu d es. Dr. H u tch in s agreed th a t steriliz a tio n should b e volu n tary bu t believed D H E W guidelines w ere to o rigid as a resu lt o f g o v ern m en t o v errea ctio n to th e u p ro ar su rrou n d in g Relf. D o c to rs should b e given latitu d e in d ecid ing w ho should b e sterilized .138 D o c to rs in th e N o rth ea st agreed. B o s to n C ity H o sp ital as w ell as h osp itals in N ew Y ork C ity p erfo rm ed u n n ecessa ry hys­ te re c to m ie s on b la ck w om en, o sten sibly to tra in in tern s in th e p ro ced u re.139 The fa ct th a t w hite d o cto rs ta rg e ted b la ck w o m en im plies th a t physicians believed th a t they, n o t w om en, had th e right to d ecid e w ho p ro crea tes. D esp ite th e steriliz a tio n controversy, C on g ress am end ed se c tio n 19 o f th e S o cia l Se cu rity A ct in 1 9 7 5 to allow fed eral funds to pay 9 0 p e rce n t o f its co st fo r in d igen t p atients. C on cu rren tly, fed eral funds covered only 5 0 p e rce n t o f ab o rtio n s. Th ese revisions en ticed h ea lth care officials to p ro m o te steriliz a ­ tio n .140 N o t only did th e se fin a n cia l in d u ce m en ts d ecrea se re tu rn p atients at clin ics, b u t fed eral coverage cou ld b e view ed as a b la n k et en d o rse m en t o f sterilizatio n . The C o m m itte e fo r A b o rtio n R ig h ts and A g ainst S te riliz a ­ tio n A bu se, fou nd ed in 1 9 7 6 , argued th a t p o p u latio n co n tro llers p u rp o se­ fully funded steriliz a tio n b u t n o t a b o rtio n to fo rce ind igent w om en, m any o f w h om w ere also w o m en o f color, to end th e ir fertility p erm anently .141 In S e p te m b er 1 9 7 7 th e N ation al C o n fere n ce on S teriliz a tio n A buse brou ght d elegates fro m fifty org anizatio n s to W a sh in g to n , D .C ., in clu d in g fem in ists, h ealth refo rm e rs, fam ily p lan n ers, m in o rity w om en, N ative A m e rica n s, and

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ch u rch so cial a ctio n groups. They co n ferred w ith D H E W rep resen tatives and d em and ed s tric te r reg u latio n s. In re sp o n se D H E W issued a new p o licy in 1978 th a t req u ired a tra n sla to r w h ere need ed , p ro h ib ited gaining co n se n t during any o th e r m e d ica l p ro ced u re (a b o rtio n or b irth ), lim ited sterilizatio n to th o se tw en ty -o n e or older, and exten d ed th e w aiting p eriod fro m th re e to th irty days. M an y fem in ists saw th e la tte r as p a tern a listic: w o m en did n o t n eed th irty days to m ak e up th e ir m in d s.142 W h ile a w om an seeking steriliz a ­ tio n m ight n o t n ee d th is tim e, ind igent w o m en facing pressu re fro m officials cou ld u se it to investigate th e ir righ ts. W ith n ew guidelines in p lace, m o st abuse w atchd og org anizatio n s disbanded. The u n e th ica l u se o f steriliz a tio n as a form o f p op u lation co n tro l led m any ind igent groups, p articu larly eth n ic and ra cia l m in o rities, to m istru st fam ily ­ p lanning services. A survey o f 1 ,8 9 0 black s in on e n o rth e rn and on e sou th ern city found th a t 4 7 p e rce n t re je c te d steriliz a tio n as a m ean s o f b irth con trol. Y et Dr. E m ily H a rtsh o rn e M u d d o f P en n sy lvan ia fou n d th a t a su rprising n u m b er o f b lack w o m en ch o se steriliz a tio n follow ing th e co m p letio n o f th e ir last w anted pregnancy. B ec a u se o f th e g en o cid e issue, M udd req u ired th a t a m arried w om an o b ta in th e co n se n t o f h er husband. A lthou g h m e n w ere leery o f sterilizatio n for th em selv es, th e y ag reed to it fo r th e ir w ives, esp ecially if th e ir e co n o m ic situ atio n w as desp erate. M o st b lack s p referred less p e rm a ­ n en t b irth co n tro l. N in ety p e rce n t o f th o se polled ag reed th a t co n tra ce p tio n should b e tau g ht in ju n io r and sen io r h ig h sch o o ls, and 8 7 p e rce n t approved pu blicly fin an ced co n tra cep tiv e clin ics.143

Sterilization in Rhode Island W h ile sterilizatio n abu se w as co m m o n in m an y areas, P P R I rem ain ed u n ­ scathed : no accu sa tio n s o f g en o cid e o r c o e rcio n o ccu rred . The sta ff differed fro m w elfare officials in reco m m en d in g steriliza tio n fo r m en , n o t fo r w om en. A s a private n o n p ro fit o rg anization , it had no bu d g etary co n n e ctio n s to th e c o n c e rn over w elfare co sts. W ith no laws regu latin g steriliz a tio n in R h od e Island , th e d ecisio n w as left to d o cto rs. M o st p h y sician s refu sed to steril­ ize single m e n or first-tim e fath ers u p set by th e d isru p tio n o f a n ew baby, and m o st re q u ired a co n se n t fo rm signed by b o th hu sband and w ife. The late 1 9 6 0 s saw a grow ing g ra ssro o ts d em and fro m m e n fo r easier a ccess to v a se cto m ie s.144 P P R I resp o n d ed w ith th e first v a se cto m y clin ic in N ew England on 3 0 S e p te m b e r 1 9 7 0 . F ro m th e sta rt it had a “long w aiting list.” M a rried m en m e t w ith th e m e d ica l d ire cto r; th e clin ic en cou rag ed bu t did n o t m an d ate w ives’ atten d an ce. To ease m ale em b a rra ssm en t th e clin ic h ired a m ale aide. P P R I co n tin u ed to serve as a tra in in g center, allow ing m ale stu d ent nurses

W ho Pays for What? Abortion and Sterilization, 1960—1975

to atten d each v a secto m y clin ic. B y N o v em b er P P R I had receiv ed over 175 ap p lication s, and 1 2 2 m e n w ere w aiting fo r a p p o in tm en ts. P P R I exp erien ced p roblem s staffing th e clin ic b eca u se o f “an acu te shortag e o f u ro lo g ists" W h ile dem ands for tu b al ligations also in creased , P P R I em phasized th e relative ease o f vasectom y.145 The em phasis o n m ale versus fem ale p ro ced u res w as due to c o n c e rn fo r w o m en ’s health , b u t e c o n o m ics m ay have played a ro le as well. P P R I cou ld n o t p erfo rm tu b a l ligations b u t could p e rfo rm v a secto m ies. For th e rem ain d er o f th e d ecad e th e n u m b er o f v a se cto m ies m ou n ted . In early 1971 “th e dem and fo r v a se cto m ies far surpass[ed] our ability to p erfo rm th e m " M o re th a n 1 5 0 m e n w ere on a w aiting list, lead ing th e L y in g -In to o p en a v asecto m y clin ic in A ugust 1971; it w as im m ed iately bo o k ed , w ith “a long w aiting lis t" P P R I hired five u rolo g ists to cu t th e w ait tim e .146 T he clin ic allow ed lo w -in co m e m e n th e sam e rep ro d u ctiv e c o n tro l as m id d le- and u p­ p er-class m e n w ho could afford private physicians. Dr. Rudy K. M eiselm an , a P rovid en ce u rolo g ist, cite d tw o fa cto rs fo r th e g rassro o ts dem and. First, b o th m e n and w o m en “ro u tin ely d iscu ssed " all available m e th o d s o f co n tra ce p tio n . S e co n d , th e w id espread use o f th e pill “p ro m o ted th e n o tio n o f sp o n tan eity in sexu al re la tio n sh ip s" W h e n e v e r n eg ­ ative p u b licity su rfaced co n c ern in g side effects fro m th e pill, M eiselm a n and P P R I ex p erien ced an in crea sed d em and fo r vase cto m ies. Dr. N ath an C h aset, c h ie f o f u rology at L ying-In, co n cu rre d bu t added th a t “W o m en ’s L ib e ra tio n [brought] p ressu re fo r a reassig ning o f re sp o n sib ilitie s" C h a set argued th a t re search ers should develop m ale m eth o d s: “T h ere ought to b e so m e way o f g ettin g to th e m ale. The average w o m an is ready to qu it (having child ren) at 3 0 , and to put h e r th ro u g h all th a t (the pill, etc) fo r a n o th e r 2 0 years d oesn ’t m ake s e n s e "147 Y et W is e fou nd ta rg etin g m e n w as n o t always su ccessfu l b eca u se o f r e ­ m ainin g “h an g u p s" W iv es w ould co m e to P P R I and “g et all th e in fo rm a tio n fo r th e ir husbands," b u t th e n m e n failed to follow th rou g h on th e p roced u re. Dr. C harles P o tte r o f P P R I found m ale re lu cta n ce ro o te d in “fea rs” o f “re d u c­ tio n in his (sexual) drive." Dr. M eiselm a n co n cu rre d , co n ten d in g th a t it p er­ haps explained th e resid ual so cia l stig m a a ttach ed to th e p roced u re. H e had so m e p atien ts w ho “p referred to pay out o f th e ir p o ck et (ra th er th a n put in fo r B lu e Shield) b eca u se th e y don’t w ant peop le around th e ir office to know. T h e re’s still a cloud over i t " 148 T h ose m e n w ho did u nd ergo v a se cto m ies w ere satisfied. O n e m an ’s a c ­ co u n t w as revealing: “In less tim e th a n it to o k m y w ife to have a cup o f co f­ fee w ith a frien d . . . I w as sterile. . . . It w ould b e n ice to say th a t th e Z ero P op ulation G ro w th m o v em en t had g o tte n to m e, th a t I had u nd ergone a v a­ secto m y fro m a sense o f so cia l and eco lo g ica l responsibility. B u t th e tru th is, th e ch o ice w as purely selfish. W e had ju s t had our fo u rth ch ild " T en w eeks

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a fter th e o p eratio n “arg u m en ts and d iscu ssion s over th e Pill, th e L oop , th e Foam , and o th e r co n tra cep tiv e m e th o d s w ould seem as re m o te fro m m y new lifestyle as th e h o rse and buggy"149

Conclusion H ow su ccessfu l w ere fam ily -p lan n in g prog ram s during th e 1 9 6 0 s and 1 9 7 0 s? The 1 9 7 0 cen su s suggests th a t during th e late 1 9 6 0 s th e b irth ra te in fam ilies w ith less th a n $ 5 ,0 0 0 an n u al in c o m e d eclined sharply. T he n u m b er o f b irth s fell alm o st tw ice as far in ind igent as it did in w ealthy fam ilies: b irth s to in d i­ gen t w o m en dropped th irty -tw o p er th ou san d , w hile th e re st o f th e pop u la­ tio n dropped sev en teen p er th ou san d . The largest d ecrea se o ccu rred am ong b lack w o m en — a d eclin e o f fo rty -n in e p er thou sand . Newsweek claim ed th a t th e “c h ie f cau se” fo r th is re d u ctio n w as “th e in c rea se in g ov ern m en t sp o n ­ sored b irth co n tro l c lin ic s " A n o th e r study found th a t subsidized fam ily -p lan ­ n in g services low ered th e p reg n an cy rate am o n g teen a g ers and th a t a ccess to a b o rtio n su bstantially red u ced th e in cid e n ce o f illeg itim ate ch ild b irth .150 In ord er to low er illegitim acy, b re a k th e cy cle o f poverty, and red u ce w el­ fare exp en d itu res, th e g ov ern m en t subsidized serv ices, inclu d ing c o n tra ce p ­ tives, a b o rtio n for a sh o rt tim e, and sterilization . G o v ern m e n t a ctio n in th is area had little to do w ith w o m en ’s rig h t to c o n tro l th e ir bod ies bu t ra th er w ith co n ce rn s over m o u n tin g w elfare exp en d itu res and p erceiv ed u n co n tro lled fertility am o n g th e ind igent, esp ecially eth n ic and ra cia l m in o rities. To re ­ solve th e se “p ro b lem s” th e fed eral g ov ern m en t in crea sed fin an cial su pport fo r fam ily p lanning by 1 ,3 0 0 p e rce n t b etw een 1 9 6 7 and 19 7 3 . This involve­ m e n t co in cid ed w ith th e w elfare exp lo sio n o f th e late 1 9 6 0 s and th e e sca la t­ ing co sts to so ciety o f p rog ram s fo r th e ind igent. T hrou gh subsidized c o n tra ­ ce p tio n w hite elites in p ow erful p o sitio n s attem p ted to shape th e ra cia l and so cio e co n o m ic quality o f th e p op u latio n along lines su itab le to th em . W h ile m any w o m en faced co erciv e ta c tic s , o th e rs w ere able to tak e ad vantage o f n ew subsidized serv ices to g overn th e ir life ch o ices. A t P P R I th e se ch o ices inclu d ed a full rang e o f co n tra cep tiv es, a b o rtio n , and vasectom y.

8

Backlash, 1973-2000

G o v ern m en t subsidies and p o p u lation co n tro l ad v ocacy o f co n tra ce p tio n and sterilizatio n co n tin u ed th ro u g h th e end o f th e tw e n tieth century. B y 2 0 0 0 fem ale sterilizatio n w as th e m o st co m m o n co n tracep tiv e, esp ecially am ong w o m en o f co lo r and low er e c o n o m ic m eans. The use o f p u blic funds fo r ab o r­ tio n , on th e o th e r hand , ca m e u n d er in crea sin g a tta ck . The b attleg rou n d shifted fro m efforts to legalize a b o rtio n to organized and so m etim es violen t attem p ts to recrim in a liz e or re stric t a ccess to it. The m o d ern a n tich o ice c a m ­ paign resem b les n in e te e n th -c e n tu ry efforts to u n d erm in e w o m en ’s dem ands fo r eq u al righ ts by forcin g th e m to rev ert to th e tra d itio n a l role o f m other. W h ile b o th cam paigns p ortrayed a b o rtin g w o m en as selfish and u nnatural, few in th e n in e te e n th cen tu ry d ebated th e legal status or p e rso n h o o d o f th e fetu s. The p o st-^ o e op p o sitio n , on th e o th e r hand , p rio ritized th e legal and co n stitu tio n al p ro te ctio n o f th e fetu s over th e m other. T he v o cal an tia b o rtio n cam p led p op u latio n co n tro llers to em p hasize in stead steriliz a tio n and lon g a ctin g co n trace p tiv es, esp ecially D ep o P rovera (D P) and N o rp lan t, as th e answ er to p erceived p op u lation problem s. A s a b o rtio n b e c a m e to o politically charged to p ro m o te as a cost-savin g m e th o d fo r g ov ern m en ts, state and fed ­ eral fund ing d ried up. Funds for sterilizatio n and lo n g -a ctin g co n tracep tiv es, on th e o th er hand, rem ain ed in ta ct. Th ese m eth o d s b e tte r suit th e pop u lation co n tro l agenda as th e y are p erm a n en t, or sem ip erm a n en t, and th u s avoid any a ccid e n tal p reg n an cies th a t ind igent w o m en cou ld n o t afford to ab o rt.

Contraceptive and Abortifacient Developments P op ulation co n tro llers latch ed on to n ew co n tra cep tiv e te ch n o lo g ie s, esp e­ cially D P and N o rp la n t, to p rev en t socially and eco n o m ica lly “u n su ita b le” w o m en fro m co n ceiv in g , w hile avoiding th e a b o rtio n issue. A b o rtio n r e ­ strictio n s d isp ro p ortion ately affected in d igen t o r lo w -in co m e w om en, o ften m in o rities and te en a g ers, th e very groups w hite con serv ativ e elites targ eted fo r d ecreased fertility. They h op ed to c o rre c t th e co n se q u e n ce s o f a b o rtio n lim itatio n s th rou g h th e d isp ersal o f new, lo n g -lastin g co n tracep tiv es.

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DP, m an u factu red by U p jo h n C om pany, is an in je cta b le co n tracep tiv e, ef­ fectiv e fo r th re e m o n th s and ch e a p er th a n th e pill. M o s t clin ica l tria ls w ere co n d u cted o n w om en o f color, esp ecially in K enya, M ex ico , and Thailand. In 1 9 6 7 U p jo h n applied to th e FD A , bu t n o t u n til 1 9 7 2 did D P gain approval, and th e n only for in o p erab le c a n c e r tre a tm e n ts b eca u se o f its p ossib le ca r­ cin o g e n ic qu alities. The follow ing year C on g ress receiv ed assu ran ces fro m U p jo h n th a t th e com p any w ould n o t d istribu te D P fo r unapproved p u rp oses. U p jo h n reapplied in 1 9 7 8 for co n tra cep tiv e use, bu t th e F D A refused. N ev ­ erth eless, U p jo h n m ark eted D P as a co n tra cep tiv e in developing n atio n s and d em and ed a h earin g b efo re a pu blic bo ard o f in q u iry con sistin g o f n o n -F D A m em b ers. The C en te r fo r D rugs and B io log ics in fo rm ed th e board th a t “never has a drug w hose ta rg et p o p u latio n is entirely h ealth y p eop le b e e n show n to b e so pervasively ca rcin o g e n ic in an im als as D ep o P rovera has b e e n " D P failed te sts in th re e sp ecies: dog, m onkey, and m ouse. The 1 9 8 4 b o ard re p o rt con clu d ed th a t D P w as u nsafe and could n o t b e approved fo r m ark etin g . O n e bo ard m e m b e r d issented bu t urged approval fo r only tw o groups o f w om en, th e m entally retard ed and drug abu sers. In 1 9 8 6 U p jo h n w ith d rew its appli­ catio n fro m th e F D A .1 Stu d ies d iscovered o th e r side effects. P erm a n en t sterility w as p ossible; even su p p o rters o f th e drug urged th a t it n o t b e used on w o m en w ho had n o t co m p leted th e ir fam ilies. D P could also cau se irreg u lar bleed in g, ce ssa ­ tio n o f p erio d s, m iscarriag es, stillb irth s, b irth d efects, or dam age to a nursing in fan t, and it could cau se or aggravate h e a rt disease, strok e, o r lung co m p li­ catio n s. It could also lead to severe d ep ression and so m etim es suicide, but d o cto rs d ism issed th is side effect as “triv ia l" as th e y did w ith th e pill in th e early 1 9 6 0 s . Dr. G ary R ichw ald o f th e U C L A S c h o o l o f P u blic H ea lth found th a t seriou s d epression, n o t m o o d sw ings, o ccu rred am o n g 15 to 4 0 p erce n t o f u sers. O th e r re p o rts in d icated th a t D P ’s effect on th e im m u n e system was unclear, p ossibly leaving w om en m o re su scep tib le to tu b ercu lo sis, A ID S , and o th e r d iseases.2 D esp ite th e se p ro b lem s and th e F D A ban, co n g ressio n a l investigations in 1987 u ncov ered m isu se o f D P am o n g ind igent and lo w -in co m e, o ften m in o r­ ity, w om en. U p jo h n failed to keep its p ro m ise to C on g ress and ship ped D P to fam ily-p lan n in g clin ics, cou n ty h ea lth d ep artm en ts, stu d ent h ea lth cen ters, private p hysicians, and th e IH S. The IH S ig n ored FD A safety d eterm in atio n s and p re scrib ed D P to N ative A m e rica n w om en, th e m a jo rity o f w h om w ere m entally retard ed . The IH S ju stifie d its a ctio n s by arguing th a t su ch w o m en could n o t b e relied u p o n to tak e o th e r co n tra cep tiv es, y et it gave th e sh ot to health y N atives as well, alm ost all o f th e m on welfare. The IH S had n o w ritten in fo rm ed co n se n t, and it failed to m e n tio n th a t th e F D A had n o t approved DP. It p re scrib ed a p oten tially ca rcin o g en ic drug w ith o th e r serious side ef­

Backlash, 1973-2000

fe cts to physically health y w o m en w ith ou t g u aran teein g th e y w ere aw are o f th e possible co n se q u e n ce s.3 C ongress also discovered th a t d o ctors gave th e sh ot to w o m en w ho “w ould n o t” tak e o th e r co n tra cep tiv es. A C O G ’s p o licy “strong ly re co m m en d s th a t D ep o P rov era b e u sed as a co n tra ce p tiv e in th o se w o m en w ho are u nable o r unw illing to u se o th e r co n tra ce p tiv e m e th o d s”; W H O , In te rn a tio n a l P lan n ed P aren th o o d F ed eration , th e A m e rica n A cad em y o f P ed iatrics, and th e A M A agreed w ith A C O G ’s p o sitio n . The literatu re o n D P listed groups o f w o m en fo r w hom D P w as reco m m en d ed : w o m en w ho w ould n o t use a n ­ o th e r m eth o d ; had refu sed sterilizatio n ; w ere “unm otivated,” “u nreliable or irresponsible,” “less co m p ete n t or in co m p eten t,” “illiterate,” “retarded,” or “o f low in tellig e n ce”; w ere “p ro b lem w o m en ” o r had “p ro b lem fa m ilie s”; w ere p sy ch iatric p a tien ts; w ere “p rom iscu ou s,” esp ecially if young; or cou ld n o t u n d erstan d English. The list end ed by hailing D P as a sign ifican t aid in p o p u ­ latio n co n tro l. The N atio n al W o m e n ’s H ea lth N etw o rk te stified regard ing th e registry it kept o f D P u sers fro m 1 9 7 9 to 19 8 7 . N in ety p e rce n t received n o in ­ fo rm atio n regard ing th e d rug’s u napproved statu s, and n o n e w ere to ld th a t it w as th e only co n tra cep tiv e m eth o d linked to ca n c ers in all anim als te ste d .4 K aren B ran an , a w hite m id d le-cla ss w om an, co n firm ed D P abu se. Sh e te le p h o n ed six clin ics th a t ca tered p rim arily to in d igen t w o m en o f co lo r to ask fo r DP. E a ch told h e r to co m e in fo r th e shot. W h e n she asked if problem s existed w ith it, th e y assu red h er n o; n o n e told h e r th a t th e FD A had n o t ap­ proved DP. B ran a n th e n called six private d o cto rs’ offices caterin g prim arily to w hite m id d le- and u p p er-class w om en; th e y expressed sh o ck th a t she had h eard o f D P and stron g ly re co m m en d e d ag ain st tak in g it. O n e d o cto r in ­ form ed h e r th a t D P w as for retard ed w om en and w om en w ho could n o t care fo r th em selv es. A ll six revealed th a t th e F D A had n o t approved it.5 B ran an w en t on to prod u ce a d o cu m en ta ry en titled The Ultimate Test Animal. Sh e sen t on e b lack and on e N ative A m e ric a n w o m an in to clin ics serving w elfare clie n ts w here th e y asked fo r b irth co n tro l, n o t DP. In every ca se th e sta ff reco m m en d e d DP. O n e w om an told clin ic officials she had d iabetes, a c o n ­ train d icatio n fo r DP, bu t th e d o cto r offered h er th e drug anyway. S o m e clin ics provided D P free o f charge, b u t no o th e r co n tra cep tiv e m e th o d w as g ratu ­ itous. B la ck and N ative A m e rica n w om en to ld B ra n a n th a t D P w as th e only m eth o d to w h ich th e d o cto r in tro d u ced th em . B ra n a n b lam ed th e “p a tern a l­ ism and racism o f th e d o ctors w ho, alm o st w ith ou t ex cep tio n . . . w ere en th u ­ siastic ab o u t it, spoke o f w o m en ’s ig n o ra n ce and in ab ility to b e resp o n sib le fo r th e ir ow n con tracep tio n .” H ea lth officials targ eted ind igent, lo w -in com e, and m in o rity w o m en w ith an unapproved and p oten tially d angerous drug for p u rp oses o f p o p u latio n co n tro l. PPFA favored D P and u rged rem ov al o f th e FD A b a n .6 The F D A approved it in th e su m m er o f 1 9 9 2 .

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S in ce FD A approval D P has co n tin u ed to b e con tro v ersial. Sid e effects persist. U p jo h n ’s studies fou nd th a t 6 0 p e rce n t o f th e w o m en using it exp e­ rien ce d w eight gain o f up to fifteen pou nd s. Q u e stio n s regard ing its possible link to b re a st, liver, and ce rv ica l ca n cers rem a in u nan sw ered , a lth ou g h som e re sea rch in d icates th a t th is link m ay n o t b e as stron g as previously thou ght. The sh o t’s d u ratio n m ean s side e ffects are p rolong ed : th e average w om an n eed s six to eight m o n th s to expunge th e drug fro m h er system ; fo r som e, th e effects last eigh teen m o n th s or longer, even afte r a single shot. W o m en th e re ­ fore ex p erien ce a lo n g er delay b efo re co n c e p tio n th a n th o se w ho d iscon tin u e use o f pills, IU D s, or b a rrie r m eth o d s. This delay lim its th e ir co n tro l over re p ro d u ctio n and m ak es D P all th e m o re a ttractiv e to p o p u lation co n tro llers and m e d ical p ro fessio n als. M oreov er, D P cou ld b e used fo r th e “ch e m ica l ca stra tio n ” sen ten ces th a t so m e ju d g es have co n sid ered fo r clien ts th e y deem u nw orthy o f m o th erh o od . Sim ila r co n tro v ersy em erg ed over N o rp la n t, a co n tra ce p tiv e su rgically in se rted in th e a rm th a t lasts at least five years and as long as eight. M any con sid ered N o rp la n t-d e v e lo p e d by th e P op u lation C o u n cil and approved by th e FD A in 1 9 9 0 - t o b e th e b est co n tra cep tiv e in n o v atio n since th e pill. N o r­ p lant offered ind igent and lo w -in co m e w om en, w ho have m o re u np lanned p reg n an cies, a very reliable, n o n p erm a n e n t o p tio n to m e e t th e ir in ten d ed child b earin g goals. T esting b eg an in 1 9 6 8 and, sim ilar to th e pill and DP, was co n d u cted p rim arily on w o m en o f co lo r in u nd erd eveloped n atio n s. M o re th a n on e m illion In d o n esia n w o m en w ho have used it since th e early 1 9 8 0 s have in d icated th a t th e y receiv ed in co m p le te in fo rm a tio n and th a t h ea lth o f­ ficials pu shed th is o p tio n over o th ers and d eterred w o m en fro m early ex tra c­ tio n . P op u lation co n tro l p o licies and m e d ica l re sea rch resu lts, n o t w o m en ’s h ealth and ch o ice, d irected N o rp la n t’s availability.7 N u m erou s side effects plagued N o rp la n t u sers. Irreg u la r bleed in g, p ro ­ longed p erio d s, h ead ach es, a cn e, w eight gain, d erm atitis, nau sea, n erv o u s­ n ess or m o o d sw ings, m astalg ia, chang es in app etite, ovarian en larg em en t, and in fe ctio n at th e site o f im p lan tation w ere co m m o n . P ro b lem s also existed w ith rem oval, inclu d ing difficulty lo ca tin g and ex tra ctin g th e device, w hich so m etim es req u ired surgery u nd er g en eral a n esth esia and resu lted in sca r­ rin g and lo n g -te rm pain. M o s t p rim ary care phy sicians w ere n o t tra in ed in rem oval, fo rcin g w o m en to seek sp ecialists available at P lanned P aren th oo d or large te a ch in g h o sp ita ls.8 O th e r p ro b lem s existed. N o rp la n t’s high c o s t $ 3 5 0 fo r th e device and $ 1 5 0 ea ch to em b ed and e x tra ct i t - m a d e officials re lu cta n t to com p ly w ith req u ests for early rem oval. M ed ica id defrayed th e co st in all fifty states, bu t b eca u se pay m ent fo r o th e r co n tracep tiv es varied, th is universal coverage exerted e c o n o m ic p ressu re on th e in d igen t to ch o o se N orp lan t. N o rp lan t, sim ilar to DP, m ad e w o m en d ep en d en t o n m e d ica l ex­

Backlash, 1973-2000

p e rtise fo r in se rtio n , bu t it also req u ired th e m to seek m e d ica l a tten tio n for its rem oval. B o th N o rp lan t and D P led to a d ecreased u se o f co n d o m s, w hich m ay have in crea sed A ID S am o n g u sers.9 A s w ith DP, h ea lth officials targ eted m inority, lo w -in co m e, and ind igent w o m en for N o rp lan t. In Ju ne 1991 IH S b eg an offering it to clien ts. The N a ­ tive A m e rica n W o m e n ’s H ea lth E d u ca tio n R eso u rce C en te r (N A W H E R C ) in vestigated IH S use in S o u th D a k o ta and p u blished its findings in 1 9 9 2 . N o rp lan t w as a p o o r ch o ice fo r average N ative A m e rica n s on reserv atio n s b ecau se th e y had th e h ig h est rates o f diabetes and gall bladd er d is e a s e - tw o co n train d icatio n s fo r N o rp lan t use. O th e r co n tra in d ica tio n s inclu d ed hyp er­ te n sio n , cancer, sm oking, and cirrh o sis. Yet IH S co n tin u ed to en cou rag e its use in m ed ically a t-risk w om en. Tw o w o m en w ith fam ily h isto rie s o f b re a st ca n ce r o n S o u th D ak o ta’s R osebu d R eserv a tio n w ere given N o rp la n t; n o one in fo rm ed eith e r o f th e m o f th e a sso cia tio n b etw een N o rp la n t and b re a st c a n ­ cer. A heavy sm o k er w ith h ig h b loo d p ressu re also w as n o t w arn ed o f th e risks. N A W H E R C fou nd th a t IH S had no p ro to c o l fo r in fo rm ed co n se n t and n o guidelines ab o u t rem oval. IH S clin ician s so m etim es ig n ored dem ands to rem ov e th e device if w o m en had n o t kept it in long enou gh to offset th e co st o f im p lan tation . By 1 9 9 2 d ozens o f N ative A m e rica n w o m en rep o rted th a t th e ir req u e sts fo r rem ov al w ere d iscouraged or refu sed by ph y sician s.10 The N atio n al B la c k W o m e n ’s H ea lth P ro je c t (N B W H P ) initially hailed N o rp lan t b u t grew co n cern e d w ith h ea lth co n d itio n s a ffectin g b la ck w om en. Sim ila r to N A W H E R C , N B W H P co n clu d ed th a t m an y w o m en o f co lo r lacked th e n ecessa ry h ea lth care to evaluate w h eth er N o rp lan t w as safe for th em . N B W H P qu estio n ed th e punitive and racially m o tiv ated u se o f N o r­ plant: “B e ca u se it’s th e clo sest th in g to sterilizatio n , folks have seized on th is and trie d to im p o se it on th e w o m en w ho have th e least p ow er in our s o c i­ ety. . . . They see it as so cia l co n tro l fo r th o se w o m en w ho th e y believe are re ­ sp onsible fo r all o f our so cia l issues.” O n e m eans o f im p o sitio n w as in cen tiv e program s: w hile in cen tiv es w ere n o t a “bad thing,” th e d istin c tio n betw een in d u ce m en t and co m p u lsio n in state packages w as o b scu re b eca u se officials only offered th e m to ce rta in w o m e n -in d ig e n t, usually single m o th e rs on re lie f w ho w ere o ften w o m en o f color.11 Th ese w o m en w ere th e very group p op u latio n co n tro llers did n o t tru st to rep ro d u ce in socially d esirable ways. B a ltim o re w as a case in p oin t. W ith on e o f th e n a tio n ’s h ig h est ad o lescen t b irth ra tes, 10 p e rce n t o f all fifte e n - to sev en teen -y ea r-o ld s gave b irth at a g o v ern m en t co st o f $ 2 2 2 m illio n in 1 9 9 0 . In 1991 2 3 p e rce n t o f all city b irth s w ere to te e n s. C ritic s hailed N o rp lan t as on e solu tion . H ea lth d ep artm en t fam ily-p lan n in g clin ics m ad e N o rp la n t available to ad o lescen ts in th e su m ­ m e r o f 1 9 9 2 , bu t officials believed th e b est d istrib u tio n m e th o d w ould be in already existin g sc h o o l-b a se d h ea lth cen ters in six h ig h scho o ls. The city

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in stitu ted a p ilo t p ro g ram for th e 1 9 9 2 - 9 3 sc h o o l y ear in P aqu in S c h o o l, a co m b in ed m iddle and high sch o o l fo r p aren tin g and p reg n an t te e n s ch o sen b ecau se te e n s w ho gave b irth w ere at a h ig h er risk o f p reg n an cy th a n oth ers. O p p o sitio n had em erg ed by Jan u ary 1 9 9 3 am on g a sm all bu t v o ca l group. They argued th a t th e city used N o rp lan t to ta rg e t in n e r-c ity b la ck te e n a g ­ ers, w h ich w as ta n ta m o u n t to g en ocid e: P aqu in w as 9 0 p e rce n t black . They also co n ten d ed th a t N o rp lan t had n o t b e e n su fficiently te ste d on b la ck te en s and had d angerous side effects. Its users w ere less likely to use con d om s and th u s p laced th em selv es at a h ig h er risk o f S T D s and A ID S . A city co u n cil h earin g in F eb ru a ry 1 9 9 3 resp o n d ed to charges o f g en o cid e, arguing th a t all co n tracep tiv es w ere available in sc h o o l-b a se d prog ram s. T he m a jo rity at th e h earin g su p p orted th e p ro g ram as long as it w as n o t coercive. B a ltim o re co n tin u ed to m ake N o rp lan t available at P aquin and th re e o th e r hig h scho o ls w ith plans to expand to th e rem ain in g tw o.12 Fears o f gen o cid e m ay have b e e n ju stifie d in light o f th e ease o f c o e rcio n w ith N orp lan t. S o m e argued th a t its involu ntary in se rtio n did n o t necessarily violate a w o m an ’s rig h t to privacy, as fertility re tu rn ed rapidly u p o n rem oval. S u ch arg u m en ts d ep icted m and ated in se rtio n as m o re a ccep ta b le th a n ster­ ilizatio n b ecau se N o rp la n t’s reversibility did n o t p erm an en tly deny w o m en th e ir right to rep rod u ce, y et it re a sserted ju d icia l and legislative co n tro l over so m e w o m en ’s rep ro d u ctio n . L eg islators co n c ern e d w ith p op u latio n co n tro l p ro p o sed m an d a to ry u se o f o r in cen tiv e plans fo r N o rp la n t, claim in g th a t so ciety should b e able to avoid p u b lic exp en d itu res a sso cia te d w ith b irth s am o n g ce rta in groups, inclu d ing th e ind igent, m entally o r physically h an d i­ cap ped , and H IV -p o sitiv e. Su p p o rters to u te d N o rp lan t, as th e y had th e pill earlier, as th e cu re fo r teen ag e pregnancy, w elfare depend ency, child abuse, and d ru g-ad d icted m o th e rs.13 This sim p listic answ er to co m p lex p ro b lem s su b je cted N o rp lan t users to th e p o p u latio n agend a o f so m e h ea lth p ro fessio n als. M e d ica l officials w ho w ished to cu rta il ce rta in w o m en ’s re p ro d u c tio n eith e r d eliberately o r su b ­ lim inally en cou rag ed th e m to a cc ep t N o rp lan t by dow nplaying its side effects and fram in g o th e r ch o ice s in a negative light. R ep o rts co n firm ed th a t physi­ cian s co n tin u ed to jud g e c e rta in w o m en in c o m p e te n t to em ploy effectively o th e r o p tio n s, su ch as th e pill. M oreov er, w o m en relying on p u blic funds, w ho co n stitu ted m o re th a n h a lf o f N o rp la n t users by 1 9 9 4 , faced difficulty co n v in cin g h ea lth officials to rem ov e N o rp la n t b efo re th e five-y ear p eriod w as co m p lete u nless th e y ex p erien ced severe m ed ical p roblem s: a p a tie n t’s desire to b e c o m e p reg n an t or co m p lain t ab o u t “m in o r” side effects w as d is­ m issed. M an y ind igent w o m en did n o t seek early rem ov al d espite side effects b ecau se o f th e co s t.14 In th is fram ew o rk N o rp lan t served w ell th e in tere sts o f trad itio n al p op u latio n c o n tro l p o litics.

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E xam p les o f co e rciv e ta c tic s abou nd ed . The Philadelphia Inquirer ran an ed ito rial en titled “Poverty and N o rp lan t: C an C o n tra ce p tio n R ed u ce th e U n d erclass?” p rop osin g th a t N o rp lan t b e used as “a to o l in th e fight against b lack poverty” T he Philadelp hia A sso cia tio n o f B la c k Jo u rn a lists attack ed th e ed ito rial as a “ta c it en d o rse m en t o f slow g en o cid e” N u m ero u s states sug­ gested th a t ind igent w om en, o ften w o m en o f color, b e fo rced o r financially en ticed to accep t N o rp la n t.15 B etw een 1991 and 1 9 9 2 leg islato rs in tro d u ced tw en ty bills in fo u rteen states offering ca sh in cen tiv es to in d igen t w om en fo r using N o rp la n t or m ak ­ ing it a co n d itio n o f eligibility fo r A F D C . In K ansas R ep u b lican R ep re sen ta ­ tive K e rry P atrick called fo r w elfare m o th ers to be paid $ 5 0 0 to b e im planted; th e state w ould pay for th e im p lan t and fo r an n u al m e d ica l follow -u p s and give th e w o m an a fifty -d ollar an n u al b o n u s fo r k eep ing th e im plant. H e ju s ­ tified h is p ro p o sal by co n ten d in g th a t “it’s tim e w e stopp ed w orryin g abou t th e righ ts o f th e m o th e r and sta rted w orryin g ab o u t th e righ ts o f th e ch ild ren sh e’s brin gin g in to th e w orld ” H e also claim ed th a t “we, th e com m u nity, have a righ t to b e spared u n n ecessa ry co sts . . . to provide w elfare p aym ents and ed u catio n . . . if th a t kid is b o rn drugged.” The legislature defeated th e bill. In M ich ig an in 1 9 9 2 th e legislature approved $ 7 5 5 ,6 0 0 for fam ily-p lanning program s, $ 5 0 0 ,0 0 0 o f w hich w as earm arked for N o rp lan t b eca u se it w as th e m o st co st-effectiv e. S u p p o rters m a in ta in ed th a t “th e p rog ram n o t only co sts less [than pills] bu t saves m o n ey w h en it co m es to th e h o sp ital co sts fo r an u nw anted cra ck baby b o rn to an ad d ict w ho cou ld have opted fo r N orplant.” In M ississip p i leg islato rs trie d b u t failed to pass a b ill in 1 9 9 2 m and ating N o rp lan t fo r all w elfare w o m en o f rep ro d u ctiv e age as w ell as w o m en w ith fou r or m o re ch ild ren w ho receiv ed g ov ern m en t su p p o rt.16 T w en ty -o n e states co n sid ered su ch p ro p o sals b etw ee n 1 9 9 3 and 1 9 9 4 . S o u th C aro lin a d iscu ssed req u irin g w elfare w o m en to use N orp lan t. G o v er­ n o r W illiam S ch a efer o f M ary lan d called o n th e legislature to req u ire w elfare w o m en w ith illeg itim ate ch ild ren to u se N orp lan t. A lth ou g h m o st attem p ts failed, a S o u th D a k o ta law stated th a t if M ed icaid paid for th e in se rtio n , it w ould n o t pay fo r rem ov al unless a clea r m e d ica l re a so n existed. O n e w om an in a sh elter gained sixty-five p ou nd s in six m o n th s and ex p erien ced tro u b le w ith h er k n ees and b lo o d p ressure, b u t still d o cto rs in fo rm ed h e r th e y w ould n o t rem ov e th e im p lan t u nless she ag reed to a tu b a l ligation, a p ro ced u re she did n o t re q u e st or w ant. A lthou g h d ebated, n o state laws passed m and ating th e u se o f N o rp lan t o r offering fin a n cia l in cen tiv es fo r im p la n ta tio n .17 C o e rcio n w as also em ployed in ce rta in crim in a l sen ten cin g , esp ecially child abuse and drug cases. A d vocates argued th a t if child abu sers could be sen ten ced to jail, w here th e y w ere d enied m any lib ertie s, in clu d in g p ro c re ­ ation, th e n denying th e m th e rig h t to b e a r ch ild ren w ith N o rp lan t w hile on

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p ro b atio n ra th er th a n in ja il w as th e lesser p u n ish m en t. This line o f re a so n ­ ing is p ro b lem atic. M an d atin g N o rp lan t w as g end er biased : it re stricte d th e rep ro d u ctiv e rights o f only th e m oth er, w hile abusive fath ers w ere n o t legally p ro h ib ited fro m having ch ild ren . N o studies show ed th a t N o rp la n t m ade w o m en less violen t m o th e rs. The sta te ’s c o n c e rn fo r a m o th e r’s inability to care fo r h e r ch ild ren prop erly w as n o t served by prob ation . R a th er th a n N o r­ p lant, officials should have offered child abu sers services su ch as cou n selin g , jo b assistan ce, and p re- and p o stn a ta l care. In extrem e cases, rem ov al o f th e child m igh t have b e e n n ecessary .18 Still, jud ges used th e ir pow ers to m an d ate N o rp lan t fo r so m e w om en. The first case o ccu rred in C alifo rn ia in 1991. Judge H arry B ro ad m an sen ten ced D arlen e Joh n so n , a tw en ty -sev en -y ear-o ld b la ck m o th e r o f four, to N o rp lan t fo r child abuse. Jo h n so n had b ea ten tw o ch ild ren w ith a b elt and ele c trica l cord afte r she cau ght th e m sm oking. B ro a d m a n co n ten d ed th a t state in te r­ est in p ro te ctin g th e rights o f th e w om an’s fu tu re ch ild ren , inclu d ing th o se n o t yet con ceived , outw eighed h e r rig h t to privacy and rep ro d u ctiv e choice. F u rth erm o re , so ciety had th e rig h t to p ro te c t its e lf fro m fu tu re so cia l and e co n o m ic co sts a sso cia te d w ith su ch abuse. Yet Jo h n so n ’s status as an in d i­ gen t b lack w om an had as m u ch to do w ith h e r sen ten cin g as h e r crim e. H er case fits th e h isto ric a l fra m ew o rk o f rep ro d u ctiv e p o licies aim ed a t th o se co n sid ered “u ndesirable.”19 In th e w ake o f th is case variou s states co n sid ered legislation to m an d ate N o rp lan t fo r ce rta in fem ale co n v icts as a co n d itio n o f sen ten cin g or parole. In O h io S e n ate B ill 8 2 d eem ed b ea rin g a d ru g-ad d icted child seco n d -d eg ree aggravated assault. P u n ish m en t fo r a w om an w ith no p rio r child abuse c o n ­ v ictio n w as eith e r a drug ad d iction p ro g ram or N o rp la n t, w ith an ag reem en t to ab stain fro m drugs for five years. For a w om an w ith previou s child abuse co n v ictio n s th e p u n ish m en t w as m an d atory N o rp lan t paid for by th e w om an. In S o u th C aro lin a B ill 9 8 6 req u ired phy sicians to te s t n ew b o rn s fo r drugs if th e y su sp ected drug abu se by th e m other. A p ositive resu lt w as grounds fo r sterilizatio n o r N orp lan t. K e rry P a trick o f K ansas in tro d u ced legislation m an d atin g N o rp lan t fo r all w o m en o f ch ild b earin g age co n v icted o f p o sse s­ sion o r d istrib u tio n o f co c a in e , cra ck , or h eroin . A Texas co u rt sen ten ced C athy L an el K n ig h ten to N o rp la n t as p art o f h e r plea barg ain follow ing h er co n v ictio n fo r sm o th erin g h e r in fan t daughter. T he p ro se cu to r claim ed th a t “it w as a qu estio n o f w h eth er so m eo n e like th is goes to p riso n and g ets out and rep ro d u ces, or w e do som eth in g like th is ” Id a Jean Tovar, also o f Texas, agreed to N o rp lan t in stead o f p riso n a fter h e r child abuse co n v ictio n .20 N o on e explained how th is p u n ish m en t p ro tected h er child. This m isu se o f N o rp lan t had a ra ce and class bias. Stu d ies show ed th a t b la ck w o m en w ere te n tim e s m o re likely to b e p ro se cu ted fo r drug abu se

Backlash, 1973-2000

th a n w hite w om en, desp ite p ro p o rtio n a l drug use a m o n g p reg n an t w o m en o f b o th races. A s a resu lt, m any b la ck fem ale drug u sers avoided p ren atal care and drug tre a tm e n t, fearing crim in a l p ro secu tio n . D o ro th y E. R o b e rts argues th a t “pu nishing drug ad d icts w ho ch o se to ca rry th e ir p reg n an cies to te rm bu rd ens th e co n stitu tio n a l rig h t to au to n o m y over rep ro d u ctiv e d eci­ sio n s” The only w ay to avoid p ro se cu to ria l a c tio n was a b o rtio n , w h ich suited th e agenda o f pop u latio n co n tro llers and fiscal con servatives. O th e r studies co n clu d e th a t ind igent m in o rity w o m en faced h ig h er rates o f arraig n m en ts and sen ten cin g fo r child abuse th a n w ealthy w h ites and th e refo re o f forced sterilizatio n , alb eit tem p orary , by th e sta te.21 P oignant sim ilarities exist b etw een earlier steriliz a tio n in ju stice s and th e co erciv e p o te n tia l o f N o rp lan t. In b o th in sta n ce s p ro p o n e n ts g rasped new m e d ical te ch n o lo g y th a t appeared m o re legally and socially a ccep ta b le th a n earlier m e th o d s to solve perceived so cia l and e c o n o m ic p roblem s. S ta te leg ­ islatio n , ju d icia l sen ten cin g , and ad m in istrativ e a ctio n s in d ica te th a t elite b iases ag ain st in d igen t and m in o rity w o m en rem a in ed relatively c o n sta n t th rou gh o u t th e tw e n tieth centu ry.22 N o rp lan t sim ply rep laced earlier, grosser attack s on ce rta in w o m en ’s fertility. O fficials used it, as th e y did sterilizatio n , to avoid re p ro d u ctio n con sid ered socially and eco n o m ica lly irresp on sible. Parallels are also ap p aren t b etw een N o rp lan t and a b o rtio n . T he ex ten sion in th e N o rp lan t debate o f legal re co g n itio n to ch ild ren n o t y et con ceived , as in th e K ansas and C alifo rn ia cases, is sim ilar to th a t given fetu ses in th e a b o r­ tio n controversy. W ith N o rp la n t, how ever, officials a ttem p ted to safeguard a child w ho did n o t exist in any sense. I f th e state m an d ated N o rp lan t, th e n th e “ch ild ” it sought to p ro te c t w ould n ev er exist. To p ro te c t th is child th e state m u st nullify its possibility. Thus, state in tere st in N o rp lan t had little to do w ith individual righ ts, d espite official rh e to ric . In stead , it w as co n c ern e d w ith fin an ces, “so cia l control,” and th e co m p o sitio n o f th e p o p u latio n .23 The search fo r scap eg oats fo r th e e c o n o m ic and so cia l p ro b lem s o f th e co u n try converged w ith con serv ativ e and pu nitive attack s on sexually active w om en. N o rp la n t m oved fro m in crea sin g w o m en ’s rep ro d u ctiv e free d o m to facilitatin g state rep ressio n fo r ce rta in w om en. P u blic op in io n su pported th is g o v ern m en t in tercessio n . A July 1991 Glamour m ag azine poll fou nd th a t 4 7 p e rce n t b elieved w elfare w o m en should b e offered e c o n o m ic in cen tives to u se N o rp lan t, and 5 5 p e rce n t favored m an d ato ry N o rp la n t fo r co n v icted child abu sers. A Los Angeles Times survey th e sam e y ear re p o rte d th a t 4 7 p e rce n t strongly approved o f m a n d a to ry N o rp lan t fo r d ru g-abusing w om en o f ch ild b earin g age, w hile 15 p e rce n t “som ew h at approved”24 A 1 9 9 5 ed ito rial by nation ally sy ndicated co lu m n ist D on ald K au l played on th e se b eliefs. P o liticia n s, h e argued, ag reed o n on e clea r goal, “to stop in co m p e te n t peop le fro m having child ren, in co m p eten t in th e sense o f . . . ex­

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tre m e y ou th or p overty o r a d d iction o r o th e r circu m sta n ces.” T o ach ieve th is goal h e p ro p o sed a “steriliz a tio n bou nty ” w h ereby th e g ov ern m en t w ould offer free steriliz a tio n and a ca sh pay m ent o f $ 1 ,0 0 0 to individuals re ce iv ­ ing p u blic a ssista n ce or living below th e p overty lin e.25 The g ov ern m en t did n o t ad op t h is idea, bu t B a rb a ra H a rris estab lish ed a com p arab le, privately fund ed p ro g ram in C aliforn ia. S h e offered fem ale ad d icts $ 2 0 0 if th e y p ro ­ vided p ro o f fro m a p hy sician th a t th e y w ere using lo n g -te rm b irth co n tro l m e th o d s su ch as N o rp la n t or IU D s or had b e e n sterilized . S im ila r private p rogram s em erg ed in C hicag o; M in n ea p o lis; F ort P ierce, F lorid a; and D a l­ las.26 W h ile ad vocates hailed th e se prog ram s as a “barg ain” fo r society, th e ir volu n tary n atu re w as highly su sp ect. O fferin g w hat m any young, ind igent, or ad d icted p eop le m ig h t co n sid er a great deal o f m o n ey added an elem en t o f u nfair bargaining pow er fo r th o se pu shing th e prog ram s. M oreover, su ch p rogram s left th e se w o m en d ep en d en t o n m e d ica l officials for rem oval. By th e 1 9 8 0 s and 1 9 9 0 s w o m en on M ed ica id w ere tw o to fou r tim e s m o re likely, depend ing on geo g rap h ic region , to b e sterilized th a n w o m en n o t on public assistan ce. Stu d ies show ed th a t 3 8 .5 p e rce n t w ere unaw are o f its irre v e rs­ ibility, b u t 4 5 p e rce n t o f black s, 59 p e rce n t o f H isp an ics, and only 2 4 p e rce n t o f w h ites w ere m isin form ed , hig hlighting th e ra cia l bias o f m an y w elfare o f­ ficials and ph ysician s.27 N o rp lan t and D P w ere only tw o o f various new fem ale con tracep tiv es since th e 1 9 4 0 s , lead ing m u ch o f so ciety to view b irth c o n tro l as a w om an’s, n o t a m an ’s, issue. The Today sponge, th e fem ale la tex con d om , th e M ire n a IU D , th e m o n th ly co n tra ce p tiv e in je c tio n Lunelle, th e Evra co n tra ce p tiv e patch , th e co n tracep tiv e film , and N uvaR ing have provided w o m en w ith m any op ­ tio n s, n o n e o f w h ich has b e e n m isu sed as D P and N o rp lan t have been . N o t surprisingly, no h o rm o n a l m eth o d s fo r m e n w ill b e available fo r so m e tim e, alth ou g h a b im on th ly in je c tio n o f te sto ste ro n e and p ro g estin w as in clin ical trials in A pril 2 0 0 5 .28 O n ly 8 p e rce n t o f re sea rch funds have b e e n devoted to m ale c o n tra ce p ­ tives. P ressu re fo r su ch re se a rc h ca m e fro m tw o so u rces: fem in ists w ho w anted m e n to share th e bu rd en and g ov ern m en ts in In d ia and C h in a in ­ te rested in cu rtailin g p op u latio n grow th. E x p erim en ts w ith m ale pills in th e 1 9 6 0 s and w ith G o ssy p o l in th e 1 9 7 0 s p resen ted adverse side effects. F u rth er re sea rch had d ried up by th e late 1 9 7 0 s due to liability fears over th e w om an’s pill and th e D alk on shield. A ndrology, a m ale rep rod u ctive specialty, em erged in th e late 1 9 7 0 s b u t w as view ed as seco n d class co m p ared to gynecology. P h arm ace u tical co m p an ies tu rn ed again to m ale co n tra cep tiv es in th e 1 9 9 0 s , investigating m ale in je ctio n s and m ale im p lan ts.29 Find ing m ale p a rticip an ts fo r exp erim en ts w as difficult: m any m en did n o t co n sid er co n tra ce p tio n th e ir responsibility, and th e y feared side effects, in p a rticu la r im p o ten ce and th e

Backlash, 1973-2000

“loss o f m ale libido.”30 The loss o f sexu al drive w as c o m m o n in so m e ch e m ica l m e th o d s fo r w om en, b u t re sea rch ers ap p eared u n c o n ce rn ed , em phasizing in stead th e effectiv en ess o f th e se te ch n iq u e s. S o c ie ty a ccep ted w o m en ’s de­ creased sexu al drive b eca u se th e p u blic co n tin u ed to see w o m en as sexually d angerous. A m e rica n cu ltu re, o n th e o th e r hand , a ccep ted virility as in teg ral to m ale identity. M en d em and a “z e ro -risk ” co n tracep tiv e, a n u n realistic goal and on e n o t ex p ected fo r w om en. The gend er in eq u ity in sexu al co n tro l and fund ing m ad e head lines in th e late 1 9 9 0 s . V iagra, th e m ira cle drug to am elio rate im p o ten c y in m en, h it th e m ark et in 1 9 9 8 and g ained b o th F D A approval, d esp ite c o n c e rn s over its h ea lth risks, and in su ra n ce coverage, d esp ite its sig n ifican t exp en se a t $10 p er pill. W o m e n had fo r d ecad es b e e n fighting fo r co n tra ce p tiv e coverage in in su ran ce packages to n o avail. In th e w ake o f V iagra w o m en b o m b ard ed state h o u ses, arguing fo r th e sam e e c o n o m ic righ ts to express th e ir sexuality as m en. B y D e ce m b e r 2 0 0 5 tw e n ty -th ree states passed laws covering pills, IU D s, d iaphragm s, N o rp la n t, and D P.31 W h e n co n tra ce p tiv e te ch n iq u e s failed, h ea lth p ro fessio n als em p hasized “em erg en cy co n tra cep tio n .” F em in ists d iscovered a “co n sp ira cy o f sile n c e ” su rrou n d in g th e “m o rn in g -a fte r pill.” D isp en sed to rap e v ictim s fo r m o re th a n tw en ty years, it h as a 7 5 to 8 9 p e rce n t su ccess rate if ta k en w ith in sev­ en ty-tw o h ou rs o f in terco u rse. A lthou g h th e m o rn in g -a fte r pill is d istribu ted in C anad a, England , F ran ce, G erm any, and elsew here, a n tia b o rtio n ists in th e U n ited S tates eq u ated it w ith a b o rtio n , and it receiv ed little, if any, publicity. O n ly in th e m id -1 9 9 0 s did it b e c o m e a ccessib le to th e p u blic. In ad d ition, a n ew IU D cou ld b e in se rted up to five days a fter coitu s to p rev en t pregnancy. Dr. Paul B lu m en ta l o f Joh n s H opkins argued th a t if “h ea lth ca re co n su m ers w ere m o re know led geable a b o u t em erg en cy co n tra ce p tio n , w e cou ld avoid ab o u t h a lf o f th e a b o rtio n s w e have to p e rfo rm every year”32 This high rate o f effectiveness, how ever, w ill n o t erad icate ab o rtio n . W o m en facing an u n e x p ecte d or u nw anted p reg n a n cy w ill co n sid er a b o rtio n . W h ile 1 9 9 0 to 1 9 9 5 w itn essed a d eclin e in a b o rtio n , th is tre n d ca n b e explained by effective co n tracep tiv es su ch as N o rp lan t and DP, in crea sed use o f con d om s w ith A ID S , h eigh ten ed stig m atizatio n o f a b o rtio n , and m ou n tin g v iolen ce at a b o rtio n clin ics. Yet th e n u m b er o f an n u al a b o rtio n s has clim b ed since 1 9 9 5 . W elfare “refo rm ” pu shed m any w om en in to th e w orkforce, leaving th e m little rep ro d u ctiv e ch o ice. In c rea se d negative p u blicity a sso cia te d w ith N o rp lan t and D P d ecreased th e ir accep tability. In th e late 1 9 9 0 s m o re th a n 3 m illion u np lanned p regn an cies o cc u rred annually: h a lf o f th e se w o m en w ere using b irth co n tro l; 1 .4 3 m illio n w o m en ch o se a b o rtio n .33 A s th e n ew cen tu ry op ened , w o m en could ch o o se b etw een su rgical a b o r­ tio n o r a m ife p risto n e pill, w h ich b lo ck s p ro g estero n e and cau ses m isc a r­

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riage. A pp roxim ately sev en ty -tw o h ou rs a fter tak in g th e pill, a w o m an vagi­ nally in se rts fou r ta b lets o f m isop ro sto l, w h ich provokes co n tra ctio n s. T here are positive a sp e cts to th is option. It is 9 8 p e rce n t effectiv e; it ca n b e done earlier in th e pregnancy, m aking it safer; and it allow s a w o m an to avoid a n ­ tich o ice blockad es at clin ics by visiting h er regu lar physician. In a 1 9 9 8 poll 4 5 p e rce n t o f fam ily p ra c titio n e rs w ere w illing to em ploy th is m eth o d , w hile only 2 p e rce n t p e rfo rm e d su rgical a b o rtio n s. T he pill b en efited all w o m en bu t esp ecially th o se in ru ral areas w here a b o rtio n w as p ra ctica lly n o n ex iste n t.34

Opposition to Abortion The “n ew p o litics” o f a b o rtio n th a t em erged follow ing Roe affected state and fed eral gov ern m en ts. M em b e rsh ip in feta l rig h ts groups soared , as did v io ­ len ce at a b o rtio n clin ics. P ro ch o ice ad vocates sounded a call to arm s b u t faced an organized , w ell-fu nd ed , and v isible a n tia b o rtio n m o v em en t. B o th sides b u ilt n etw orks and co a litio n s. P ro ch o ic e a ctiv ists tied a b o rtio n to b ro ad er issues su ch as sex ed u catio n , availability o f co n tra cep tiv es, and w atch d og e f­ fo rts regard ing steriliz a tio n abuse. A n tia b o rtio n ad vocates allied w ith rig h t­ w ing groups co n cern e d w ith tra d itio n a l g en d er and sexu al m o re s .35 A lth o u g h C a th o lic lead ers en erg ized th e a n tia b o rtio n m o v em en t, th e y w ere jo in e d by th e N ew R ig h t, w h ich em erged b etw een 1 9 7 4 and 1 9 7 5 and w hose ad h eren ts w ere tied to fu n d a m en ta list evangelists. O n e m o tiv atio n in th e a n tia b o rtio n cam p aig n w as to gain p o litica l d o m in a n ce.36 U nw illing to appeal to th e p u blic w ith so c io e c o n o m ic p rog ram s, a n tia b o rtio n rh e to ric rallied p o litica l su p p ort am o n g th e less ed u cated . The N ew R ig h t’s a b o rtio n stan ce w as n o t p art o f p ro n atalist ad v ocacy : c o n c e rn for fetal rig h ts ended at b irth . M an y m e m b ers p ro m o ted denying unw ed m o th ers u nd er th e age o f tw en ty -o n e and th e ir ch ild ren , m any o f w h om w ere ra cia l or eth n ic m in o ri­ tie s, a ccess to p u blic funds as a way to red u ce g ov ern m en t exp en d itu res and p u n ish single w o m en fo r th e ir sexuality. The N ew R ig h t’s a n tia b o rtio n c r u ­ sade, th e refo re, w as n o t a single issue. A s Faye G insbu rg argues, “op p o sitio n to a b o rtio n is n o t th e end so m u ch as th e m ean s to a larger g oal o f retu rn in g A m e rica to ‘tra d itio n a l C h ristia n v a lu es’”37 It is p art o f a b a ck la sh ag ainst fem in ism and sexu al freed om . The a n tia b o rtio n m o v em en t b e c a m e in crea sin g ly m ilita n t. The m a jo r­ ity o f p ro testers in th e 1 9 8 0 s , a cco rd in g to G in sbu rg, w ere “m o stly fem ale m o d erates . . . fo r w h om a b o rtio n signified th e cu ltu ral devaluing o f life and th e n u rtu re o f others.” B y th e late 1 9 8 0 s and early 1 9 9 0 s th e y w ere “m ostly evan gelical P ro te sta n t m e n ” w ho co n sid ered th e m o v em en t “a v eh icle for C h ristia n so cial action.” P art o f th is tra n sfo rm a tio n ca m e w ith th e founding

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o f O p era tio n R escu e by T e rry R andall, an evan g elical P ro te sta n t, in 19 8 8 . R andall galvanized th o u san d s o f new, con servative, P ro te sta n t p ro testers to ad op t co n fro n ta tio n a l ta c tic s at clin ics and ag ainst a b o rtio n providers and th e ir fam ilies. S u ch m ilita n t ta c tic s u n d erm in ed th e g oal o f m o d era tes to secu re a co n stitu tio n a l am en d m en t to p ro h ib it a b o rtio n .38 M o u n tin g v iolen ce split th e a n tia b o rtio n m ovem en t. The A m e rica n C o a li­ tio n o f Life A ctiv ists, fou nd ed in 1 9 9 4 , co n d o n ed v iolen ce and circu la ted a list o f th e “D ead ly D o z e n " tw elve A m e rica n d o cto rs slated fo r h arassm en t. Su p p o rters targ eted n o t only d o cto rs bu t th e ir fam ilies, frien d s, colleagu es, ban k s, and o th e r affiliates. Dr. D avid G u nn, m e d ica l d ire cto r o f a P ensacola h ealth care clin ic, w as fatally sh ot outsid e an a b o rtio n clin ic. Dr. G eo rg e T il­ ler survived a b u llet w ound su stained as h e left his clin ic in W ic h ita , K ansas. Paul H ill, a fo rm er P resb y terian m in iste r w ho fou nd ed th e m ilita n t D efensive A ctio n , sh o t and killed Jo h n B ritto n , a six ty -n in e -y ea r-o ld d octor, and his sev en ty -fou r-y ear-old bodyguard, Jam es B a rre tt, and w ound ed B a rre tt’s wife outsid e P en sacola’s Lad ies C en te r d espite th e ir b u lle tp ro o f vests. Jo h n Salvi killed tw o and w ound ed five in a sh o o tin g ram p ag e at a B ro o k lin e, M a s ­ sach u setts, clin ic in 1 9 9 5 . The R everen d M a tth ew T rew hella o f M ilw aukee in stru cte d his follow ers to a rm and tra in th e ir ch ild ren w ith assau lt rifles.39 Facing su ch risks, 8 4 p e rce n t o f U.S. co u n ties offered no a b o rtio n serv ices in th e 1 9 9 0 s . The fed eral g o v ern m en t resp o n d ed to th is v iolen ce w ith th e F ree­ dom o f A ccess to C lin ics E n tra n c es A c t in 1 9 9 5 . It d eem ed th re a ts or physi­ cal blockad es o f clin ics a fed eral o ffense and im p o sed fines a n d /o r p riso n se n te n ce s.40 M o d e rate a n tia b o rtio n ists re je c te d v io len ce and jo in e d w ith so m e p ro ­ ch o ice activ ists to fo rm th e C o m m o n G rou nd N etw ork fo r Life and C h o ice in 1 9 9 4 . This diverse group rem ain ed id eologically co m m itted to th e ir individ­ ual b eliefs bu t, acco rd in g to G insbu rg, shared a “co m m o n in tere st in m aking A m e rican so ciety m o re h o sp itab le to w o m en ’s lives and b o d ie s" M em b e rs shared sim ilar b ackg rou n d s and a co m m itm e n t to so cia l and co m m u n ity a c ­ tivism . C o m m o n G ro u n d ch ap ters w ere m o st active in areas w here a b o rtio n had b e e n a lo n g -d raw n -o u t battle. A lthou g h a sm all p art o f th e m o v em en t, it w as im p o rta n t b eca u se m e m b ers co o p e ra te d to red u ce v io len ce and th e n eed fo r a b o rtio n .41 T h eir shared co m m itm e n t to w o m en dispels th e n o tio n th a t all a n tia b o rtio n activ ists are a n tifem in ist. S o m e su p p o rted a fem in ist agend a bu t cou ld n o t su p p o rt a b o rtio n out o f p e rso n a l co n v ictio n s. They w ere n o t, as G insbu rg argues, “re a ctio n a ry housew ives and m o th e rs passed by in th e sw eep o f so cia l change. They are astu te, a le rt to so cia l and p o litica l developm ents." M an y drew on im ages and arg u m en ts used by m o ra l re fo rm so cietie s since th e n in e te e n th cen tu ry: “th e dangers o f m ale lu st, and th e p ro ­ te c tio n o f th e w eak ag ainst th e d ep red ation s o f self-in terest u n lea sh e d " They

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saw a b o rtio n as th rea te n in g w o m an h oo d , ju s t as so m e n in e te e n th -c e n tu ry activ ists b elieved suffrage and p o litica l p a rticip a tio n u nd erm in ed w o m en ’s m o ral fou n d ation s. G in sbu rg co n clu d es th a t th e a b o rtio n co n tro v ersy w as “th e m o st re ce n t exp ression o f a tw o -h u n d red -y ea r tra d itio n o f fem ale r e ­ fo rm m o v em en ts engaged in d efending w hat a ctiv ists co n sid er to b e th e b est in tere sts o f w o m e n "42

Prochoice Movement I f n o t all a n tiab o rtio n ists w ere an tifem in ist, n eith e r w ere all p ro ch o ice rs cold h earted , m ale- and ch ild -h atin g shrew s. M an y w ere m o th ers and su pported b e tte r serv ices fo r p reg n a n t w o m en and ch ild ren . G in sbu rg believ es th e y p laced a b o rtio n rig h ts w ith in a fram ew o rk th a t “id entified th e ir efforts w ith n u rtu ran ce and d o m esticity " They co n ten d ed th a t “th e ir activ ism is n o t for p erso n al gain or individual ind u lg ence bu t serves th e in tere sts o f w o m en and so cial ju s tic e " 43 They called fo r expanded g ov ern m en t-su b sid ized prog ram s to in crease so cio e c o n o m ic o p p o rtu n ities for b o th w o m en and child ren. As a b u m p er stick er p ro claim ed , “P ro c h o ic e /P ro c h ild " The p ro ch o ice m o v em en t exp erien ced a tra n sfo rm a tio n in th e 1 9 9 0 s . P rior to Roe, fem in ists w orked a lm o st exclusively to legalize a b o rtio n b ased on w o m en ’s righ ts to co n tro l rep ro d u ctio n . F ro m 1 9 7 3 th ro u g h th e 1 9 8 0 s p roch o ice rs w ere o n th e defensive ag ainst th e grow ing a n tia b o rtio n m o v em en t and its in creasin g violence. The elec tio n o f B ill C lin to n and th e su p p ort o f th e Su p rem e C o u rt by th e m id -1 9 9 0 s led th e p ro c h o ice m o v em en t to w iden its agenda. The co n v ersion o f th e N atio n al A b o rtio n R ights A c tio n League to th e N atio n al A b o rtio n and R ep ro d u ctiv e R ig h ts A c tio n League in 1 9 9 4 reflected th is change. This org anizatio n w orked n o t only fo r a b o rtio n rights bu t fo r full access to all rep ro d u ctiv e ch o ice s, in clu d in g a b o rtio n , co n tra ce p tiv es, and b irth in g h ealth y b abies fo r all w om en regard less o f so cio e c o n o m ic statu s.44 P ro ch o icers so m etim es found them selves aligned w ith strange bedfellow s. P op u lation co n tro llers su p p orted b irth co n tro l, a b o rtio n , and steriliz a tio n bu t n o t as a m eans to rep ro d u ctiv e free d o m fo r w om en. C oerciv e te ch n iq u e s to co n tro l w om en, n o t individual autonom y, drove th e agend a o f p o p u lation co n tro llers. Yet th e ir elite pow er and in flu en ce help ed keep a b o rtio n legal.

The Black Community and Abortion M ain stream civil righ ts org anizations su ch as th e N A A C P rem ain ed silent on a b o rtio n during th e 1 9 7 0 s and 1 9 8 0 s . The N atio n al U rb a n League, how ever, did sign a legal b rie f ad vocating th e rig h t to ch o o se. S o m e b lack s m a rch ed in th e 1 9 8 6 and 1 9 8 9 p ro c h o ice M a rch e s o n W a sh in g to n , b u t th e m a rc h ­

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ers w ere overw helm ingly w hite and m iddle class. The a b se n ce o f m in o rity groups p rom p ted a le tte r fro m Jea n C arey B o n d , d ire cto r o f p u b licatio n s for th e A C LU , and te n b la ck fem ale colleagu es: “W h e re w ere you ?” it asked. M in o rity w o m en n eed Roe v. Wade m o re th a n any o th e r w o m en in th is country. W h y ? B ec a u se m o re o f us th a n n o t are p o o r— ind eed , we are d isp ro p ortion ately rep resen ted in th e rank s o f th e p o o r— and p o o r w o m en n eed Roe th e m o st. B la c k and H isp an ic w o m en w ill b e th e first to end up in th e b a ck alleys on th e b u tch e rs’ b lo ck s if a b o rtio n is c rim i­ nalized again. N ev er m ind th a t ce rta in p sy ch o so cia l p h en o m en a give th e a b o rtio n issue so m e u niq u e spins in m in o rity co m m u n itie s. The b o tto m lin e is th a t b la ck w o m en and o th e r w o m en o f co lo r n ee d Roe

v. Wade. A lth ou g h b lacks opp osed a b o rtio n m o re th a n th e g en eral p o p u lation , low in co m e and m in o rity w o m en a cco u n ted fo r a d isp ro p o rtio n a te n u m b er o f a b o rtio n s. N on w h ite w o m en co n stitu ted 16.7 p e rce n t o f th e ch ild b earin g p o p u latio n b u t 3 1 .4 p e rce n t o f a b o rtio n s; co rresp o n d in g figures fo r w hite w o m en w ere 8 3 .3 p e rce n t and 6 8 .6 p e rce n t.45 W h ile v o cal b la ck p ro c h o ice ad vocates w ere few, b la ck a n tia b o rtio n p ro ­ p o n en ts did speak up in th e 1 9 8 0 s. They fou nd ed B la c k A m erican s fo r Life (B A L ), h ead q u artered in W a sh in g to n , D .C ., to “challenge th e p ro -a b o rtio n p ortrayal o f th e B la c k C om m unity.” They opp osed sc h o o l-b a se d clin ics b e ­ cau se th e y did n o t offer co m p reh en siv e h ea lth care to te e n s; th e y excluded b abies, ad ults, and th e elderly; and th e ir “real agend a [was] to address te e n p re g n an cy ” w ith a b o rtio n “offered as a p rim ary to o l”46 B A L co m p ared a b o r­ tio n to slavery, arguing, “O n Jan u ary 2 2 , 1 9 7 3 , seven m e n on th e S u p rem e C o u rt d ecid ed you w ere n o t a legal p e rso n w ith in th a t w om b. T he Su p rem e C o u rt d ecid ed th a t B la ck s w ere n o t legal p e rso n s either, in th e D red S c o t d ecisio n o f 1 8 5 7 ”47 A n o th e r p am p h let harp ed o n th e sam e th e m e: “1857: I f you th in k slavery is w rong, th e n n o b o d y is fo rcin g you to be a slave-ow ner. B u t don’t im p o se you r m o ra lity o n som ebod y else! 19 7 3 : I f you th in k a b o r­ tio n is w rong, th e n no b o d y is fo rcin g you to have one. B u t d on’t im p o se your m o rality on so m eb o d y else! 1857: A m a n has a rig h t to do w hat h e w ants w ith his ow n property. 19 7 3 : A w om an has a right to do w hat she w ants w ith h e r bod y” This p am p h let co n clu d ed th a t so ciety had “o n ce again allow ed on e class o f citiz en s to b e deprived o f th e ir righ ts fo r th e so cia l co n v en ience o f o th e rs!”48 B lack s, in th e ir view, had a duty to fight fo r fetal righ ts. A s an op pressed group, b lack s w ere b est su ited to em p ath ize w ith th e plight o f th e em bryo. B A L also re su rre cted cries o f genocid e. This tim e, how ever, w o m en ra th er th a n m en a sso cia te d a b o rtio n w ith g en ocid e: B A L lead ership w as prim arily

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fem ale. The n atio n a l org anizatio n did n o t sp ecifically m e n tio n g en o cid e, but th e u n d erto n es w ere clear: “Tragically, d isp ro p ortion a te n u m b ers o f b la ck b ab ies are b ein g killed. . . . It app ears th a t th e w h ole a b o rtio n in d u stry is targ etin g b lack A m e rica n s w hile m o st o f us are saying and doing nothing.” B a rb a ra B ell, p resid en t o f th e ch a p ter M a ssa ch u setts B la ck s fo r L ife (M B L ), did n o t skirt th e issue. S h e jo in e d th e fight “b eca u se th e B L A C K ra ce is being w iped o u t th ro u g h a b o rtio n . T h ere is a B L A C K g en o cid e going on and w e as a B L A C K peop le n eed to stop it now ” The M B L accu sed P lan n ed P aren th oo d o f bein g “resp o n sib le for th e BLACK GENOCIDE” b eca u se “P lan n ed P a ren t­ h o o d ’s m ain id ea is to g et b lack s to kill b la ck s” th ro u g h a b o rtio n .49 W h e n th is p am p h let circu lated in 1 9 8 9 , th e p resid en t o f P lanned P a ren th o o d and th e ch airm an o f th e bo ard w ere b o th black . M B L re so rted to in flam m ato ry rh e to ric to gain a tten tio n fo r its cause. O n e M B L p u b licatio n , fo r exam ple, cried , “Y esterday th e y sn atch ed B la c k b abies fro m th e ir m o th e r’s arm s and sold th e m in to slavery, tod ay w e cu t th e m o u t o f th e ir m o th e r’s w om b and use th e m fo r ex p e rim e n ta tio n o r th ro w th e m in th e g arbage”50 This group failed to p o in t out th a t slave m o th e rs had n o c o n tro l over th e ir ow n and th e ir ch ild ren ’s fate, w hile b la ck w om en w ho co n scio u sly and freely ch o se a b o rtio n w ere governing th e ir destiny. B y th e 1 9 9 0 s so m e b lack s had b e c o m e m o re activ e in th e p ro c h o ice m o v em en t and had ta k en th e lead in som e in sta n ce s. T he A frica n A m e rica n W o m en fo r R ep rod u ctiv e F reed o m form ed in 1 9 8 9 to fight fo r a ccess to c o m ­ p lete rep ro d u ctiv e o p tio n s, inclu d ing a b o rtio n , co n tra ce p tio n , and b irth . In th e early 1 9 9 0 s th e N atio n al B la ck W o m e n ’s H ealth P ro je c t d om inated th e push to rep eal th e Hyde A m en d m en t, w hich cu t federally funded a b o rtio n s fro m a b o u t 3 0 0 ,0 0 0 in 1 9 7 7 to few er th a n 3 0 0 in 1 9 9 2 . B y 1 9 9 4 only sev­ en tee n states funded a b o rtio n s. The lack o f fund ing d isp ro p ortion ately im ­ p acted b lacks b eca u se so m any relied on p u blic a ssista n ce fo r m ed ical care. M an y activ ists jo in e d th e cau se for “full rep rod u ctive righ ts for B la c k w om en ” b ecau se o f th e ir previous activ ism in rap e crisis cen ters o r b attered w o m en ’s shelters. L o re tta J. R oss argues th a t “a b o rtio n righ ts has m oved fro m th e m a r­ gins to th e ce n te r o f th e dialogue a b o u t B la ck fem in ist a ctiv ism ” S o m e black s w orked w ith th e R ep rod u ctiv e H ea lth T ech n o lo g ies P ro je c t, w h ich em erged in 1 9 8 9 as a b ro ad -b ased co a litio n to ov erco m e race and class biases in h ea lth care.51

State and Federal Actions G o v ern m e n t a ctio n in th e w ake o f Roe, in flu en ced by a n tich o icers, w as fast and furious in th e legislative and ju d icia l realm s. In 1 9 7 3 S e n a to r Jam es B u ck ­ ley (R -N Y ) in tro d u ced th e H u m an L ife A m en d m en t to th e C o n stitu tio n to

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p ro te ct th e u n b o rn and d ism antle Roe and Doe. H is seco n d v ersion, in tro ­ duced in 1 9 7 4 , defined person in th e F o u rte en th A m en d m en t to inclu d e th e u n b o rn , excep t w hen co n tin u a tio n o f th e p reg n an cy w ould k ill th e m other. H is b ill tied th e fetu s’s legal status to th e m o th e r’s state: if she w as healthy, th e fetu s w as a p erso n ; if she w as critica lly ill, th e fetu s had n o legal p ro ­ te ctio n . Fro m a n o th e r view p oint, his b ill valued th e w om an over th e fetus. S e n a to r Jesse H elm s (R -N C ) elim in ated th is co n tra d ic tio n w ith his H u m an L ife A m en d m en t in 1974: it had n o ex cep tio n fo r th e m o th e r’s life, valuing th e fetu s over th e m other. B o th a m en d m en ts died in co m m itte e .52 The R o n callo A m en d m en t w ould have d enied M ed ica re and th e B a rtle tt A m en d m en t M ed icaid funds fo r a b o rtio n s, bu t n e ith e r passed. The c o st-e ffe c t arg u m ent fo r su bsid ized a b o rtio n am o n g th e in d ig en t still outw eig hed a n tia b o rtio n rh e to ric at th is p o in t. The C h u rch A m en d m en t, on th e o th e r hand, b eca m e law. It allow ed private in stitu tio n s th a t receiv ed fed eral fund s, esp ecially C ath o lic h osp itals, to refu se to p e rfo rm a b o rtio n s.53 S ta te legislators jo in e d th e fray. A s L in d a G ree n h o u se argues, a b o rtio n tu rn ed “in to a kind o f legislative g u errilla w arfare, w ith states erectin g new b arriers as quickly as th e C o u rt cou ld strik e recen tly en acted ones down.”54 A 1 9 7 4 M isso u ri law m an d ated w ritten co n se n t fro m th e w om an b efo re th e ab o rtio n , fro m th e husband if she w as m arried , and fro m a p aren t or guard­ ian if she w as u nd er eighteen. It also stipu lated th a t, a fte r th e tw elfth w eek, ab o rtio n s had to b e p erfo rm ed in a h o sp ital ra th er th a n in th e less expensive and m o re su pportive atm osp h ere o f a clin ic. D o c to rs had to ce rtify th a t th e fetu s w as n o t viable. L ast, th e law p ro h ib ited fetal re se a rc h .55 C hallenges led to Planned Parenthood o f Central Missouri v. Danforth, 4 2 8 U .S. 5 2 (1976): in a six -to -th re e vote, th e S u p rem e C o u rt d eclared th e state c a n n o t em pow er a husband to veto his w ife’s d ecisio n and, in a fiv e -to -fo u r vote, p ro claim ed th a t p aren ts o f an unw ed m in o r did n o t have ab so lu te veto over th e ir d au g h ter’s d ecision. A b o rtio n b e ca m e an issue in th e 1 9 7 6 electio n . H oping to a ttra c t th e C a th ­ olic C h u rch and o th e r rig h t-to -life groups, P resid ent G erald Ford argued th a t

Roe had g on e “m u ch to o fa r” bu t th a t th e H u m an L ife A m en d m en ts w ere “to o inflexible.” H is wife, B etty Ford, ca m e out in su pport o f ch o ice: “I am glad to see th a t a b o rtio n h as b e e n ta k en out o f th e b ackw ood s and b e e n put in th e h o sp ital w here it belongs.” The C a th o lic C h u rch en co u rag ed p arish ion ers to su p p o rt a n tia b o rtio n can d id ates. W alk in g a fine lin e b etw een opposing cam p s, G erald Ford signed a b ill fo r states ra th er th a n th e fed eral g o v e rn ­ m e n t to decid e on a b o rtio n .56 N o su bstantive a c tio n follow ed. A lth ou g h th e D e m o cra tic p latfo rm inclu d ed a p ro c h o ice plank, can d id ate Jim m y C a rte r d isagreed w ith it. H e split w ith his w ife, R osalyn, w ho stated th a t she could n o t u nd ergo an a b o rtio n b u t b elieved she had n o rig h t to p rev en t o th e r

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w om en. W ith C a rte r in th e W h ite H ou se, th e a n tia b o rtio n m o v em en t found an ally. H e su p p orted co n g ressio n a l a ttem p ts to stop fed erally subsidized a b o rtio n fo r th e ind igent b eca u se h e believed it w as “an en co u ra g em en t o f a b o rtio n and its a cc e p ta n ce as a ro u tin e co n tra cep tiv e m e a n s "57 C o st-e ffe c­ tive ratio n alizatio n had n o im p a ct on th is so u th ern B ap tist. P u blic fund ing fo r a b o rtio n w as a co n tro v ersia l issue during th e C a rte r ad m in istratio n . Follow ing Roe, th e fed eral g ov ern m en t trea te d th is o p eratio n in a way sim ilar to its tre a tm e n t o f o th e r m e d ica l p ro ced u res, providing co v ­ erage fo r in d igen t w om en. O n 2 4 Ju ne 1 9 7 6 , how ever, R ep resen tativ e H en ry J. H yde (R -IL ) p ro p o sed an am e n d m e n t to th e L abor, H ea lth and W elfare ap p rop riation s b ill fo r fiscal y ear 1 9 7 7 . Its orig in al fo rm stated th a t no funds ap p rop riated u nd er T itle X o f th e P u b lic H ealth S e rv ice A c t cou ld pay for ab o rtio n s. A lth ou g h th e H ou se a ccep ted it, th e S e n a te am end ed it to allow funds if th e w om an’s life w as in danger. The Hyde A m en d m en t passed b o th hou ses in S e p te m b e r 1 9 7 6 . In June 1 9 7 7 th e seco n d Hyde A m en d m en t ex­ ten d ed coverage to p rev en t w o m en ’s seriou s and lo n g -te rm h ea lth p roblem s and to v ictim s o f rape and in cest. This versio n passed ea ch bu dg et u n til 1981, w h en C on g ress co n fo rm ed to th e 1 9 7 6 g u id elin es.58 As th e P P R I execu tiv e co m m itte e con clu d ed , th e Hyde A m en d m en t effectively m ad e “a b o rtio n u n ­ available to th e p o o r"59 The co st-e ffectiv e rh e to ric so pop u lar in th e m o v e­ m e n t to lib eralize a b o rtio n n ow fell o n d ea f ears. The Su p rem e C o u rt review ed th e se fund ing re strictio n s. In Beal v. Doe, 4 3 2 U.S. 4 3 8 (1 9 7 7 ), and Maher v. Roe, 4 3 2 U.S. 4 6 4 (1 9 7 7 ), th e C o u rt held th a t n e ith e r th e S o c ia l S e cu rity A c t n o r th e eq u al p ro te c tio n clause o f th e F o u rte en th A m en d m en t req u ired fed eral and state g ov ern m en ts to pay for n o n th e ra p eu tic a b o rtio n s u n d er p rog ram s th a t fund ed ch ild b irth co sts for th e m ed ically ind igent. W ith th e vote six to th re e in b o th cases, th e m in o rity d issented . Ju stice Thu rgood M a rsh a ll stated : “It is all to o obvious th a t th e gov ern m en tal actio n s in th e se ca ses, o sten sibly ta k en to ‘en co u ra g e’ w o m en to ca rry p reg n an cies to te rm , are in reality in ten d ed to im p o se a m o ra l view ­ p o in t th a t n o S ta te m ay co n stitu tio n a lly en fo rce. S in ce efforts to ov ertu rn [Roe v. Wade and Doe v. Bolton] have b e e n u nsu ccessfu l, th e o p p o n en ts o f a b o rtio n have a ttem p ted every im ag in ab le m ean s to circu m v en t th e co m ­ m and s o f th e C o n stitu tio n and im p o se th e ir m o ra l ch o ice s u p o n th e re st o f so ciety " For B lack m u n , th e se d ecisions w ere “punitive and tra g ic ” for indigent w om en. In a th ird case, Poelker v. Doe, 4 3 2 U .S. 519 (1 9 7 7 ), th e C ity H osp ital o f S t. Louis, M isso u ri, on th e m a y o r’s ord ers, refu sed to p e rfo rm a b o rtio n s u nless a p regn an cy end ang ered th e m o th e r’s life. The S u p rem e C o u rt found n o v io latio n o f th e eq u al p ro te c tio n clau se and held th a t th e C o n stitu tio n does n o t forbid th e g ov ern m en t fro m p referrin g b irth over ab o rtio n . Sev eral ju stic e s again d issented , arguing th a t th e C o u rt had allow ed th e m a jo rity ’s

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w ill to p u n ish th e m in o rity and im p o se its co n c e p ts o f “socially desirable,” “pu blicly accep table,” and “m o rally sou nd ” values on a n eed y m inority. The late 1 9 7 0 s w itn essed o th e r re strictiv e m easu res. In 1 9 7 8 C on g ress passed th e A d o lescen t H ea lth S e rv ices and P reg n an cy P rev en tion and C are A ct, w h ich p ro m o ted co n tra cep tiv e d istrib u tio n as w ell as a b o rtio n co u n sel­ ing and referrals to teen a g ers. Belloti v. Baird, 4 4 3 U .S. 6 2 2 (1 9 7 9 ), h o w ­ ever, re stricte d te e n a b o rtio n rig h ts in so m e states. In an e ig h t-to -o n e vote th e Su p rem e C o u rt stru ck dow n a M a ssa ch u setts law th a t req u ired p aren tal co n se n t for m in o rs b eca u se th e statu te did n o t inclu d e a ju d icia l bypass. A l­ th o u g h th e C o u rt had held in Danforth th a t m an d atin g p aren tal co n se n t for m in o rs w as u n co n stitu tio n a l, th e C o u rt n ow d ecid ed th a t p aren tal co n sen t w as allow able as lo n g as an alternativ e p ro ced u re, su ch as a ju d g e’s approval, w as in place. The follow ing su m m er th e Su p rem e C o u rt ag ain h eard arg u m en ts on funding and reaffirm ed its stan ce w ith Harris v. McRae, 1 0 0 S .C t. 2 6 7 1 (1 980). In a fiv e -to -fo u r d ecisio n th e C o u rt fou nd th a t n e ith e r due p ro cess n o r any o th e r co n stitu tio n a l p rovision p ro h ib its C on g ress fro m denying pu blic funds fo r ce rta in m ed ically n ecessa ry a b o rtio n s w hile fund ing child b irth . A lthough th e g o v ern m en t ca n n o t p lace o b sta cles to a b o rtio n , it n eed n o t rem ov e th o se it did n o t create. Indigency, acco rd in g to th e C o u rt, falls in to th e la tte r ca t­ egory. Ju stice W illia m B re n n a n spoke fo r th e d issenters: “In je c tin g coerciv e fin an cial in cen tiv es favoring ch ild b irth in to a d ecisio n th a t is co n stitu tio n ­ ally gu aran teed to b e free fro m g ov ern m en tal in tru sio n . . . deprives th e in ­ digent w om an o f h e r free d o m to ch o o s e ” B y cu ttin g o ff funds fo r a b o rtio n w hile cov erin g steriliz a tio n , th e g o v ern m en t pressu red in d igen t w o m en to end th e ir rep ro d u ctiv e capacity. Beal, Maher, Harris, and Poelker sh ifted th e a b o rtio n co n tro v ersy fro m a m o ra l and legal arg u m en t to a fin a n cia l dispute, p lacing d ecisio n m ak ing on th e states. H ow did states resp on d ? T hirty -five end ed a b o rtio n fund ing fo r all bu t life-en d an g erin g situ atio n s, th re e co n tin u ed to fund “m ed ically n e c e ssa ry ” a b o rtio n s, and tw elve plus th e D istric t o f C o lu m b ia assu m ed th e fin an cial b u rd en o f a b o rtio n prog ram s. The states th a t elim in ated ten d ed to be less u r­ b an th a n th o se th a t co n tin u ed fin a n cia l assistan ce. S ta te in c o m e level also in ­ flu en ced fund ing p olicy.60 A lth ou g h e c o n o m ics led lo w -in co m e states to cu t fund ing, p o litics also played a role. M an y p o o r states w ere in th e B ib le B elt, w here th e N ew R ig h t held con sid erable legislative influence. C a th o lic C hu rch im p act on state p o licy varied. S o m e states w ith h ig h C a th o lic p ercen tag es su ch as C o n n e ctic u t, Illin ois, L ou isiana, and R h od e Island fund ed a b o rtio n s only in life-en d an g erin g situ atio n s, w hile o th ers su ch as M arylan d and M a s ­ sach u setts provided full coverage. O verall, th e p rim a ry fa c to r re strictin g state fund ing w as th e n u m b er o f C a th o lics living in th e state follow ed by

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P ro te stan t fu n d am en talists. S ta tes w ith large p ercen tag es o f N A R A L m e m ­ b ers and w ith D e m o c ra ts d om in atin g th e state h o u se generally had liberal fund ing p o licies.61 S im ilar to state d ifferences, p u blic op in io n varied as well. F ro m 1 9 7 3 to 1 9 8 0 p o litical and d em o g rap h ic variables seem ed th e w eakest d eterm in an ts and religiou s variables th e stro n g est. The d eg ree o f religiou s co m m itm e n t w as m o re im p o rta n t th a n d en o m in a tio n , alth o u g h g en erally m a in stre a m P ro te stan ts and Jew s w ere m o re supportive o f a b o rtio n th a n C a th o lics and fu n d am en talists. W o m en su pported a b o rtio n rig h ts slightly m o re th a n m en, and th e low er and low er m iddle classes opp osed a b o rtio n m o re strongly th a n th e p ro fessio n al and u pper m iddle classes.62 W h ite s in g en eral favored legal a b o rtio n m o re th a n b la ck s.63 The p eop le ag ainst w hom a class a n d /o r race bias on th e p art o f th e w hite elite m ig h t b e p o sited w ere th e m o st against ab o rtio n . These attitu d es m ig h t have b e e n a b a ck lash against earlier re p ro ­ ductive co e rcio n d irected at in d igen t, p articu larly m inority, w om en. B y 1 9 8 0 a b o rtio n had p o larized p o litica l p arties. T he D e m o c ra tic p lat­ fo rm reco g n ized “rep ro d u ctiv e free d o m as a fu n d am en tal h u m an rig h t” and en d orsed p u blic fund ing fo r ind igent w om en. C a rte r again o b jected . The R e ­ p u b lican P arty and R onald R eag an su p p orted a co n stitu tio n a l a m en d m en t to p ro h ib it a b o rtio n .64 R eagan, elected w ith help fro m a b o rtio n o p p o n en ts, p ro m ised to ap p oint Su p rem e C o u rt ju stic es sy m p ath etic to th e platform . U n d er R eagan, p ro c h o ice suffered setb ack s. T he C en te rs for D isease C o n ­ tro l ta sk force in 1981 investigated th e p rev en tio n o f spreading A ID S fro m m o th e r to fetu s b u t did n o t re co m m en d a b o rtio n . The sam e year, C ong ress fold ed th e A d o lescen t H ea lth S e rv ices A c t o f 1 9 7 8 in to th e M a te rn a l and C hild H ealth b lo c k grant to th e states and en acted th e A d o lescen t Fam ily Life A ct, w h ich forbad e a b o rtio n co u n selin g o r re fe rra l and su p p orted ch astity and ad o p tio n bu t n o t co n tra ce p tio n . This a c t co n tra d icted th e reality o f te e n cu lture: H ollyw ood and telev isio n p ro m o ted sexually active te e n s, designers p ro m o ted sexually suggestive te e n clo th in g , and m u sic ly rics and videos w ere sexually explicit. Y et th e g o v ern m en t p ro m o ted a b stin en ce in th e face o f th is sexu al onslau ght and w orked to outlaw a b o rtio n . S e n a to r H elm s in tro d u ced th e H u m an L ife statu te w ith R eag an ’s su p p ort, and C on g ress held hearings on co n stitu tio n a l a m en d m en ts to re tu rn a b o rtio n to th e sta tes.65 In H.L. v.

Matheson, 4 5 0 U .S. 3 9 8 (1981), th e C o u rt upheld in a six -to -th re e vote a U tah law th a t req u ired d o cto rs to n o tify p aren ts o f an “im m atu re,” d ep en ­ d ent m in o r b efo re allow ing h e r an a b o rtio n . A lth o u g h th e 1 9 8 2 electio n s b ro u gh t ad d ition al p ro c h o ice v otes to C on g ress, a b o rtio n co n tin u ed to be attack ed .66 In January 1 9 8 3 R eag an co n firm ed his drive to h alt “a b o rtio n on dem and.” C on g ress cu t a b o rtio n fu nd ing , ex cep t life-savin g p ro ced u res, in h ealth in su ran ce plans affectin g te n m illio n fed eral w orkers. S e n a to r O rrin

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H atch (R -U T ) in tro d u ced an a m en d m en t to re tu rn a b o rtio n to state co n tro l; it lo st by tw o v o te s.67 In th e su m m er o f 1 9 8 3 th e C o u rt stru c k dow n so m e state re strictio n s and reaffirm ed Roe. In City of Akron v. Akron Centerfo r Reproductive Health, Inc. 4 6 2 U .S. 416 (19 8 3 ), th e C o u rt d ecid ed , six to th re e , th a t states cou ld n o t su bstantially lim it a b o rtio n in th e first trim e ste r and could only regu late it during th e seco n d trim e ste r if a “rea son a b le m e d ica l b a sis” existed. R eag an’s in terv e n tio n w ith a b rie f d em and ing th e o v ertu rn in g o f Roe, a cco rd in g to B lack m u n , signaled th e “re a l seco n d rou nd o f th e a b o rtio n co n tro v ersy ”68 The fight co n tin u ed w ith Planned Parenthood o f Kansas City v. Ashcroft 4 6 2 U .S. 4 7 6 (1983); a fiv e -to -fo u r vote nullified h o sp ita l stip u lation s for a b o r­ tio n s, allow ing clin ics to co n tin u e and rep ealin g laws in tw en ty -tw o states. The ju s tic e s also revok ed tw e n ty -fo u r-h o u r w aiting p erio d s and in fo rm ed co n se n t clauses req u irin g d o cto rs to n o tify th e p a tie n t th a t h u m an life b eg an at co n cep tio n . The la tte r a sp e ct w as u n a cce p ta b le to th e C o u rt b eca u se it in terfered w ith th e “d isc re tio n o f th e p reg n a n t w o m an ’s physician,” giving pow er to th e state ra th er th a n th e d octor, to w h om th e C o u rt believed it b e ­ longed. Thus, th e C o u rt reaffirm ed m e d ica l co n tro l over ab o rtio n . M oreover, th e C o u rt d eclared th a t states could n o t im p ose a “heavy, and u nnecessary , b u rd en on w o m en ’s a ccess to a relatively inexpensive, oth erw ise accessib le, and safe a b o rtio n p ro ced u re”69 The 1 9 8 4 electio n s saw ab o rtio n again divide p o litica l p arties. D e m o cra ts reaffirm ed th e 1 9 8 0 p lan k p ro te ctin g ch o ice and pledged to w ork ag ainst grow ing v iolen ce tow ard providers and seekers o f a b o rtio n . The R ep u b lican p latfo rm opp osed a b o rtio n and called fo r legislation to en su re th a t “th e 14th A m e n d m en t’s p ro te ctio n s apply to u n b o rn ch ild re n ” In a cam p aig n sp eech R eagan called sexu al in te rc o u rse “th e m ean s by w h ich hu sband and w ife p articip ate w ith G o d in th e crea tio n o f a n ew h u m an life”70 This rev ersio n to n in e te e n th -c e n tu ry n o tio n s o f sex w ith in m arriag e fo r p ro c re a tio n only co n flicted w ith th e reality o f in crea sin g p rem a rita l sexu al activ ity and sex as a m ean s o f p erso n a l fu lfillm en t, n o t p aren th ood . A lth ou g h R eag an w on, D e m o cra ts in C on g ress k ep t th e ir pledge to w ork to end violen ce. H ou se C o m m itte e on th e Ju d iciary investigations led D o n Edw ards (D -C A ), ch a ir o f th e su b co m m itte e, to q u estio n w hy R ep u b lican ap p o in tees in th e Ju stice D ep a rtm en t had n o t investigated v iolen ce so o n er: “The Ju stice D e p a rtm e n t has available to it a statu te m aking it a Fed eral crim e to in terfere w ith th e exercise o f a co n stitu tio n a l right. R ep rod u ctiv e freed om s are co n stitu tio n ally p ro tected , y et th e Ju stice D e p a rtm e n t has n o t in terv en ed h e re ” W h e n R ep u blican s ju stified th e ir in a c tio n w ith First A m en d m en t rights o f free sp eech, P a tricia S c h ro e d e r (D -C O ) co u n tered th a t a n tia b o rtio n ta c ­ tics had “g on e bey on d m ere sp e ech . . . ; free d o m o f sp e ech does n o t allow

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b reakin g and en terin g , invasion o f privacy, b o m b th re a ts, and v an d alism " In spite o f th e se h earin gs, p ick ets h arassed 8 0 p e rce n t o f clin ics by th e end o f 1985. A n tia b o rtio n ists p ick eted h o m es, ch u rch e s, and sch o o ls o f clin ic staff and th e ir fam ilies; p u blicized n a m es and addresses o f a b o rtio n ists; id entified p atien ts by lice n se plates; m ad e bogu s a p p o in tm en ts at clin ics; and vand al­ ized clin ics. They set up m o ck a b o rtio n clin ics th a t offered n e ith e r a b o rtio n s n o r a b o rtio n cou n selin g b u t in stead in u n d ated clien ts w ith g ru eso m e p ic ­ tu res o f ab o rte d fetu ses and in a ccu ra cies regard ing a b o rtio n risk s.71 The R eagan a d m in istra tio n did virtu ally n o th in g to end su ch d ecep tio n and v io len ce and co n tin u ed its drive to o v ertu rn Roe. T he a d m in istra tio n su b m itted a b rie f in Thornburgh v. American College o f Obstetricians and

Gynecologists 4 7 6 U.S. 7 4 7 (1 9 8 6 ), asking th e C o u rt to d ism an tle Roe and a l­ low states to regu late ab o rtio n . A Pennsylvania law co m p arab le to th e A k ron statu te fo rced d o cto rs to deliver th e fetu s as if it w ere b ein g b irth ed , leading so m e d o cto rs to em ploy a b o rtio n te ch n iq u e s h a rm fu l to th e m oth er. In a fiv e -to -fo u r vote th e C o u rt stru ck it dow n, claim in g th e law ’s in ten t w as to d iscourage a w o m an ’s ch o ice, n o t p ro te ct h er health. Ju stice B la ck m u n ’s m a ­ jo rity d ecisio n defined a b o rtio n w ith in a fem in ist versus his earlier m ed ica l fram ew o rk o f Roe: “Few d ecisio n s are m o re p erso n a l and in tim ate, properly private, or m o re b a sic to individual d ignity and autonom y, th a n a w o m an ’s d ecisio n . . . w h eth er to end h e r pregnancy. A w o m an ’s rig h t to m ake th a t ch o ice freely is fu n d a m en ta l" Follow ing th is d ecisio n , C h ie f Ju stice W a r­ ren B u rger retired , W illia m R eh n q u ist rep laced him , and A n to n in S ca lia , a C ath o lic fath er o f n in e, filled th e vacancy. Tw o years later, Lew is Pow ell, a stron g p ro te cto r o f ch o ice, resig ned , and A n th on y K en n ed y filled his seat. K en n ed y ’s law clerks had in fo rm ed th e a d m in istra tio n th a t K en n ed y hoped to see Roe ov ertu rned .72 B e fo re R eagan left th e W h ite H ou se his a d m in istra tio n fu rth er re stricte d ab o rtio n . The D ep a rtm en t o f H ea lth and H u m an S e rv ices ad opted regu la­ tio n s in 1 9 8 8 know n as th e “gag ru le " w h ich p ro h ib ited T itle X (P u blic H ealth S e rv ices A ct) re cip ie n ts fro m providing p atien ts w ith in fo rm atio n , co u n sel­ ing, or re ferrals c o n c e rn in g a b o rtio n , even if a w o m an asked fo r in fo rm a ­ tio n or th e d o cto r believed a b o rtio n w as m ed ically ind icated . R eag an also d irected Su rgeo n G en e ra l C. E v erett K oop to investigate th e psy ch olog ical and physical im p a ct o f a b o rtio n ; th e fin al re p o rt w as n o t released b ecau se th e findings did n o t fit th e R ep u b lican p o litica l agenda. C on g ress in itiated hearin gs o n a b o rtio n ’s im p a ct at w h ich K oop testified th a t “o b ste tricia n s and g yn ecologists had long since con clu d ed th a t th e physical seq u elae o f a b o rtio n w ere n o different th a n th o se fou nd in w o m en w ho carried p reg n a n cy to te rm or w ho had n ev er b e e n pregnant." A s fo r p sy ch o lo g ical im p act, h e claim ed his studies “could n o t b e co n clu siv e" M o re likely, h e en co u n tered n u m erou s

Backlash, 1973-2000

re p o rts show ing d ep ression is fa r m o re c o m m o n follow ing ch ild b irth th a n a b o rtio n and th a t th e m o st ty p ica l feeling a fter a b o rtio n is relief.73 W h e n R ep u b lican G eo rg e B u sh en tered th e W h ite H ou se, h e co n tin u ed his p re d e ce sso r’s crusade. In 1 9 8 9 th e FD A b a n n ed th e im p o rta tio n o f R U 4 8 6 fo r safety reason s. C on g ressio n al investigations could find n o evid ence th e ag en cy had co n d u cted re se a rc h on th e d rug’s safety. The hearin g s c o n ­ cluded th a t th e F D A b ased its d ecisio n on le tters fro m “a n tia b o rtio n a ctiv ­ ists and th e ir allies in C ongress.”74 B u sh th e n asked th e C o u rt to u se Web­ ster v. Reproductive Health Services, 4 9 2 U.S. 4 9 0 (1 9 8 9 ), to ov ertu rn Roe. P ro ch o ice ad vocates resp on d ed w ith th e M a rch on W a sh in g to n on 9 A pril 1 9 8 9 w ith b etw een 3 0 0 ,0 0 0 and 6 0 0 , 0 0 0 d em o n stra to rs, m any w earing coat hangers around th e ir n eck s and ch an tin g “N ever A g ain ”75 E llen C onvisser, p resid en t o f N O W ’s B o s to n chapter, told th e press: “W e are send ing a strong m essage to th e S u p rem e C o u rt, to th e P resid en t and to our elected officials th a t th e p ro ch o ice m a jo rity w ill n o t a ccep t any re strictio n s on o u r rig h t to safe and legal a b o rtio n s”76 W h ile a leg itim ate arg u m en t, it w as n o t p ersu a­ sive, b eca u se a b o rtio n re fo rm had n o t b e e n based on fem in ist dem ands for rep ro d u ctiv e righ ts b u t on co st-e ffectiv e m eans to red u ce w elfare, a pop u la­ tio n co n tro l agenda, and m e d ica l autonom y. W ith steriliz a tio n and sem ip er­ m a n en t co n trace p tiv es an sw erin g th e first tw o ju stific a tio n s , only m ed ical au ton om y rem ain ed as a basis fo r legal a b o rtio n s. F em inist arg u m en ts w ere stron g er by th e late 1 9 8 0 s and early 1 9 9 0 s th a n th e y had b e e n tw o d ecades earlier, bu t m any re je c te d th e m , esp ecially R ep u blican , C a th o lic, and fu n d a­ m e n talist leaders.

Webster involved a 1 9 8 6 M isso u ri law th a t p ro h ib ited state em ployees fro m involvem ent in ab o rtio n s o r cou nseling , req u ired d o cto rs to te s t fetu ses tw en ty w eeks old o r m o re fo r viability, and stated th a t life beg in s at c o n c e p ­ tio n . H arvard P ro fesso r C harles Fried argued th a t th e C o u rt n eed n o t over­ tu rn privacy righ ts form alized in Griswold : “W e are n o t asking th e C o u rt to u nravel th e fa b ric o f u n en u m erated and privacy rig h ts w h ich th is C o u rt has w oven. . . . R a th er w e are asking th e C o u rt to pull th is on e th read . . . . A b o r­ tio n is different. It involves th e p u rp o sefu l te rm in a tio n . . . o f p o te n tia l life” F ran k Su sm an , law yer fo r R ep rod u ctive H ealth S e rv ices, argued th a t a b o r­ tio n could n o t b e b a n n ed w ith ou t affectin g co n tra cep tiv e a ccess and o th e r privacy righ ts: “I th in k th e so licito r g en era l’s su b m ission is som ew h at d is­ ingenu ous w hen h e suggests to th is C o u rt th a t h e d oes n o t seek to unravel th e w h ole clo th o f p ro c re a tio n a l rig h ts, b u t m erely to pull a th read . It has always b e e n m y p e rso n a l e x p e rie n ce th a t w hen I pull a th read , m y sleeve falls off. . . . I suggest th a t th e re ca n b e n o ord ered lib erty fo r w o m en w ithou t co n tro l over th e ir ed u catio n , th e ir em p loy m en t, th e ir health, th e ir ch ild b ear­ ing and th e ir p e rso n a l a sp ira tio n s”77 The ju stic e s refu sed to co m m e n t on

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w h en life begin s bu t, in a fiv e -to -fo u r d ecisio n, upheld o th e r a sp e cts, th ereb y re strictin g pu blicly fund ed a b o rtio n s w hile in crea sin g a b o rtio n co sts. The m in o rity d issented . B la ck m u n w rote: “F or today, at le a st, th e law o f a b o r­ tio n stand s u nd istu rbed . For today, th e w o m en o f th is N a tio n still re ta in th e lib erty to co n tro l th e ir d estinies. B u t th e signs are evid ent and very om in ou s, and a ch ill w ind b lo w s" A s B la ck m u n p o in ted out, Webster had serious ra m i­ ficatio n s. N o t only did it re p rese n t th e first real cra ck in th e legal fou nd ations o f Roe, bu t th e language o f th e d ecisio n, w ritte n by R eh n q u ist, suggested th a t th e C o u rt h op ed to undo Roe p iece by piece. In ad d ition, th e C o u rt e n ­ cou raged states to devise laws to lim it a b o rtio n , attem p tin g to fo rce a b o rtio n p o licy out o f th e ju d icia l and in to th e p o litica l arena. States d iscussed 4 2 5 bills b etw een 1 9 8 9 and 1 9 9 0 , 3 4 4 a n tich o ice and 81 p ro ch o ice. O n ly sixtee n eventually passed: tw elve a n tich o ice and fou r p roch o ice .78 By 1 9 9 0 th irty -tw o states had passed n o tifica tio n ru les. A lth ou g h in ten d ed to allow p aren ts to en ter th e ju v e n ile’s d ecisio n -m ak in g p ro cess, th e laws usually affected only tro u b le d or d y sfu n ctio n al fam ilies w here in te ra c­ tio n w as m inim al. In th e fou r years M in n e so ta en fo rced tw o -p a re n t n o ti­ ficatio n , th e M in n e a p o lis b irth ra te fo r ages fifte en to sev en te en in crea sed approxim ately 4 0 p e rce n t and th e p ro p o rtio n o f te e n a b o rtio n s p erfo rm ed during th e seco n d trim e s te r ro se to 2 6 p e rce n t: te e n s a ttem p ted to avoid co n fro n tatio n s in th e h om e. D uk e U niversity law p ro fesso r W a lte r D ellin g er con clu d ed th a t “how ever w ell in ten tio n ed , p aren tal involvem ent laws o ften b e co m e a fo rm o f sta te-sp o n so red child a b u se "79 N ationw id e, approxim ately 4 0 p e rce n t o f te e n s ch o se a b o rtio n , bu t th e y had to ru n th e g auntlet o f p a re n ­ ta l co n se n t or ju d icia l by pass.80 A n tia b o rtio n groups scored a n o th e r v icto ry w ith Rust v. Sullivan, 5 0 0 U.S. 173 (1991). In th is ca se th e C o u rt upheld th e gag ru le in a fiv e -to -fo u r vote. R eh n q u ist w ro te fo r th e m a jo rity : “The g ov ern m en t has n o t d iscrim in ated on th e basis o f v iew point. It h as m erely c h o se n to fund on e activ ity [fam ­ ily planning] to th e exclu sio n o f a n o th e r [a b o rtio n ]" Su p p o rtin g R eh n q u ist w ere B y ron W h ite , S ca lia , K ennedy, and B u sh ap p o in tee D avid Sou ter, w ho rep laced re tired p ro ch o ice W illia m B ren n a n . B la ck m u n w ro te th e dissent: The pu rp ose and resu lt o f th e challenged reg u latio n s is to deny w om en th e ability v o lu n tarily to d ecid e th e ir p ro crea tiv e destiny. This is a co u rse nearly as noxious as overruling Roe directly, for if a right is found to b e u n en fo rceab le, even ag ainst flag rant a ttem p ts by g ov ern m en t to circu m v en t it, th e n it ce a ses to b e a rig h t a t all. T his, I fear, m ay be th e effect o f to d a y ’s d ecision. . . . U n til today, th e co u rt has allow ed to stand only th o se re strictio n s u p on rep ro d u ctiv e free d o m th a t, w hile lim itin g th e availability o f a b o rtio n , have left in ta c t a w om an’s ability

Backlash, 1973-2000

to decid e w ith ou t c o e rcio n w h eth er she w ill co n tin u e h e r p reg n an cy to te rm ___ Today’s d ecisio n aband ons th a t p rin cip le, and w ith disastrous results. Ju stice Jo h n Paul Stev en s argued th a t Rust im p osed u n co n stitu tio n a l re s tric ­ tio n s o n a b o rtio n and free sp eech. Ju stice San d ra D ay O ’C o n n o r agreed, a s­ sertin g th a t th e reg u latio n s raised “seriou s F irst A m e n d m en t co n cern s.”81 Free sp e ech and m e d ica l autonom y, n o t th e ab rid g em en t o f w om en ’s righ ts, drew th e m o st pu blic c riticism o f th is d ecision.

Rust a ffected a b o u t fou r th o u sa n d c lin ics serving roughly 4 .5 m illion, m o stly lo w er-in co m e w om en. P rio r to Rust, a b o u t 8 0 p e rce n t w ho d iscov­ ered th e y w ere p regn an t ch o se ab o rtio n . A lth o u g h clin ics could n o t provide fed eral fund s fo r th e p ro ced u re, th e y cou ld re fe r p a tie n ts elsew here. A fter

Rust, physicians cou ld n o t even suggest th e Yellow Pages. In stead , th e y had to state th a t th e clin ic “d oes n o t co n sid er a b o rtio n an ap p rop riate m e th o d o f fam ily p lan n in g ” Rust, th e refo re, fo rced h ea lth officials to ch o o se betw een badly n eed ed fed eral fund s to stay o p en and a re stricte d fo rm o f cou n selin g th e y believed to b e u nsou n d .82 C ou n selin g and fund ing sterilizatio n , DP, and N o rp lan t rem ain ed in ta ct. The tim in g o f Rust w as also n otable. The C o u rt hand ed dow n its d ecisio n on e day after th e H ou se voted to p e rm it a b o rtio n s at m ilita ry h ea lth facilities overseas. Just as a n tia b o rtio n groups seem ed w ith in re a ch o f a solid m a jo r­ ity o n th e C o u rt, esp ecially w ith th e re tire m e n t o f Ju stice M arsh all and th e ap p o in tm en t o f C la re n ce T h o m as, ch o ice gained stren g th in C on g ress. O n e m o n th a fte r Rust, b ip a rtisa n su p p ort nullified th e gag rule. R ep resen tativ e Jo h n Edw ard P o rte r (R -IL ) b ro k e p arty ra n k and p ro p o sed an am en d m en t to p ro h ib it th e B u sh a d m in istra tio n fro m spending funds to im p lem en t th e regu lation. S o m e legislators believed th e gag ru le abridged free sp e ech and in terfered w ith th e d o cto r-p a tie n t relation sh ip . O th ers saw th e co st o f 3 .6 m illio n b abies to lo w -in co m e w om en. O n 2 6 Ju ne th e H ou se voted 3 5 3 to 7 4 to allow fed erally fund ed clin ics to co n tin u e a b o rtio n cou nseling . B etw een O c to b e r 1 9 8 9 and th e fall o f 1991, C on g ress v o ted five tim es to lib eralize fund ing o f ab o rtio n s, bu t B u sh veto ed every tim e, and C on g ress w as unable to overrid e his a ctio n s.83 In th e Su p rem e C o u rt Planned Parenthood o f Southeastern Pennsylvania v. Casey, 5 0 5 U .S. 8 3 3 (1 9 9 2 ), ch allen ged fou r stip u lation s in th e Pennsylva­ n ia a b o rtio n statute: a tw e n ty -fo u r-h o u r w aiting p eriod , p aren tal co n se n t or ju d icial bypass, husband n o tifica tio n , and d o cto rs’ efforts to discourage a b o r­ tio n by in fo rm in g w o m en o f feta l d evelopm ent and alternativ es to ab o rtio n . A lth ou g h ch o ice ad v ocates feared th e C o u rt w ould rev erse Roe, th e right to a b o rtio n survived by on e vote. O ’C on n or, K ennedy, and S o u te r argued

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th a t th e states should have m o re pow er to regu late a b o rtio n , and th e y u p ­ held th e re strictio n s, ex cep t husband n o tifica tio n . T hey reaffirm ed , how ever,

Roe’s re co g n itio n o f a w om an’s rig h t to ch o o se. B la ck m u n and Stev en s w rote th a t th e C o u rt should n o t u phold any o f th e Pennsylvania re strictio n s, w hile R eh n q u ist, W h ite , S ca lia , and Th om as co n ten d ed th a t Roe should b e over­ tu rned . Tw o w o m en ’s groups su p p o rted Roe’s o v ertu rnin g . W o m e n E xp lo ited by A b o rtio n w as a rig h t-w in g religiou s group w h o se m e m b ers had earlier ch o se n ab o rtio n . They p u rp o rted to help w o m en o v erco m e th e ir “g u ilt” by com p ellin g n ew m e m b ers to “ad m it th a t Y O U ch o se to le t a budding life d ie”84 The group F em inists fo r Life o f A m e rica , w h ich had b e e n arou n d since 1 9 7 2 , m ain tain ed it w as co n tin u in g th e w ork o f fem in ists su ch as Su san B. A n th on y: it ad vocated natu ral b irth co n tro l and opp osed a b o rtio n . By th e early 1 9 9 0 s th e group pu blished a q u arterly jo u rn a l, Sisterlife, and b o a sted th irty -s ix state ch a p ters.85 B u sh relied o n su p p ort fro m su ch groups. H e opposed all a b o rtio n s excep t w h en th e m o th e r’s life w as th rea te n ed or in cases o f rap e or in cest. H e sup­ p o rted fetal tissu e re sea rch fro m sp on tan eou s ab o rtio n s, ecto p ic p regn an cies, and cell cu ltu res b u t op p osed it fro m “d elib erately -in d u ced a b o rtio n s” b e ­ cau se it could “en cou rag e a b o rtio n s, and it raises serious m o ra l q u estio n s”86 H e did n o t clarify if he believed m o re w o m en w ould opt fo r a b o rtio n s to fu rth e r th e cau se o f sc ie n c e o r if d o cto rs w ould p ressu re w o m en to undergo ab o rtio n s to expand th e ir research . B eca u se th e N atio n al In stitu tes o f H ealth R eau th o rizatio n A ct inclu d ed fund ing fo r feta l tissu e re sea rch , B u sh v etoed it. In th e 1 9 9 2 e le c tio n th e R ep u b lican Party found m an y o f its fem ale ca n d i­ dates n o t to e in g th e p arty line on a b o rtio n . F o rty -six R ep u b lican w o m en ran fo r C on g ress, b u t only T exan D o n n a P eterso n cam p aig n ed o n a rig h t-to -life platform . The R ep u b lican p rim aries saw p ro c h o ice defeating a n tich o ice c a n ­ didates. G lend a G reenw ald fou nd ed th e W o m en in th e H ou se and S e n a te List to raise fund s for p ro c h o ice R ep u b lican fem ale cand id ates. T he list signified th e deep division w ith in th e R ep u b lican P arty over a b o rtio n . A private G O P p oll o f R ep u b lican prim ary voters in con serv ativ e O ran g e C ounty, C aliforn ia, co n firm ed th is division: 78 p e rce n t favored a b o rtio n righ ts d espite th e op ­ p o sitio n o f th e ir p resid en tial cand id ate. A t th e p latfo rm c o m m ittee m eetin g , p ro ch o ice R ep u b lican s urged th e p arty to drop its o p p o sitio n b eca u se th e an tich o ice stand d em eaned w om en, dam aged can d id ates, and did n o t re flec t th e attitu d e o f m o st A m e ric a n s.87 W ith B ill C lin to n ’s e le c tio n th e pend u lu m sw ung tow ard th e p ro c h o ice cam p. H e suspend ed th e gag rule, lifted re strictio n s on th e u se o f feta l tissu e

Backlash, 1973-2000

in fed erally fund ed m e d ica l re sea rch , urged th e liftin g o f th e b an on R U 4 8 6 , rem ov ed th e b an o n a b o rtio n s in overseas m ilita ry h osp itals as long as w o m en used private funds to pay fo r th e m , and rem ov ed th e R eag an /B u sh d irective th a t barred U .S. aid to in tern a tio n a l fam ily -p lan n in g p rog ram s th a t inclu d ed a b o rtio n co u n selin g .88 P ro ch o ice ad vocates used th is chang ed clim ate to em ploy fed eral law to en jo in d em o n strato rs fro m tresp assin g on clin ic ground s. In Bray v. Alexan­

dria Women’s Health Clinic, 5 0 6 U.S. 2 6 3 (1 9 9 3 ), th e C o u rt held in a fiveto -fo u r vote th a t th e 1871 civil rig h ts law ag ainst th e Ku K lu x K lan cou ld n o t b e used to p ro te c t citiz en s ag ainst law less activ ities relating to ab o rtio n . The p ro ch o ice cam p regrou ped . N O W filed suit on b e h a lf o f th e D elaw are W o m ­ en’s H ealth O rg a n iz a tion in M ilw aukee a ccu sin g O p era tio n R escu e, th e P ro ­ L ife A ctio n League, In c., and its leader, Josep h Scheid ler, th e P ro -L ife D ire ct A ctio n L eague, P ro je c t Life, and o th e rs o f ru n n in g a nationw id e co n sp iracy to elim in ate a b o rtio n clin ics w ith in tim id ation , b o m b in g s, and o th e r violent acts. The Su p rem e C o u rt ag reed to h ea r th is case, w ith C lin to n ap p oin tee R u th B ad er G insbu rg rep lacin g W h ite . G insbu rg w as p ro c h o ice b u t c ritica l o f Roe b ecau se o f its “c o n c e n tra tio n on a m ed ically approved au ton om y idea, to th e ex clu sio n o f a co n stitu tio n a lly b ased sex -eq u a lity p e rsp e c tiv e "89 In

National Organizationfo r Women v. Scheidler, 510 U.S. 2 4 9 (1 9 9 4 ), th e C ou rt ru led u nan im ou sly th a t clin ics ca n invoke th e 1 9 7 0 fed eral R a ck ete er-In flu ­ en ced and C orru p t A ct to sue violen t p ro test groups for trip le d am ages.90 That sam e year electio n s b ro u g h t R ep u b lican m a jo ritie s to b o th th e H ou se and th e Sen ate. R ep u b lican s in tro d u ced m o re th a n tw elve a b o rtio n -re la ted bills; m any cam e d irectly fro m th e C h ristia n C o a litio n ’s C o n tra ct w ith th e A m e rican Family. O n e b ill w ould have m ad e d o ctors liable to crim in a l and civil charges fo r p e rfo rm in g a “p a rtia l-b irth ” a b o rtio n . T he acco m p an y in g propagand a did n o t m e n tio n th a t physicians used it in only .0 4 p e rce n t o f ab o rtio n s, usually in cases o f severe fetal d eform ity o r if th e m o th e r’s h ealth w as th rea te n ed .91 This ta c tic left th e p u blic w ith th e assu m p tion th a t d o ctors p erfo rm ed m o st a b o rtio n s in th is m anner. The 1 9 9 4 ascen d a n cy o f R ep u b lican co n g ressio n al ru le revived n o tio n s o f w ho w as fit to rep ro d u ce and w ho w as n o t and co n cern s a b o u t bu rgeoning w elfare expend itu res. P ro p o n en ts o f w elfare re fo rm d ecried th e large n u m ­ bers o f single m o th e rs d ep en d en t on p u blic a ssista n ce w ith rh e to ric re m in is­ ce n t o f th e 1 9 3 0 s and th e 1 9 6 0 s . R ep resen tativ e Jam es G reen w o o d (R-PA ) led th e fight in 1 9 9 5 to save a fam ily -p lan n in g p ro g ram targ eted by th e R eli­ gious R igh t by arguing th a t “w hen you p rev en t u nw anted b abies, you preven t w elfare d ep en d en cy "92 R ig ht-w ing R ep u blican s su ch as S e n a to r L au ch Fairclo th (R -N C ) and Jesse H elm s (R -N C ) p ro p o sed cu ttin g o ff p u blic funds for

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unw ed m o th e rs u nd er th e age o f tw enty-five. N o t only w ould th is p rop osal save m oney, in th e ir view, bu t it w ould also reaffirm p a re n ta l co n tro l over “w ayw ard” daughters; n e ith e r sen a to r m e n tio n e d w ayw ard sons. The m id -1 9 9 0 s w itn essed th e re tu rn o f th e b lam e gam e. S im ila r to th e early tw e n tieth centu ry, ed u cated w hite w o m en cam e u nd er a tta ck fo r th e p erceiv ed b irth d earth. R ich ard H e rn ste in and C harles M u rray argued in

The Bell Curve th a t in tellig en t w om en, th o se b est su ited for p aren tin g , ch o se h ig h er ed u catio n and ca reers over m o th erh o o d . T he R eligious R ig h t targ eted college grad uates and p ro fessio n a l w o m en fo r th e d eclin e in th e b irth ra te ju s t as ra ce su icid e th e o rists had done at th e b eg in n in g o f th e century. Pat B u ch an an , P at R o b e rtso n , and o th e r righ t-w in g sp ok esp erson s d ecried ris ­ ing b lack illeg itim a cy w h en in fa c t it had peaked and b eg u n to fall by th e la tte r p a rt o f th e 1 9 9 0 s .93 The rh e to ric m ay have ch anged , b u t th e b o tto m line rem ained : th e w rong types o f p eop le w ere having b abies w hile fit w o m en shirked th e ir duties. A s th e decad e ended, a n tia b o rtio n ists jo in e d con serv ativ e R ep u blican s to co n tro l w o m en ’s ch o ices w hile sim ultaneou sly n eg lectin g m illion s o f child ren w ho lived in poverty, lacked h ea lth care, and suffered u neq u al ed u catio n al op p o rtu n ities. S o m e states again trie d to b an “p a rtia l-b irth ” a b o rtio n s.94 In Ju ne 2 0 0 0 th e C o u rt stru c k dow n th e se laws in Stenberg v. Carhart, 5 3 0 U .S. 914 (2 0 0 0 ), b eca u se no exem p tio n existed fo r th e m o th e r’s life. A t th e sam e tim e, Hill v. Colorado, 5 3 0 U.S. 7 0 3 ( 2 0 0 0 ), stated th a t a C olo rad o law p ro h ib itin g p ro testers fro m w ith in on e hund red feet o f clin ics did n o t violate free sp e ech .95

Conclusion R ace, gender, and class in eq u ality has b e e n ram p an t in rep ro d u ctiv e p o licies th ro u g h o u t A m e rica n history. C o lo n ia l officials elim in ated legal p ro ceed in g s against u n m arried m ale fo rn ica to rs 2 5 0 years ago bu t co n tin u ed to punish unw ed m o th e rs.96 Sim ilarly, fem ale te en s in th e late tw e n tieth cen tu ry su f­ fered u nd er a b o rtio n re strictio n s, w hile m ale te e n s w ere ig n ored in th e de­ b ate regard ing a d o le scen t sexu al b eh av ior and its co n se q u e n ce s. The cu lture o f m ascu lin ity played a ro le in early p reg n an cy : young m ales en cou rag ed p eers to “sow ” th e ir “w ild oats,” esp ecially w ith as m any virgins as possible. For th e m , p regn an cy w as p ro o f o f th e ir adult, m a ch o , and h etero se xu a l id en ­ tity. The a ct o f im p reg n atio n w as ab o u t as fa r as th e ir resp on sibility w ent. The d ecisio n to te rm in a te a p reg n an cy fell to th e fem ale, w hile th e m ale w as o ften spared any know ledge o f o r oblig atio n tow ard it. The re strictio n s on a b o r­ tio n w ere a w o m an ’s p roblem . D o c to rs, ju d g es, p a ren ts, and o ften th e w elfare system evaluated th e w o m an ’s behavior, w hile m ale b eh av ior rem ain ed u n ­

Backlash, 1973-2000

scru tin ized . Teenage w o m en b e c a m e on e ta rg et group in th e a b o rtio n b ack ­ lash as states en a cte d reg u latio n s th a t pu nished th e m by req u irin g p aren tal n o tifica tio n o r denying a b o rtio n u nless th e y could raise th e n ecessa ry cash. These re strictio n s w ere passed, ostensibly, to p ro te ct feta l righ ts, d espite th e clearly negative co n se q u e n ce s fo r te e n s and in d igen t w om en. The o th e r group th a t suffered fro m re strictio n s w as th e ind igent, m an y o f w h om w ere w o m en o f color. T w en ty -fou r-h ou r w aiting p erio d s p osed an in ­ su rm o u n tab le b a rrie r to m an y w om en. W ith 8 4 p e rce n t o f co u n ties offering n o a b o rtio n serv ices, m an y in d igen t and lo w -in co m e w o m en had to travel far to clin ics. The co st o f a ho tel, tra n sp o rta tio n , and m issed days o f w ork left th e m w ith n o real rep ro d u ctiv e free d o m to ch o o se w hat w as b est fo r th em . L a ck o f fed eral fund ing fo r th e p ro ced u re itself, even if a clin ic w as nearby, p laced th is o p tio n o u t o f re a ch fo r m any w om en. The p olitically charged natu re o f a b o rtio n elim in ated th e rh e to ric reg ard ­ ing th e co st-cu ttin g im p a ct o f a b o rtio n fo r th e ind igent. In stead , p o p u lation co n tro llers tu rn ed th e ir a tten tio n to p e rm a n en t and sem ip e rm a n en t m e th ­ ods su ch as steriliz a tio n , N o rp la n t, and DP. G o v e rn m e n t fund ing o f th e se op tio n s b u t n o t o f a b o rtio n cu rtailed eq u al a ccess to a full range o f re p ro ­ d uctive ch o ice s. A b o rtio n refo rm , how ever, w as n o t th e resu lt o f fem in ist arg u m en ts for equality bu t o f p op u latio n co n c ern s and m e d ica l autonom y. W ith o th er o p tio n s to c o n tro l th e pop u lation, th e g ov ern m en t had no re a so n to en d orse su ch a co n tro v ersial p ro ced u re, esp ecially in th e fa ce o f th e w ellfunded, highly organized, and very v o ca l a n tia b o rtio n faction .

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The tw en ty -first cen tu ry op ened w ith a p resid en tial cam p aig n in w h ich th e R ep u b lican can d id ate, G eo rg e W . B u sh , p ro claim ed h im se lf to b e a “co m p a s­ sion ate conservative.” H is d efin ition o f co m p assio n varied fro m m a in strea m in terp retatio n s. H is ad m in istratio n , electe d to a seco n d te rm in 2 0 0 4 , c o n ­ firm ed th e co n tin u in g la ck o f regard fo r th e ind igent and low er classes obvi­ ous in th e p o p u latio n c o n tro l ag end a o f th e last tw o cen tu ries. T h reats to o v ertu rn Roe and re tu rn w o m en to u nd ergrou n d serv ices and b ack -alley ab o rtio n s grew w ith th e new cen tu ry as did attem p ts to eq u ate c o n tra ce p ­ tives w ith ab o rtio n . The on e area p o p u lation co n tro llers, in clu d in g B u sh , did n o t atta ck w as sterilizatio n . Funding th is p ro ced u re w hile a ttack in g all o th e r op tio n s fo rced ind igent and lo w -in co m e w o m en to re so rt to th is p erm a n en t m eth o d o f fertility co n tro l, w h ich suits th e p o p u latio n co n tro l agenda. In th e n in e te e n th ce n tu ry th e issue o f feta l rig h ts had little im p a ct on a b o rtio n p o licy ; sin ce Roe th is to p ic has b e e n th e ce n te r o f th e controversy. O v e r on e hu nd red years ago activ ists voiced m o re co n c e rn ab o u t th e im p act o f a b o rtio n on th e co m p o sitio n o f th e A m e ric a n p op u latio n th a n its m o ral a sp e cts. N ativism , n o t relig io n and fe ta l rig h ts, w as th e m o st freq u en tly em ployed ju stific a tio n in d ecid ing a b o rtio n policy. T he ce n tra l issue, th e y claim ed , w as th a t th e w rong w o m en — w hite u p p er-class P ro te sta n ts— w ere having a b o rtio n s and th e reb y co n trib u tin g to th e e x tin ctio n o f th e A n g lo S a x o n “ra c e ” in th e U n ited S ta tes. S u ch p ropagand a g ained an in flu en tial au d ien ce and co n trib u te d to th e b an n in g o f th e p ro ced u re. T h ese a ctiv ists did n o t con fess th e ir d esire to rep ress m id d le- and u p p er-class w om en during a tim e w h en th e y w ere a ssertin g th e ir in d ep en d en ce and d em and ing equal righ ts w ith m en. Sim ilarly, since Roe an tich o ice activ ists have used feta l rights and m o rality as th e ir p rim ary ju stifica tio n for re strictin g a b o rtio n and have gained a sign ifican t follow ing w ith su ch ta c tic s w ith ou t acknow led ging th e ir desire to reverse w o m en ’s legislative and ju d icia l su ccesses in th e p o litica l and e co n o m ic spheres. C learly statin g th is aim w ould have b e e n u n a ccep ta b le in eith er century. Thus, a ctiv ists em ployed ju stific a tio n s th a t w ould appeal to th e p u blic and to p ow erful elites to ach ieve th e ir goals. T o m E h rich , an E p is­ co p al p riest in D u rh am , N o rth C arolin a, su m m arized w ell th is attitud e. In a

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N o v em b er 2 0 0 5 ed ito rial E h rich argued th a t “a b o rtio n is to o u r so ciety w hat w earing th e veil has b e c o m e to Isla m ic fu n d a m en ta lists— a way to balance a s o cie ty ’s m o ra l led ger by forcin g so m eth in g on w o m en " R eligious fu n d a­ m e n talists, b e th e y C h ristia n o r Islam ic, d esired to cu rta il w o m en ’s “p erso n al freed o m , arguing th a t th e fu tu re o f b o th religion and state depend ed o n it " E h rich criticiz ed a n tia b o rtio n forces fo r focu sin g exclusively on w om en, n o t th e m e n w ho im p reg n ate th e m , on “denying w o m en a p erso n a l freed o m , and on pu nishing w o m en w ho are p o o r and v u ln era b le "1 B y lim itin g fund ing for ab o rtio n , th e state pushed “p o o r and v u ln erab le” w o m en to ch o o se steriliz a ­ tio n , a govern m en t-fu n d ed and final an sw er to th e perceived p ro b lem s o f th e p op u lation . The sam e hold s tru e fo r o th e r a sp e cts o f rep ro d u ctiv e p o licy and its c o n ­ n e c tio n to p op u latio n issues. A rguing in th e early tw e n tieth cen tu ry th a t th e “b est sto c k ” u tilized co n tra ce p tio n to m a in ta in low b irth ra tes in th e face o f high fertility am o n g th e “less desirable," elite m e m b ers, inclu d ing h ig h gov­ ern m en t officials, co n d em n ed b irth co n tro l as th e lead ing fa c to r in th e im m i­ n en t d eclin e o f A n g lo -S a x on P ro te sta n t h eg em o n y in th e country. W h e n th e “su p erio r” groups refu sed to h eed th e se w arnings and ab an d o n co n tracep tiv e p ractice s, critics ch an g ed ta c tic s and b eg an to argue fo r lo o sen ed re strictio n s on co n tracep tiv e d istrib u tio n am on g th o se d eem ed “in fe rio r" and even re ­ so rted to involu ntary re stra in ts and state-fu n d ed clin ics. The fed eral gov ern m en t jo in e d th e cru sad e in th e 1 9 6 0 s , w hen co n tin u ed high fertility am o n g th e ind igent and d ep en d en t led to in crea sed w elfare ex ­ p en d itu res. M an y p o litica l lead ers co n sid ered fed erally fund ed c o n tra ce p ­ tives th e m o st effectiv e m ean s to d ecrea se A F D C co sts and o th e r program s aim ed at th e poor. B eg in n in g w ith only co n tra cep tiv e devices, th e g ov ern ­ m e n t u ltim ately fund ed steriliz a tio n and a b o rtio n , th e la tte r only fo r a tim e, am o n g th e ind igent. This p o licy brou gh t th e co u n try full circle, fro m a n a tio n w ith few re strictio n s on re p ro d u ctio n in th e early n in e te e n th cen tu ry to one w ith stric t regu lation s in th e late n in e te e n th cen tu ry and b a ck to on e w ith few guidelines by th e early tw en ty -first century. The biggest push fo r p olicy ch an ges o ccu rred in th irty -y e a r cy cles d irectly related to e c o n o m ic issues. D u rin g th e D ep ressio n th e cries o f “dole b a b ies” sapping lim ited g ov ern m en t reso u rces led to in crea sin g pu blic a cc e p ta n ce o f co n tra cep tiv e dispersal, ju st as criticism o f exploding A F D C co sts in th e 1 9 6 0 s b rou gh t la rg e-sca le fed eral in terv e n tio n in w hat o n ce had b e e n a private m atter. The 1 9 9 0 s again w it­ n essed critics claim ing th a t th e fertility ra te am o n g th e in d igen t ballo o n ed w elfare exp en d itu res; th e sim p listic solu tion , in th e ir view, w as n ew c o n tra ­ ceptive te ch n o lo g ie s, esp ecially D P and N o rp lan t, th a t could help “re fo rm ” w elfare. W elfare ch an g es in th e 1 9 9 0 s added to th e re strictio n s ind igent w o m en

Conclusion

faced in rep ro d u ctiv e m atters. C on g ress passed, and C lin to n signed, th e P er­ son al R esp o n sib ility and W o rk O p p o rtu n ity R e co n c ilia tio n A ct o f 1 9 9 6 to “end w elfare as w e k now it " G iven th e m isn o m e r o f “w elfare reform ,” th is a ct end ed th e N ew D ea l p ro te ctio n afforded ind igent fam ilies w ith child ren, leaving th o u san d s o f w o m en and ch ild ren struggling to survive. S o m e r e ­ ceived fin an cial a ssista n ce fro m T em p o ra ry A ssista n ce to N eed y F am ilies, bu t its five-year lim it left gaps in th e safety n e t establish ed by th e N ew D eal. A s B u sh b egan his seco n d te rm , for exam ple, 12.7 p e rce n t o f A m erican s (37 m illio n p eop le) lived below th e poverty line, m any o f th e m single w o m en w ith ch ild re n .2 W h e re a s th e p ro c h o ice ag end a expand ed to p ro m o te full rep ro d u ctiv e o p tio n s fo r all w om en, in clu d in g th e ability to ra ise ch ild ren outsid e th e squ alor o f poverty, th e c o n c e rn am o n g m any prolifers and c o n ­ servative R ep u blican s fo r th e fetu s did n o t extend to th e se ch ild ren living in poverty. The em phasis on “co m p assio n ate co n serv a tism ” allow ed B u sh and th e R ep u b lican Party to p ro cla im th e ir c o n c e rn fo r feta l righ ts w hile u nd er­ m inin g th e righ ts o f ch ild ren and w o m en living in poverty. T he bu dget passed in D e ce m b e r 2 0 0 5 saw R ep u b lican sen ato rs cu t $ 4 0 b illion over five years. It in crea sed M ed ica id fees by re q u irin g copays fo r p reg n an t w o m en and ch ild ren ; cu t fed eral funds fo r ch ild -su p p o rt en fo rce m e n t, fu rth e r shifting resp o n sib ility fro m sexually active m e n to w om en; forced state w elfare p ro ­ gram s to im p o se w ork re q u irem e n ts on all re cip ie n ts; and red u ced stud ent loans. The H ou se v ersion w en t even farther, cu ttin g fo ster care funds, aid to th e disabled, th e F ood Stam p P rogram , and th e subsidized lu n ch pro g ram for sch o o lch ild ren . W h ile ju stify in g th e se steps as n ecessa ry to stem b u rgeon in g g o v ern m en t exp en d itu res, th e sam e R ep u b lican legislators p rop osed $ 7 0 b il­ lio n in ta x cu ts th a t w ould b en efit th e top 3 p e rce n t o f A m e rica n s m o re th a n any o th e r group.3 To su m up, “co m p assio n ate co n serv a tism ” tra n sla ted into d eficits o f u n seen p ro p o rtio n s for th e n ex t g en eratio n and cu ts in prog ram s fo r in d igen t w o m en and ch ild ren to fin a n ce an e c o n o m ic w indfall fo r th e wealthy. These g ov ern m en t fund ing p o licies d iscrim in a ted ag ainst free d o m o f re ­ p rod u ctiv e ch o ice fo r all w om en. W ith th e re d u ctio n o f so cia l p rog ram s for th e ind igent and th e erad icatio n o f w elfare, low - and n o -in co m e w o m en had n o safety n e t upon w h ich to rely should th e y b e c o m e pregnant. A b o rtio n costs w ere beyond th e ir m eans. The la ck o f re co u rse fo r low er-class w om en, m any o f w hom w ere w o m en o f color, led th e m to su bm it to steriliz a tio n b ecau se th e g ov ern m en t fund ed th is m e th o d o f co n tro l. F orcin g w o m en in to th is b o x suited p o p u latio n co n tro lle rs’ agend a to end p erm an en tly th e fertility o f th e poor. W h ile n o t as b la ta n t as th e fo rced sterilizatio n s o f earlier p eriod s, d is­ crim in a to ry fund ing p o licies ach ieved th e sam e goal. Sim ultaneou sly, a p ro f­ itab le bu siness b o o m ed su rrou n d in g fertility tre a tm e n ts fo r w ealthy w om en,

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m o st o f w h om w ere w hite. D o ro th y R o b e rts argues th a t evid en ce exists th a t in vitro fertilizatio n prog ram s have a ttem p ted to dissuade b la ck cou ples from seeking te ch n o lo g ic a l a ssista n ce in ch ild bearin g . A m e rica n cu ltu re fo r c e n ­ tu ries has valued w hite over b la ck m o th erh o od . D evaluing m o th e rh o o d for w o m en o f co lo r has u nd erm in ed th e ir id en tity as w o m en o f im p o rta n ce to th e n atio n .4 Thus, th e ra c ist and classist co m p o n e n t o f A m e rica n re p ro d u c­ tive p o licy co n tin u ed in to th e tw en ty -first centu ry, perhaps n o t as overtly as earlier, b u t co v ert efforts to c o n tro l p op u lation u ltim ately ach ieve th e sam e o b je c t iv e - c h o o s in g w ho is and w ho is n o t a fit p arent. A b o rtio n p o litics has plagued th e A m e rica n p o litica l lan d scap e sin ce th e n in e te e n th century. F irst u sed to p rev en t W A S P w o m en fro m d estroying w hite P ro te stan t hegem ony, p op u latio n co n tro llers have em ployed it since th e 1 9 7 0 s as a m eans to suppress w o m en and force ind igent w o m en to su bm it to sterilizatio n by w ithhold ing fund ing fo r a b o rtio n s. T he issue rem ain ed a p o litica l foo tb a ll in to th e tw e n ty -first century. G eo rg e W . B u sh p ick ed up w here his fath er and R eagan left o ff in attem p tin g to re s tric t a b o rtio n b o th at h o m e and overseas. In th is on e a ren a R ep u b lican s reversed th e ir m o tto th a t less g ov ern m en t is b e tte r and in sisted on g ov ern m en t in terv e n tio n in a private d ecision. F or all o f C lin to n ’s sexu al d ebacles, h e w as co n siste n t in his p ro te ctio n o f w o m en ’s rig h t to ch o o se, v etoin g tw o attem p ts in th e late 1 9 9 0 s to re strict fu rth e r w o m en ’s a ccess to w hat w as a legal p roced u re. B ush, on th e o th e r hand, ap p oin ted Jo h n R o b e rts to rep lace W illia m R eh n q u ist as c h ie f ju stic e o f th e Su p rem e C o u rt in S e p te m b e r 2 0 0 5 . R o b e rts stated th a t th e C o u rt w rongly d ecid ed Roe and th a t a b o rtio n had n o co n stitu tio n a l p ro ­ te ctio n ; h e did ad m it th a t a b o rtio n w as th e settled law o f th e land. S ev eral m o n th s later, B u sh ap p oin ted Sam u el A lito to th e C o u rt to rep lace San d ra D ay O ’C onnor. A lito w orked in th e R eag an a d m in istra tio n to ov ertu rn Roe. This new ly co n stitu ted C o u rt h eard its first a b o rtio n ca se in N o v em b er 2 0 0 6 . A R ep u b lica n -le d H o u se and S e n a te had passed a b an o n “p a rtia lb irth ” a b o rtio n in 2 0 0 2 . W h ile C lin to n had v etoed sev eral sim ilar m easu res, B u sh signed th e bill in to law in 2 0 0 3 . H is a tto rn ey g eneral, Jo h n A sh cro ft, su bp oen aed m e d ica l re co rd s fro m hosp itals and university h ea lth cen ters to d o cu m en t w h eth er “p a rtia l-b irth ” a b o rtio n s w ere b ein g p e rfo rm e d to save w o m en ’s lives, m u ch in th e w ay L eslie R eag an fou nd state officials in C hicag o a ce n tu ry earlier p ressu rin g d o cto rs to en fo rce th e law. A n u p ro ar ensu ed over violatio ns o f d o cto r-p a tie n t confid entiality. L ow er co u rts stru ck dow n th e law b ecau se it co n ta in ed n o exem p tio n fo r th e w om an’s health. In Gonza­

les v. Carhart etal., 1 2 7 S .C t. 1610 (2 0 0 7 ), th e Su p rem e C o u rt upheld th e law in a fiv e -to -fo u r vote. Ju stice G insbu rg, th e only w om an o n th e C o u rt, bitterly d issented , arguing th a t th is d ecisio n u nd erm in ed b o th w o m en ’s h ea lth and p hy sician s’ d iscretion .

Conclusion

P o litical w rangling has b e e n th e m ain stay o f rep ro d u ctiv e p o licy in th e U n ited Sta te s sin ce th e n in e te e n th centu ry. N u m ero u s p o liticia n s, physi­ cian s, eu g en icists, and p o p u latio n co n tro llers have used rep ro d u ctiv e p o l­ icy to ach ieve th e ir larger agenda. In th e n in e te e n th ce n tu ry m any d o ctors pu shed for th e crim in a liz a tio n o f a b o rtio n as a m ean s to c o n tro l re p ro d u c­ tio n , b irth , m idw ives, w om en, and p op u latio n grow th. The nativist rh e to ric th e y em ployed a ttra c te d th e su p p ort o f state legislators co n cern e d w ith th e p ro liferatio n o f im m ig ran t p o p u lation s th a t did n o t co n fo rm to th e “A m e ri­ can ” ideal, to w it, th e y w ere n o n -P ro te sta n ts, o ften o f d ark er co m p lex ion th a n A n g lo -Sax on s. In th e tw e n tieth cen tu ry eu g en icists latch ed o n to re p ro ­ ductive p o licy as a m eans to “save” so ciety fro m th e breed in g o f th e “u n fit” The exp en se o f seg regation o f th e “u n fit” in to in stitu tio n s and th e m ed ical ad vances in steriliz a tio n te ch n iq u e s led th e push to sev er p erm an en tly th e rep ro d u ctiv e abilities o f th e se groups. D isp ersal o f co n tra cep tiv es at g ov ern ­ m e n t exp en se served to cu rta il th e “b re e d in g ” o f in d igen t and “u n fit” n o t re ach ed w ith sterilizatio n . S ta te leg islators g rasp ed th is sim p listic answ er to th e co m p lex so c io e c o n o m ic p ro b lem s o f th e poor. S im ila r arg u m en ts led to fed eral fund ing by th e 1 9 6 0 s . B y th e n e x t d ecad e th e p o litica l foo tb a ll had passed in to a b o rtio n p o litics, w ith R ep u blican s using a b o rtio n to a ttra c t o n e-issu e voters. This m yop ic cam p aig n in g allow ed R ep u blican s to claim to su p p ort fetal life w hile th e y d ism antled p o licies designed to su p p ort ind igent child ren. F ran ces K issling, p resid en t o f C a th o lics fo r Free C h o ice , sum m ed up th is attitu d e in a M ay 1 9 9 8 in terv iew w hen she stated th a t a n tich o icers seek to “so cialize d ecisio n m ak in g arou n d re p ro d u ctio n w hile co n tin u in g in a state in w h ich bu rd ens are individ ualized ”5 A busive rep ro d u ctiv e p o licy h as b e e n cy clical. H isto ry d em o n strates th a t overt pu shes for p e rm a n en t p ro ced u res to erad icate th e rep ro d u ctiv e ca p a c­ ity o f th e in d igen t and m in o rities co n tin u e u n til th e p ress reveals b latan t abu ses. P op u lation co n tro llers pu shed fo r g o v ern m en t in terv e n tio n fro m th e 1910s th ro u g h th e 1 9 3 0 s , and th e g o v ern m en t co m p lied w ith state fund ing o f co n tracep tiv e and state laws allow ing th e steriliz a tio n o f th e “u n fit” N o t u ntil th e abu se asso cia te d w ith H itle r’s reg im e rea ch ed th e A m e rica n pu blic did su ch overt attem p ts to cu rta il ce rta in w o m en ’s re p ro d u ctio n cease. S te riliz a ­ tio n did n o t disap pear; it co n tin u ed qu ietly u nd er th e rad ar sc ree n u n til th e late 1 9 5 0 s . Fro m th a t tim e th ro u g h th e early 1 9 7 0 s a seco n d overt pu sh o c ­ cu rred to sterilize th e in d igen t, esp ecially w o m en o f color, w ith ou t th e ir c o n ­ sent. O n ce th e b la ta n t abuse o f N ial R u th C ox, th e L a tin a s, and o th e rs broke in th e press, co erciv e ta c tic s d im inished th ro u g h th e la ter 1 9 7 0 s and 1 9 8 0 s , alth ou g h th e y did n o t disappear. D u rin g th is sam e tim e, fed eral fund ing o f sterilizatio n bu t n o t a b o rtio n left ind igent w o m en little ch o ice b u t to accep t th e fo rm er p e rm a n en t m e th o d to c o n tro l th e ir fertility. W ith th e 1 9 9 0 s th e

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th ird overt push cam e, th is tim e w ith new te ch n o lo g ie s fo r less p erm a n en t and th u s m o re a ccep ta b le m eans su ch as N o rp lan t and DP. The co n n e ctio n th a t reinvigorates th is cy cle o f overt abuse is ec o n o m ics. C ritic s w ere able to co n v in ce th e pu blic th a t e c o n o m ic w oes, cau sed in th e ir m ind s by exp en d itu res a sso cia te d w ith th e in d igen t, cou ld b e easily solved by h altin g th e rep ro d u ctiv e cap acity o f low and n o -in co m e w om en. In th e 1 9 3 0 s critics b lam ed “dole b a b ies”; in th e 1 9 6 0 s A F D C re cip ie n ts; and in th e 1 9 9 0 s “w elfare queens,” w h om th e press p ortrayed p rim arily as b lack , drugad d icted w o m en w ith large fam ilies. R a cism , th e refo re, also played a role. B e c a u se w o m en o f co lo r w ere o v errep resen ted a m o n g th e in d igen t, w hite elite p o litician s at th e state and fed eral levels view ed p op u lation c o n tro l as a m eth o d b o th to cu t co sts and to red u ce m in o rity pop u lations in th e n ation. Thus, th e efforts to co n tro l th e racial, e th n ic , and religiou s c o n te n t o f th e p o p u latio n in th e n in e te e n th ce n tu ry w ith th e crim in a liz a tio n o f a b o rtio n co n tin u ed th ro u g h o u t th e tw e n tieth cen tu ry w ith steriliz a tio n and c o n tra ­ ce p tio n dispersal. The tw en ty -first cen tu ry has w itn essed a n ew ta c tic in th e efforts to c o n ­ tro l w o m en ’s fertility. A ll m eth o d s o f co n tra ce p tio n , excep t sterilizatio n , have co m e u nd er a tta ck by so m e groups. The A m e rica n L ife L eag u e has argued th a t co n tracep tiv es are eq uivalent to a b o rtio n and has organized efforts to sway p u blic op in io n to ban th e m . C on servative p h a rm a cists have jo in e d th e fray, refu sin g to sell co n tracep tiv es. Tw elve states have “c o n sc ie n ce cla u se” laws p en d in g th a t w ould allow p h a rm a c ists p erso n ally op p osed to b irth co n tro l n o t to sell co n tra cep tiv es; fou r states have passed su ch laws. A n a n ­ tico n d o m cam p aig n , su p p orted by th e D e p a rtm e n t o f H ea lth and H u m an S e rv ice s, claim s th a t co n d o m s are only 5 0 p e rce n t effectiv e in p rev en tin g d isease.6 The m o rn in g -a fte r pill, approved by C anad a fo r o v e r-th e -c o u n te r sales in A pril 2 0 0 5 , co n tin u es to fa ce b a rriers fro m th e FD A . W h ile th e FD A scien tific ad visory bo ard re co m m en d e d it fo r o v e r-th e -c o u n te r sales in th e U n ited Sta te s, F D A d ire cto r L ester C raw ford b lock ed th is chang e.7 T he pur­ p o se o f th is n ew cam p aig n to elim in ate co n tra ce p tiv es is tw ofold: first, it seeks to co n tro l w o m en using m o ra l and religiou s arg u m en ts in ways sim ilar to th o se o f th e o ft-c ritic iz e d fu n d am en talists in o th e r co u n tries; seco n d , it seeks to co n tro l th e co m p o sitio n o f th e popu lation. In th e m id st o f th is b attle n o criticism o f steriliz a tio n ca n b e heard. It co n tin u es to b e funded by state and fed eral g ov ern m en ts. W ith b o th a b o rtio n and b irth co n tro l u n d er a t­ ta c k , in d igen t and lo w -in co m e w o m en w ill have little re co u rse fo r re p ro d u c­ tive co n tro l o th e r th a n to re so rt to sterilization . This ta c tic is th e last step in p op u latio n co n tro lle rs’ attem p ts to shape th e citiz en ry to suit th e agend a o f w hite elites, allow ing th e m to ch o o se w ho is fit fo r m o th erh o od .

Appendix A Henry Miller, "Letter to the President and Councilors of the State Medical Society," 1860

G en tlem en : A t th e m e etin g o f th e A m e rica n M e d ica l A sso cia tio n held in L ouisville, in M ay last, by a fo rm a l and u nan im ou s vote it w as R E S O L V E D , That, w hile phy sicians have long b e e n u nited in con d em n in g th e p ro cu rin g o f a b o rtio n at every p eriod o f g estatio n , ex cep t as n ecessa ry fo r preserv in g th e life o f eith er m o th e r or child, it has b e c o m e th e duty o f th is A sso ciatio n , in view o f th e p rev alen ce and in crea sin g freq u en cy o f th e crim e pu blicly to en ter an ea rn est and so lem n p ro test ag ainst su ch unw arrantable d estru ctio n o f h u m an life. R E S O L V E D , T hat in p u rsuance o f th e grand and n o b le calling w e profess, th e saving o f h u m an lives, and o f th e sacred resp o n sib ilities th ereb y devolv­ ing u pon us, th e A sso cia tio n p resen t th is su b je ct to th e a tten tio n o f th e sev­ eral legislative sasem blies [sic] o f th e U n ion , w ith th e prayer th a t th e laws by w h ich th e crim e is a ttem p ted to be co n tro lled m ay b e revised, and th a t su ch o th e r actio n m ay b e ta k en in th e p rem ises, as th e y in th e ir w isd om m ay deem necessary. R E S O L V E D , T hat th e A sso c ia tio n req u est th e zealous co -o p e ra tio n o f th e variou s S ta te M e d ica l S o cie tie s in pressin g th is su b je c t u p on th e legislatures o f th e ir re sp ectiv e S ta te s; and th a t th e P resid en t and S e cre ta rie s o f th e A sso ­ cia tio n are hereb y au th orized to ca rry o u t, by m em o ria l, th e se resolu tio n s. In p u rsu an ce o f our in stru ctio n s, a m em orial, o f w h ich a copy is h erew ith en clo sed , has b e e n tra n sm itted to th e G o v ern o r and L eg islatu re o f th e S ta te o f [nam e o f state], and it now has b e c o m e our duty earn estly to req u est o f th e bod y you re p rese n t, su ch an early and h earty a ctio n in fu rth era n ce o f th e m e m o ria l o f th e A sso cia tio n , as m ay in su re its full su ccess ag ainst th e c o m ­ m o n , th o u g h u nn atu ral crim e it aim s to ch eck . F o r th e A sso ciatio n , H e n ry M iller, P resid ent S o u r c e : Records of the Rhode Island M edical Society, Rhode Island M edical Society

Library, Providence, Rhode Island.

Appendix B Henry Miller, "Memorial to the Governor and Legislature of the State of Rhode Island," 1860

A t th e M e e tin g o f th e A sso c ia tio n held at Louisville in M ay, 1859, it w as form ally and u nan im ou sly voted , ‘to p resen t th e su b je ct o f C rim in a l a b o rtio n to th e a tten tio n o f th e several Legislative A ssem b lies o f th e U n ion , w ith th e prayer th a t th e laws by w h ich th e crim e is attem p ted to b e co n tro lled m ay be revised, and th a t su ch o th e r a ctio n s m ay b e ta k en in th e p rem ises, as th e y in th e ir w isd om m ay d eem necessary.’ S ta tistics, reliable and n o t to b e co n tro v erted , w h ich are duly su bm itted in th e papers accom p an yin g th is M em o ria l, to prove th a t an im m en se n u m b er o f living ch ild ren annually are in ten tio n a lly d estroyed in th is cou ntry, and th a t besid es th e seriou s in ju ry th e reb y in flicted u p on th e p u b lic m o rals, a d ecid ed and d etrim en ta l in flu en ce has alread y b e e n p rod u ced u p on th e rate o f in crea se o f th e n a tio n and u p o n its m a teria l prosperity. The m o ral guilt o f C rim in a l A b o rtio n d epends entirely u p on th e real and essen tial natu re o f th e a ct. It is th e in ten tio n a l d estru ctio n o f a child w ith in its p aren ts; and phy sicians are now agreed, fro m a ctu a l and variou s p roof, th a t th e child is alive fro m th e m o m en t o f co n cep tio n . The evil to so ciety o f th is crim e is evid ent fro m th is fa ct, th a t its in stan ces in th is co u n try are n ow to b e co u n ted by h und red s o f thou sand s. P u blic sen tim e n t and th e natu ral sense o f duty in stin ctiv e to p aren ts p rov ­ ing in su fficien t to c h e ck th e crim e, it w ould seem th a t an appeal should be m ad e to th e law and to its fram ers. In m any S ta te s o f th e U n ion , a b o rtio n is n o t y et legally co n sid ered an o f­ fen ce, and is u nprovided fo r by statu te; in o th ers, th e statu tes are so draw n as to b e easily evaded, or ind eed , by th e ir in c o n siste n cie s, d irectly to en co u r­ age C o m m o n Law, w hich, by a strange co n tra d ictio n , fails to reco g n iz e th e u n b o rn child as crim in ally affected , w hilst its ex iste n ce fo r all civil p u rposes is n everth eless fully acknow ledged. It has th e refo re b e c o m e th e duty o f th e A m e rica n M e d ica l A sso cia tio n , in view o f th e p rev alen ce and in crea sin g freq u en cy o f C rim in a l A b o rtio n in th is cou ntry, publicly to en ter a n e a rn est and so lem n p ro test ag ain st su ch unw arrantable d estru ctio n o f h u m an life. The duty w ould be bu t h a lf fulfilled,

260

Appendix B

did w e n o t call u p o n th o se w ho alo n e ca n c h e ck and co n tro l th e crim e, early to give th is m a tte r th e ir seriou s a tten tio n . The A sso cia tio n w ould in n o w ise tra n scen d its office, bu t th a t office is h ere so plain th a t it had full co n fid en ce in th e resu lt. W e th e refo re en ter its ea rn est prayer, th a t th e su b je c t of C rim i­ n al A b o rtio n in th e S ta te o f [n a m e], and th e laws in force on th e su b je ct in said S ta te m ay b e re ferred to an ap p rop riate C o m m ittee , w ith d irectio n s to re p o rt w hat legislative a c tio n m ay b e n ecessa ry in th e p rem ises. A cco m p an y in g th is m e m o ria l w ill b e fou nd th e R e p o rt o f th e S p e cia l C o m m itte e o f th e A sso c ia tio n u p on th is su b je ct, and th e papers o n w hich th e ir R e p o rt is based. A ll o f w h ich is resp ectfu lly su bm itted . F o r th e A sso ciatio n , H e n ry M iller, P resid en t S o u r c e : Records of the Rhode Island M edical Society, Rhode Island M edical Society

Library, Providence, Rhode Island.

Appendix C Recommended State Statute by Horatio R. Storer

S e c tio n 1: W h o ev er, w ith in ten t to cau se and p ro cu re th e m isca rria g e o f a w om an, shall sell, give, or ad m in ister to her, p re scrib e for her, or advise, or d ire ct, or cause, or p ro cu re h e r to tak e any m ed icin e, or drug, or su b stan ce w hatever, or shall use, o r em ploy, or advise any in stru m en t, or o th e r m ean s w hatever, w ith th e like in ten t, u nless th e sam e shall have b e e n n ecessa ry to p reserv e th e life o f su ch w om an, or o f h e r u n b o rn child, and shall have b e e n so p ro n o u n ced (in co n su lta tio n ) by tw o co m p e te n t p h y sician s; and any p erso n , w ith th e like in ten t, know ingly aiding and assisting su ch offend er or offend ers, shall b e d eem ed guilty o f felony and if su ch o ffen ce shall have b e e n co m m itted by a physician, o r su rgeon, o r p erso n claim in g to b e such, o r by a m idw ife, nurse, or druggist, su ch p u n ish m en t m ay b e in crea sed at th e d iscretio n o f th e co u rt. S e c tio n 2: Every w om an w ho shall so licit, p u rchase, or o b tain o f any p erso n , or in any o th e r way p ro cu re , or receiv e, any m ed icin e, drug, or su b stan ce w hatever, and shall ta k e th e sam e, or shall su bm it to any o p era tio n or o th e r m eans w hatever, o r shall co m m it any o p era tio n or v iolen ce u pon h erself, w ith in ten t th e reb y to p ro cu re a m isca rria g e, u nless th e sam e shall have b e e n by tw o co m p e te n t ph ysician s (in c o n su lta tio n ) p ro n o u n ced n ec essa ry to p reserv e h e r ow n life, or th a t o f h e r u n b o rn child, shall b e d eem ed guilty and if said offend er b e a m arried w om an, th e p u n ish m en t m ay b e in crea sed at th e dis­ cre tio n o f th e cou rt. S o u r c e : Horatio R. Storer, C r i m i n a l A b o r t i o n in A m e r i c a (Philadelphia: J. B. Lippincott

& Co., 1860).

Appendix D 1861 Rhode Island Abortion Statute

Every p e rso n w ho shall b e co n v icted o f w ilfully ad m in isterin g to any preg ­ n a n t w om an , o r to any w o m an su pposed by su ch p e rso n to b e p reg n an t, anything w hatever, or shall em ploy any m ean s w hatever, w ith in ten t th ereb y to p ro cu re th e m isca rria g e o f su ch w om an, u nless th e sam e is n ecessa ry to p reserv e h e r life, shall b e im p riso n ed n o t exceed in g on e year, or fined n o t exceed in g on e th o u san d dollars. S o u r c e : Chapter 371, A c t s a n d R e s o lv e s o f t h e G e n e r a l A s s e m b l y o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n (Providence: A. Crawford Greene, 1861), 133.

Appendix E 1867 Rhode Island Abortion Statute

S e c tio n 1: Every p e rso n w ho shall b e co n v icted o f w ilfully ad m in isterin g to any preg ­ n an t w om an, or to any w om an supposed by su ch p e rso n to b e p reg n an t, or o f advising or p rescrib in g fo r su ch w o m an or cau sing to b e ta k en by her, any­ th in g w hatever, o r shall em ploy any m eans w hatever, w ith in ten t th e reb y to p ro cu re th e m isca rria g e o f su ch w om an, or o f aiding and assisting th e rein , or by cou n sellin g and p ro cu rin g th e sam e, u nless th e sam e is n ecessa ry to p re­ serve h er life, shall, if th e w om an die in co n se q u e n ce th e reo f, b e im p riso n ed n o t exceed in g tw en ty years n o r less th a n five years; and if she do n o t die in co n se q u e n ce th e reo f, shall be im p riso n ed n o t exceed in g seven years n o r less th a n on e year: P rovid ed , th a t th e w o m an w hose m isca rria g e shall have b ee n cau sed or attem p ted , shall n o t b e liable to th e p en alties p re scrib ed by th is sectio n . S e c tio n 2: A ny p e rso n w ho shall b e in d icted fo r th e m u rd er o f any in fa n t child, or o f any p regn an t w om an, or o f any w om an supposed by su ch p e rso n to b e or to have b e e n p regn an t, m ay also b e charged in th e sam e in d ictm en t w ith any or all o f th e o ffen ces m e n tio n e d in th e p reced in g se c tio n , and if u p o n th e tria l th e ju ry shall acq u it su ch p e rso n on th e charge o f m urder, and find h im guilty o f th e o th e r offen ces or eith e r o f th e m , ju d g m en t and sen ten ce m ay be aw arded against h im accordingly. S e c tio n 3: W h o e v e r know ingly ad vertises, p rin ts, pu blishes, d istribu tes o r circu lates, or know ingly cau ses to be ad vertised , p rin ted , pu blished , d istrib u ted o r cir­ cu lated , any p am p h let, p rin ted paper, b o o k , new spaper, n o tice , a d v ertise­ m e n t, or refe ren ce, co n ta in in g w ords o r language giving o r conveying any n o tice , h in t or re fe ren ce to any p erso n , or to th e n am e o f any p erso n , real or fictitio u s, fro m w hom , or to any place, hou se, shop, o r office, w here anything w hatever, o r any in stru m e n t or m ea n s w hatever, or any advice, d irectio n , in fo rm a tio n o r know led ge m ay b e o b ta in ed fo r th e p u rp o se o f cau sing or p ro cu rin g th e m iscarriag e o f any p regn an t w om an, shall b e im p riso n ed n o t exceed in g th re e years. S o u r c e : Chapter 689, A c t s a n d R e s o lv e s o f t h e G e n e r a l A s s e m b l y o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n (Providence: Providence Press Company, 1867),

148.

Notes

Chapter 1. ABriefOverviewof American Reproductive History 1. For more on sexual regulation see Joffe, T h e R e g u l a t i o n o f S e x u a lit y ; D’Emilio and Freedman, I n t i m a t e M a t t e r s . 2. Paul Lombardo, “Eugenic Sterilization Laws,” Eugenics Archive, , accessed 2 4 O ctober 2 0 0 6 . 3. For a study o f doctors, clergy, and feminists in M assachusetts during the 1960s and 1970s see Cline, C r e a t i n g C h o i c e . 4. Gordon, W o m a n ’s B o d y ; Gordon, “Voluntary M otherhood” 5 - 2 2 ; Gordon, “The Long Struggle” 7 5 - 8 8 ; Gordon, “W ho Is Frightened” 2 3 - 2 6 . See also Reed, F r o m P r i ­ v a t e V ic e . O n birth control technology during the nineteenth century see Bullough, “A

B rief N ote” 1 0 4 -1 1 . O n fem inist propaganda see Gordon, “Social Purity” 3 2 -5 6 . 5. M i t c h e l l v. C o m m i s s i o n e r , 78 Ky. 2 0 4 , 210 (1879) upheld the com m on-law inter­ pretation o f abortion: “It never was a punishable offense at com m on law to produce, with the consent o f the mother, an abortion prior to the tim e when the m other becam e quick with child. It was not even murder at com m on law to take the life o f the child at any period o f gestation, even in the very act of delivery” Kentucky did not outlaw abor­ tion until 1910 ( K e n t u c k y A c t s , chap. 58, sec. 1, 2, 3, 4, at 189). 6. Jefferson quoted in Takaki, I r o n C a g e s , 47, 49, 50. 7. Bobsein, M argaret Sanger’s friend, used birth control in place o f voluntary m oth­ erhood. Sanger used the term in the inaugural issue of the W o m a n R e b e l (Tone, D e v i c e s a n d D e s ir e s , 118).

8. For doctors’ roles see Cirillo, “Edward Foote’s ‘M edical Com m on Sense’” 3 4 1 -4 5 ; Cirillo, “Edward Bliss Foote: Pioneer,” 4 7 1 -7 9 ; Yates, “Birth Control Literature” 4 2 - 5 4 ; Reed, “D octors”; Swierenga, “Physicians and A bortion Reform,” 5 1 -5 9 ; Butler and W albert, A b o r t i o n , M e d i c i n e , a n d t h e L a w , pt. 2; M orantz-Sanchez, S y m p a t h y a n d S c ie n c e ; M orantz-Sanchez, C o n d u c t U n b e c o m i n g a W o m a n . 9. Ray and Gosling, “A m erican Physicians,” 3 9 9 -4 1 1 ; Reed, F r o m P r i v a t e V ic e ; Reed, “D octors”; Tone, D e v i c e s a n d D e s ir e s . 10. W atkins, O n t h e P i ll, 1 2 -1 3 , 35. For development o f the pill and other devices see Hutchinson, F a i r S e x ; Johnson, “Feminism,” 6 3 - 7 8 ; Davis, “Story o f the Pill,” 8 0 -9 1 . 11. Critchlow, I n t e n d e d C o n s e q u e n c e s , 5, 9, 118, 120, 1 3 1 -3 2 . 12. Ginsburg, C o n t e s t e d L iv e s , 14, 23, 29. 13. Barker-Benfield, H o r r o r s o f t h e H a l f - K n o w n L i f e ; W ertz and W ertz, L y in g -In ; Luker, A b o r t i o n a n d t h e P o lit ic s o f M o t h e r h o o d ; M ohr, A b o r t i o n ; M argolis and Neary, “Pressure Politics Revisited,” 6 9 8 -7 1 6 ; Sm ith-Rosenberg, “The A bortion M ovem ent”; M cC orm ack, A b o r t i o n ; Sauer, “Attitudes,” 5 3 - 6 8 . For abortion’s im pact on role change for wom en see Gelb and Palley, W o m e n a n d P u b l i c P o l i c i e s , esp. 129, 134, 1 6 0 -6 1 ;

268

Notes to Pages 7 —14

D’Emilio and Freedman, I n t i m a t e M a tte r s ', Rothm an, W o m a n ’s P r o p e r P l a c e ; Harper, “Be Fruitful and Multiply.” 14. Beisel, I m p e r i l e d I n n o c e n t s , 3, 9, 11-12. 15. Ginsburg, C o n t e s t e d L iv e s , 30. 16. Reagan, W h e n A b o r t i o n W a s a C r im e , 2 - 5 . 17. Dienes, L a w , P o lit ic s , a n d B i r t h C o n t r o l; Bumpass and Presser, “Increasing A c­ ceptance”; Reed, F r o m P r i v a t e V ic e ; Rubin, A b o r t i o n . 18. D octors and social workers in 1900 estim ated that betw een 20 and 25 percent o f all pregnancies ended in abortion, the same for the 1980s. See Kennard, “Crim inal Abortion,” 7 -1 6 ; W ynne, “Abortion,” 2 1 -3 0 ; Taussig, A b o r t i o n , S p o n t a n e o u s a n d I n ­ d u c e d , 388; W iehl, “A Sum m ary o f Data,” 8 0 - 8 7 ; Brinner and N ewton, “A bortions,”

8 0 -9 1 ; Rosen et al., A b o r t i o n P r o b l e m ; Calderone, A b o r t i o n in t h e U n i t e d S t a t e s ; Bates and Zawadski, C r i m i n a l A b o r t i o n s ; Schur, C r im e s w i t h o u t V ic t im s ; Packer, T h e L i m i t s o f t h e C r i m i n a l S a n c t i o n ; Schur, L a w a n d S o c ie t y .

19. Reagan, W h e n A b o r t i o n W a s a C r im e , 1 9 3 -9 4 , 211. 20. Reagan, W h e n A b o r t i o n W a s a C r im e , 216, 2 1 8 -2 0 ; Butler and W albert, A b o r ­ tio n , M e d i c i n e , a n d t h e L a w , pt. 1.

21. Dienes, L a w , P o lit ic s , a n d B i r t h C o n t r o l; Bumpass and Presser, “Increasing A c­ ceptance”; Reed, F r o m P r i v a t e V ic e ; Rubin, A b o r t i o n . 22. Butler and W albert, A b o r t i o n , M e d i c i n e , a n d t h e L a w , pt. 1. 23. Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , Blackm un quoted on 88, 92. 24. L o v in g v . V ir g in ia , 388 U.S. 1 (1967), declared unconstitutional a Virginia statute that prohibited interracial marriage. 25. Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 95, Blackm un quoted on 96. 26. Roberts, K i l l i n g t h e B l a c k B o d y , 6; Nelson, W o m e n o f C o l o r , 1 -3 . 27. Wilder, “The Rule of Law,” 7 3 - 7 6 , 8 7 - 8 8 ; Ginsburg, C o n t e s t e d L iv e s , 6 - 7 , 18. 28. Scientists M orowitz and Trefil argued that this film represents a “pathetic fal­ lacy” because o f its claim that a twelve-week fetus has had brain waves for six weeks and is capable of em otions such as fear and pain as well as m otion, including moving to avoid the abortionist’s instrum ent. Science has proven that a twelve-week fetus has virtually no connections in its cerebral cortex and thus is incapable o f feeling em otions. Because the fetus is incapable of independent m ovement, the notion that it recognizes the instrum ent and tries to escape from it is “ridiculous.” Moreover, the im plication that the fetus experiences pain during the abortion is “misleading at best and fraudulent at worst” because before the “wiring up o f the cortex, the fetus is simply incapable o f feel­ ing anything, including pain” (M orowitz and Trefil, T h e F a c t s o f L i f e , 1 2 5 -2 7 , 158).

Chapter 2. Abortion and Contraception inthe Nineteenth Century 1.

The m ost comprehensive nineteenth-century abortion analysis is M ohr, A b o r t i o n .

O ther works include Spengler, “Notes on Abortion,” 4 3 - 5 3 , 1 5 8 -6 9 , 2 8 8 - 3 0 0 ; Sm ith, “Family Limitation,” 4 0 - 5 7 ; LaSorte, “N ineteenth Century Family Planning Practices” 1 6 3 -8 3 ; Kantrow, “Philadelphia Gentry” 2 1 -3 0 ; Harper, “Be Fruitful”; Tolnay and Guest, “Childlessness” 2 0 0 -2 1 9 ; Logue, “The Case for Birth C ontrol” 3 7 1 -9 1 ; David and Sanderson, “The Em ergence o f a Two-Child N orm ” 1 -4 1 ; Reagan, W h e n A b o r t i o n W a s a C r im e ; Beisel, I m p e r i l e d I n n o c e n t s .

Notes to Pages 14—16

2. Brodie criticizes demographers for underm ining breastfeeding as contraception and argues that w omen’s determ ination to prolong breastfeeding, even though it is not as reliable as withdrawal as a m ethod o f birth control, could have influenced their later decisions to employ more effective means o f control over their reproduction ( C o n t r a ­ c e p tio n , 4 8 -4 9 ).

3. Dr. Robert Barnes, “Relations betw een M enstruation, Conception and the Influ­ ence o f Lactation in Causing A bortion " C M J & R 8 (1853): 2 6 0 . Issues o f the C M J & R are found in the SC M S Records. 4. Brodie, C o n t r a c e p t i o n , 60, 62, 6 4 , 6 6 , 68, 70, 79, 81, 115, 2 0 6 - 9 , 213, 2 2 0 - 2 2 . En­ trepreneurs emphasized the secrecy with which these devices could be used, allowing the final decision to fall to women. Brodie challenges Gordon’s assertion that the “task o f inserting a vaginal pessary may have been beyond the em otional capabilities o f many nineteenth-century women” ( W o m a n ’s B o d y , 24). Brodie argues that “there is consid­ erable evidence that wom en . . . learned to insert and remove vaginal pessaries” and sponges; the “num ber of wom en unable” to do so due to m odesty was “quite small” 5. Tone, D e v i c e s a n d D e s ir e s , 49, 59, 6 1 -6 2 . 6. Brodie, C o n t r a c e p t i o n , 8 7 - 8 9 . In chapter 4 Brodie analyzes various editions of Owen’s M o r a l P h y s io lo g y (1831) and Knowlton’s T h e F r u it s o f P h i l o s o p h y (1832). 7. Graham, L e c t u r e to Y o u n g M e n , 22; W right, M a r r i a g e , 2 3 - 2 5 ; Graham, L e c t u r e to Y o u n g M e n , 14; R e p r o d u c t i v e C o n t r o l, 4 4 - 5 8 . See also Hollick, T h e M a r r i a g e G u i d e ;

M auriceau, M a r r i e d W o m a n ’s P r i v a t e M e d i c a l C o m p a n i o n ; W arren, A C o n f i d e n t i a l L e t t e r ; Soule, S c i e n c e o f R e p r o d u c t i o n ; Edward Bliss Foote, M e d i c a l C o m m o n S e n s e

(New York, 1860); W est, L e c t u r e s o n t h e D i s e a s e s o f W o m e n . 8. W right, M a r r i a g e , 2 3 - 2 5 ; R e p r o d u c t i v e C o n t r o l, vii, 11-14, 16, 1 8 -1 9 , 2 6 - 2 8 . 9. Brodie, C o n t r a c e p t i o n , 8 7 - 8 8 . 10. “Crim inal Abortions,” B o s t o n M e d i c a l a n d S u r g ic a l J o u r n a l , 15 M ay 1844, 3 0 2 - 3 ; N e w Y o r k H e r a l d , 6 M arch 1840, 1, 15 July 1841, 4, 26 August 1841, 3, 26 Novem ber

1841, 4, 3 D ecem ber 1841, 4, 22 Septem ber 1843, 4, 25 January 1 844, 4, 14 April 1844, 4, 2 August 1844, 4, 8 O ctober 1844, 4, 21 N ovem ber 1844, 4, 6 January 1845, 4, 11 January 1845, 4 ; N e w Y o r k S u n , 27 M arch 1839, 1, 21 O cto ber 1841, 4, 24 February 1842, 4, 6 August 1842, 1. 11. Slave wom en resorted to infanticide and abortion not to reject m otherhood but to underm ine slavery; giving birth perpetuated the very system that oppressed them . Slave midwives passed down abortion and contraceptive inform ation through oral transm ission. Few w ritten records exist. See Ross, “A frican-A m erican W omen,” 2 7 6 -7 7 ; Roberts, K i l l i n g t h e B l a c k B o d y , 24, 4 6 , 50. 12. C M J & R 5 (1850): 4 5 8 ; C M J & R 6 (1851): 4 4 8 ; SC M S, M e d i c a l S o c ie t y M in u t e s , 1 August 1860, 17, SC M S Records. 13. C M J & R 5 (1850): 1 1 9 -2 0 , 3 80; C M J & R 6 (1851): 4 3 1 -3 2 ; C M J & R 7 (1852): 1 2 6 ­ 28; C M J & R 8 (1853): 129, 259, 275, 5 6 2 - 6 3 ; C M J & R 9 (1854): 117, 451, 4 6 0 - 6 1 ; C M J & R 10 (1855): 134, 571; C M J& R 11 (1856): 118-19, 1 2 1 -2 2 , 233, 416; C M J & R 12 (1857): 131; C M J & R 15 (1860): 5 4 0 .

14. Keown, A b o r t i o n , D o c t o r s a n d t h e L a w , 25. According to Keown, whether com ­ m on law prohibited abortion is controversial. Keown rejects the 1971 assertion by legal historian Cyril C. M eans that British and A m erican wom en were “totally free from

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Notes to Pages 16—18

all restraints" to abort at any tim e during gestation. Keown argues that the failure to convict was not because the procedure was legal but because o f problems o f procedure and proof. Keown found evidence that legal authorities as early as the thirteenth cen­ tury considered the deliberate expulsion o f the fetus murder. Keown concludes that the “com m on-law courts, although not denying abortion to be a secular offence, were content to allow the exceptional difficulties o f p roof that it posed to be resolved in an ecclesiastical foru m " a forum that punished both infanticide and abortion. This situation changed with Lord Ellenborough’s A ct o f 1803. This law was a result of three factors: Ellenborough’s desire to elucidate abortion law, the recognition o f abortion as a growing “social problem " and the denial by doctors o f any qualitative distinction be­ tw een life before and after quickening (Keown, A b o r t i o n , D o c t o r s a n d t h e L a w , 3 -2 5 ). 15. Burns, O b s e r v a t i o n s o n A b o r t i o n , 5. 16. J. McF. Gaston, “Treatm ent o f M enorhagia with E rgot" C M J& R 12 (1857): 4 5 9 ­ 60. 17. Hodge, “Introductory Lecture" 15, 24, 3 2 -3 3 . 18. Dayton, “Taking the Trade" 6. 19. Hugh Sm ith, L e t t e r s to M a r r i e d W o m e n o n N u r s in g a n d t h e M a n a g e m e n t o f C h il­ d r e n (Philadelphia: M athew Carey, 1796), 35, Rhode Island M edical Society Collection,

John Hay Library. 20. Joseph Brevitt, T h e F e m a l e M e d i c a l R e p o s i t o r y (Baltim ore: Hunter & Robinson, 1810), Rhode Island M edical Society Collection, John Hay Library. 21. Buchan was an Englishman whose book was reprinted in the U nited States close to thirty times betw een 1770 and 1850. This quote is from the 1813 edition, quoted in Dayton, “‘Taking the Trade,’” 23. 22. C M J& R 5 (1850): 1 1 9 -2 0 , 3 80, 458; C M J & R 6 (1851): 4 3 1 -3 2 , 4 4 8 - 4 9 ; C M J & R 7 (1852): 1 2 6 -2 8 ; C M J & R 8 (1853): 129, 259, 275, 5 6 2 - 6 3 ; C M J & R 9 (1854): 117, 451, 4 6 0 - 6 1 ; C M J & R 10 (1855): 134, 571; C M J & R 11 (1856): 118-19, 1 2 1 -2 2 , 233, 416; C M J & R 12 (1857): 131; C M J & R 14 (1859): 8 3 - 8 4 ; C M J & R 15 (1860): 5 4 0 .

23. John B. B eck, A n I n a u g u r a l D i s s e r t a t i o n o n I n f a n t i c i d e (1817), in Sauer, “A tti­ tudes" 53; M orse Steward, “Crim inal A bortion " D e t r o i t R e v ie w o f M e d i c i n e a n d P h a r ­ m a c y 2 (January 1867): 7 - 8 .

24. Coale and Zelnik, N e w E s t i m a t e s o f F e r t ilit y , table 2, 36; Sm ith, “Family Lim ita­ tion," 48. 25. Edward D. M ansfield, L e g a l R ig h ts , L i a b i l i t i e s a n d D u t i e s o f W o m e n (Salem, 1845), 136; Hugh L. Hodge, O n C r i m i n a l A b o r t i o n (Philadelphia, 1854), 210; W right, M a r r i a g e , 111; John Todd, S e r p e n t s in t h e D o v e ’s N e s t (Boston, 1867), 238; N athan A l­

lan, “Changes in Population" H a r p e r M a g a z i n e 38 (February 1869): 389; W hitehead, O n t h e C a u s e s , 2 2 1 -2 2 ; Thom as W. Blatchford, Troy, New York, to Horatio R. Storer,

25 M arch 1859, Storer Papers; Nebinger, C r i m i n a l A b o r t i o n , 55; James C. Burn, T h r e e Y e a r s a m o n g t h e W o r k in g C l a s s e s in t h e U n i t e d S t a t e s d u r i n g t h e W a r (London, 1865),

112, Rhode Island M edical Society Collection, John Hay Library; George Rose, G r e a t C o u n t r y (London, 1868), 97; W illiam H. Dixon, N e w A m e r i c a (London, 1867), 2 4 0 ;

Alfred Falk, T r a n s - P a c ific S k e t c h e s (M elbourne, 1877), 117. 26. D’Emilio and Freedman, I n t i m a t e M a t t e r s , 58; Brodie, C o n t r a c e p t i o n , xii; G or­ don, W o m a n ’s B o d y , 11; Petchesky, A b o r t i o n , 39, 74. Limits exist to Petchesky’s argu­

Notes to Pages 18 -2 1

m ent regarding changing notions o f m otherhood and its relationship to fertility de­ cline. This framework does not apply to blacks, immigrants, the rural population who depended on child labor, and women who worked outside the hom e out o f econom ic necessity. These women lim ited their fertility not to dote on their children but to free their tim e for paid labor (Petchesky, A b o r t i o n , 75). 27. D’Emilio and Freedman, I n t i m a t e M a t t e r s , 4 7 - 4 8 , 58, 72; Sm ith, “Family Limi­ tation " 4 0 - 5 7 ; Degler, A t O d d s , 2 4 6 ; Brodie, C o n t r a c e p t i o n , xii; Petchesky, A b o r t i o n , 7 4 -7 5 ; Sm ith-Rosenberg, “The A bortion M ovem ent" 2 2 4 -2 5 . 28. Although primarily antiforeign and anti-Catholic, the Know-N othing Party was som etim es a populist reform ist organization. See, for example, Form isano, B i r t h o f M a s s P o l i t i c a l P a r t i e s ; Handlin, B o s t o n ’s I m m i g r a n t s ; Holt, “The A ntim ason ic" 596,

6 0 0 ; Billington, T h e P r o t e s t a n t C r u s a d e , 3 8 8 -9 1 . 29. “Crim inal A bo rtio n s" B o s t o n M e d i c a l a n d S u r g i c a l J o u r n a l , 15 May 1 844, 3 0 2 ­ 3; Mohr, A b o r t i o n , 93, 167; Holbrook, P a r t u r i t i o n w i t h o u t P a in , 16; Allan, “Changes" 390. 30. Gardner, C o n j u g a l S in s ; Crawford, “Crim inal A bortion " 7 7 - 7 8 ; M ulheron, “Foe­ ticid e" 3 8 6 - 8 7 ; Trader, “Crim inal A bortion " 5 87; Kellogg, P l a i n F a c t s ; Johnson, “A bor­ tion and Its E ffects" 91; Scott, T h e S e x u a l I n s t i n c t , 2 9 3 -9 4 . 31. Mohr, A b o r t i o n , 1 6 0 - 6 4 . 32. Burns, O b s e r v a t i o n s o n A b o r t i o n , 7 5 -7 6 ; Hodge, “Introductory Lecture" 15, 24, 3 2 -3 3 ; W hitehead, C a u s e s a n d T r e a t m e n t , 184; Storer, C r i m i n a l A b o r t i o n , 28, 14; J. R. M cFadden, A n I n a u g u r a l D i s s e r t a t i o n o n A b o r t i o n (1859), 2, SC M S Records; Barnes, “Relations betw een M enstruation" 259; S a t a n in S o c ie t y , Starred Collection. 33. W horton, N a t u r e C u r e s , 3 - 2 4 ; Sm ith-Rosenberg, “The A bortion M ovem ent" 2 3 2 -3 3 . For similar arguments see Mohr, A b o r t i o n ; M argolis and Neary, “Pressure Poli­ tics Revisited," 6 9 8 -7 1 6 . 34. Sauer, “A ttitudes" 57; M ohr, A b o r t i o n , chap. 2; Storer, C r i m i n a l A b o r t i o n , 14, 53; M cFadden, A n I n a u g u r a l D i s s e r t a t i o n o n A b o r t i o n , 19. O ther nineteenth-century writ­ ings also attest to the dangers o f many abortions. Cases o f botched abortions reported in the N e w Y o r k T i m e s often ended in the woman’s death. See, for example, N e w Y o r k T im e s , 12 January 1863, 5, 21 January 1863, 3, 28 Septem ber 1865, 5, 5 M ay 1867, 6, 28

M ay 1867, 5, 19 M arch 1869, 8, 26 January 1871, 3, 30 August 1871, 8, 30 August 1871, 8, 12 February 1879, 5, 7 January 1880, 2, 19 M ay 1880, 1, 12 July 1880, 1, 25 M arch 1881, 1, 30 April 1881, 8, 22 February 1883, 1, 8 July 1886, 2, 22 January 1887, 2, 28 July 1892, 2. In many cases reported, police discovered the crim e because the woman fell seriously ill. Undoubtedly, many abortions did not cause serious h arm and did not make headline news. 35. C M J & R 5 (1850): 1 1 9 -2 0 , 380; C M J & R 6 (1851): 4 3 1 -3 2 ; C M J & R 7 (1852): 1 2 6 ­ 28; C M J & R 8 (1853): 129, 259, 275, 5 6 2 - 6 3 ; C M J & R 9 (1854): 117, 451, 4 6 0 - 6 1 ; C M J & R 10 (1855): 134, 571; C M J & R 11 (1856): 118-19, 1 2 1 -2 2 , 233, 416; C M J & R 12 (1857): 131; C M J & R 15 (1860): 5 4 0 .

36. Rothm an, W o m a n ’s P r o p e r P l a c e ; M argolis, P o l i c i e s S t u d ie s J o u r n a l ; M ohr, A b o r ­ t io n ; see also Harper, “Be Fruitful and M ultiply"

37. Beisel, I m p e r i l e d I n n o c e n t s , 9, 3 6 - 3 7 , 84. 38. Ibid., 1 2 6 -2 7 .

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Notes to Pages 21-25

39. “Proceedings o f the A m erican M edical A ssociation " C M J & R 12 (1857): 565. Special investigative com m ittees were not new. Special com m ittees on epidem ics, new surgical techniques, suturing, fractures, obstetrics, fetal growth, chloroform in labor, etc., were com m on throughout the 1850s. See C M J & R 9 (1854): 5 6 6 - 7 5 ; C M J & R 10 (1855): 5 9 0 -9 1 . 4 0 . The two cases were C o m m o n w e a l t h v. I s a i a h B a n g s (1812) and C o m m o n w e a l t h v. L u c e b a P a r k e r 50 M ass. 263 (1845). The Shaw quote is from the latter case. Tone, C o n t r o l l i n g R e p r o d u c t i o n , 2 7 -2 9 .

41. Storer, W h y N o t ? 6 - 8 , 6 2 - 6 3 , 8 4 - 8 5 . 42. Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 55; Storer, C r i m i n a l A b o r t i o n , 53. 43. Storer, C r i m i n a l A b o r t i o n , 9, 17, 18, 14. 4 4 . “Proceedings o f the A m erican M edical A ssociation" C M J & R 14 (1859): 5 5 0 -5 1 , 5 63; Miller, P r i n c i p l e s a n d P r a c t i c e . 45. “Review o f Transactions o f the A m erican M edical A ssociation " C M J & R 12 (1858): 2 1 5 -1 6 ; “Review o f Transactions o f the A m erican M edical A ssociation" C M J & R 15 (1860): 3 5 8 -5 9 ; M cFadden, A n I n a u g u r a l D i s s e r t a t i o n o n A b o r t i o n , 13; “O n the Death of Charlotte B ronte" C M J & R 12 (1857): 826. 4 6 . E. M . Pendleton, “O n the Comparative Fecundity o f the Caucasian and A frican R aces" C M J & R 6 (1851): 3 5 1 -5 6 ; E. M . Pendleton, “Editorial" C M J & R 7 (1852): 455. 47. C M J & R 6 (1851): 4 4 8 - 4 9 ; SC M S, M e d i c a l S o c ie t y M in u t e s , 1 August 1860, 17. 4 8 . Storer, C r i m i n a l A b o r t i o n , 1 7 -1 9 , 7 - 8 ; H enry Miller, “Letter to the President and Councilors of the State M edical Society" 1860, and H enry Miller, “M em orial to the Governor and Legislature of the State of Rhode Island" 1860, Rhode Island M edical Society Library. Asking state medical societies for help in legislative campaigns was not unique to abortion. The A M A made similar requests to reform the coroner’s office, to require state agencies to keep accurate and com prehensive records on births, marriages and deaths, and to carry “into effect the standard o f prelim inary education adopted by this A ssociation” in 1847 (“Proceedings of the A m erican M edical A ssociation" C M J & R 14 [1859]: 56 0 ). 49. Quay, “Justifiable A bo rtio n " Quay printed m ost abortion statutes in this article. Individual codes need to be rechecked, as this article contains som e m istakes. Quay printed the statutory materials on abortion in Rhode Island from the G e n e r a l L a w s o f R h o d e I s l a n d in 1896, assuming it was the first, when a bill passed in 1861 and 1867.

50. Quay, “Justifiable A bortion " 51. SC M S, M e d i c a l S o c i e t y M i n u t e s , 1 February 1859, 3, 1 M arch 1859, 4, 1 April 1859, 5, 1 August 1859, 8, 1 August 1860, 17, 1 M arch 1861, 27. 52. M yddleton M ichel, “Poisoning by Ergot in A ttem pting Crim inal A bortion " C M J & R 5 (1850): 39, 5 6 6 - 6 0 0 ; C M J & R 11 (1856): 2 3 2 -3 3 .

53. “Dr. Storer’s Address on M edical Jurisprudence" C M J & R 6 (1851): 869. 54. Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 94. 55. Ibid., 26, 54, 9 0 - 9 9 . 56. A M A essay prizes began in 1852. See C M J & R 11 (1856): 5 48. 57. Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 26. There is no reaction from the SC M S to Storer’s prize essay; the C M J & R ceased publication from 1861 to 1873 due to the Civil W ar and Reconstruction.

Notes to Pages 25-29

58. Storer, W h y N o t ? 6 - 8 , 6 2 - 6 3 , 8 4 - 8 5 . 59. See F. W. W alker quoted in Takaki, I r o n C a g e s , 1 8 3 -8 4 ; W alker quoted in Spengler, “Notes on A bortion " 451; N e w Y o r k T im e s , 23 August 1871, 6, 21 June 1883, 1. 6 0 . See Sauer, “A ttitudes" 55; Storer, C r i m i n a l A b o r t i o n , 6 4 - 6 5 ; Allan, “Changes" 390; Nebinger, C r i m i n a l A b o r t i o n , 12. 61. R e p r o d u c t i v e C o n t r o l. 62. Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 38. 63. Blanchard, T h e A n t i - A b o r t i o n M o v e m e n t , 11-12. 6 4 . Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 4 0 - 4 1 ; M ohr, A b o r t i o n , 186. Perhaps Storer printed this letter because Fitzpatrick, similar to m ost bishops, represented up­ per-class Catholics. M uch anti-C atholic sentim ent was directed at poor, immigrant Catholics. 65. Storer, C r i m i n a l A b o r t i o n in A m e r i c a , 4 0 - 4 1 ; Todd quoted in Takaki, I r o n C a g e s , 216. 6 6 . Rev. E. Frank Howe, S e r m o n o n A n t e - N a t a l I n f a n t i c i d e , 28 M arch 1869, in Rosenberg and Sm ith-Rosenberg, S e x , M a r r i a g e a n d S o c ie t y , 1 - 6 . 67. This author also com m ented on the difficulty preachers would face from the pul­ pit because “the very audience before whom the preacher fulminates against the ‘great crim e o f the nineteenth century, is so far sprinkled with the crim inals that he feels the powerlessness o f his words" (“A Physician" S a t a n in S o c ie t y , 122, 128). 68. P r o c e e d i n g s o f t h e O l d S c h o o l P r e s b y t e r i a n A s s e m b ly , New York, 22 M ay 1869, printed in S a t a n in S o c ie t y , 129. For the doctor's quote see S a t a n in S o c ie t y , 118-19. 69. M ohr, A b o r t i o n , 1 8 6 -9 2 ; Blanchard, T h e A n t i - A b o r t i o n M o v e m e n t , 11. 70. Quay, “Justifiable"; Srebnick, T h e M y s t e r io u s D e a t h , 29, 32. 71. Quay, “Justifiable" 72. Ibid. 73. SC M S, M e d i c a l S o c ie t y M in u t e s . W hile the SC M S did not petition the legislature to ban abortion, it did petition for stronger city ordinances to prom ote public safety and health issues and for powers to deal with epidemics (SCM S, M e d i c a l S o c ie t y M in u t e s , 25 M ay 1878, 314, 30 August 1878, 319). W hy the SC M S did not take up abortion is puzzling. Perhaps m em bers believed abortion was a northern problem ; respectable southern white wom en would not resort to such practices. 74. Quay, “Justifiable." 75. Quay, “Justifiable." 76. L a w s a n d R e s o l u t i o n s o f t h e S t a t e o f N o r t h C a r o l i n a (1881), 5 8 4 - 8 5 . The passage o f the N orth Carolina law drew little attention across the state. A perusal of the A n s o n T im e s , E l i z a b e t h C ity W e e k ly E c o n o m i s t , C a r o l i n a W a t c h m a n , G o l d s b o r o M e s s e n g e r , G r e e n s b o r o W e e k ly , N o r t h S t a t e W e e k ly , O x fo r d T o r c h lig h t , P e o p l e ’s P r e s s , W e e k ly E c o n ­ o m is t , and W ils o n A d v a n c e found no m ention o f the new abortion law, even though

these papers did summarize actions taken by the general assembly, such as prohibition and the incorporation o f Durham. 77. Quay, “Justifiable" 78. Degler, O u t o f O u r P a s t , 2 4 6 ; Sm ith-Rosenberg, “The A bortion M ovem ent" 243; Petchesky, A b o r t i o n , 45. 79. W right, T h e U n w e l c o m e d C h ild , 35, 59; W right, M a r r i a g e , 23, 25, 110.

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Notes to Pages 29-36

80. E. C. Stanton, “Infanticide and Prostitution,” R e v o lu t io n , 5 February 1868, 65; for sim ilar arguments see R e v o lu t io n , 12 M arch 1868, 1 4 6 - 4 7 and 7 M ay 1868, 279; M athilda E. J. Gage, no title, R e v o lu t io n , 9 April 1868, 2 15-16. 81. Mohr, A b o r t i o n , chap. 4; Sears, T h e S e x R a d i c a l s , 120; D’Emilio and Freedman, I n t i m a t e M a t t e r s , 165.

82. Gordon, W o m a n ’s B o d y , chaps. 5, 6, but esp. 9 3 -1 1 3 ; Reagan, W h e n A b o r t i o n W a s a C r i m e , 12. The N eo-M althusian m ovem ent based its support on “econom ic,

moral, or eugenic justifications” arguing for “fewer and better” children. Unlike Vol­ untary M otherhood, the N eo-M althusian movem ent showed no concern for women’s health or self-determ ination. Adherents assumed that m otherhood was woman’s high­ est duty. See Petchesky, A b o r t i o n , 41. 83. Ross, “A frican-A m erican W omen,” 277. 8 4 . Reagan, “‘A bout to M eet Her Maker,’” 1 2 4 4 - 4 5 ; Brodie, C o n t r a c e p t i o n , 255, 2 8 1 -8 3 , 287; Petchesky, A b o r t i o n , 73. 85. Locke, R e p o r t o f t h e T r ia l, hereafter cited parenthetically in the text; Aristides, S t r ic t u r e s o n t h e C a s e o f E p h r a i m K . A v e r y , 1833, box 94, no. 12, 76, Rider Collection;

Catherine R. A. W illiam s, A n A u t h e n t i c N a r r a t i v e (Providence: M arshall, Brown & Co., 1833), 1 9 -2 8 . 86. Staples, C o r r e c t R e p o r t , 15. 87. Ibid., 23. 88. Avery’s lawyers had misinform ed him that he could not be extradited to another state without the governor o f New Hampshire’s approval (Locke, R e p o r t o f t h e T r ia l, 11). 89. T h e C o r r e c t , F u l l a n d I m p a r t i a l R e p o r t o f t h e T r i a l o f R ev . E p h r a i m K . A v e r y (Providence: M arshall and Brown, 1833), box 94, no. 15, Rider Collection. 90. Staples, C o r r e c t R e p o r t , 8. The 1830s and 1840s witnessed numerous ministers scrutinized for sexual m isconduct. The Great Awakening expanded Protestant sects and thus a need for m inisters; guidelines for ordination were not always followed. C o­ hen deals with m inisters’ sexual scandals in “M inisterial Misdeeds,” 3 4 - 5 7 . 91. Staples, C o r r e c t R e p o r t , 22. 92. W h en Avery tried Cornell, he convinced her to leave Lowell prior to the church hearing because of the sensitive nature of the charges (Locke, R e p o r t o f t h e T r ia l, 23). Her absence gave him power to persuade the church council to expel her; she could not defend herself. 93. Srebnick, T h e M y s t e r io u s D e a t h , xviii, xix, 29, 32; Cohen, T h e M u r d e r o f H e l e n J e w e t t , 3 5 5 -5 6 , 358.

94. R e p o r t o f a C o m m i t t e e o f t h e N e w E n g l a n d A n n u a l C o n f e r e n c e o f t h e M e t h o d i s t E p i s c o p a l C h u r c h (Boston: David H. Ela., 1833), box 94, no. 13, Rider Collection.

95. Sm ith-Rosenberg, “The A bortion M ovement,” 2 2 5 -3 2 . 96. Records o f the Ladies’ M oral Reform A ssociation, 1835, Rhode Island H istorical Society Library; Report of the Ladies’ M oral Reform A ssociation, 9, 11 (Providence: W eeden and Cory, 1835), box 75, no. 12, Rider Collection. 97. Srebnick, T h e M y s t e r io u s D e a t h , 136, 157. 98. Packard, H i s t o r y o f M e d i c i n e , 51. 99. Clark B. Franklin, ed., R h o d e I s l a n d M e d i c a l R e f o r m e r : A F a m i l y J o u r n a l f o r t h e

Notes to Pages 3 7-4 0

P r o m o t i o n o f H e a l t h a n d L o n g e v it y , 14 January 1843; “By-Laws of the Providence M edi­

cal A ssociation" M iscellaneous M aterial of the Rhode Island H istorical Society, vol. 2, docum ent 3, May 1855; Records o f the Davol M anufacturing Company. 100. H i s t o r y o f t h e S t a t e o f R h o d e I s l a n d : 1 6 3 6 - 1 8 7 8 (Philadelphia: Hoag, W ade & Co., 1878); Clarke, R h o d e I s l a n d ; Coleman, T r a n s f o r m a t i o n o f R h o d e I s l a n d , 1 0 9 -1 0 , 127, 137, 149, 229; Goldstein and Mauer, T h e P e o p l e o f R h o d e I s l a n d , 5; Ray, “A nti-C a­ tholicism " 2 8 - 2 9 ; Mayer, E c o n o m i c D e v e l o p m e n t , 41; M cLoughlin, R h o d e I s l a n d , 132. 101. E m i g r a t i o n , E m ig r a n t s , a n d K n o w N o t h in g s (Philadelphia: Published for the Author, 1854); T h e S a t a n i c P lo t , o r A w f u l C r i m e s o f P o p e r y in H ig h a n d L o w P l a c e s (Boston: N. B. Parsons, 1855); T h e S o n s o f t h e S ir e s (Philadelphia: Lippincott, Grambo & Co., 1855); S t a r t l i n g F a c t s f o r N a t i v e A m e r i c a n s C a l l e d K n o w - N o t h in g s ' (New York: 128 Nassau Street, 1855); P r o v i d e n c e J o u r n a l , 1 8 5 4 -6 1 . See also Raber, “Form ation" 16 -1 7 . 102. Dr. Edwin Snow’s copy o f Storer’s C r i m i n a l A b o r t i o n in A m e r i c a , Rhode Island M edical Society Library. 103. A c t s a n d R e s o lv e s (1861), 133. 104. That im portant events in young men’s lives could im pact policy decisions later has been posited by historian Jane E. Schultz. She argues that Congress passed pensions for Civil W ar nurses in 1892 in part because many legislators had served in the war and benefited from nurses’ aid (“Race, Gender,” 4 5 - 6 9 ) . 105. Verm ont was the other state. That law, passed on 21 Novem ber 1867, was ver­ batim from the Rhode Island act o f 14 M arch 1867 with only the words “in the State Prison” added to the V erm ont law and the penalty if she did not die increased to three to ten years versus the one to seven in Rhode Island. For the Verm ont law see Quay, “Justifiable A bortion " 516. New Jersey and Iowa exempted women through Court inter­ pretation o f existing law, not through the specific intention o f legislators. See H a t f i e l d v. G a n o , 15 Iowa 177 (1863), and S t a t e v. M u r p h y , 27 N.J.L. 112 (Sup. Ct. 1858).

106. A c t s a n d R e s o lv e s (1867), 1 4 8 -4 9 . 107. Sm ith-R osenberg, “The A bortion M ovem ent,” 2 23, 2 3 5 - 3 9 ; M cC orm ack, A b o r t i o n ; D’Emilio and Freedman, I n t i m a t e M a t t e r s , 1 4 6 -4 7 ; Petchesky, A b o r t i o n , 82.

108. In no way do I m ean to challenge Sm ith-Rosenberg’s conclusions. Her find­ ings are valid for the larger picture. I do not believe that the wom an-hating rhetoric so prevalent in the propaganda she analyzed was as im portant in Rhode Island as it was elsewhere. 109. A c t s a n d R e s o lv e s (1867), 1 4 8 -4 9 . The state revised the abortion statute in 1872 and 1882, but the only changes made were com m as and a few word changes such as “Every” to “Any” in 1872. See T h e G e n e r a l S t a t u t e s o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n s (Cambridge: Riverside Press, 1872), 541; T h e P u b l i c S t a t u t e s o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n s (Providence: E. L. Freem an & Co.,

1882), 6 69. 110. Sm ith-Rosenberg, “The A bortion M ovement,” 2 3 8 -4 2 . 111. C M J & R 7 (1852): 4 27; M ichel, “Poisoning,” 39; “O n the D eath o f Charlotte Bronte,” 8 2 5 - 2 6 ; C M J & R 4 (1 8 7 6 -7 7 ): 140. 112. Sm ith-Rosenberg, “The A bortion M ovem ent” 235, 243. 113. The text o f the act reads: “W hoever im ports, prints, publishes, sells, or dis­

275

276

Notes to Pages 4 0 -4 2

tributes a book, pam phlet, ballad, printed paper or other thing containing obscene, indecent or impure language, or manifestly tending to the corruption o f the morals of youth, or an obscene, indecent, or impure print, picture, figure or description, m ani­ festly tending to the corruption of the morals o f youth, or introduces into a family, school, or place o f education, or buys, procures, receives or has in his possession any such book, pam phlet, ballad, printed paper, print, picture, figure or other thing, either for the purpose of sale, exhibition, loan or circulation, or with intent to introduce the same into a family, school, or place o f education, shall be punished by im prisonm ent not exceeding two years, or by fine not exceeding one thousand nor less than one hun­ dred dollars.” This act encouraged citizens to turn in those distributing obscene m ateri­ als because half the fine went to “the person who inform ed” A c t s a n d R e s o lv e s (1897), 30. 114. M y thanks to Esther Katz for pointing out divisions among ethnically diverse Catholics as a possible explanation for the church’s inability to influence legislation. 115. N arragansett Bay is one of the two best natural harbors in N orth A m erica. Halifax is the other. 116. See John Hay, L i f e a n d S o c ie t y in A m e r i c a , 2nd ed. (London, 1880), 242; Nathan A llan”The New England Family” N e w E n g l a n d e r M arch 1882: 1 3 7 -6 0 ; F. Gaillardet, L a r i s t o c r a t i e e n A m e r i q u e (Paris, 1883), 243; “Alleged Decay o f the Family” M e t h o d i s t R e v ie w L X IX (1887): 8 5 8 -8 2 ; Samuel W. Dike, P e r i l s to t h e F a m i l y (W ashington, D.C.,

1887), 112; J. S. Billings, “Dim inishing Birth-rate in the United States” F o r u m (1893): 4 6 7 - 7 7 ; H. S. Pomeroy, I s M a n T o o P r o l i f i c ? T h e S o - c a l l e d M a l t h u s i a n I d e a (1891), 5 5 - 5 6 , in Rosenberg and Sm ith-Rosenberg, S e x , M a r r i a g e a n d S o c ie t y . 117. Petchesky, A b o r t i o n , 53. 118. No record number, Clara E. Patterson, M arch 1876, box 17989; no record num­ ber, Josephine Hinton, O ctober 1881, box 17989; no record number, Jannis D. Niven, August 1882, box 17989; no record number, Bertha Tost, D ecem ber 1884, box 17994; record 168, Sarah Hood, June 1895, box 1 80 0 0 ; record 318, Eugenia Reynolds, February 1896, box 17944; record 22, Alice Bodel, Septem ber 1897, box 17990; record 58, Lena Clarke, January 1900, box 17990; record 320, A nnie Richardson, April 1901, box 17994; record 4 2 4 , N ancy Pearson, D ecem ber 1904, box 17995; record 4 5 6 , Agnes Harrison, August 1906, box 17995; record 519, Rose Badger, D ecem ber 1908, box 19997; record 5 6 0 , M ary Meiggs, August 1910, box 17998; record 555, M aud Brautano, May 1910, box 17998; record 5 6 6 , Helen Miller, O ctober 1910, box 17998; record 6 0 7 , Bertha Richards, M ay 1912, box 17999; record 625, Jane Cunningham, N ovem ber 1912, box 17999; re­ cord 755, Ellen Fogarty, August 1918, box 18067; record 792, Eva Knight, January 1920, box 18068, all in Coroners’ Records. 119. Blanchard, T h e A n t i - A b o r t i o n M o v e m e n t , 11-12; Reagan, W h e n A b o r t i o n W a s a C r im e , 7.

120. Lewis, “Sociological Considerations,” 8 5 - 9 6 ; M apes, “Infanticide” 7 4 1 -4 7 ; Atkinson, “Sociological Status,” 1 8 2 -8 6 ; “Infants’ Rights” L iv i n g A g e , 8 January 1916, 115-17. 121. N e w Y o r k T im e s , 5 May 1867, 6, 28 M ay 1867, 5, 25 August 1867, 8, 26 August 1867, 8, 24 N ovem ber 1867, 5, 19 M arch 1869, 8, 30 August 1871, 8, 30 August 1871, 8, 6 Septem ber 1871, 8, 12 February 1879, 5, 13 February 1879, 8; N a t i o n a l P o l i c e G a z e t t e , 6

Notes to Pages 4 2 -4 8

D ecem ber 1879, 7; N e w Y o r k T im e s , 7 January 1880, 2, 14 M arch 1880, 12, 19 M ay 1880, 1, 12 July 1880, 1, 25 M arch 1881, 1, 6 April 1881, 1, 30 April 1881, 8, 22 February 1883, I, 5 January 1884, 2, 8 July 1886, 2, 22 January 1887, 2, 28 July 1892, 2. See also lectures by Thom as, A b o r t i o n a n d I t s T r e a t m e n t , 4 3 - 4 4 . Thom as claimed that although women from “the upper walks of life" still practiced abortion, they did so less than wom en “in the lower class" For scholars, see M ohr, A b o r t i o n ; Sm ith-Rosenberg, “The A bortion M ovem ent"; Rubin, A b o r t i o n , chap. 1. 122. H o u s e P a t i e n t s , T w in C ity H o s p i t a l , 1 8 9 6 -1 9 1 4 , Twin City Hospital Records. 123. SC M S, M e d i c a l S o c i e t y M i n u t e s , 1 July 1872, 189, 9 D ecem ber 1872, 195, 2 M arch 1874, 2 0 6 , 1 April 1880, 354. 124. W hitehead, O n t h e C a u s e s , 1 9 2 -9 3 ; Storer, C r i m i n a l A b o r t i o n , 5 1 -5 2 ; George J. Engleman, “Education N ot the Cause o f Race D ecline" P o p u l a r S c ie n c e M o n t h l y 63 (June 1903); Iseman, R a c e S u i c i d e , 137; Jacoby, “First Conviction for A bo rtio n " 59.

Chapter 3. Race Suicide, Eugenics, and Contraception, 1900-1930 1. Calhoun, S o c i a l H is t o r y , 2 36; Faulkner, T h e Q u e s t f o r S o c i a l J u s t i c e , 19; Schlesinger, T h e R is e o f t h e C ity , 1 2 5 -2 6 .

2. Som erville, “Scientific Racism " 249. 3. Samuel W. Dike, “Perils to the Family" in N a t i o n a l P e r ils a n d O p p o r t u n i t i e s , ed. Evangelical Alliance (W ashington, D.C., 1887); W illiam Potts, “Birth R ate" N a t i o n 52 (1891): 4 4 0 - 4 1 . 4. Francis A. Walker, “Im m igration and Degradation" F o r u m 11 (August 1891): 637, 6 4 0 -4 2 . 5. Hunter, P o v e r t y , 3 0 2 - 3 , 312-13. 6. Ibid., 3 0 9 -1 2 . 7. Roosevelt, W o r k s , 14:127, 135; Gordon, W o m a n ’s B o d y , 133. 8. Lewis, C o m p i l a t i o n , 5 4 8 ; Theodore Roosevelt, “Race D ecadence" O u t lo o k , 13 Septem ber 1927, 7 6 4 - 6 7 . For m ore on his race concepts see Dyer, T h e o d o r e R o o s e v e lt , esp. chap. 7. 9. Commander, A m e r i c a n I d e a , 4 5 - 4 7 , 1 6 -1 7 , 2 0 - 2 2 . 10. Ripley, “Races in the United S tates" A t l a n t i c M o n t h l y 102 (D ecem ber 1908): 7 4 5 -5 9 . See also R e a d e r M a g a z i n e 7 (February 1906): 3 0 9 -1 0 ; W e s t m in s t e r R e v i e w 165 (June 1 906): 5 9 5 -6 0 1 ; W o r ld T o - d a y 10 (M arch 1 906): 3 2 2 -2 3 ; N a t i o n , 16 August 1906, 1 3 4 -3 5 ; P o p u l a r S c i e n c e M o n t h l y 69 (D ecem ber 1906): 5 1 2 -2 9 ; N i n e t e e n t h C e n t u r y a n d A f t e r 6 0 (D ecem ber 1906): 8 9 5 - 9 9 ; N o r t h A m e r i c a n R e v ie w , 15 February 1907,

4 0 7 - 1 2 ; N a t i o n , 7 M arch 1907, 2 1 5 -1 6 , 25 July 1907, 7 2 - 7 3 ; A m e r i c a n M a g a z i n e 65 (M arch 1908): 5 4 5 - 4 6 ; W o r ld ’s W o r k 16 (Septem ber 1908): 1 0 6 3 9 -4 0 ; W e s t m in s t e r R e v ie w 172 (Septem ber 1909): 2 6 7 -7 4 .

11. J. W. Jenks and W. J. Lauck, T h e I m m i g r a t i o n P r o b l e m , 6th ed. (New York, 1926) summarizes the forty-one-volum e report o f the Im m igration Com m ission, W ashing­ ton, D.C., 1911. 12. P r o v i d e n c e J o u r n a l , 26 August 1912, 2. 13. Roosevelt, W o r k s , 15:599, 14:164. 14. Pernick, T h e B l a c k S t o r k , 23. 15. Rentoul, R a c e C u lt u r e , 106. Rentoul’s arguments resemble those advanced by

277

278

Notes to Pages 48 -55

Plato in T h e R e p u b l i c . Com m ander quotes numerous others who held sim ilar views ( A m e r i c a n I d e a , 83, 4 3 - 4 4 ) .

16. Commander, A m e r i c a n I d e a , 45, 22. 17. Commander, A m e r i c a n I d e a , 4 - 6 , 8; Frank W. N icolson, “Family Records of Graduates o f W ellesley University,” S c i e n c e , 19 July 1912, 7 4 - 7 6 ; Em erick, “College W omen,” 2 6 9 -8 3 ; A. L. Sm ith, “Higher Education o f W om en and Race Suicide,” P o p u ­ l a r S c ie n c e M o n t h l y 6 6 (M arch 1905): 4 6 6 - 7 3 .

18. Charles F. Em erick, “Is the Dim inishing Birth-rate Volitional?” P o p u l a r S c ie n c e M o n t h l y 28 (1911): 7 1 -8 8 ; Hunsberger, no title, J o u r n a l o f t h e A m e r i c a n M e d i c a l A s ­ s o c i a t i o n , 10 August 1907, 538; H arrington quoted in Beale, R a c i a l D e c a y , 271, 272.

19. Gordon, W o m a n ’s B o d y , 134, 1 4 5 -4 6 . 20. Rotundo, A m e r i c a n M a n h o o d . 21. Reilly, S u r g i c a l S o lu t io n , 3, 109; Larson, S e x , 18; Paul, C o n t r o ll in g H u m a n H e r e d ­ ity, 3; Hasian, T h e R h e t o r i c o f E u g e n ic s , 27.

22. Hasian, T h e R h e t o r i c o f E u g e n ic s , 3, 13; Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 18; Soloway, “The ‘Perfect Contraceptive,” 6 3 7 - 6 4 . 23. Hasian, T h e R h e t o r i c o f E u g e n ic s , 22, 26, 30, 3 8 - 4 0 , 43; Pernick, T h e B l a c k S t o r k , 24, 4 1 - 4 2 , 45; Ladd-Taylor, “Saving Babies” 139. 24. Paul, T h e P o lit ic s o f H e r e d i t y , 6 3 - 6 4 , 158; Dowbiggin, K e e p i n g A m e r i c a S a n e , 82. 25. Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 4 2 - 4 4 . 26. Reilly, S u r g i c a l S o lu t io n , 9 -1 0 ; Larson, S e x , 19, 72. 27. Haller, E u g e n ic s , 3 - 4 , 1 6 0 -6 3 ; Gordon, “The Politics” 6 6 - 6 7 ; Gordon, W o m a n ’s B o d y , 2 7 4 -7 8 ; Reilly, S u r g i c a l S o lu t io n , 3, 109; Larson, S e x , 18.

28. Kline, G e n d e r , S e x u a lit y , a n d E u g e n ic s , 2 - 3 . 29. Gordon, W o m a n ’s B o d y , 2 7 0 -7 1 ; Shapiro, P o p u l a t i o n , 3 4 - 3 5 ; Haller, E u g e n ic s , 62; Kuhl, N a z i C o n n e c t io n , 79; Dowbiggin, K e e p i n g A m e r i c a S a n e , 7 8 -7 9 . 30. Larson, S e x , 17, 3 0 -3 1 , 86, 89; Pernick, T h e B l a c k S t o r k , 32. 31. Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 5 6 - 5 7 ; Hasian, T h e R h e t o r i c o f E u g e n ic s , 52, 53, 73, 8 2 -8 3 , 86, 94, 1 0 1 -2 ; Pernick, T h e B l a c k S t o r k , 35, 54; Kline, G e n d e r , S e x u a lit y , a n d E u g e n ic s , 5; Dowbiggin, K e e p i n g A m e r i c a S a n e , ix -x i, 9 9 -1 0 0 , 111; Grob, T h e M a d a m o n g U s.

32. Paul, T h e P o l i t i c s o f H e r e d i t y , 11, 1 3 -1 6 ; Pernick, T h e B l a c k S t o r k , 32. 33. Higham, S t r a n g e r s in t h e L a n d , 72; Larson, S e x , 101. 34. Reilly, S u r g i c a l S o lu t io n , 2 5 - 2 6 ; Larson, S e x , 2 2 - 2 3 . 35. Kuhl, N a z i C o n n e c t io n , 1 3 -1 5 ; Shapiro, P o p u l a t i o n , 35. 36. Reilly, S u r g i c a l S o l u t i o n , 11; Larson, S e x , 2 3 - 2 5 , 75, 79, 84; Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 6 7 - 7 0 ; Paul, T h e P o lit ic s o f H e r e d i t y , 117-21, 125.

37. Reilly, S u r g i c a l S o lu t io n , 29; Paul, T h e P o lit ic s o f H e r e d i t y , 1 2 6 -2 7 ; Kline, G e n d e r , S e x u a lit y , a n d E u g e n ic s , 3.

38. Reilly, S u r g i c a l S o lu t io n , 3 0 -3 1 , 112; Larson, S e x , 27. 39. Chapple, T h e F e r t ilit y o f t h e U n fit; Harry Sharp, E u g e n ic s R e v ie w 4 (1912): 2 0 4 - 5 ; Reilly, S u r g i c a l S o l u t i o n , 3 1 -3 2 . 4 0 . Braslow, “In the Name of Therapeutics” 31, 38, 4 0 , 42, 4 6 , 4 8 ; Gugliotta, “Dr. Sharp with His Little Knife,” 373.

Notes to Pages 55-59

41. W hitney, T h e C a s e f o r S t e r i l i z a t i o n , 126; M eyerson et al., E u g e n i c a l S t e r i l i z a t i o n , 4 -5 . 42. Pennsylvania passed bills in 1901 and 1905; the governor failed to sign them into law (Haller, E u g e n ic s , 50). 43. Haller, E u g e n ic s , 124; Reilly, S u r g i c a l S o lu t io n , 39; Larson, S e x , 3 1 -3 2 ; Paul, C o n ­ t r o llin g H u m a n H e r e d i t y , 8 2 -8 3 .

4 4 . Dowbiggin, K e e p i n g A m e r i c a S a n e , 1 2 2 -2 3 . 45. Reilly, S u r g i c a l S o lu t io n , 4 0 , 53, 55, 7 1 -7 3 , 89. 4 6 . B u c k v. B e ll, 247 U.S. 2 0 0 (1927), my emphasis. A year after Carrie was sterilized the State Colony sterilized her sister Doris, who was told she was undergoing an ap­ pendectomy. Doris and her husband tried for years to have children and did not learn of this deception until 1980. N either Carrie nor Doris was feeblem inded but instead were daughters o f an “anti-social prostitute" (Smith, E u g e n ic A s s a u l t , 4 - 6 ; see also Shapiro, P o p u la t io n , 3 -4 ).

47. Laughlin, L e g a l S t a t u s , 65; Salm on to Davis, 28 M ay 1920, and Davis to Ray­ mond B. Fosdick, 2 February 1921, file 177, series 3, box 8, BSH Records. 4 8 . The new laws protected due process and the equal protection clause by mandat­ ing that eugenicists scan the whole populace, not ju st those institutionalized (Reilly, S u r g i c a l S o l u t i o n , 84).

49. H 1050, 20 M arch 1925, F a i l e d B i lls o f 1 9 2 5 , 1 -7 , State Archives. 50. Rhode Island did not keep records o f hearings. Thus, historians cannot discern the vote or arguments used for or against proposed legislation. The bill received no at­ tention in the newspapers. 51. Dennett, B i r t h C o n t r o l L a w s , 2 0 - 2 2 , 6 3 - 6 5 ; I. N. Thurman, “Excerpts from Ad­ dress o f I. N. Thurm an on the Legal Status of Birth C ontrol" 1926, box 12, A BC L Pa­ pers. 52. Tone, D e v i c e s a n d D e s ir e s , xvii, 26, 30, 32, 4 0 , 4 8 , 65. 53. Parmelee, P o v e r t y a n d S o c i a l P r o g r e s s , 1 8 4 -8 6 , 3 09. 54. See Ellis, P r o b l e m o f R a c e - R e g e n e r a t i o n ; Saleeby, M e t h o d s o f R a c e R e g e n e r a t i o n ; P o p u l a r S c ie n c e M o n t h l y 78 (January 1911): 8 1 -8 3 ; S c ie n t i fic A m e r i c a n , 2 Septem ber

1911, 2 0 6 ; W e s t m in s t e r R e v ie w 177 (M arch 1912): 3 4 8 - 5 2 ; C u r r e n t L i t e r a t u r e 52 (April 1912): 4 3 6 - 3 9 ; W e s t m in s t e r R e v ie w 177 (May 1912): 5 7 9 -8 1 ; S u r v e y , 23 Novem ber 1912, 2 4 4 - 4 6 ; W o r ld ’s W o r k 25 (D ecem ber 1912): 2 3 8 - 3 4 ; N a t i o n a l E d u c a t i o n A s s o c i a t i o n , P r o c e e d i n g s a n d A d d r e s s e s (1913): 7 7 2 -8 3 ; S c ie n t i fic A m e r i c a n , 10 M ay 1912, 4 2 6 ; L i t ­ e r a r y D ig e s t , 18 O cto ber 1913, 676; T e c h n i c a l W o r ld M a g a z i n e 20 (N ovem ber 1913):

3 2 8 -2 9 ; O u t lo o k , 15 N ovem ber 1913, 5 8 5 -8 8 ; L iv i n g Age, 29 Novem ber 1913, 5 6 6 - 6 9 ; I n d e p e n d e n t , 28 Septem ber 1914, 4 3 0 -3 1 ; N i n e t e e n t h C e n t u r y a n d A f t e r 75 (February

1915): 4 3 4 - 4 5 ; S u r v e y , 1 January 1916, 4 0 7 - 8 ; L i t e r a r y D ig e s t , 3 February 1917, 2 4 4 - 4 5 . This list is a selection of articles dealing with the “problem ” of population. 55. Roosevelt, W o r k s , 4 :7 7 -7 9 , 1 5 2 -5 3 , 14:172. 56. Gordon, W o m a n ’s B o d y , 2 3 6 -3 7 ; Petchesky, A b o r t i o n , 95. 57. Paul, C o n v e r s a t i o n s w it h A l i c e P a u l , 4 9 4 . 58. For radical elem ents o f the birth control movem ent see Gordon, W o m a n ’s B o d y ; Gordon, “The Long Struggle,” 7 5 - 8 8 ; Schofield, “Rebel Girls and U nion Maids,” 3 3 5 ­ 58.

279

280

Notes to Pages 59-62

59. Goldman, “Love and M arriage" 3. 6 0 . Grant Sanger, interview with Ellen Chesler, August 1976, 20, Family Planning

Oral H istory Project. 61. For m ore on Sanger see Kennedy, B i r t h C o n t r o l in A m e r i c a ; Douglas, M a r g a r e t S a n g e r ; Gordon, W o m a n ’s B o d y ; Reed, F r o m P r i v a t e V ic e ; and Chesler, W o m a n o f V a lo r .

M anuscript collections include A BC L Papers and M argaret Sanger Papers. 62. See Reed, F r o m P r i v a t e V ic e , 135, 4 0 3 n. 18. 63. Grant Sanger interview, 18. 6 4 . Chesler, W o m a n o f V a lo r , 216; Gordon, W o m a n ’s B o d y , 275. 65. Franks, M a r g a r e t S a n g e r ’s E u g e n ic L e g a c y , 1. 6 6 . The only device at the clinic was the M izpah Pessary, also available at phar­ macies for wom en with a prolapsed uterus; it also served as a contraceptive device. Chesler, W o m a n o f V a lo r , 151. 67. Chesler, W o m a n o f V a lo r , 1 5 1 -5 2 ; Reed, F r o m P r i v a t e V ic e , 1 0 6 -1 4 ; Gaulard, “W om an R ebel" Approximately twenty activists were arrested on federal charges and more on state charges (Gordon, W o m a n ’s B o d y , 228). 68. Anne Kennedy, “Report o f the A m erican Birth Control League A ctivities" 1923, box 11, A BC L Papers. 69. D’Emilio and Freedman, I n t i m a t e M a t t e r s , 233; Peiss, “Charity G irls" 7 8 - 8 0 ; Meyer, A n y F r i e n d o f t h e M o v e m e n t , 50. 70. Gordon, W o m a n ’s B o d y , 1 8 6 -2 0 3 . 71. Tone, D e v i c e s a n d D e s ir e s , 1 0 6 -1 0 ; Meyer, A n y F r i e n d o f t h e M o v e m e n t , 56. 72. Gordon, W o m a n ’s B o d y , 2 4 0 -4 1 ; Haag, “In Search of ‘The Real Thing’” 163­ 64. 73. This shift in tactic has parallels in the suffrage m ovement, which split in 1869 into the National W om an Suffrage A ssociation and the A m erican W om an Suffrage A s­ sociation. The form er maintained its relatively radical stance, continuing to fight for the vote but also labor, marriage and divorce reform , and free love, and it closed its ranks to men. The A m erican W om an Suffrage A ssociation fought only for the vote and chose male leaders to gain legitimacy. 74. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 31. 75. Chesler, W o m a n o f V a lo r , 2 2 5 -2 6 . 76. Kennedy, “Report of the A BC L A ctivities”; “Som e M aterial for Publicity Season 1 9 2 2 -1 9 2 3 " 1922, box 2, file 2, A BC L Papers; “A m erican Birth Control League,” n.d., file 4, series 3, box 1, BSH Records. 77. “A m erica’s Need for a Federal Birth C ontrol C om m ission" n.d., box 10, A BCL Papers. 78. The Im m igration A ct of 1917 excluded “all idiots, im beciles, feeble-m inded per­ sons, epileptics, insane persons; . . . persons of constitutional psychopathic inferior­ ity" as well as alcoholics, beggars, vagrants, paupers, those with contagious diseases, crim inals, polygamists, prostitutes, and “persons likely to becom e a public charge" (U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 14). 79. The 1921 and 1924 acts set quotas favoring northw estern over southeastern Eu­ ropeans and virtually elim inated im m igration from A sia (“A m erica’s Need"). 80. For nativist reactions see Higham, S t r a n g e r s in t h e L a n d .

Notes to Pages 6 2-6 4

81. Dublin, “The Fallacious Propaganda" 1 8 6 -8 7 ; Rossiter, I n c r e a s e o f P o p u l a t i o n , 28, 101. 82. W illiam Louis Poteat, “The Social Significance o f Hereditary" Presidential Ad­ dress to the Southern Baptist Education A ssociation, 21 February 1923, file 1078, box 9, W FR G 0091, Poteat Collection. 83. Slosson, T h e G r e a t C r u s a d e , 146; E. W. M acBride to M argaret Sanger, 10 O c­ tober 1923, box 10, A BC L Papers; Lynd and Lynd, M i d d l e t o w n , 1 2 3 -2 5 ; N a t i o n , 2 N ovem ber 1921, 4 95; A m e r i c a n M e r c u r y 2 (June 1924): 2 3 1 -3 6 ; L i t e r a r y D ig e s t , 22 N ovem ber 1924, 36; S u r v e y , 15 May 1925, 25; N o r t h A m e r i c a n R e v ie w 224 (D ecem ber 1927): 6 2 2 -2 9 . 84. Brandt, N o M a g i c B u l l e t ; Gordon, W o m a n ’s B o d y ; Gelb and Palley, W o m e n a n d P u b l i c P o l i c i e s , 5 - 6 , 129, 134, 1 6 0 -6 1 .

85. Bellingham and M athis, “Race, Citizenship" 157. 86. The Bureau o f Social Hygiene was established in 1911 by John D. Rockefeller, Jr., for the “study, amelioration, and prevention of those social conditions, crim es and diseases which, adversely, affect the wellbeing o f society" The BSH was independent of the Rockefeller Foundation but supported by Rockefeller, Jr. It initially concentrated on prostitution but shifted to the study of sex, “the fundam ental on which the life o f the race depends" Dr. Katherine B. Davis served as general secretary from 1918 to 1928. “A Report for the Year 1 9 2 9 " file 2, series 3, box 1; Katherine B. Davis to John D. Rock­ efeller, Jr., 27 April 1927, file 4 4 , series 3, box 7; “Attitude o f M aternity C enter A ssocia­ tion to Birth C ontrol" 22 April 1931, file 166, series 3, box 7, all in BSH Records. 87. See Campbell, “Birth C ontrol" 1 3 1 -4 7 ; Sulloway, B i r t h C o n t r o l; Curran, I s s u e s in S e x u a l a n d M e d ic a l E th ic s .

88. Cardinal Gibbons quoted in Com mander, A m e r i c a n I d e a , 8 4 - 8 6 ; Blanchard, T h e A n t i - A b o r t i o n M o v e m e n t , 11-12.

89. Kennedy, “Report of an Interview with Fr. W ard o f the National W elfare Confer­ ence" 1926, box 11, A BC L Papers. 90. Hardin, P o p u l a t i o n , 242. 91. “C om m ittee on M aternal H ealth Revised Statem en t" 9 M arch 1923, file 172, series 3, box 7, BSH Records; Louise Gilm an Hutchins, M .D., interview with James W. Reed, January 1975, 7, Family Planning Oral H istory Project; “Interview with Boughto n " 17 April 1931, file 162, series 3, box 7, BSH Records; “CM H Statem ent" 7 D ecem ­ ber 1928, file 173, series 3, box 7, BSH Records. 92. Brandt, N o M a g i c B u l l e t , 8 - 9 ; Reed, F r o m P r i v a t e V ic e , chap. 3; Reed, “D o cto rs" 111-12. 93. Tone, D e v i c e s a n d D e s ir e s , 66. 94. John Fulton to M ary W are D ennett, 30 April 1918, and Fulton to D ennett, 9 May 1918, box 12, A BC L Papers; Robinson, S e v e n t y B i r t h C o n t r o l C lin ic s , 105, 2 6 0 -6 1 . See also Dublin, “The Fallacious Propaganda" 1 9 0 -9 2 ; Blacker, B i r t h C o n t r o l, 9, 13. 95. For a discussion of this controversial decision see Ray and Gosling, “A m erican Physicians" 3 9 9 -4 1 1 ; Gordon, “The Long Struggle" 96. “Som e M aterial for Publicity Season 1 9 2 2 -1 9 2 3 " 1922, file 2, box 2, and Ken­ nedy to the S ecretary o f the W innipeg M edical Society, 4 M ay 1923, file 1, box 2, A BC L Papers.

281

282

Notes to Pages 6 5-68

97. “N oted O bstetrician W ill Lecture Here on Birth Regulation" A n n A r b o r M i c h i ­ g a n D a i l y , 24 N ovem ber 1926, box 11; James Cooper, “Report on M eeting, Reading,

Pennsylvania" 29 May 1925, box 11; James Cooper, “Dr. Cooper’s R eport" 7 -1 3 O cto ­ ber, no year, all in A BC L Papers. 98. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 12, 38. The A m eri­ can Gynecological Society in 1925 called for the mail to transm it medical and scientific journals and other pam phlets containing birth control inform ation, but it recanted this resolution for “political reasons" U.S. Congress, Senate, Com m ittee on the Judiciary, E x tra ct, 40.

99. Gordon, W o m a n ’s B o d y , 2 4 9 - 5 0 , 270. 100. Sm ith, E u g e n ic A s s a u l t , 1 3 -2 5 ; Dorr, “A rm and A rm " 1 4 2 -4 4 . For m ore on the alliance betw een this club and Garvey see Sm ith, E u g e n ic A s s a u lt , chap. 2. 101. “The New Family and Race Im provem ent" V ir g in ia H e a l t h B u l l e t i n 17 (Novem­ ber 1925): 3 - 3 0 . 102. “People’s Foundation," 11 April 1932, file 178, series 3, box 8, BSH Records; Shapiro, P o p u l a t i o n , 4 5 - 4 7 ; Gordon, W o m a n ’s B o d y , 274. 103. Irving Fisher to Katharine Davis, 24 N ovem ber 1924, and Davis to Fisher, 26 N ovem ber 1924, file 181, series 3, box 8; Lawrence B. Dunham to M iss Topping, 27 Septem ber 1932, file 178, series 3, box 8, both in BSH Records. 104. “Com m ittee on M aternal Health Revised Statem ent" 9 M arch 1923, file 172, series 3, box 7; “A Report to the Trustees Covering the Years 1928, 1929, 1 9 3 0 " 15 De­ cem ber 1930, file 1, series 3, box 1, 7 2 -7 3 , both in BSH Records. 105. Robert Latou Dickinson, “Birth Control: Som e Definitions and C om m ents" n.d., file 173, series 3, box 7, BSH Records. 106. “A Report to the Trustees Covering the Years 1928, 1929, 1 9 3 0 " 69. 107. “CM H Statem ent" Despite sim ilarities, the CM H did not cooperate with the A BC L because of the lay- versus m edical-directed nature o f the A BC L. 108. “A m erican Birth Control League" n.d., file 4, series 3, box 1; “A Report o f the Trustees Covering the Years 1928, 1929, 1 9 3 0 " 15 D ecem ber 1930, 7 6 - 8 0 , file 1, series 3, box 1; “Birth C ontrol Clinical Research Bureau" n.d., file 12, series 3, box 1; “A Report for the Year 1 9 2 9 " n.d., file 2, series 3, box 1; and “Annual Report to the Tru stees" 1931, 71, file 4, Series 3, box 1, all in BSH Records. 109. Harry H. Laughlin to Sanger, 24 M arch 1923, file 3, box 2, A BC L Papers. 110. By the 1920s the A BC L had open racists and eugenicists on its board such as Lothrop Stoddard, author o f T h e R is in g T i d e o f C o l o r a g a i n s t W h it e W o r ld - S u p r e m a c y , and C. C. Little. The B i r t h C o n t r o l R e v ie w also reflected eugenic and racist attitudes. See Gordon, W o m a n ’s B o d y , 278. 111. “Som e M aterial for Publicity Season 1 9 2 2 -1 9 2 3 " file 2, box 2, A BC L Papers. For examples of speeches see “Notes on M eeting at Colony C lub" 4 February 1923, box 11; Anne Kennedy to M rs. Park M atthew son, 27 June 1923, file 2, box 2; Kennedy to M rs. George Forbes, 24 April 1923, file 1, box 2, all in A BC L Papers. 112. M argaret Sanger to Dr. W illiam Thom as Belfield, 5 July 1923, file 4, box 2, A BCL Papers; Robinson, S e v e n t y B i r t h C o n t r o l C lin ic s , 104. 113. M argaret Sanger to Harry H. Laughlin, 7 Septem ber 1923, file 3, box 2; Sanger to Dr. M adison Grant, 24 Septem ber 1923, file 3, box 2; Professor W illiam M cDougall

Notes to Pages 6 9 -71

to Sanger, 24 Septem ber 1923, file 4, box 2; Pauline Carvel Daniel to M iss Em eth Tuttle, 6 Septem ber 1923, file 3, box 2; Sanger to Horatio M . Pollack, 31 August 1923, file 3, box 2; “Statistics Com piled from Reports o f the D epartm ent o f C orrection and D epartm ent o f Public W elfare, New York S tate" 1921, box 11, all in A BC L Papers. 114. A nne Kennedy to Professor W illiam H erbert H obbs, 7 July 1923, file 4, box 2, A BC L Papers. 115. Sanger to Eliot, 15 Novem ber 1923, file 6, box 2; Julia Kirkwood to Sanger, 7 N ovem ber 1923, file 5, box 2; James Cooper, “Dr. Cooper’s R ep orts" 7 -1 3 O ctober, no year, box 11; “Intelligent M otherhood Is Birth C ontrol G ospel" A b e r d e e n M o r n i n g A m e r i c a n , 18 Septem ber 1926, box 11, all in A BC L Papers.

116. Sanger, “Address o f W elcom e, Sixth International N eo-M althusian and Birth Control Conference," 25 M arch 1925, box 10, A BC L Papers. 117. Again, parallels betw een birth control and suffrage movem ents can be seen. M any suffragists adopted racial argum ents to ju stify women’s suffrage following the Civil War, contending that white educated women’s vote could offset the vote of igno­ rant black m en enfranchised through the Fifteenth Amendm ent. 118. Owen R. Lovejoy, “Birth C ontrol and Child Labor,” 27 M arch 1925, box 10; m es­ sage from Hendrick W. van Loon to Sixth International N eo-M althusian Conference (hereafter referred to as SIN C ), M arch 1925, box 10; message from U pton Sinclair to SIN C, M arch 1925, box 10, all in A BC L Papers. N um erous additional speeches and letters argued the same point: “Professor Pearl Calls for a M ilitant Crusade,” 26 M arch 1925, box 10; message from H enry W. N evinson to SIN C, M arch 1925, box 10; N orm an Thom as, “Som e O bjections to Birth Control Considered" M arch 1925, paper delivered at SIN C, box 10; see also “The Race Suicide B ogie" for release 26 M arch 1925, box 10; Dr. A letta Jacobs, “A G eneration of Birth C ontrol in H olland" paper delivered at SIN C, box 10, all in A BC L Papers. 119. M essage from Oswald G arrison Villard to SIN C, M arch 1925, box 10; message from Hudson M axim to SIN C, M arch 1925, box 10; message from M ajor Haldane M acFall to SIN C, M arch 1925, box 10; message from M . P. W illcocks to SIN C, M arch 1925, box 10; message from Charles E. S. W ood to SIN C, M arch 1925, box 10, all in A BCL Papers. 120. “Sum m ary o f Proceedings at Sixth International N eo-M althusian and Birth Control Conference," n.d., box 10; “Eugenics," 28 M arch 1925, box 10, both in A BC L Papers. 121. See Reed, F r o m P r i v a t e V ic e , 135, 4 0 3 n. 18. His source for this conclusion is a 1946 letter from Clarence Gam ble to the PPFA and a 1946 letter from Sanger to Gam ble, yet he locates her rejection of eugenics in the 1920s. By the 1940s eugenics had been discredited by its association with Hitler. She probably disavowed her eugenic leanings in hindsight. See Sanger, “W hy N ot Birth C ontrol" 1 0-11; Sanger, W o m a n a n d t h e N e w R a c e , 34; Sanger, T h e P i v o t o f C i v i l i z a t i o n , 1 7 7 -7 8 .

122. The VPL was established by D ennett in 1919. See Dennett, B i r t h C o n t r o l L a w s ; M ary W are Dennett, “The Birth C ontrol C onference" N a t i o n , 8 N ovem ber 1922, 5 0 0 ­ 501. 123. Sanger, M a r g a r e t S a n g e r , 414; A nne Kennedy to M rs. M ary W are D ennett, 6 June 1923, file 3, box 2, A BC L Papers.

283

284

Notes to Pages 7 1 -7 4

124. H 6 6 5 , 6 February 1923, F a i l e d B i lls o f 1 9 2 3 , 23, State Archives. 125. Sanger, M a r g a r e t S a n g e r , 415. 126. Ida H. Tim m e, “Report to the Congressional C om m ittee of the A m erican Birth Control League" 1 M arch 1926, box 11, A BC L Papers; Sanger, M a r g a r e t S a n g e r , 415. Although the BSH refused to fund the A BCL’s propaganda work, it did financially sup­ port the A BCL’s push for a doctors-only bill because the BSH believed the “responsibil­ ity for this problem ” should rest squarely “on the shoulders of the medical profession" “A m erican Birth C ontrol League, In c." n.d., file 12, series 3, box 1, BSH Records. 127. Grant Sanger interview, 4 7 - 5 0 . 128. H 8 0 7 , 26 February 1926, F a i l e d B i lls o f 1 9 2 6 , 26, State Archives; Kennedy, congressional report (hereafter referred to as CR) nos. 33, 36, 1 Janu ary-1 M ay 1926, box 11, A BC L Papers. 129. Kennedy, CR nos. 33, 36, 12, 11, and 2, 1 Janu ary-1 M ay 1926, box 11, A BCL Papers. 130. Kennedy, CR no. 12, 11 February 1926, box 11, A BC L Papers. 131. Kennedy, CR nos. 26, 25, and 14, 2 4 February-1 April 1926, box 11; and Ken­ nedy and M . Huse, “Interview with the Officials of the Ku Klux K lan" n.d., box 11, all in A BC L Papers. 132. For statem ents regarding im m orality see Senator Kenneth M cK ellar (D-TN ) and Senator George W. Pepper (R-PA) in CR nos. 37 and 5, box 11; for statem ents re­ garding the public/private split see CR nos. 34 and 14, box 11, all in A BC L Papers. 133. Kennedy, CR nos. 27, 38, 21, and 3, 1 Janu ary-1 M ay 1926, box 11; and for addi­ tional statem ents against the medical profession see CR nos. 35, 33, and 27, 1 January-1 M ay 1926, box 11, all in A BC L Papers. 134. Sanger’s m other was Catholic; Sanger was raised Catholic but raised her chil­ dren Episcopalian. According to Grant, Sanger “ju st couldn’t stand the Irish Catho­ lics. . . . They were ignorant, and they were the Irish types that she abom inated” (Grant Sanger interview, 5 3 -5 5 ). 135. Sanger, M a r g a r e t S a n g e r , 416. 136. W o m a n R e b e l 1, no. 1 (M arch 1914): 1 - 3 , 8. 137. Chesler, W o m a n o f V a lo r , 2 7 1 -7 2 , 3 0 0 . 138. James F. Cooper, “Report on Dallas Texas A .M .A . M eeting " 2 0 - 2 3 April 1926, box 11, A BC L Papers; Sanger, M a r g a r e t S a n g e r , 417. 139. The religious affiliation o f Congress was Senate, 90 Protestants, 4 Catholics, and 2 M orm ons; House o f Representatives, 393 Protestants, 3 4 Catholics, 1 M orm on, and 7 Jews. 140. Kennedy, CR nos. 23 and 4 0 , 1 Janu ary-1 M ay 1926, box 11, A BC L Papers. 141. Kennedy, “Short Synopsis of Interviews with Senators" 1 M ay 1926, box 11; Ken­ nedy, CR nos. 33, 30, 22, and 19, 1 Janu ary-1 May 1926, box 11, all in A BC L Papers. 142. Kennedy, “Short Synopsis" 1 M ay 1926, box 11; and Kennedy, CR no. 38, 19 April 1926, box 11, both in A BC L Papers. Kennedy did not explain her interviewing so few m em bers; perhaps the A BC L lacked adequate staff to question each House m em ­ ber. 143. “A Report to the Trustees Covering the Years 1928, 1929, 1 9 3 0 " 7 6 - 8 0 . Chesler argues that Sanger left the A BC L not only to head the BC C R B but also because she

Notes to Pages 74 -8 2

was not prepared to follow new regulations passed in her absence (she spent eighteen months in Europe). Sanger also disagreed with the board’s views. Last, she was “testy" toward the second generation o f reform ers who “thought they knew better than she did” (Chesler, W o m a n o f V a lo r , 238). 144. “Interview with Dr. Alice C. Boughton,” 17 April 1931, file 162, series 3, box 7, BSH Records. 145. Piotrow, W o r ld P o p u l a t i o n C r is is , 8. 146. “Katharine Bem ent Davis to Mr. Raymond B. Fosdick” 9 D ecem ber 1927, file 173, series 3, box 7, BSH Records; and “CM H Statem ent” 147. M rs. A lan F. Guttm acher, interview with James W. Reed, N ovem ber 1974, 4 - 5 , Family Planning Oral H istory Project; and U.S. Congress, Senate, C om m ittee on the Judiciary, H e a r in g s , 4. 148. Sarah M arcus, M.D., interview with Ellen Chesler, April and Septem ber 1976, ii-iv, 1 6 -2 5 ; and Emily H artshorne Mudd, interview with James W. Reed, M ay-A ugust 1974, 2 6 -3 1 , Family Planning Oral H istory Project. 149. Twin City Hospital was a segregated facility. 150. H o u s e P a t i e n t s , T w in C ity H o s p i t a l . 151. H o u s e P a t i e n t s , T w in C ity H o s p i t a l . 152. Mohr, A b o r t i o n in A m e r i c a , 2 4 0 - 4 2 . 153. Salem College is one o f the oldest A m erican female colleges. 154. S t a t e v. W a l t e r L . J o h n s o n , 41 R.I. 253 (1918). 155. Reagan, W h e n A b o r t i o n W a s a C r im e , 37, 70. 156. P r o v i d e n c e E v e n in g B u l l e t i n , 5 August 1921, 1. 157. P r o v i d e n c e E v e n in g B u l l e t i n , 2 4 N ovem ber 1924, 2; P r o v i d e n c e J o u r n a l , 22 M arch 1926, 4. 158. P r o v i d e n c e E v e n in g B u lle t in , 8 Septem ber 1921, 4, 25 January 1923, 4, 11 April 1923, 3, 27 August 1923, 4, 20 February 1924, 2, 20 M ay 1924, 4, 3 June 1924, 4, 29 June 1926, 3, 23 Novem ber 1926, 3, 22 July 1926, 1, 15 N ovem ber 1927, 1. 159. “R. Topping to Mr. Dunham ” 5 January 1932, file 162, series 3, box 7; “Am erican Birth Control League” 5 and 9 January 1934, file 163, series 3, box 7; and “A m erican Birth Control League,” 1935, file 163, series 3, box 7, all in BSH Records.

Chapter 4. Population Control and the Great Depression, 1930-1939 1. S. J. H olm es, “W ill B irth C ontrol Lead to E xtinction?” S c i e n t i f i c M o n t h l y 34 (M arch 1932): 247, 2 50; “Approval Is Seen on B irth Control,” E v e n in g S t a r (W ashington, D.C.), 5 June 1935. See Hofstadter, S o c i a l D a r w i n i s m ; Haller, E u g e n ic s . 2. Hutchins interview, 20; Loraine Leeson Campbell, interview with James W. Reed, D ecem ber 1 9 7 3 -M a rc h 1974, 28, Family Planning Oral H istory P roject; and Mudd interview, 27. 3. “A Report to the Trustees Covering the Years 1928, 1929, 1930,” 7 6 - 8 0 ; “Birth Control for Jobless New Goal,” P r o v i d e n c e J o u r n a l , Social Section, bk. 2, and “Birth Control League to O pen Sessions,” N e w Y o r k H e r a l d T r i b u n e , Social Section, bk. 2, both in PPRI Records. W h en I exam ined the PPRI records in the summ er o f 1997, they were housed at the clinic. In the spring of 1998 they were moved to the Rhode Island H istorical Society. M y citations correspond to the PPRI filing system.

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Notes to Pages 8 3 -8 7

4. Sydenstricker and Perrott, “Sickness" 127, 1 2 9 -3 0 , 1 3 2 -3 3 . 5 . Bromley, “Birth C ontrol" 5 6 3 - 6 4 ; P r o v i d e n c e J o u r n a l , 9 April 1935, 10 O ctober

1935. 6. Mudd interview, 33; James Rorty, “W h at’s Stopping Birth Control?" N e w R e p u b lic , 3 February 1932, 3 1 3 -1 4 ; Bromley, “Birth C ontrol" 5 6 3 - 6 4 . 7. Pearl, “Prelim inary Notes," 4 6 , 53; Pearl, “Second Progress Report," 2 50, 258, 2 6 8 - 6 9 ; Pearl, “Third Progress Report," 258, 2 6 0 , 2 6 6 - 6 7 , 2 7 1 -7 2 , 2 7 9 -8 1 ; Pearl, “Fer­ tility," 505. 8. The 1930s introduction o f latex condom s increased sales, with 1.5 m illion pro­ duced daily at about a dollar per dozen, m ost within disease prevention, dissociating the condom from sexual pleasure and reproduction and sidestepping prohibitions on contraceptives. See Gam son, “Rubber W ars" 265, 277. 9. Andrea Tone, “Political Econom y" in Tone, C o n t r o l l i n g R e p r o d u c t i o n , 212; Tone, D e v i c e s a n d D e s ir e s , xvi, 152, 163, 165, 170.

10. Petchesky, A b o r t i o n , 10. 11. Clinics by state: A rizona, 1; California, 20; Colorado, 1; Delaware, 1; Florida, 1; Il­ linois, 9; Iowa, 1; M aryland, 1; M assachusetts, 1; M ichigan, 6; M innesota, 2; New Jersey, 3; New York, 23; Ohio, 4; Pennsylvania, 9; Rhode Island, 1; Virginia, 1; W est Virginia, 1. See U.S. Congress, House, C om m ittee on Ways and M eans, R e p o r t , 22. 12. P r o v i d e n c e J o u r n a l , 5 M arch 1931, 2. 13. A bout a thousand people at the conference called on FDR to distribute contra­ ceptives through public health and social welfare programs; he refused to m eet del­ egates. See Chesler, W o m a n o f V a lo r , 3 4 4 . 14. “Goldstein Asks U.S. Sanction B irth C on trol" N e w Y o r k H e r a l d T r ib u n e , 16 January 1934; “Says Birth C ontrol Gains Public Favor," P r o v i d e n c e J o u r n a l , 22 January 1932. 15. Gordon, W o m a n ’s B o d y , 3 09; Bromley, “Birth Control," 5 6 7 - 6 8 . Som e social workers may have been a legacy of middle-class Progressives. Their “moral superiority" may have influenced their decisions as to who should lim it families. Gordon concluded that m ost social workers were “condescending": they believed they “knew what kind of help was good for the poor" and considered their clients “the problem," not as “having problem s" ( W o m a n ’s B o d y , 320). Yet other social workers were genuinely concerned with m aternal and infant health and mortality. They sent wom en to clinics to help, not control, them . 16. P r o v i d e n c e J o u r n a l , 14 O cto ber 1936; S t a r E a g l e (Newark, N.J.), 16 February 1935, 4. 17. “Fraud of Sterilization," C o m m o n w e a l , 21 February 1936, 4 5 1 -5 2 . 18. U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 18. 19. “A m erican Birth Control League" n.d., file 4, series 3, box 1, BSH Records; U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r i n g s , 31; Grant Sanger interview, 25; Chesler, W o m a n o f V a lo r , 3 2 6 -2 7 . 20. Sanger, M a r g a r e t S a n g e r , 4 1 7 -2 0 . 21. Ibid., 4 1 7 -2 0 . 22. U.S. Congress, House, C om m ittee on Ways and M eans, R e p o r t , 51. Charlotte Perkins Gilm an also spoke o f a woman’s “right to decide," not whether or not to have

Notes to Pages 8 7-8 9

children but “how often" she would perform her “duty, in childbearing, to improve the hum an race" Gilm an believed poor, “defective” wom en had no right to procreate, while rich, educated wom en had no right n o t to procreate (U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 5 5 -5 7 ). 23. Sanger’s advocacy o f a doctors-only bill eliminated fem inist demands for birth control. A t the 1932 hearings Sanger argued that condoms were “generally unsafe” when bought “over the counter” and were reliable only with proper medical instructions (U.S. Congress, Senate, C om m ittee on the Judiciary, H e a r in g s , 14; Grant Sanger interview, 51). The Bureau o f Social Hygiene also supported a doctors-only bill. See Dunham to Fosdick, 19 M arch 1931, file 166, series 3, box 7; “A m erican Birth Control League" 19 April 1932, file 162, series 3, box 7, both in BSH Records. 24. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 2, 31, 36, 10, 11, 5, 3 2 -3 5 , 48, 55. Sim ilar arguments were made before the House C om m ittee on HR 11082. See U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 138, 7, 58, 43, 4 4 , 50. 25. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 2; U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 57; Sanger, M a r g a r e t S a n g e r , 4 2 2 - 2 3 ; Robert S. Allan, “Congress and Birth C ontrol" N a t i o n , 27 January 1932, 1 0 4 -5 . 26. The Population Reference Bureau, established in 1930, distributed data con­ cerning “population problem s” and published research in the P o p u l a t i o n B u l l e t i n , a quarterly bulletin with Guy Irving Burch, a student of Fairchild, as general editor. Ruth Topp to Mr. Lawrence Dunham, 1 May 1931, file 190, series 3, box 9, BSH Records; U.S. Congress, Senate, C om m ittee on the Judiciary, H e a r in g s , 8, 11-12, 36, 60; U.S. C on­ gress, House, C om m ittee on Ways and M eans, R e p o r t , 6, 8, 14, 26, 33, 34, 55, 57. 27. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 8, 43, 5 5 - 5 7 ; U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 30, 8, 140, 47, 59, 28, 33. 28. The House com m ittee voted nineteen to four against the bill because it was “too controversial” to take up congressional tim e during this period o f “econom ic unrest and discontent” (U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 2). 29. U.S. Congress, Senate, Com m ittee on the Judiciary, H e a r in g s , 23. 30. U.S. Congress, House, Com m ittee on Ways and M eans, R e p o r t , 1, 7 8 - 8 0 ; Allan, “Congress,” 1 0 4 -5 ; “M rs. Sanger Asks Congress to Act,” Political Section, bk. 2, PPRI Records. Ryan opposed contraception based on Catholic doctrine but chose politically expedient term s to voice his objections and rem ained silent on the church’s official stance. For more on the church and birth control see Sulloway, B i r t h C o n t r o l ; Campbell, “Birth C ontrol”; N oonan, C o n t r a c e p t i o n ; Egner, C o n t r a c e p t i o n . 31. U.S. Congress, Senate, C om m ittee on the Judiciary, H e a r in g s , 6 4 , 75, 79, 8 0 -8 1 , 6 5 - 6 6 , 6 8 - 6 9 , 77; U.S. Congress, House, C om m ittee on Ways and M eans, R e p o r t , 93, 72, 73, 5 5 - 5 6 , 115, 75, 89, 112, 91. 32. Chesler, W o m a n o f V a lo r , 339. 33. As with mainland tactics, no effort was made to reform abortion, which re­ mained a felony. U.S. Congress, Senate, C om m ittee on Interoceanic Canals, H e a r in g s , 13, 8 4 - 8 5 . 34. Sanger, M a r g a r e t S a n g e r , 4 2 9 - 3 0 ; U.S. Congress, House, C om m ittee on Ways and M eans, R e p o r t , 3 1 -3 3 , 41, 58.

287

288

Notes to Pages 8 9 -9 4

35. U.S. Congress, Senate, C om m ittee on the Judiciary, E x t r a c t ; U.S. Congress, House, Com m ittee on the Judiciary, E x t r a c t ; Sanger, M a r g a r e t S a n g e r , 4 2 4 - 2 5 ; “C on­ gress W ill G et Birth Control B ills" P r o v i d e n c e J o u r n a l , 16 January 1934; “Birth Control: Capitol Has Bill to Repeal Com stock Law" N e w s w e e k , 27 January 1934, 28. 36. “D ocum ent 10: Proposal to A m end the Com stock A ct to Allow D octors to Prescribe Contraceptives. Testim ony Opposing the A m endm ent by Father Charles E. Coughlin, 1 9 3 4 " in Rubin, T h e A b o r t i o n C o n t r o v e r s y , 30; “Birth Control: Capitol Has Bill to Repeal Com stock Law" N e w s w e e k , 27 January 1934, 28; “Birth Control A ct Hear­ ing Crow ded" P r o v i d e n c e J o u r n a l , 19 January 1934; Em m a Bugbee, “‘Com m ercial’ Hint Stirs Ire of M rs. Sanger" N e w Y o r k H e r a l d T r ib u n e , 20 January 1934. 37. U.S. Congress, House, C om m ittee on the Judiciary, E x t r a c t , 5 - 8 , 63, 9 6 - 9 7 ; “Birth Control A ct Hearing Crowded." 38. “Birth C ontrol M ove G aining" W a s h in g t o n P o s t , 29 May 1935. 39. C hester T. Crowell, “Babies Just B abies" N e w R e p u b lic , 29 M ay 1935, 71. 4 0 . F a r m a n d F i r e s i d e and C h u r c h m a n surveys quoted in W ecter, A g e o f t h e G r e a t D e p r e s s i o n , 179; F o r t u n e , 14 July 1936, 158; Gallup, G a l l u p P o l l P u b l i c O p in io n , 1 9 3 5 ­ 1 9 7 1 , 41.

41. May, H o m e w a r d B o u n d , 4 0 , 93. 42. Blanchard, T h e A n t i - A b o r t i o n M o v e m e n t , 12. 43. Grant Sanger interview, 26. 4 4 . Sanger, M a r g a r e t S a n g e r , 4 2 7 ; Dienes, L a w , P o lit ic s , a n d B i r t h C o n t r o l, 109. 45. U n i t e d S t a t e s v. O n e P a c k a g e , 13 F. Supp. 334 (E.D. N.Y. 1936), aff’d F. 2d 737 (2d Cir. 1936); Sanger, M a r g a r e t S a n g e r , 427. 4 6 . U n i t e d S t a t e s v. D e n n e t , 39, F. 2d 5 6 4 (2d Cir. 1930); U n i t e d S t a t e s v. O n e O b ­ s c e n e B o o k E n t i t l e d “M a r r i a g e L o v e " 4 8 F. 22d 821 (S.D.N.Y. 1931); U n i t e d S t a t e s v. O n e B o o k E n t i t l e d “C o n t r a c e p t i o n " 51 F. 2d 525 (S.D.N.Y. 1931); Y o u n g ’s R u b b e r C o . v. C . T. L e e a n d C o ., 4 5 F. 2d 103 (2d Cir. 1930).

47. Chesler, W o m a n o f V a lo r , 331; Gam son, “Rubber W ars" 2 6 9 - 7 0 ; Gordon, W o m ­ a n ’s B o d y , 319; Tone, D e v i c e s a n d D e s ir e s , 149, 1 5 1 -5 4 .

4 8 . Tone, D e v i c e s a n d D e s ir e s , 115, 1 3 4 -3 5 , 138; Meyer, A n y F r i e n d o f t h e M o v e m e n t , 15, 4 4 ; Piotrow, W o r ld P o p u l a t i o n C r is is , 8. 49. Chesler, W o m a n o f V a lo r , 3 7 6 -7 7 ; Reed, F r o m P r i v a t e V ic e , 2 6 6 ; Grey, N e w D e a l M e d i c i n e , 98, 9, 10, 16, 172; Schoen, C h o i c e & C o e r c i o n , 5 5 - 5 6 .

50. M ary Steichen Calderone, M .D., interview with James W. Reed, August 1974, 11-12, Family Planning Oral H istory Project. 51. M uch o f N orth Carolina’s public health expansion was funded by out-of-state sources, namely, the Rockefeller Foundation, the United States Public Health Service, and the Children’s Bureau. See Reed, F r o m P r i v a t e V ic e , 253. 52. H istorian James Reed cites reasons for this low percentage: no significant cam ­ paigns to reach clients occurred, som e doctors believed patients had no use for ser­ vices, and som e health officers argued that large families continued to be an asset in many rural areas ( F r o m P r i v a t e V ic e , 2 5 3 -5 5 ). See also Schoen, C h o i c e & C o e r c i o n , 60. 53. Reed, F r o m P r i v a t e V ic e , 2 5 2 -5 7 .

Notes to Pages 9 4 -9 8

54. “Birth Control: South Carolina Uses It for Public H ealth" L i f e , 6 M ay 1 940, 6 4 ­ 68; U.S. Congress, Senate, C om m ittee on Governm ent O perations, H e a r i n g s (1965); Schoen, “Fighting for Child H ealth" 9 0 -1 1 3 . 55. Briggs, R e p r o d u c i n g E m p i r e , 7 4 -7 6 . 56. Hartman, R e p r o d u c t i v e R ig h ts , 2 3 1 -3 2 . 57. Cadbury, “O utlook" 3 1 9 -2 0 ; Thim m esch, “Puerto R ico" 2 5 2 -6 2 ; Curt, “Puerto R ico" 2 2 9 - 3 0 ; Piotrow, W o r ld P o p u l a t i o n C r is is , 3 1 -3 2 . 58. Shapiro, P o p u l a t i o n , 53; Cadbury, “O utlook" 320; Reed, F r o m P r i v a t e V ic e , 2 5 9 ­ 6 0 ; Gordon, W o m a n ’s B o d y , 332; Briggs, R e p r o d u c i n g E m p i r e , 149. 59. Tone, D e v i c e s a n d D e s ir e s , 86; Roberts, K i l l i n g t h e B l a c k B o d y , 78, 8 2 -8 3 . 6 0 . Kelly Miller, “Eugenics of the Negro Race" S c ie n t i fic M o n t h l y 5 (July 1917): 5 7 ­ 59; Rodrique, “The Black Com m unity" 336. 61. Cobb, “The Negro as a Biological E lem ent" 3 4 5 - 4 6 . 62. W .E.B. DuBois, “Black Folk and Birth C ontrol" B i r t h C o n t r o l R e v ie w (June 1932): 1 6 6 -6 7 ; George Schuyler, “Q uantity or Quality" B i r t h C o n t r o l R e v ie w (June 1932): 165­ 6 6 ; Charles H. Garvin, “The Negro D octor’s Task" B i r t h C o n t r o l R e v i e w (November 1932): 2 6 9 -7 0 . 63. Hill, T h e M a r c u s G a r v e y , 7 :6 0 3 -5 . 6 4 . Rodrique, “The Black Com m unity" 3 3 9 - 4 0 . 65. DuBois, “The D am nation of W om en"; DuBois, “Birth”; Garvin, “The Negro D oc­ to r’s Task"; Chandler Owen, “W om en and Children o f the South" B i r t h C o n t r o l R e v ie w 3 (Septem ber 1919): 9, 20; Rodrique, “The Black Com m unity" 336. 6 6 . M ary Burrill, “They That Sit in D arkness" B i r t h C o n t r o l R e v ie w 3 (Septem ber 1919): 5 - 8 ; Grim ke, R a c h e l . 67. Ross, “A frican-A m erican W om en" 168. 68. Ross, “A frican-A m erican W o m en" 169, 171. 69. Newell L. Sim s, “Hostages to the W hite M an " B i r t h C o n t r o l R e v ie w 16 (Ju ly August 1932): 2 1 4 -1 5 ; Rodrique, “The Black Com m unity" 337; Sm ith, S i c k a n d T ir e d , 9 2 - 9 3 ; Roberts, K i l l i n g t h e B l a c k B o d y , 86. 70. The Birth Control Federation o f A m erica was the name given to the reorganized A BC L in 1939. 71. “Am erican Birth Control League" 3 D ecem ber 1932, file 162, series 3, box 7, BSH Records; Rodrique, “The Black Com m unity" 339; Ross, “A frican-A m erican W om en" 168; Roberts, K i l l i n g t h e B l a c k B o d y , 101. 72. Ross, “A frican-A m erican W om en" 2 7 7 -7 8 ; Ross, “A frican-A m erican W om en" 1 7 0 -7 1 ; Rodrique, “The Black Com m unity" 341. 73. Schoen, C h o i c e & C o e r c i o n , 4 4 . 74. This group was established in 1927 following the First W orld Population Confer­ ence in Geneva. See “Population Problem s" 4 July 1931, file 191, series 3, box 9, BSH Records. 75. “A Report to the Trustees Covering the Years 1928, 1929, 1 9 3 0 " 79; H i s t o r i c a l S t a t i s t i c s , 51; Ross, “A frican-A m erican Women," 2 7 7 -7 8 ; Rodrique, “The Black Com ­

munity" 339; M cC ann, B i r t h C o n t r o l P o lit ic s , 1 3 6 -3 7 , 146; M cFalls and M asnick, “Birth C ontrol" 8 9 -1 0 6 ; M cBride, “M edicine and the H ealth C risis" 112-16; Ross, “A frican-

289

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Notes to Pages 99—101

A m erican W om en" 1 6 1 -2 0 7 ; Rodrique, “The Black Com m unity”; Tolnay, “The Decline o f Black M arital Fertility" 211, 217; Tolnay, “Family Econom y" 2 6 7 -8 3 ; M asnick and M cFalls, “A New Perspective" 2 1 7 -4 4 ; Engerm an, “Black Fertility" 1 1 7 -3 8 . 76. Executive S ecretary’s Report, February 1947, file 1947, PPRI Records. 77. Annual Report, 7 May 1931, file 1931; M a n u a l f o r B o a r d o f D i r e c t o r s 1 9 4 8 - 1 9 4 9 , 28 April 1948, 7 -1 3 , file 1948; M rs. Lomas M em o, n.d., file 1935; Report Given by M rs. Henry Salom on, 21 January 1932, file 1932; Annual Report o f the President, 2 N ovem­ ber 1933, file 1933; and M inutes o f the Board of D irectors, 12 June 1940, all in PPRI Records. 78. M inutes o f C om m ittee on Contraceptive Advice o f the RIBC L, 12 June 1931, file 1931, PPRI Records; P r o v i d e n c e J o u r n a l , 29 July 1931, 1. 79. P r o v i d e n c e J o u r n a l , 7 August 1931, 1, 4 Septem ber 1931, 1; M inutes o f Regu­ lar M onthly M eeting, 5 N ovem ber 1931, file 1931, PPRI Records; H 7 3 6 , F a i l e d B i lls o f 1 9 3 5 , 12 M arch 1935, 35, State A rchives; Report of the Executive Secretary— Five

M onths, Novem ber 1939-A p ril 1940, file 1940, PPRI Records; “25th Anniversary" 11 April 1956, file 1956, PPRI Records. 80. Report o f the Social Worker, February 1932, file 1932; Report of Chairm an of Ad­ visory Board Birth Control League of R.I., 3 N ovem ber 1932, file 1932; Social W orker’s Report, file 1933; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 8 -1 Novem ber 1939, file 1939; and Report of the President o f the RIBC L, 20 January 1939, file 1939, all in PPRI Records. 81. Report o f the Social W orker for Septem ber 1931, file 1931; Social W orker’s Re­ port, February 1932, file 1932; Notes for Talks on Birth Control, n.d., file 1933; Annual Report o f Social W orker, 1 N ovem ber 1 9 3 4 -1 N ovem ber 1935, file 1935; Annual Report o f Social W orker, 1 N ovem ber 1 9 3 5 -1 N ovem ber 1936, file 1936; Annual Report of Social W orker, 1 Novem ber 1 9 3 6 -1 N ovem ber 1937, file 1937; Annual Report o f Social W orker, 1 Novem ber 1 9 3 7 -1 N ovem ber 1938, file 1938; and Annual Report o f Social W orker, 1 Novem ber 1 9 3 8 -1 N ovem ber 1939, file 1939, all in PPRI Records. 82. Tone, D e v i c e s a n d D e s ir e s , 136. 83. Kopp studied m edicine for 3.5 years but discontinued for family reasons. She later com pleted her doctorate in philosophy, not m edicine, at the University of Ferrara. M arie E. Kopp, Resume 1932, file 183, series 3, box 8, BSH Records. 84. M arcus interview, 1 8 -2 5 ; Kopp, B i r t h C o n t r o l in P r a c t i c e , 133; Himes, M e d i c a l H is t o r y o f C o n t r a c e p t i o n , 3 3 6 -3 7 .

85. M onthly Reports o f Social Worker, file 1932; M onthly Reports o f Social Worker, file 1933; M onthly Reports o f Social W orker, file 1935; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 5 -1 N ovem ber 1936, file 1936; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 7 -1 Novem ber 1938, file 1938; Annual Statistical Report of the Social W orkers, April 1 9 4 0 -A p ril 1941, file 1941; Annual Statistical Report o f the Social W orkers, April 1941-A p ril 1942, file 1942; and Supplem entary Annual Report o f Social W orker, M arch 1943, file 1943, all in PPRI Records. 86. Report o f the Social Worker, February 1932, file 1932; Report of Chairm an o f Ad­ visory Board Birth Control League of R.I., 3 N ovem ber 1932, file 1932; Social W orker’s Report, file 1933; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 8 -1 Novem ber

Notes to Pages 101—107

1939, file 1939; and Report of the President o f the RIBC L, 20 January 1939, file 1939, all in PPRI Records. 87. The “other" category included referrals from the Birth Control Research Bureau, husbands, employers, and midwives. 88. Reports of the Physician in Charge, 1931, file 1931; Social W orker’s Reports, 1932, file 1932; Statistics for June, July, August 1932, file 1932; Reports o f the Social Worker, 1933, file 1933; Annual Report o f the Social W orker, file 1935; Annual Report o f the Social Worker, file 1936; Annual Report o f the Social Worker, file 1937; Annual Report o f the Social W orker, file 1938; and Annual Report o f the Social W orker, file 1939, all in PPRI Records. 89. Annual Report o f the Social Worker, 1 Novem ber 1 9 3 8 -1 N ovem ber 1939, file 1939, PPRI Records. For national trends see Tone, D e v i c e s a n d D e s ir e s , 135; Meyer, A n y F r i e n d o f t h e M o v e m e n t , 31.

90. Annual Report of the Social Worker, 1 Novem ber 1 9 3 8 -1 Novem ber 1939, file 1939, PPRI Records. 91. Report of Social Worker, Septem ber 1932, file 1932; Report of the Social Worker, M arch 1933, and Social W orker Reports, file 1933; and Supplem entary Report for N o­ vem ber 194 0 , file 1940, all in PPRI Records. 92. Six M onths’ Review, 1 N ovem ber 1 9 3 4 -1 M ay 1935, file 1935; Annual Report o f Social W orker, file 1935; Annual Report o f Social W orker, file 1936; Annual Report o f Social W orker, file 1937; Annual Report o f Social Worker, file 1938; Annual Report o f Social W orker, file 1939; and Supplem entary Annual Report o f Social W orkers, file 1941, all in PPRI Records. 93. Report o f the Social Worker, August 1931, file 1931; and Social W orker’s M onthly Report, January 1942, file 1942, both in PPRI Records. 94. Annual Report of the Social W orker, N ovem ber 1932, file 1932; Annual Report o f Social Worker, 1 N ovem ber 1 9 3 5 -1 N ovem ber 1936, file 1936; and Annual Report of Social Worker, 1 Novem ber 1 9 3 8 -1 N ovem ber 1939, file 1939, all in PPRI Records. 95. P r o v i d e n c e J o u r n a l , 3 N ovem ber 1933, 8; Address by M rs. F. Robertson Jones Delivered at the Annual M eeting o f the RIBC L, 2 Novem ber 1933, file 1933, PPRI Re­ cords. 96. R IBC L to Richard S. Aldrich, 6 M ay 1932, Legislative A ction 1934 file; and RIBC L to Senator Felix Hebert, 8 M ay 1934, Legislative A ction 1934 file, both in PPRI Records. 97. N otes for B.C. Talks—M . S. Foster, n.d., file 1933, PPRI Records. 98. Meyer, A n y F r i e n d o f t h e M o v e m e n t , xv, x x -x i, 26, 32, 85, 109. 99. Reagan, W h e n A b o r t i o n W a s a C r im e , 133, 1 4 9 -5 3 , 155. 100. Reports o f the Physician in Charge for August 1931, O ctober 1931, and N ovem­ ber 1931, file 1931; Annual Report o f the Social Worker, 1 N ovem ber 1 9 3 4 -1 Novem ber 1935, file 1935; Notes for Talks on Birth Control, file 1933; and Annual Reports of the Social W orkers, files 1936, 1937, 1938, 1939, all in PPRI Records. 101. P r o v i d e n c e E v e n in g B u l l e t i n , 10 M arch 1931, 4; P r o v i d e n c e J o u r n a l , 13 N ovem­ ber 1932, 11; P r o v i d e n c e E v e n in g B u lle t in , 9 M ay 1933, 21; S t a t e v. C o n c e t t a G u a r a n e r i , 59 R.I. 173; 194 A. 5 89, 1937.

291

292

Notes to Pages 108—114

102. Rongy, A b o r t i o n : L e g a l o r I l l e g a l ? 3 6 - 3 7 , 4 0 - 4 1 , 56, 73, 112. 103. Ibid., 112, 115-16, 9 6 - 9 7 . 104. Ibid., 1 0 8 -9 , 1 4 0 -4 7 , 21. 105. Rongy estim ated that abortion fees ranged from $50 to $ 2 5 0 during the 1920s and 1930s ( A b o r t i o n : L e g a l o r I l l e g a l ? 137). 106. Rongy, A b o r t i o n : L e g a l o r I l l e g a l ? 103, 1 3 3 -3 4 , 136, 143. 107. Ibid., 2 0 0 - 2 0 9 . 108. Reagan, W h e n A b o r t i o n W a s a C r im e , 143. 109. Ladd-Taylor, “Saving Babies" 138; Reilly, S u r g i c a l S o lu t io n , 93, 101; Larson, S e x , 119; Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 84. 110. Haller, E u g e n ic s , 1 6 0 -6 3 ; Petchesky, A b o r t i o n , 87. 111. HBF, H u m a n S t e r i l i z a t i o n , n.d., file 5 4 5 , box 5, Poteat Collection. 112. HBF, “Effects o f Eugenical Sterilization as Practiced in California" n.d., file 178, series 3, box 8, BSH Records; HBF, H u m a n S t e r i l i z a t i o n . 113. “M rs. Sanger Hits New Deal Attitude on Birth C ontrol" P r o v i d e n c e J o u r n a l , 9 April 1935. 114. Laughlin quoted in Kuhl, N a z i C o n n e c t i o n , 48. 115. Laughlin, E u g e n i c a l S t e r i l i z a t i o n , 3 3 8 -3 9 ; “Sterilization Laws" S c ie n c e , 4 De­ cem ber 1936, supp. 9 -1 0 ; “Sterilization O peration Perform ed in the United States" S c ie n c e , 11 D ecem ber 1936, supp. 7; J. H. Landman, “Sterilization—A Pointedly Frank

Discussion o f a Grave Social Problem " C u r r e n t H i s t o r y 4 4 (August 1936): 91. 116. HBF, “Human Sterilization" n.d., file 190, series 3, box 9, BSH Records; HBF, “Effects o f Eugenical Sterilization”; HBF, H u m a n S t e r i l i z a t i o n . 117. Landman, C u r r e n t H is t o r y , 9 3 - 9 4 ; “CM H Statem ent" 118. U.S. Congress, House, C om m ittee to Investigate the Interstate M igration of D estitute Citizens, I n t e r s t a t e M i g r a t i o n , 305. 119. Popenoe and Gosney, T w e n t y - E ig h t Y e a r s o f S t e r i l i z a t i o n in C a l i f o r n i a , i i- 6 , 14; HBF, “A Report to All O ur C orrespondents" 1933, file 178, series 3, box 8, BSH Re­ cords. 120. Reilly, S u r g i c a l S o lu t io n , 9 4 - 9 8 ; Braslow, “In the Name o f Therapeutics" 45; Carey, “Gender and Com pulsory Sterilization" 7 4 -1 0 5 ; Ladd-Taylor, “Saving B abies" 1 3 6 -5 3 . 121. Sm ith, E u g e n ic A s s a u l t , 6; Kuhl, N a z i C o n n e c t io n , 2 3 - 3 9 ; W hitney and Kopp quoted in Kuhl, N a z i C o n n e c t i o n , 36, 56. Unlike A m erican eugenicists, those in Great Britain were “relatively critical" o f Nazi Germany. 122. Cam pbell quoted in Kuhl, N a z i C o n n e c t i o n , 3 4 - 3 5 . 123. M yerson et al., E u g e n i c a l S t e r i l i z a t i o n , 2 - 5 , 24; “Sterilization Flayed" T im e , 16 N ovem ber 1936, 80; M yerson, “Sterilization" A t l a n t i c M o n t h l y 186 (Novem ber 1950): 52; “Racial Superiority and Sterilization" S c ie n c e , 15 N ovem ber 1935, supp. 7; “People’s Foundation" 11 April 1932, file 178, series 3, box 8, BSH Records. 124. Kuhl, N a z i C o n n e c t io n , 7 7 -7 8 ; Paul, C o n t r o ll in g H u m a n H e r e d i t y , 120; “Eugen­ ics Research A ssociation" 27 April 1932, file 178, series 3, box 8, BSH Records; Reilly, S u r g i c a l S o lu t io n , 1 2 2 -2 3 ; Dowbiggin, K e e p i n g A m e r i c a S a n e , 9 8 - 9 9 , 114.

125. “M ethodist Conference Approves Sterilization" C o m m o n w e a l , 26 April 1940, 2 - 3 ; M yerson, “Sterilization," 52.

Notes to Pages 114—121

126. S 203, 7 M arch 194 0 , F a i l e d B i lls o f 1 9 4 0 , 4 0 - 4 4 , State Archives. 127. Report o f Clinic C om m ittee for Novem ber 1935, file 1935, PPRI Records. 128. Russell Owen, “Hawaii Experim enting with Birth Control, Sterilization" P r o v i ­ d e n c e J o u r n a l , 1932, Social Section, bk. 2, PPRI Records.

129. “Hawaii Debates a Sterilization Law" A m e r i c a , 11 April 1953, 34. 130. Ross, “A frican-A m erican W om en" 278; P i t t s b u r g h C o u r ie r , 30 M arch 1935, 10. See also Rodrique, “The Black Com m unity" 3 3 7 -3 8 . 131. Robert A. Cook, “Population Policy and the Japanese Peace Treaty" P o p u l a t i o n B u l l e t i n 7 (August 1951): 1 2 -1 5 ; see also Landman, C u r r e n t H is t o r y , 91; A braham M y-

erson, S p e a k i n g o f M a n (New York: Knopf, 1950). 132. Q uoted in Kuhl, N a z i C o n n e c t i o n , 60. 133. Kuhl, N a z i C o n n e c t i o n , 5 9 - 6 3 . 134. Kuhl, N a z i C o n n e c t i o n , 7 9 - 8 0 , 105; Dowbiggin, K e e p i n g A m e r i c a S a n e , 79; Braslow, “In the Name o f Therapeutics" 49; Paul, T h e P o lit ic s o f H e r e d i t y , 1 0 3 -4 , 129. 135. Kline, G e n d e r , S e x u a lit y , a n d E u g e n ic s , 4, 6; Briggs, R e p r o d u c i n g E m p i r e , 126.

Chapter 5. WorldWar II, the Baby Boom, and the Population Explosion, 1939-1963 1. “Parran Assails National Health” and “Draft Rejections Pass 4 0 P ercent" Health o f Draftees 1941 file, box 15, Rhode Island M edical Society Collection, Rhode Island H istorical Society Library (hereafter cited as RIM S, RIHS Library); Farley quoted in Burch, “A m erica’s M anpower" 5; Burch, “Is A m erican Intelligence Declining?" 19. 2. Trum an quoted in Burch, “Is A m erican Intelligence Declining?" 14. 3. “D octor Discusses D raftee’s H ealth" “O ur Unfit Youth; Fact or Fancy" and G o v e r n ­ m e n t S e r v i c e 26, no. 2, all in H ealth of Draftees 1941 file, box 15, RIM S, RIHS Library.

Sim ilar conclusions can be found in “Health of Young M en under Selective Service," J o u r n a l o f t h e A m e r i c a n M e d i c a l A s s o c i a t i o n , 4 January 1941, and National Headquar­

ters, Selective Service System, W ashington, D.C., Release no. 195, 22 April 1941, both in Health of Draftees 1941 file, RIM S, RIHS Library; “Analysis o f Reports of Physical Exam ination" M e d i c a l S t a t is t ic s B u lle t in , 10 N ovem ber 1941, and “Cause o f Rejection and Incidence of D efects" M e d i c a l S t a t is t ic s B u lle t in , 1 August 1943, both in Analysis o f Draftee Exam ination Data file, 1941, 1943, box 15, RIM S, RIHS Library. 4. Thom as Parran, “W hy Don’t W e Stam p O ut Syphilis?" R e a d e r ’s D ig e s t (July 1936): 6 5 - 7 3 ; Brandt, N o M a g i c B u lle t , 1 3 8 -4 6 , 1 5 6 -5 9 . 5. Cosm as and Cowdry, M e d i c a l D e p a r t m e n t , 22, 1 4 2 -4 7 ; Lee, T h e E m p l o y m e n t o f N e g r o T r o o p s , 2 4 0 , 277, 2 8 0 - 8 9 . C oncern for the health and fitness o f black sol­

diers did not extend to all black men. W hile the military paid attention to VD among black troops, the Public H ealth Service participated in the Tuskegee Syphilis Study in Alabam a with four hundred black sharecroppers. Initiated in 1932, it attempted to discover the course o f syphilis without medical intervention. For over forty years the Public Health Service inform ed these m en that governm ent doctors were treating the disease when in reality they received no medication. O ne quarter succum bed to tertiary syphilis. Brandt, N o M a g i c B u l l e t , 1 5 7 -5 8 . 6. Cosmas and Cowdry, M e d i c a l D e p a r t m e n t , 1 4 4 -4 5 ; Meyer, “Creating G.I. Jane" 5 8 2 -8 7 ; May, H o m e w a r d B o u n d , 6 9 -7 1 .

293

294

Notes to Pages 121—124

7. Fairchild, “Family Limitation,” 85; M ildred Gilman, “Babies: Q uantity or Quality?” A m e r i c a n M e r c u r y 56 (April 1943): 4 5 0 - 5 5 . Gilm an pointed to an institute for the

feeblem inded in Mansfield, Connecticut, that had room for 1,0 0 0 patients with another 1,0 0 0 on a wait list. In one year, wait-listed wom en gave birth to 6 5 0 babies; Gilman would have prevented this “breeding” with contraceptives and, if necessary, steriliza­ tion. 8. Gordon, W o m a n ’s B o d y , 3 4 4 - 5 2 . 9. Fairchild, “Family Limitation,” 81; Chesler, W o m a n o f V a lo r , 3 90; Gordon, W o m ­ a n ’s B o d y , 347; Paul, C o n t r o l l i n g H u m a n H e r e d i t y , 121; K olbert and Miller, “Legal Strat­

egies,” 77. 10. Fairchild, “Family Limitation,” 81; “D octors on Contraception,” N e w s w e e k , 24 February 1947, 58. 11. “From Birth Control to Fertility” T im e , 27 O ctober 1941, 74. 12. “The Fortune Survey,” F o r t u n e 28 (August 1943): 24, 30. 13. Fairchild, “Family Lim itation” 82; Chesler, W o m a n o f V a lo r , 3 8 7 - 9 0 . 14. May, H o m e w a r d B o u n d , 149; Gordon, W o m a n ’s B o d y , 3 3 6 -5 3 ; Chesler, W o m a n o f V a l o r , 3 9 3 -9 5 .

15. M inutes o f the Annual M eeting, 14 N ovem ber 1939, M inutes o f the M eeting o f the Clinic Com m ittee, 26 January 1939, file 1939; Report of the Executive S ecre­ tary— Five M onths, N ovem ber 1 939-A p ril 1940, M inutes o f the Board o f D irectors, 12 June 1 940, 13 Novem ber 1 940, file 1 940; Report o f the President, 8 April 1942, file 1942; Social Service D epartm ent Report, 18 April 1951, file 1951; Five Year Plan, 1 9 4 6 -5 1 , file 1946; Supplementary Annual Report o f Social Worker, April 1 9 4 0 -A p ril 1941, file 1941, all in PPRI Records. 16. Annual Report of Executive Secretary, 14 Novem ber 1939, file 1939; M inutes of the May M eeting of the Board o f D irectors, 8 M ay 19 40; Report o f Executive Secretary on Birth Control Federation Board M eeting Held in New York City, 15 May 194 0 , file 1940, all in PPRI Records. 17. A nnual R eport o f the President o f R IB C L , 7 N ovem ber 1938, file 1937 [sic]; M inutes o f the M ay M eeting o f the Board o f D irectors, 8 M ay 194 0 , Supplem entary R eport for N ovem ber 1 9 4 0 , file 1 9 4 0 ; W orkers M anual for Tenth A nnual Cam paign o f the RIM H A , M arch 1941, file 1941; Supplem entary A nnual R eport o f the Social W orker, April 1942, Report o f the President, 8 April 1942, file 1942, all in PPRI Re­ cords. 18. W orkers’ M anual for Tenth Annual Campaign o f RIM H A , M arch 1941, Supple­ m entary Report for 1 O cto ber 1941, file 1941; M inutes o f the Board o f D irectors, 12 April 1944, and D. Kenneth Rose to Elizabeth G. Lisle, 22 May 1 944, Sum m ary o f Dis­ cussion by M em bers o f the Board on State Financial Participation, O cto ber 1944, file 1944, in PPRI Records. 19. Supplem entary Annual Report o f Social Worker, August 1 9 4 0 -A p ril 1941, M in­ utes o f the Board o f D irectors, 12 February 1941, 14 M ay 1941, file 1941; Annual Report o f the President, April 1944, Report o f the M eeting in New York, 19 O ctober 1944, file 1944; Annual Report, 1945, file 1945; M inutes o f Executive C om m ittee M eeting, 18 June 1946, file 1946, all in PPRI Records. 20. M inutes of the Board of D irectors, 13 N ovem ber 194 0 , file 1940; W orkers’ M an­

Notes to Pages 124—127

ual for Tenth Annual Cam paign o f the RIM H A , M arch 1941, M inutes o f the Board of D irectors, 12 N ovem ber 1941 and 10 D ecem ber 1941, file 1941; Report o f the President, 14 April 1943, Supplem entary Annual Report o f Social W orker, M arch 1943, file 1943, all in PPRI Records. 21. M onthly Reports o f Social Worker, file 1932; M onthly Reports o f Social Worker, file 1933; M onthly Reports o f Social W orker, file 1935; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 5 -1 N ovem ber 1936, file 1936; Annual Report o f the Social W orker, 1 N ovem ber 1 9 3 7 -1 N ovem ber 1938, file 1938; Annual Statistical Report of the Social W orkers, April 1 9 4 0 -A p ril 1941, file 1941; Annual Statistical Report o f the Social W orkers, April 1941-A p ril 1942, file 1942; Supplem entary Annual Report of Social W orker, M arch 1943, file 1943, all in PPRI Records; U.S. Bureau o f the Census, F i f t e e n t h C e n s u s , 755, 771; U.S. Bureau o f the Census, S i x t e e n t h C e n s u s , 2 9 0 , 320.

22. Meyer, A n y F r i e n d o f t h e M o v e m e n t , 88. 23. “M ajor Relationships o f U rban League o f Rhode Island" n.d., no. 2, box 10, file 398; and “National Leaders A gree— Planned Parenthood M eans Better Fam ilies" no. 7, box 2, folder 6 0 , both in U rban League o f Rhode Island Papers. 24. A nnual M eeting o f the RIM H A , April 1943, R eport o f the President, 14 April 1943, M inutes o f Board M eeting, 13 O cto b er 1943, file 1943; M inutes o f Board M eet­ ing, January 1 9 4 4 , 8 M arch 194 4 , Executive S ecretary ’s Annual Report, 27 April 1 944, file 1 9 4 4 , all in PPRI Records; “M ajor Relationships o f U rban League o f Rhode Is­ land " 25. Supplem entary Annual Report o f the Social W orker, April 1942, M inutes of O ctober Board M eeting, 1942, Social W orker’s Report, Septem ber 1942, file 1942; Sup­ plem entary Social W orker’s Annual Report for 1943, file 1943; Executive S ecretary’s Annual Report, 27 April 1944, U ntitled Report, January 1944, file 1944; President’s Annual Report, April 1946, file 1946, all in PPRI Records. 26. In 1 9 4 0 the RIM H A served one hundred clients from M assachusetts and ten from C on necticu t. R eport o f the President, 2 4 January 1941, file 1941, PPRI Re­ cords. 27. Annual Report o f the Social Worker, 1 N ovem ber 1939, file 1939; Report for the Providence M aternal Health Center, 1 April 1940, Supplem entary Report, Septem ber 1940, M inutes of the Clinic M eeting, M ay 1940, file 1940; Social W orker’s Supplem en­ tary Sum m er R eport, 1941, Supplementary Annual Report o f Social Worker, April 1941, file 1941; Annual Statistical Report o f the Social W orkers, April 1942, M inutes of Board M eeting, N ovem ber 1942, file 1942; Clinic Total Sheet, April 1943, Annual M eeting of the RIM H A , April 1 943, Supplem entary Annual Report o f Social W orker, M arch 1943, file 1943; Untitled Report, January 1944, Annual M eeting o f the RIM H A , April 1944, file 1944; Annual M eeting of the RIM H A , April 1945, and Annual Report 1945, file 1945; Social W orker’s Report, April 1946, file 1946, all in PPRI Records. 28. President’s Report, April 1945, Annual Report, 1945, file 1945; O utline o f Activi­ ties, 1946, Executive Secretary’s Annual R eport, April 1 946, President’s Annual Report, April 1 946, file 1946; Executive S ecretary’s Annual Report, April 1947, Social W orker’s Report, April 1947, file 1947; Social W orker’s Annual Report, April 1948, file 1947 [sic], all in PPRI Records. 29. Reilly, S u r g i c a l S o lu t io n , 95, 125.

295

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Notes to Pages 127—132

30. “Protestant Babies,” T im e , 4 February 1 946, 4 6 . 31. Burch, “Is A m erican Intelligence Declining?” 17 -1 8 ; Burch, “A Revolution” 20; com m ents by Dr. H. J. Muller, 1946 N obel Prize winner, and J. B. D. Haldane, British biologist, in Burch, “Is A m erican Intelligence Declining?” 1 6 -1 7 ; P. K. W helpton and Clyde V. Kiser, M i l b a n k M e m o r i a l F u n d Q u a r t e r l y (July 1943). See also Burch, “A m er­ ica’s M anpower”; Burch, “N eeded— Higher Birth Rate,” 7. 32. Census data quoted in Burch, “Differences in Birth Rate,” 2 5 - 2 6 ; Burch, “Birth Rates and Education,” 3; Edgar Schmiedeler, O SB, “Are A m erican W om en Shirkers?” C a t h o l i c W o r ld 153 (July 1941): 4 2 6 - 2 9 .

33. “Are You Too Educated to Be a M other?” L a d i e s H o m e J o u r n a l 63 (June 1946): 6; “Fewer Babies and Why,” C o l l i e r ’s , 2 D ecem ber 1944, 86. 34. See May, H o m e w a r d B o u n d . 35. Bouvier, “America’s Baby Boom,” figure 1. 36. Bouvier, “America’s Baby Boom,” figure 3; Francis X. Murphy, CSSR, “Catholic Perspectives on Population Issues II,” P o p u l a t i o n B u l l e t i n 35 (February 1981): figure 3. 37. Easterlin, A m e r i c a n B a b y B o o m ; Friedan, T h e F e m i n i n e M y s t i q u e ; Easterlin, P o p ­ u l a t i o n , L a b o r F o r c e , 18; DeJong and See, “Changes in Childlessness,” 1 2 9 -4 2 ; Bouvier,

“Am erica’s Baby Boom,” 8 - 9 ; Cherlin, “Explaining,” 5 7 - 6 3 ; Nugent, S t r u c t u r e s , 128; Hayden, R e d e s i g n in g t h e A m e r i c a n D r e a m ; M inutes o f Board M eeting, January 1944, file 1944, PPRI Records. 38. “Books versus Babies,” N e w s w e e k , 14 January 1 946, 79. 39. “Are You Too Educated to Be a M other?” 6. 4 0 . Hartm ann, T h e H o m e F r o n t a n d B e y o n d , 70. 41. Elizabeth Cohen Arnold, interview with James Reed, Novem ber 1974, 4 2, 5 5 -5 7 , Family Planning Oral H istory Project. Sanger opposed the fertility clinic at the M SRB because she believed this service should rem ain in the hands of private physicians, not clinical workers. See Arnold interview, 42. 42. Calderone interview, 1 -7 , 2 5 - 2 6 ; Beatrice Blair, interview with Ellen Chesler, April 1976, 2 5 - 2 6 , Family Planning Oral H istory Project; M arcus interview, 2 8 - 2 9 . 43. Blair interview, 2 5 - 2 6 ; Calderone interview, 25; M arcus interview, 2 3 - 2 9 ; Campbell interview, 73. 4 4 . Piotrow, W o r ld P o p u l a t i o n C r is is , 1 3 -1 5 . See also Shapiro, P o p u l a t i o n , chap. 3; Critchlow, I n t e n d e d C o n s e q u e n c e s , 14, 27. 45. Cam pbell interview, 7 9 - 8 2 . 4 6 . Piotrow, W o r ld P o p u l a t i o n C r is is , 16. 47. Chesler, W o m a n o f V a lo r , 4 3 8 - 3 9 ; Piotrow, W o r l d P o p u l a t i o n C r is is , 1 8 -1 9 ; Reed, F r o m P r i v a t e V ic e , 2 8 2 -8 3 . 4 8 . Draper Report quoted in Piotrow, W o r ld P o p u l a t i o n C r is is , 3 6 -4 1 . 49. Eisenhower quoted in D. S. Greenberg, “Population Planning: 1963 M arked by Reduction o f Controversy and Shift in Governm ent Attitude,” S c ie n c e , 20 D ecem ber 1963, 1 5 5 4 -5 5 . 50. Piotrow, W o r ld P o p u l a t i o n C r is is , 4 2 - 4 6 . 51. John F. Kennedy quoted in U.S. Congress, Senate, Com m ittee on Governm ent Operations, H e a r i n g s (1965), 1347; N e w Y o r k T im e s , 20 Septem ber 1961, 23. 52. Piotrow, W o r ld P o p u l a t i o n C r is is , 5 9 - 6 3 .

Notes to Pages 132—137

53. United Nations docum ent X/C. 2/L.657, in Gardner, P o p u l a t i o n G r o w t h , 13. 54. The narrow defeat o f this resolution, according to Gardner, was “the price that had to be paid for achieving a broad consensus among the mem bership" ( P o p u l a t i o n G r o w t h , 8 - 9 ) . See also Gardner, “Toward a W orld Population Program " 3 50; Gardner,

“The Politics o f Population" 19. A m erican public opinion seem ed influenced by the emphasis on the population explosion. A Gallup poll in D ecem ber 1959 found that only 5 4 percent favored contraceptive distribution to other nations versus 72 percent o f A m ericans who agreed it should be available at hom e. By 1963 65 percent favored distribution to other nations; in 1965 77 percent approved. See Gallup, G a l l u p P o l l P u b l i c O p in io n , 1654, 1822; Erskine, “The Polls" 311.

55. National Academy of Sciences, C om m ittee on Science and Public Policy, T h e G r o w t h o f W o r ld P o p u l a t i o n , 1 - 9 ; John F. Kennedy quoted in U.S. Congress, Senate,

C om m ittee on Governm ent O perations, H e a r i n g s (1965), 1347; “Congress M ay Ap­ prove First Birth Control Bill in 1 9 6 6 " C o n g r e s s i o n a l Q u a r t e r ly , 10 June 1966, 1235­ 38. 56. Foreign A ssistance A ct o f 1963, 88th Cong., 1st sess., Report no. 588, HR 7855, 19; U.S. Congress, Senate, C om m ittee on Foreign Relations, L e g i s l a t i o n , 19. 57. Eisenhower quoted in U.S. Congress, Senate, Com m ittee on Governm ent O p­ erations, H e a r i n g s (1965), 1790. He made a similar statem ent in his article, “Let’s Be H onest with O urselves" S a t u r d a y E v e n in g P o s t, 26 O cto ber 1963, 27. 58. “All about Birth C ontrol" N e w s w e e k , 7 January 1963, 3 6 - 3 7 . 59. W atkins, O n t h e P i ll, 1 9 -2 1 , 2 8 - 2 9 . 6 0 . Briggs, R e p r o d u c i n g E m p i r e , 130, quote on 140, 110. 61. The International Planned Parenthood Federation was form ed in 1948 at an international conference held at Cheltenham . 62. Hartman, R e p r o d u c t i v e R ig h ts , 232; M ass, “Puerto R ico" 73; Cadbury, “O utlook" 321. 63. Briggs, R e p r o d u c i n g E m p i r e , 1 4 8 -4 9 , 1 5 2 -5 7 . 6 4 . Ramirez de Arellano and Seipp, C o l o n i a l i s m , 9 3 - 9 5 ; M inutes o f Board o f D irec­ tors M eeting, 10 M ay 1955, file 1955, PPRI Records. 65. Gam ble quoted in Ramirez de Arellano and Seipp, C o l o n i a l i s m , 99, 107. 6 6 . Hartman, R e p r o d u c t i v e R ig h ts , 177; M cC orm ick quoted in Ramirez de Arellano and Seipp, C o l o n i a l i s m , 99, 107; Finch and Green, C o n t r a c e p t i o n t h r o u g h t h e A g e s , 115-16; Briggs, R e p r o d u c i n g E m p i r e , chap. 3. 67. W atkins, O n t h e P i ll, 3 0 -3 1 ; Tone, D e v i c e s a n d D e s ir e s , 2 2 0 -2 2 . 68. M astroianni, Faden, and Federman, W o m e n a n d H e a l t h R e s e a r c h , 118-19; M acklin, “Justice in International Research" 1 3 4 -3 5 ; Tone, D e v i c e s a n d D e s ir e s , 222. 69. Chesler, W o m a n o f V a lo r , 4 3 4 - 4 4 ; Reed, F r o m P r i v a t e V ic e , 3 5 9 -6 2 ; Ramirez de Arellano and Seipp, C o l o n i a l i s m , 116; Tone, D e v i c e s a n d D e s ir e s , 226. 70. Gordon, W o m a n ’s B o d y , 421, 177; Hardin, B i r t h C o n t r o l, 8 2 - 8 3 ; Ramirez de Arellano and Seipp, C o l o n i a l i s m , 116-17. 71. Calderone interview, 21. 72. M inutes o f Clinic Functions Com m ittee, 30 O ctober 1952, file 1952; M inutes of Board of D irectors M eeting, 13 January 1953, and Annual M eeting, “Talk Given by M rs. C. Tracy B arn es" 14 April 1953, file 1953; M inutes o f Executive C om m ittee M eeting,

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298

Notes to Pages 137—140

24 Septem ber 1954, file 1954; Report o f President, Annual M eeting 1955, M inutes of Joint Clinic Functions and M edical Advisory Com m ittees, 23 M ay 1955, and M inutes o f Board o f D irectors M eeting, 10 May 1955, file 1955, all in PPRI Records. 73. W ith FDA approval o f the pill Searle sent fifteen thousand “detailmen” to con­ vince physicians to prescribe it. See W atkins, O n t h e P ill, 3 6 - 3 7 . 74. P r o v i d e n c e J o u r n a l , 9 April 1957, 4; RIM HA M inutes, 13 May 1958, file 1958; Board o f D irectors M eeting, 11 O cto ber 196 0 , and RIM H A Executive C om m ittee M eeting, n.d., file 1960, all in PPRI Records; “Birth Control Pill under Probe Sold in R.I. since 1957” P r o v i d e n c e J o u r n a l , 6 August 1962, 21. 75. W atkins, O n t h e P ill, 32; Ramirez de Arellano and Seipp, C o l o n i a l i s m , 188; W H O task force m em ber quoted in Hartman, R e p r o d u c t i v e R ig h ts , 177. 76. Cadbury, “Outlook,” 321; Kantner and Stycos, “N on-Clinical A pproach” 5 7 3 -8 1 ; Vazquez, “Fertility and D ecline” 8 6 4 - 6 5 ; Thim m esch, “Puerto Rico” 2 5 2 -6 2 . 77. Kantner and Stycos, “N on-Clinical Approach,” 578; Thim m esch, “Puerto Rico” 2 5 2 -6 2 . 78. Schoen, C h o i c e & C o e r c i o n , 210-11, 213. 79. Reagan, W h e n A b o r t i o n W a s a C r im e , 15, 1 6 1 -6 4 ; Ross, “A frican-A m erican W omen,” 173. 80. Potter, Inform al Talk Given to Brow n-Pem broke Students, 13 April 1948, file 1948; Social W orker’s Annual Report, April 1948, file 1947 [sic], both in PPRI Records; S t a t e v. P e t e r L o r e n z o , 72 R.I. 175 (1946); S t a t e v. A n g e lo , 72 R.I. 412, 52 A. 2d 513 (1947); G e n e r a l L a w s o f R h o d e I s l a n d 1 9 5 6 , 7 - 9 ; P r o v i d e n c e J o u r n a l , 17 O ctober 1959, 17; M ary

Steichen Calderone, “E x A = B R ” 29 N ovem ber 1956, in PPRI Records. 81. Potter, Informal Talk; Social W orker’s Annual Report, April 1948, file 1947 [sic], PPRI Records. 82. Kopp, B i r t h C o n t r o l in P r a c t i c e ; Rubin, T h e A b o r t i o n C o n t r o v e r s y , 3 6 - 3 7 ; Calde­ rone, “E x A = BR”; Gebhard et al., P r e g n a n c y , B i r t h , a n d A b o r t i o n , 162; Calderone, A b o r t i o n in t h e U n i t e d S t a t e s , 180; Schur, C r i m e s w i t h o u t V ic t im s , 25; Tietze, “Induced

A bortion and Sterilization,” 1161-71; Kinsey, “Illegal Abortions,” 1 9 6 -9 7 . 83. Solinger, “‘A Com plete Disaster,’” 2 4 3 - 4 4 . Solinger challenges K ristin Luker’s assertion that betw een 1920 and 1960 the therapeutic abortion rates com pared to de­ livery rates did not change. See Luker, A b o r t i o n a n d t h e P o lit ic s o f M o t h e r h o o d , 4 6 . 84. Reagan, W h e n A b o r t i o n W a s a C r im e , 174, 176, 193; Solinger, “‘A Com plete Di­ saster,’” 2 4 2 - 4 8 , 258, 263. Solinger also found changes with respect to single pregnant women. Prior to W orld W ar II the belief in the genetically flawed illegitim ate m other and child prevailed, and society pressured these mothers to keep their children. The postwar era witnessed a decline in the genetic deficiency argum ent; thus, white babies becam e a valuable commodity, and mothers faced pressure to surrender their infants to white middle-class couples. See Solinger, W a k e u p L i t t l e S u s ie , 9 -1 7 . 85. M aternal Health C om m ittee Report, Appendix B, 19 M ay 1970, A bortion Re­ ports file, box 39, RIM S, RIHS Library. 86. Solinger, “‘A Com plete Disaster’” 2 5 9 - 6 0 ; Reagan, W h e n A b o r t i o n W a s a C r im e , 174, 176, 193, 194, 1 9 6 -9 7 , 1 9 8 -9 9 , 211. 87. Joffe, “‘Physicians o f C onscience’” 4 7 -5 2 .

Notes to Pages 141—144

88. Joffe, “‘Physicians o f Conscience,’" 4 6 - 5 0 ; A rnold interview, 57; “H ealthier M o th ers" 1809; Ross, “A frican-A m erican W o m en" 2 7 9 -8 0 . 89. Calderone, “Illegal A bortion " 9 4 8 - 5 3 ; Calderone interview, 15. 90. Campbell interview, 3 1 -4 1 ; Grant Sanger interview, 55. 91. Meyer, A n y F r i e n d o f t h e M o v e m e n t , 58. 92. M inutes of Executive Com m ittee M eeting, 22 April 1946, file 1946; M rs. Rich­ ard B. Knight, President, 28 Septem ber 1951, Knight to M rs. Philip W. Pillsbury, 24 Septem ber 1951, file 1951; M inutes o f Board o f D irectors M eeting, 9 June 1948, file 1948; M inutes o f Board o f D irectors M eeting, 11 O ctober 1949, all in PPRI Records. 93. PPFA, P l a n n e d P a r e n t h o o d W o r k e r ’s H a n d b o o k , 1948, RIM H A , “Suppose You W ere?”; RIM H A , M a n u a l f o r B o a r d o f D i r e c t o r s 1 9 4 8 - 1 9 4 9 , 28 April 1948, file 1948; Clinic C om m ittee Report, 28 M arch 1950, file 1950; Annual M eeting Report, 18 April 1951, file 1951, all in PPRI Records. 94. Social Service D epartm ent Report, 18 April 1951, file 1951; M inutes of Board of D irectors M eeting, 12 D ecem ber 1950, file 1950; M inutes of Annual M eeting, 8 April 1952, file 1952; M inutes o f Joint M eeting o f the Clinic Functions and M edical Advi­ sory Com m ittees, 19 February 1953, file 1953, and 17 June 1954, file 1954; M inutes of M edical and Clinic Functions C om m ittee M eeting, 16 June 1953, Annual M eeting, 14 April 1953, file 1953; Report o f President, Annual M eeting 1955, file 1955, all in PPRI Records. 95. Annual Report—Social Service D epartm ent, 1948, file 1948; Annual Report of Social Service D epartm ent, 1949, file 1949; M edical Advisory and Clinic M eeting, 22 January 1951, file 1951; M inutes o f Annual M eeting, 8 April 1952, file 1952; Annual M eeting, 14 April 1953, file 1953; M inutes of Annual M eeting, 27 April 1954, file 1954; Report to the Board o f D irectors, 12 January 1 960, file 1960, all in PPRI Records. 96. President’s Report and RIM H A M inutes, 14 January 1958, 13 M ay 1958, 25 N o­ vem ber 1958, 9 D ecem ber 1958, file 1958; RIM H A M inutes, 13 January 1959, an Invita­ tion and a Report from the RIM H A , Inc., 1959, RIM H A M inutes, 10 February 1959, M eeting o f the Board, 10 February 1959, Social W orker’s Report, 14 April 1959, M inutes o f the M edical Advisory Com m ittee, 2 February 1959, file 1959, all in PPRI Records. 97. President’s Report, “25th A nniversary Annual R eport" 11 April 1956, file 1956; President’s Annual M eeting Report, 8 April 1957, file 1957; RIM H A M inutes, 14 O cto ­ ber 1958, file 1958; Excerpts from M inutes o f M eeting o f M edical Advisory Com m it­ tee, 2 February 1959, Board o f Directors M eeting, 10 February 1959, file 1959; Board of D irectors M eeting, 14 N ovem ber 1961, file 1961, all in PPRI Records. 98. Social W orker’s Report, April 1947, file 1946 [sic]; M a n u a l f o r B o a r d M e m b e r s , 1 9 4 8 - 1 9 4 9 , 28 April 1948, file 1948; Campaign Report for 1950, file 1950; Report on

Campaign and Education, May 1953, file 1953; M inutes of Board o f D irectors M eeting, 9 M arch 1954; 19 May 1954, file 1954; Report to the Board of D irectors, 12 January 1960, file 1960; O utline o f A ctivities, 1946, file 1946; Social W orker’s Annual Report, April 1948, file 1947 [sic]; Annual Report—Social Service D epartm ent, 1948, file 1948; Annual Report o f Social Service Departm ent, 1949, file 1949; Social Service Depart­ m ent Report, 18 April 1951, file 1951; Report o f Annual M eeting, 8 April 1952, file 1952; Annual M eeting, 1954 Report, file 1954; Report of President, Annual M eeting

299

300

Notes to Pages 144—146

1955, M inutes o f Board of Directors M eeting 10 M ay 1955, file 1955; President’s Report, “25th Anniversary Annual Report,” 11 April 1956, file 1956; President’s Report, Annual M eeting, 1958, RIM H A M inutes, 9 D ecem ber 1958, file 1958; Social W orker’s Report, Annual M eeting 1959, file 1959, all in PPRI Records. 99. The RIM H A discussed services for unm arried wom en in 1958, but the presence o f the Catholic Church led them to m aintain the m arried-only policy. W om en’s ages: 62 percent betw een twenty-one and thirty; 23 percent betw een thirty-one and forty; 12 percent under twenty; 3 percent over forty. Board of D irectors’ M inutes, 25 Novem ber 1958, file 1958; Social W orker’s Report, April 1947, file 1946 [s ic ]; Social W orker’s A n­ nual Report, April 1948, file 1947 [sic]; Annual Report—Social Service D epartm ent, 1948, file 1948; Annual Report o f Social Service D epartm ent, 1949, file 1949; Social Service D epartm ent Report, 18 April 1951, file 1951; M inutes o f Annual M eeting, 8 April 1952, Report o f Annual M eeting, 8 April 1952, file 1952; Annual M eeting, Report o f 1954, file 1954; Executive D irector’s Report, Annual M eeting 1959, Social W orker’s Report, Annual M eeting 1959, file 1959; Report to the Board of D irectors, 12 January 1960, file 1960, all in PPRI Records. 100. M cBride, “M edicine and the Health C risis” 113-14. 101. Five Year Plan, 1 9 4 6 -5 1 , Executive S ecretary’s Report, N ovem ber 1946, file 194 6 ; Executive S ecretary’s Report, January 1947, Annual Luncheon, 22 April 1947, file 1947; Executive D irector’s Report, 29 Septem ber 1948, President’s Annual Report, April 1948, file 1948; Report o f Executive D irector Board M eeting, 9 M arch 1949, Re­ port of Executive D irector for June-Septem ber, 1949, file 1949, all in PPRI Records; Betty Lisle to M rs. Hunt, 24 January 1947, no. 6, box 1, file 39, U rban League of Rhode Island Papers. 102. M inutes o f Executive Board M eeting, 18 April 1955, M inutes of Board o f Di­ rectors M eeting, 10 M ay 1955, file 1955; President’s Report, “25th Anniversary Annual Report,” 11 April 1956, file 1956, all in PPRI Records; U.S. Bureau of the Census, C e n s u s o f P o p u l a t i o n : 1 9 5 0 , 39; U.S. Bureau o f the Census, C e n s u s : 1 9 6 0 , 17.

103. M inutes o f Executive Board M eeting, 18 April 1955, M inutes of Board o f Di­ rectors M eeting, 10 M ay 1955, file 1955; President’s Report, “25th Anniversary Annual Report,” 11 April 1956, file 1956, both in PPRI Records. 104. M rs. Federico F. M auck to Chairm an o f the Regional Long Range Planning C om m ittees, 29 April 1949, Long Range Planning Report, 1949, Report of the Long Range Planning Com m ittee, 27 O ctober 1949, file 1949, PPRI Records. 105. Report on New York Conference, 1944, file 1 944; M inutes o f Board of Directors M eeting, 11 D ecem ber 1951, file 1951; Dr. Brock Chisholm, “The W orld’s M ost Pressing Problem,” delivered to PPFA annual luncheon, 3 M ay 1956, Calderone, “E x A = BR”; President’s Report, “25th Anniversary Annual M eeting” 11 April 1956, file 1956, all in PPRI Records. 106. M a n u a l f o r B o a r d o f D i r e c t o r s 1 9 4 8 - 1 9 4 9 , 28 April 1948, 5 -1 4 , file 1948; M a n u a l f o r B o a r d o f D i r e c t o r s , 1 9 5 0 - 1 9 5 1 , 28 April 1950, file 1950; A nnual M eet­

ing o f RIM H A , 18 April 1951, file 1951; M inutes o f Annual M eeting, 8 April 1952, file 1952; M inutes o f Annual M eeting, 14 April 1953, file 1953; M inutes o f Annual M eet­ ing, 27 April 1954, file 1954; Report o f President, Annual M eeting 1955, file 1955; At­ tendance— Board M eeting, D ecem ber 1957, file 1957; A ttendance— Board M eeting, 6

Notes to Pages 146—151

June 1958, file 1958; Report to the Board of D irectors, 13 O ctober 1959, M inutes o f the Annual M eeting, 1959, file 1959, all in PPRI Records. 107. RIM H A M inutes, 6 June 1958, file 1958; M eeting of the Board, 10 February 1959, Board o f D irectors M eeting, 8 D ecem ber 1959, President’s Report on Annual M eeting, 1959, file 1959; Executive D irector’s Report, 11 O ctober 1960, file 1960, box 2; M rs. John L. Clark to Board o f D irectors, 14 M arch 1961, file 1961, box 2, all in PPRI Records. 108. RIM H A M inutes, 11 February 1958, file 1958; Report to the Board o f Directors, 12 January 1960, file 1960, box 2; Board o f D irectors’ A ttendance Sheet, 13 February 1962, Board o f Directors M eeting, 8 M ay 1962 and 20 Novem ber 1962, file 1962, box 2, all in PPRI Records.

Chapter 6. Who Pays? Contraceptive Services and the Welfare State, 1963-1975 1. Lader, B r e e d i n g O u r s e lv e s to D e a t h . 2. D’Emilio and Freedman, I n t i m a t e M a t t e r s , 2 5 0 -5 1 ; Patricia M aginnis, interview with Jeannette Bailey Cheek, Novem ber 1975, 78, Family Planning Oral H istory Proj­ ect; Calderone quoted in U.S. Congress, Senate, Com m ittee on G overnm ent O pera­ tions, H e a r i n g s (1965), 1382. 3. Board o f D irectors M eeting, 9 May 1961, M inutes o f the Clinical Staff M eeting, 26 Septem ber 1961, M inutes of the Clinical Staff M eeting, 15 Novem ber 1961, Board o f D irectors M eeting, 12 D ecem ber 1961, file 1961, box 2; M edical D irector’s Report to Board o f Director, 26 May 1964, file 1964, box 2, all in PPRI Records. 4. M ethods of birth control at RIM H A O ctober 1961: diaphragm, 1,954; pill, 4 7; jelly or cream, 25; Emko (foam), 7; rhythm, 2. Board o f Directors M eeting, 10 O ctober 1961, file 1961, box 2, PPRI Records. RIM H A hom e visitors used Emko because it could be given without a doctor’s exam. 5. Board of Directors M eeting, 13 February 1962, 9 O cto ber 1962, file 1962, box 2; Board of D irectors M eeting, 12 M arch 1963, 1 O ctober 1963, file 1963, box 2; Annual Report for 1963, M edical Director, 17 April 1964, M edical D irector’s Report to Board o f D irectors, 26 M ay 1964, file 1964, box 2, all in PPRI Records. 6. Board of D irector M eeting, 19 Novem ber 1963, file 1963, box 2; Annual Report of M edical D irector for 1963, 17 April 196 4 , Executive Com m ittee M eeting M inutes, 20 April 1964, M edical D irector’s Report to Board o f D irectors, 26 M ay 1964, file 1964, box 2, all in PPRI Records. 7. M arshall A. Taylor to Executive Com m ittee, 8 June 196 4 , file 196 4 , box 2, PPRI Records. 8. M rs. John L. Clark, President, to Board o f D irectors, 14 M arch 1961, file 1961, box 2; M edical D irector’s Report to Board o f D irectors, 26 M ay 1964, file 1964, box 2, both in PPRI Records. 9. Board of D irectors M eeting, 14 N ovem ber 1961, Sum m ary o f Dr. G uttm acher’s Speech, 3 0th Annual M eeting, 11 April 1961, file 1961, box 2; Board o f D irectors M eet­ ing, 20 N ovem ber 1962, file 1962, box 2, in PPRI Records; A rnold interview, 4 6 . 10. M inutes of Board M eeting, 20 M ay 1965 and 30 Septem ber 1965, Executive C om m ittee M inutes, 13 April 1965, file 1965, box 2; Report of the M edical D irector 1966, January 1967, file 1967, box 2, in PPRI Records.

301

302

Notes to Pages 151—156

11. W atkins, O n t h e P ill, 6 - 7 , 43, 48, 50, 52, 53; Tone, D e v i c e s a n d D e s ir e s , xv, 82, quote on 2 03, 2 3 9 - 4 0 . 12. W atkins, O n t h e P i ll, 3 - 4 , 8 6 - 8 8 , 89, 9 0 , 96, 99, 109, 115, 120. 13. A lan G uttm acher to Charles Potter, 3 O ctober 1968, file 1968, box 2; M edical D irector’s Report 1969, file 1969, box 2; Board M eeting M inutes, 22 June 1970, Staff M eeting M inutes, 23 Septem ber 1970, file 1970, box 2; Executive C om m ittee M inutes, 15 January 1973, Staff M eeting M inutes, 31 January 1973, and 25 April 1973, file 1973, box 2, all in PPRI Records. 14. U.S. Congress, Senate, Com m ittee on G overnm ent O perations, H e a r i n g s (1965), 1068; “Fact Sheet on Birth C ontrol" C o n g r e s s i o n a l Q u a r t e r ly , 10 June 1966, 1 2 3 5 -3 8 . 15. N e w Y o r k T i m e s , 9 February 1 964; Patterson, A m e r i c a ’s S t r u g g le , 1 4 2 -5 4 . 16. Piotrow, W o r ld P o p u l a t i o n C r is is , 91; Critchlow, I n t e n d e d C o n s e q u e n c e s , 6 8 ­ 69. 17. State of the U nion Address, 4 January 1965; 20th Anniversary o f the U nited Na­ tions in San Francisco, 25 June 1965; the swearing-in cerem ony o f John W. Gardner as secretary o f the D epartm ent of Health, Education and W elfare, 18 August 1965; and letter to the secretary general of the U nited N ations, second U nited Nations W orld Population Conference, Belgrade, Yugoslavia, 30 August 1965. Q uoted in U.S. Con­ gress, Senate, C om m ittee on G overnm ent O perations, H e a r i n g s (1965). 18. N ational A cadem y o f Sciences, T h e G r o w t h o f U .S. P o p u l a t i o n , 23; Piotrow, W o r ld P o p u l a t i o n C r is is , 9 0 - 9 3 .

19. Critchlow, I n t e n d e d C o n s e q u e n c e s , 52. 20. U.S. Congress, House, Com m ittee on Education and Labor, H e a r i n g s ; U.S. C on­ gress, Senate, C om m ittee on Labor and Public Welfare, H e a r i n g (1966), 130. 21. U.S. Congress, C o n g r e s s i o n a l R e c o r d 3 (21 July 1965): S 17729. 22. Greene, “Federal Birth C ontrol" 3 5 - 3 6 . 23. U.S. Congress, Senate, C om m ittee on Governm ent O perations, H e a r i n g s (1965), 1 4 6 5 -7 0 ; U.S. Congress, Senate, C om m ittee on G overnm ent O perations, H e a r i n g s (1967), 34; Elinor Langer, “Birth Control: Academy Report Stresses Burdens o f High Birth Rate among the Impoverished Here," S c i e n c e , 28 May 1965, 1206. 24. Estelle Griswold, interview with Jeannette Bailey Cheek, M arch 1976, 3 0 - 4 6 , Family Planning O ral H istory Project. 25. Erskine, “The Polls" 3 0 6 - 7 ; U.S. Congress, Senate, C om m ittee on Labor and Public W elfare, H e a r i n g (1966), 6 1 -7 4 ; John Finney, “Poll Finds Catholics Back Birth Curb A id" N e w Y o r k T im e s , 17 February 1966; “Ahead o f W ashington" T im e , 25 Febru­ ary 1966, 25; D’A ntonio, “Birth C ontrol" 249. 26. HR 8 4 4 0 and HR 8451, 89th Cong., 1st sess., U.S. Congress, C o n g r e s s i o n a l R e c o r d , 111 (25 May 1965), 89th Cong., 2nd sess. (1965), 19; Public Law 91-662, 8 January

1971, U n i t e d S t a t e s S t a t u t e s a t L a r g e 8 4 Stat. 1973; “Congressional Q uarterly Fact Sheet on Birth C ontrol" C o n g r e s s i o n a l Q u a r t e r ly , 10 June 1966, 1 2 3 5 -3 8 . 27. U.S. Congress, Senate, Com m ittee on Governm ent O perations, H e a r i n g s (1965), 1455, 1470, 1663. 28. U.S. Congress, Senate, Com m ittee on Governm ent O perations, H e a r i n g s (1965), 1 4 6 5 -1 0 , 1314-16. 29. U.S. Congress, Senate, Com m ittee on Labor and Public W elfare, H e a r i n g (1966),

Notes to Pages 156—161

111-13; U.S. Congress, Senate, C om m ittee on G overnm ent O perations, H e a r i n g s (1965), 1 0 5 6 - 6 0 , 1 0 6 4 - 7 0 , 1 0 7 4 -7 5 , 1133, 1781, 1788. 30. U.S. Congress, Senate, Com m ittee on Governm ent Operations, H e a r i n g s (1965), 1 0 6 4 - 7 0 , 1 0 7 4 -7 5 , 1781. 31. “Fam ily-Planning Cam paign—The Louisiana Story" U .S. N e w s a n d W o r ld R e ­ p o r t , 28 July 1969, 5 5 -5 7 .

32. U.S. Congress, Senate, C om m ittee on G overnm ent O perations, H e a r i n g s (1967), 34; “Congressional Q uarterly Fact Sheet on Birth C on trol" C o n g r e s s i o n a l Q u a r t e r ly , 10 June 1966, 1 2 3 5 -3 8 ; A rthur J. Lesser, “Equalizing Opportunity" P T A M a g a z i n e 61 (April 1967): 2 1 -2 2 . 33. “Birth C ontrol ‘Cost-Effectiveness,’” S c ie n c e , 12 May 1967, 7 66. 34. U.S. Congress, Senate, Com m ittee on Labor and Public Welfare, H e a r i n g (1966), 2-

8, 81, 1 1 3 -2 9 . 35. U.S. Congress, Senate, C om m ittee on Labor and Public W elfare, H e a r i n g (1966),

9, 35; U.S. Congress, Senate, Com m ittee on G overnm ent O perations, H e a r i n g s (1967), 99. 36. U.S. Congress, Senate, C om m ittee on Governm ent Operations, H e a r i n g s (1967), 14, 18. 37. U.S. Congress, Senate, Com m ittee on G overnm ent O perations, H e a r i n g s (1967), 2 0 -2 2 . 38. U.S. Congress, Senate, Com m ittee on Governm ent O perations, H e a r i n g s (1967), 3-

9, 1 2 -1 3 , 17, 2 8 - 2 9 , 36, 137; U.S. Congress, House, C om m ittee on Education and

Labor, H e a r i n g s , 2 1 5 9 -6 0 . 39. P i t t s b u r g h C o u r ie r , 30 Septem ber 1967, 1; P i t t s b u r g h P e a c e a n d F r e e d o m N e w s 2, no. 2 (S ep tem b er-O cto b er 1967): 6. 4 0 . S o c i a l S e c u r it y A m e n d m e n t s o f 1 9 6 7 , Public Law 9 0 -2 4 8 , 9 0 th Cong., 1st sess. (1967), 58, 1 0 2 -6 . 41. N e w Y o r k T i m e s , 11 January 1967, 11 M ay 1967, 16 M ay 1967; Piotrow, W o r ld P o p u l a t i o n C r is is , 1 3 3 -4 5 .

42. PPFA survey in U.S. Congress, House, C om m ittee on Education and Labor, H e a r in g s , 2179; W a s h in g t o n P o s t , 9 April 1967, A2.

43. U.S. Office o f Econom ic Opportunity, N e e d f o r S u b s i d i z e d F a m i l y P l a n n i n g S e r ­ v ic e s .

4 4 . “$ 5 0 0 for N ot Having a Baby" A m e r i c a , 16 M arch 1968, 336; A nn Ludwigsen Goodstadt, “How M any Children A re W e Entitled to Have?” R e d b o o k 136 (M arch 1971): 12. 45. “Congress Votes M onies for Family Planning" C h r i s t i a n C e n t u r y , 4 D ecem ber 1968, 1530. 4 6 . U.S. Congress, House, Com m ittee on Education and Labor, H e a r i n g s , 2162; Da­ vid, “Unwanted Pregnancies," 4 4 9 - 5 0 . 47. M enken, “Teenage Childbearing" 3 3 4 -3 5 ; Zelnik and Kantner, “Sexuality" 358, 3 7 2 -7 3 . See also W endy H. Baldwin, “A dolescent Pregnancy and Childbearing—Grow­ ing Concerns for Americans," P o p u l a t i o n B u l l e t i n 31 (Septem ber 1976). 4 8 . U.S. National C enter for H ealth Statistics, V i t a l S t a t i s t i c s ; Cutright, “Illegiti­ m acy" 4 0 8 - 9 .

303

304

Notes to Pages 162—167

49. Roberts, K i l l i n g t h e B l a c k B o d y , 119. 50. Sadja Goldsm ith, M.D., interview with Jeannette Bailey Cheek, Novem ber 1975, v, Family Planning Oral H istory Project; Mudd interview, 2 4 7 - 4 8 . 51. U.S. National C enter for H ealth Statistics, V i t a l S t a t i s t i c s ; Cutright, “Illegiti­ m acy" 4 0 8 - 9 ; Dryfos et al., “Eighteen M onths Later" 2 9 - 4 4 ; National Academy of Sciences, R e s o u r c e s a n d M a n , 2. 52. F e d e r a l R e g is t e r 3 4 (28 January 1969): 1356; Nixon, “Special M essage" 5 2 1 -3 0 . 53. N e w Y o r k T im e s , 3 February 1970, 23. 54. N e w Y o r k T i m e s 15 July 1970, 1 D ecem ber 1970, 27 D ecem ber 1970, 1. 55. Critchlow, I n t e n d e d C o n s e q u e n c e s , 173. 56. President’s Report, A n n u a l R e p o r t 1 9 7 0 , 7 - 8 , Executive C om m ittee M inutes, 16 February 1970, Board o f Directors M eeting, 19 O ctober 1970, file 1970, box 2, PPRI Records. 57. Calderone interview, 12; U.S. Congress, Senate, C om m ittee on Labor and Public W elfare, H e a r i n g (1966); Greene, “Federal Birth Control" 36. 58. Laura Bergquist, “Kentucky D octor: O ne M an’s W ar Against Poverty" L o o k , 16 Novem ber 1965, 77. 59. Jack Shepherd, “Birth C ontrol and the Poor: A Solu tion" L o o k , 7 April 1964, 6 3 - 6 4 ; Schoen, C h o i c e & C o e r c i o n , 65. 6 0 . Lonny M yers, M .D., interview with Ellen Chesler, Septem ber 1976, iii, 2 3 - 2 9 , Family Planning O ral H istory Project. 61. U.S. Congress, Senate, C om m ittee on Governm ent O perations, H e a r i n g s (1965), 1 7 5 4 -5 8 ; Bruno, “Birth C ontrol" 3 2 - 3 4 ; “Unmanaged N ew s" A m e r i c a , 18 M ay 1963, 701. 62. Myers interview, 26; Littlewood, T h e P o lit ic s o f P o p u l a t i o n C o n t r o l, 34; Bruno, “Birth Control," 3 3 - 3 4 . 63. Myers interview, 24; U.S. Congress, Senate, C om m ittee on Governm ent O pera­ tions, H e a r i n g s (1965), 1 7 5 4 -5 8 . 6 4 . “Birth C ontrol and W elfare" C o m m o n w e a l , 7 February 1964, 5 6 0 -6 1 . 65. The states were Alabam a, Arizona, A rkansas, California, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, M aine, Maryland, M ichigan, Mississippi, Nevada, New Jersey, New M exico, New York, N orth Carolina, N orth Dakota, O kla­ hom a, South Carolina, Tennessee, Texas, Virginia, W ashington, W est Virginia, W is­ consin. See U.S. Congress, Senate, Com m ittee on G overnm ent O perations, H e a r in g s (1965), 1183. 6 6 . U.S. Congress, Senate, Com m ittee on Labor and Public Welfare, H e a r i n g (1966), 10, 8 8 - 8 9 , 93. 67. U.S. Congress, Senate, Com m ittee on Governm ent Operations, H e a r i n g s (1965), 1779. 68. U.S. Congress, House, C om m ittee on Education and Labor, H e a r in g s , 56; D on­ ald Harting et al., “Family Planning Policies and Activities o f State Health and W elfare D epartm ents" P u b l i c H e a l t h R e p o r t s 8 4 (February 1969): 1 2 7 -2 8 . 69. Critchlow, I n t e n d e d C o n s e q u e n c e s , chap. 4. 70. “Silence Is Broken" A m e r i c a , 11 Septem ber 1965, 2 56; Davis, “O f M any Things" 511.

Notes to Pages 167—171

71. Bishops’ statem ent quoted in D’A ntonio, “Birth C ontrol" 247. 72. “B irth-C ontrol Plea Denied in M aryland" N e w Y o r k T im e s , 26 M arch 1964; “W elfare Birth C ontrol" A m e r i c a , 1 February 1964, 157; James O ’Gara, “Birth Control and Public Policy" C o m m o n w e a l , 23 August 1963, 5 0 4 . 73. D’A ntonio, “Birth C ontrol" 247. 74. W atkins, O n t h e P ill, 47. 75. During the 1940s this debate received publicity in the N e g r o D ig e s t . Dr. Julian Lewis, pathologist and form er professor at the University o f Chicago, argued that the black race was dependent on a high birthrate and that birth control was a white plot to weaken blacks. E. Franklin Frazier, distinguished sociologist, disagreed, asserting that “m ore and more babies born indiscriminately, without thought o f the parent’s health or ability to rear them , [was] not the answer.” The survival of the race depended upon strong healthy babies. See Lewis, “Can the Negro Afford Birth C ontrol" N e g r o D i g e s t 3 (May 1945): 1 9 -2 2 ; Frazier, “Birth C ontrol for M ore Negro Babies" N e g r o D ig e s t 3 (July 1945): 4 1 - 4 4 . 76. Ross, “A frican-A m erican W om en" 2 80; Greene, “Federal Birth C ontrol" 37; Da­ vis, “O f M any Things" 511. 77. Baraka, A f r i c a n C o n g r e s s , 419; W eisbord, G e n o c i d e ? 94. 78. M u h a m m a d S p e a k s , 24 January 1969, 4 July 1969, 11 July 1969, 29 August 1969; M alcolm X, “The Black Revolution" 4 5 - 4 6 ; Barbara A. Sizem ore, “Sexism and the Black M ale" B l a c k S c h o l a r (M arch-A pril 1973): 6. 79. PPCP N e w s l e t t e r 1, no. 1 (1966), and 1, no. 3 (1967), PPCP Papers. 80. PPCP N e w s l e t t e r 1, no. 3 (1967), PPCP Papers. 81. I contacted G reenlee in 1992 to interview him, but he refused to discuss the genocide controversy. 82. P i t t s b u r g h P r e s s , 21 August 1968; Hallow, “The Blacks Cry G enocide" 5 3 5 -3 7 ; Sm ith, “Birth Control," 29. 83. “Family Planning and M aternal H ealth" 10 M ay 1967, H om ew ood-Brushton City Renewal Council, FF 202.M , box 11B, Rice Papers. Pittsburgh was one of five O EO programs funded in 1966. David Epperson, interview with the author at his office at the University of Pittsburgh, 16 O cto ber 1992. 84. PPCP Letter o f Introduction for Home Visitors, 1 August 1 966, Planned Parent­ hood file, FF 371, box 18B, Rice Papers. 85. P i t t s b u r g h P o s t G a z e t t e , 30 July 1974, Haden file, FF 193, box 11A, Rice Papers. 86. “Report on the By-laws Com m ittee M eeting " n.d., H om ew ood-Brushton A lli­ ance file, 1 9 6 7 -6 8 , FF 2 0 0 , box 11A, Rice Papers. 87. Radio Sunday, 20 N ovem ber 1966, W W SW , Radio Broadcasts, 1966, 4th quar­ ter, FF 759, box 29, Rice Papers; P i t t s b u r g h P r e s s , 21 August 1968, 18. 88. “M ullen’s Maneuver,’’ P i t t s b u r g h C a t h o l i c , 1966, FF 8 56, box 32, Rice Papers. 89. Rice to Editor o f V illa g e V o ic e , 1 M arch 1968, Correspondence, 1968, FF 637, box 26, Rice Papers. 90. “Population Planners M iss P oint" P i t t s b u r g h C a t h o l i c , 27 D ecem ber 1 968, 1968 file, FF 857, box 32, Rice Papers; P i t t s b u r g h P r e s s , 21 August 1968, 18; NAACP, “The Statem ent by Planned Parenthood That They Do N ot So licit Clientele in the Black

305

306

Notes to Pages 171—173

Neighborhoods Is an O ut & O ut Lie,” 28 D ecem ber 1967, Planned Parenthood file, FF 371, box 18B, Rice Papers; Epperson interview. 91. C A P’s goal was to “attack poverty through a com prehensive plan focused on means o f removing the causes o f social disorder and bringing people out o f poverty and into the m ainstream o f life in the com munity” The eight targeted neighborhoods included N orth Side, H om ew ood-Brushton, Hill D istrict, South Oakland, Southwest Pittsburgh, Hazelwood-Glenwood, Lawrenceville, and East Liberty-G arfield. CA P’s structure encom passed a board o f directors responsible for policy and chaired by the mayor, Joseph M . Barr in this case. The mayor appointed two-thirds o f the board (sixteen), and the neighborhoods elected one delegate from each of the eight targeted neighborhoods. See “Com m unity A ction Program for the City o f Pittsburgh” and “CAP Interim Report,” both in Com m unity A ction Pittsburgh file, Rice Papers. 92. P i t t s b u r g h P r e s s , 5 February 1969, 1; P i t t s b u r g h C o u r ie r , 9 N ovem ber 1968, 1; P i t t s b u r g h C o u r ie r , 30 D ecem ber 1967, 2.

93. “O EO N eighborhood Proposals, Fiscal Year 1 July 1967 to 30 June 1 9 6 8 ” FF 202. G, box 11B, Rice Papers. 94. PPCP N e w s l e t t e r 3, no. 5 (1969), PPCP Papers. 95. “U nited M ovem ent for Progress” 8 July 1967, H om ew ood-Brushton Alliance, 1 9 6 7 -6 8 , FF 2 0 0 , box 11A, Rice Papers. 96. This grant cam e out o f the Fund for Aid o f Neighbors in Need, established by Bishop John W right o f Pittsburgh, to fund programs in disadvantaged areas. P i t t s b u r g h C o u r ie r , 13 July 1968, 1.

97. P i t t s b u r g h C o u r ie r , 13 July 1968, 1; “Anonymous Letter to Rice,” 11 O ctober 1968, Correspondence 1968, FF 637, box 26, Rice Papers. M ore hate mail and abusive phone calls are in Correspondence 1968, FF 637, box 26, Rice Papers. 98. Epperson interview; Sarah Bradford Campbell, interview with author conducted at Cam pbell’s hom e, 15 O ctober 1992. 99. This threat was serious. In 1969 Rice discovered two hundred sticks of dynamite near Holy Rosem ary and called the police as well as Haden. A fter the police left Haden laughed as he told Rice that he had hidden the explosives, planning to blow up clinics, but had forgotten about the dynamite. See M cG eever, R e v e r e n d C h a r l e s O w e n R ic e , 178. 100. H om ew ood-Brushton file, 1 9 6 7 -6 8 , FF 2 0 0 , box 11A; “B irth C ontrol Unit W arned by Haden,” 1 August 1968, no newspaper title, clipping sent anonymously to Rice, Haden file, FF 193, box 11A; “Haden Denies Negroes’ Rights,” Haden file, FF 193, box 11A, all in Rice Papers; P i t t s b u r g h P r e s s , 15 August 1968, 41. 101. N e w Y o r k T im e s , 11 August 1968, 4 4 ; P i t t s b u r g h P r e s s , 15 August 1968, 41. 102. Ibid. 103. Ibid. 104. Epperson interview. 105. P i t t s b u r g h P r e s s , 5 February 1969, 1. For com m ents by Rice see P i t t s b u r g h C a t h ­ o lic , 1968 file, FF 857, box 32, Rice Papers, especially a D ecem ber 1968 article entitled

“Population Planners M iss Point,” in which he stated that “black m ilitants could use some allies these days in their alm ost hopeless fight against policies that they justly condem n as genocidal”

Notes to Pages 173—177

106. P i t t s b u r g h P r e s s , 24 February 1969, 2. 107. P i t t s b u r g h P r e s s , 5 M arch 1969, 1. 108. Sarah Bradford Campbell interview; Epperson interview. PPCP had 2,215 cli­ ents from the areas under question who made a total of 8,3 6 8 visits during 1968. These figures suggest that clients returned, apparently without coercion, for follow-up visits. See Planned Parenthood file, PPCP Papers. 109. Epperson interview; “M .D. C olum n" P i t t s b u r g h C o u r i e r , 31 August 1968, 7; “B rief Sum m aries o f Programs and Budgets for Fiscal 1 9 7 0 " in CAP file, Rice Papers. 110. Sm ith, “Birth C ontrol" 28. 111. Sm ith, “Birth C ontrol" 29; P i t t s b u r g h C o u r ie r , 27 July 1968, 3. 112. “Analysis o f the Pill" T h r u s t, 19 July 1968, 1. 113. “Birth Control: Losing Support of N egroes?” U .S. N e w s a n d W o r ld R e p o r t , 7 August 1967, 11; Task Force, “E thics" 2 4 - 2 5 ; Hallow, “The Blacks Cry G enocide" 535; N e w Y o r k T i m e s , 15 N ovem ber 1968.

114. Turner and Darity, “Fears of G enocide" 1 0 2 9 -3 4 . 115. Frances M . Beal, “Double Jeopardy: To Be Black and Fem ale" in M organ, S is t e r ­ h o o d I s P o w e r fu l, 3 4 3 - 4 4 ; Davis, A n g e l a D a v i s , 161; LaRue, “Black Liberation" 61. See

also Giddings, W h e r e a n d W h e n I E n t e r , 314-19. 116. LaRue, “Black L iberation" 62; Toni Cade, “The Pill: G enocide or Liberation?" in Cade, T h e B l a c k W o m a n , 1 6 3 -6 4 . 117. Black W om en’s Liberation Group, “Statem ent on Birth C ontrol" M t. Vernon, New York, in M organ, S i s t e r h o o d I s P o w e r f u l , 3 6 0 -6 1 ; Dara Abubakari, “The Black W om an Is Liberated in Her Own M ind" in Lerner, B l a c k W o m e n , 587. 118. Bogue, “Family Planning in the Negro G hettos o f C hicago" M i l b a n k M e m o r i a l F u n d Q u a r t e r ly , no. 2 (April 1970): pt. 2: 2 8 3 - 9 9 ; Lipson and W olm an, “Polling A m eri­

can s" 3 9 - 4 2 ; W eisbord, G e n o c i d e ? 182. 119. “Planned Parenthood Honors Founder’s S o n " P i t t s b u r g h C o u r ie r , 21 O ctober 1967, 10; King quoted in Sm ith, “Birth C ontrol" 37; “Chivers W arns Parents" P i t t s b u r g h C o u r ie r , 29 June 1968, 16; U.S. Congress, Senate, C om m ittee on G overnm ent O pera­

tions, H e a r i n g s (1966), 1549; U.S. Congress, Senate, Com m ittee on Labor and Public W elfare, H e a r i n g s , 2255. 120. Langston Hughes, “Population Explosion" N e w Y o r k P o s t , 10 D ecem ber 1965; Joseph H. Fichter, “ZPG : A Bourgeois Conspiracy?" A m e r i c a , 19 August 1972, 89; Han­ nah Lees, “The Negro Response to Birth C ontrol" R e p o r t e r , 19 M ay 1966, 4 6 . 121. Blair interview, 21; Myers interview, 3 0 - 3 2 . 122. Board o f D irectors M eeting, 8 M arch 1960, file 1960, box 2; Board o f D irec­ tors M eeting, 10 O ctober 1961, M inutes o f the Clinical Staff M eeting, 26 Septem ber 1961, file 1961, box 2; President’s Report, 10 April 1962, Board of D irectors M eeting, 13 February 1962 and 13 M arch 1962, file 1962, box 2; Fact Sheet, n.d., Social W orker’s Annual Report, 1963, M edical D irector’s Annual Report, 1963, file 1963, box 2; M inutes o f Board M eeting, 20 M ay 1965, file 1965, box 2, all in PPRI Records. 123. Report to the Board of D irectors, 12 January 1960, file 1960, box 2; Clark to Board o f D irectors, 14 M arch 1961, file 1961, box 2; Board o f D irectors M eeting, 13 M arch 1962 and 9 O ctober 1962, file 1962, box 2; Board o f Directors M eeting, 12 Febru­ ary 1963, 21 M ay 1963, M edical D irector’s Annual Report 1963, file 1963, box 2; Execu­

307

308

Notes to Pages 178—180

tive Com m ittee M eeting, 14 July 1964, Executive D irector’s Report, 26 May 1964, file 1964, box 2; Campaign C om m ittee Report, 2 M arch 1965, file 1965, box 2; Executive D irector’s Annual Report 1969, file 1969, box 2, all in PPRI Records. 124. President’s Report, 10 April 1962, file 1962, box 2; Fact Sheet, n.d., file 1963, box 2; M rs. Henry W ise to Mr. Augustine W. Riccio, Director, 1963, file 1 9 6 4 [sic], box 2; Annual Report, April 1965, file 1 9 6 4 [sic], box 2; Executive D irector’s Annual Report 1969, file 1969, box 2, all in PPRI Records. 125. 1966 Annual Report o f Social W orker, January 1967, file 1967, box 2, PPRI Records. 126. W om en continued to hold the presidency and were the m ajority of vice presi­ dencies, all secretaries, executive directors, and medical directors until the late 1960s. W om en also continued to dominate the board of directors. 127. RIM H A , Inc., Report on Audit, 31 D ecem ber 1962, file 1962, box 2; 1 9 6 4 Cam ­ paign R eport, n.d., United Fund to PPRI, 23 July 1964, President’s Report, 14 May 1964, file 1964, box 2; Cam paign Report, 1965, file 1965, box 2; Statem ent o f A ccounts, file 1966, box 2, all in PPRI Records. 128. Annual Report of President, January 1967, file 1967, box 2; Executive D irector’s Annual Report 1967, 29 January 1968, M edical D irector’s Report to the Board o f D irec­ tors: February 1968, 31 January 1968, Executive D irector’s Report, 19 Novem ber 1968, Executive Com m ittee M inutes, 23 O ctober 1968, file 1968, box 2; Executive Com m ittee M inutes, 31 July 1969, Executive D irector’s Report, 11 D ecem ber 1969, file 1969, box 2, all in PPRI Records. 129. Executive Com m ittee M inutes, 9 February 1966, M inutes of Board M eeting, 25 O ctober 1966, file 1 966, box 2; M idsum m er M em o, 5 August 1967, Executive D irector’s Report, 24 O ctober 1967, file 1967, box 2; Executive Com m ittee M inutes, 17 D ecem ber 1968, file 1968, box 2, all in PPRI Records. 130. Board M eeting M inutes, 15 February 1966, file 1966, box 2; Executive D irector’s Annual Report 1966, 17 January 1967, Board M eeting M inutes, 16 May 1967, Statem ent o f A ccounts, file 1967, box 2; Executive D irector’s Annual Report 1969, file 1969, box 2; Treasurer’s Report, 31 D ecem ber 1959, file 1960 [sic], box 2, all in PPRI Records. 131. Anne W ise, M arch 196 4 , file 196 4 , box 2; Executive D irector’s Report, January 1965, file 1 9 6 4 [sic], box 2; Executive D irector’s Annual Report 1966, 17 January 1967, file 1967, box 2; Executive D irector’s Annual Report 1967, 29 January 1968, Executive Com m ittee M inutes, 18 June 1968, file 1968, box 2; Executive C om m ittee M inutes, 9 January 1969, 11 June 1969, and 31 July 1969, file 1969, box 2, all in PPRI Records. 132. Social W orker’s Annual Report 1968, Executive D irector’s Report, 24 Septem ­ ber 1968, file 1968, box 2; Social W orker’s Annual Report 1969, Annual Report o f Presi­ dent, 22 January 1969, file 1969, box 2, all in PPRI Records. 133. M edical D irector’s Report to the Board o f D irectors: February 1968, 31 January 1968, file 1968, box 2, PPRI Records. 134. W atkins, O n t h e P ill, 115. 135. M edical D irector’s Report to the Board of D irectors: February 1968, 31 January 1968, file 1 968, box 2; M edical D irector’s Report, A n n u a l R e p o r t s 1 9 7 0 , 4, file 1970, box 2, both in PPRI Records.

Notes to Pages 180—183

136. Executive D irector’s Annual Report, 1968, Board M eeting M inutes, 2 4 Septem ­ ber 1968, file 1968, box 2, PPRI Records. 137. M edical D irector’s Report 1966, January 1967, file 1967, box 2; Executive Di­ rector’s Annual Report 1967, 29 January 1968, file 1968, box 2; Executive D irector’s Annual Report 1969, file 1969, box 2; D irector o f Education, 13 M arch 1970, file 1970, box 2; A n n u a l R e p o r t s 1 9 7 3 , 9 -1 1 , file 1973, box 2, all in PPRI Records; C om m ittee on M edicine and Religion Report, n.d., M aternal Health 1 9 6 6 - 6 9 file, box 39, RIM S, RIHS Library. 138. M eyer also speaks o f this em barrassm ent in A n y F r i e n d o f t h e M o v e m e n t , 147­ 48. 139. Annual Report o f the President, 25 February 1970, file 1969, box 2; Executive Com m ittee M inutes, 2 April 1970, file 1970, box 2; Staff M eeting, 25 April 1973, file 1973, box 2, all in PPRI Records. 140. PPFA A n n u a l R e p o r t 1 9 7 3 , Staff M eeting, 31 January 1973, file 1973, box 2, PPRI Records. 141. Executive Com m ittee M inutes, 11 M ay 1966, file 1966, and 15 N ovem ber 1966, file 1965 [sic], box 2; Executive D irector’s Report, 24 O cto ber 1967, file 1967, box 2; Executive D irector’s Report, 30 April 1968, Executive Com m ittee M inutes, 13 M arch 1968, file 1968, box 2, all in PPRI Records; P r o v i d e n c e J o u r n a l , 2 M ay 1968, 1, 12 May 1968, N 40, 14 May 1968, 1. 142. P r o v i d e n c e J o u r n a l , 16 M ay 1968, 29; Executive C om m ittee M inutes, 22 May 1968, 18 June 1968, Executive D irector’s Annual Report 1968, 22 January 1969, file 1968, box 2, all in PPRI Records. 143. Lionel J. Jenkins to James N. W illiam s, M onthly Report for June 1966, no. 2, box 28, file 1800, U rban League o f Rhode Island Papers. 144. Report on South Providence, n.d., file 1965, box 2; Board M eeting M inutes, 15 February 1966, Executive Com m ittee M inutes, 11 M ay 1966, file 1966, box 2; Annual Report of the President, January 1967, file 1967, box 2; Board o f D irectors M eeting, 20 April 1970, Situation Testing, n.d., file 1970, box 2, all in PPRI Records. 145. The slate o f officers was 1968, female president, male first vice president, two female and two male vice presidents, male secretary, male treasurer, and male assistant treasurer; 1969, male president, female first vice president, three male vice presidents, female secretary, male treasurer, and female assistant treasurer; 1970, same exact slate as 1969; 1971, female president, three male vice presidents, male treasurer, female as­ sistant treasurer, and female secretary; 1972, female president, male first vice president, two male vice presidents, female secretary, female treasurer, and male assistant trea­ surer; 1973, female president, male first vice president, two male vice presidents, female secretary, female treasurer, and male assistant treasurer. 146. Executive D irector’s Report, 19 April 1966, file 1966, box 2; Board M eeting M inutes, 25 Septem ber 1969, Social W orker’s Annual Report 1969, file 1969, box 2; Ex­ ecutive D irector’s Report, 22 June 1970, 19 O cto ber 1970, Report of Discussion Group II, 23 June 1970, file 1970, box 2; Board o f D irectors M eeting, 20 D ecem ber 1971, file 1971, box 2; Executive D irector’s Report, 26 June 1972, file 1972, box 2, all in PPRI Re­ cords.

309

310

Notes to Pages 183—190

147. Executive D irector’s Report, 18 January 1971, 22 M arch 1971, file 1971, box 2; A n n u a l R e p o r t s , 1 9 7 2 , 3, 11, file 1972, box 2, both in PPRI Records.

148. Executive D irector’s Report, A n n u a l R e p o r t s 1 9 7 0 , 2, 17, Executive Com m ittee M inutes, 16 February 1970, file 1970, box 2; M inutes o f Staff M eeting, 8 M ay 1971, file 1971, box 2; M inutes o f Staff M eeting, 26 January 1972, file 1972, box 2; Report of the Planning C om m ittee o f Planned Parenthood o f Rhode Island, 22 M ay 1974, 2, file 1974, box 2; PPRI Statem ent for Period Ending Decem ber, 31 D ecem ber 1976, file 1976, box 2, all in PPRI Records. 149. Family Planning Training Curriculum Syllabi, Septem ber 1970, file 1970, box 2, PPRI Records. 150. W atkins, O n t h e P ill, 64. 151. M edical D irector’s Report, A n n u a l R e p o r t s 1 9 7 0 , 5, Board o f Directors M eet­ ing, 20 April 1970, 19 O cto ber 1970, Executive C om m ittee M inutes, 20 July 1970, 21 Septem ber 1970, file 1970, box 2; Board M inutes, 13 M arch 1972, A n n u a l R e p o r t s 1 9 7 0 , 2, 4, 11, file 1972, box 2; A n n u a l R e p o r t s 1 9 7 3 , 15, file 1973, box 2; 1 9 7 4 A n n u a l R e p o r t , file 1974, box 2; “Referral Guidelines,” file 1975, box 2; Viola Landes, no title, February 1976, file 1976, box 2, all in PPRI Records. 152. U.S. Congress, Senate, Com m ittee on Labor and Public Welfare, H e a r i n g (1966), 7; U.S. Congress, Senate, C om m ittee on G overnm ent Operations, H e a r i n g s (1967), 52; and U.S. Congress, Senate, C om m ittee on the Federal Role in Health, R e p o r t , 485. 153. Cutright and Jaffe, I m p a c t o f F a m i l y P la n n in g .

Chapter 7. Who Paysfor What? Abortion and Sterilization, 1960-1975 1. Abernathy, Greenberg, and Horvitz, “Estimates o f Induced A bortion” 19. 2. “M ore A bortions: The Reasons W hy” T i m e , 17 Septem ber 1965, 82; “A bortions on the Increase” A m e r i c a , 25 Septem ber 1965, 311; Hern, “Family Planning,” 17-19. 3. P r o v i d e n c e J o u r n a l , 24 August 1962, 15, 9 O cto ber 1962, 35. 4. H elen B. Taussig, M .D., interview with Charles A. Janeway, M.D., August 1975, v, 4 1 - 4 6 , Family Planning Oral H istory Project. 5. Finkbine, “Sherri Finkbine’s Story” in Rubin, T h e A b o r t i o n C o n t r o v e r s y , 6 9 - 7 0 . 6. Sarah W eddington, interview with Jeannette Cheek, M arch 1976, 5 4, Family Plan­ ning Oral H istory P roject; Gallup, G a l l u p P o l l P u b l i c O p in io n , 19 Septem ber 1962, 1784. 7. U.S. Congress, C o n g r e s s i o n a l R e c o r d 13 (3 May 1971): 157; Schoen, C h o i c e & C o ­ e r c i o n , 179.

8. Schoen, C h o i c e & C o e r c i o n , 1 7 6 -7 7 . 9. M aginnis interview, 1 0 5 -6 . 10. Schoen, C h o i c e & C o e r c i o n , 185. 11. A rlene Carm en, interview with Ellen Chesler, January 1976, 2 - 6 , 9 -1 0 , 3 5 - 3 6 , Family Planning O ral H istory Project. 12. Goldsm ith interview, 2 2 - 2 3 ; W eddington interview, 43; Carm en interview, iii, 21. 13. Hern, “Family Planning,” 1 7 -1 8 ; C h r i s t i a n C e n t u r y , 11 January 1961, 37; A m e r i c a , 21 M ay 1966, 7 3 8 - 4 2 ; N e w s w e e k , 14 Novem ber 1966, 92; P a r e n t s M a g a z i n e 45 (O c­

Notes to Pages 190—195

tober 1970): 5 8 -6 1 ; R e d b o o k 125 (O cto ber 1965): 7 0 -7 1 , 1 4 7 -5 0 ; N e w R e p u b l i c , 25 O ctober 1969, 12. 14. Cutright, “Illegitimacy,” 382; Teitelbaum, “Som e G enetic Implications,” 495. 15. Gallup, G a l l u p P o l l P u b l i c O p in io n , 19 Septem ber 1962, 1784, and 21 January 1966, 1985. 16. Jones and W estoff, “Attitudes toward Abortion,” 5 7 0 -7 1 . 17. Greene, “Federal Birth Control,” 3 5 - 3 6 ; U.S. National C enter for Health Statis­ tics, V i t a l S t a t is t ic s ; Cutright, “Illegitim acy” 4 0 8 - 9 . 18. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (3 May 1971): 13161. 19. Task Force Report on Family Law and Policy, “Personal Rights Relating to Preg­ nancy,” in Rubin, T h e A b o r t i o n C o n t r o v e r s y , 5 7 - 6 3 . 20. Nelson, W o m e n o f C o l o r , 5 - 6 . 21. N O W , “Bill of Rights” in M organ, S i s t e r h o o d I s P o w e r fu l, 5 1 2 -1 4 ; W andersee, O n t h e M o v e , 1 8 -1 9 .

22. Hole and Levine, R e b i r t h o f F e m i n i s m , 298; Cisler, “Unfinished Business” 2 46, 2 7 6 -7 8 . 23. A C O G , College Statem ent and M inority Report on Therapeutic A bortion, May 1969, A bortion Reports file, box 39; “2 8 0 Psychiatrists Urge End o f A bortion Laws” B o s t o n G l o b e , 5 N ovem ber 1969, M aternal Health 1 9 6 6 - 6 9 file, box 39, both in RIM S,

RIHS Library. 24. David, “Unwanted Pregnancies” 4 5 5 - 5 6 ; J. de M oerloose, “A bortion Legisla­ tion throughout the W orld” W H O F e a t u r e s , no. 3 (M arch 1971); Francom e, A b o r t i o n F r e e d o m ; Sachdev, I n t e r n a t i o n a l H a n d b o o k o n A b o r t i o n .

25. The Society for Humane A bortion, originally named the Citizen’s Com m ittee for Humane A bortion Laws, changed perm anently to the Society for Humane A bortion in 1 9 6 4 and existed until 1975. M aginnis interview, 7 9 - 9 7 ; Lana Clarke Phelan, interview with Jeannette Baily Cheek, Novem ber 1975, iv-v, 34, Family Planning Oral History Project. 26. M aginnis interview, 9 9 -1 0 2 , 149; Goldsm ith interview, 14. 27. Phelan interview, 17 -1 8 ; M aginnis interview, 1 0 0 -1 0 1 , 1 5 0 -5 2 . 28. Myers interview, 3 6 - 4 8 . 29. Jain and Sinding, N o r t h C a r o l i n a A b o r t i o n L a w 1 9 6 7 , 1 5 -1 6 , 4 8 -5 1 . 30. Myers interview, 3 6 - 3 9 ; M aginnis interview, 1 5 2 -5 4 . Estimates for legal abor­ tions in 1970 range from 19 7 ,0 0 0 to 2 3 6 ,0 0 0 . See David, “Unwanted Pregnancies,” 4 5 6 ; Tietze, “The Potential Impact,” in 581. 31. Constance Cook, interview with Ellen Chesler, January 1976, 2 7 - 2 8 , 3 4 - 3 8 , 4 2 - 4 5 , 4 8 - 4 9 , 52, 54, 5 6 - 6 4 , 7 2 - 7 3 , 79, Family Planning Oral H istory Project; Guttm acher quoted in President’s Report, A n n u a l R e p o r t s 1 9 7 0 , 6 - 7 , file 1970, box 2, PPRI Records. 32. David, “Unwanted Pregnancies,” 4 5 6 ; N e w Y o r k T im e s , 7 February 1971, 70, 6 April 1971, 78, 21 August 1971, 26, 15 O cto ber 1971, 38. 33. Pakter and Nelson, “A bortion” 1 -1 5 . See also Djerassi, “Fertility C ontrol” 9 -1 4 , 4 1 -4 5 . 34. Chisholm, U n b o u g h t , 120.

311

312

Notes to Pages 195—199

35. Pakter and Nelson, “Abortion,” 1 -1 5 ; N e w Y o r k T im e s , 13 O ctober 1971, 15; Car­ m en interview, 5 9 - 6 0 , 73, 80, 8 2 - 8 3 . Church reaction was swift: twenty C atholic bish­ ops in New York warned in a pastoral letter that “the church disowns by immediate ex­ com m unication any Catholic who deliberately procures an abortion or helps som eone else to do so” (New Y o r k T im e s , 7 April 1971, 43). 36. Pakter and Nelson, “Abortion,” 1 -1 5 ; Pakter et al., “Two Years Experience,” 5 2 4 ­ 35. 37. Carm en interview, 45. 38. Frances M . Beal, “Double Jeopardy: To Be Black and Female,” in M organ, S is ­ t e r h o o d I s P o w e r fu l, 3 4 9 - 5 0 ; Ross, “A frican-A m erican W omen,” 161; Renee Ferguson,

“W om en’s Liberation Has a Different M eaning for Blacks,” in Lerner, B l a c k W o m e n , 5 8 7 -9 2 . 39. Chisholm, U n b o u g h t , 1 14-16, 122; Carm en interview, 45. See also Carolyn Jones, “A bortion and Black Women,” B l a c k A m e r i c a 5 (Septem ber 1970): 4 9; M arsha Coleman, “A re A bortions for Black W om en Racist?” M i l i t a n t , 21 January 1972, 19; Treadwell, “Is A bortion Black G enocide?” 4 - 5 . 4 0 . N e w Y o r k T im e s , 20 July 1971, 30, 21 N ovem ber 1971, 95. 41. “A .M .A . Eases A bortion Rules,” N e w Y o r k T i m e s , 26 June 1970, 1. 42. The case was U n i t e d S t a t e s v. V u itc h , 4 0 2 U.S. Reports 62 (1971). See N e w Y o r k T im e s , 4 M ay 1971, 38, 15 August 1971, 56.

43. N e w Y o r k T im e s , 20 D ecem ber 1970, 42, 28 O ctober 1971, 1. 4 4 . “A BA Convention Approves A bortion ‘O n Dem and’” in N e w s D i c t i o n a r y 1 9 7 2 (New York: Facts on File, Inc., 1973), 1; “Worldwide Use Widespread,” in N e w s D i c t i o n ­ a r y 1 9 7 2 , 2; “Liberalized Laws Urged, Rejected,” in N e w s D i c t i o n a r y 1 9 7 1 (New York:

Facts on File, Inc., 1972), 2. This report was read into the record during the introduction o f the A bortion Rights A ct o f 1972. See U.S. Congress, C o n g r e s s i o n a l R e c o r d 118 (2 May 1972): 15331. 45. N ixon-Agnew Campaign Com m ittee, N i x o n o n t h e I s s u e s , 124. 4 6 . “Speech by Senator Bob Packwood,” in Rubin, T h e A b o r t i o n C o n t r o v e r s y , 7 2 ­ 74. 47. U.S. Congress, C o n g r e s s i o n a l R e c o r d 116 (15 June 1970): S 2 0 0 7 9 - 8 0 ; U.S. C on­ gress, C o n g r e s s i o n a l R e c o r d 116 (25 August 1970): S 3 0 0 0 0 ; U.S. Congress, C o n g r e s ­ s i o n a l R e c o r d 116 (12 M arch 1970): H 5619.

4 8 . U.S. Congress, C o n g r e s s i o n a l R e c o r d 116 (12 M arch 1970): H 7 4 1 5 -1 6 ; U.S. C on­ gress, C o n g r e s s i o n a l R e c o r d 116 (12 June 1970): S 1 9 6 0 0 . 49. U.S. Congress, C o n g r e s s i o n a l R e c o r d 116 (3 M arch 1970): S 5 6 1 6 -1 7 . 50. U.S. Congress, C o n g r e s s i o n a l R e c o r d 116 (3 M arch 1970): S 56 1 7 -1 8 , 116 (15 June 1970): 2 0 0 7 9 , 116 (25 August 1970): 3 0 0 0 1 -2 , 116 (23 M arch 1970): H 9 4 5 0 , 116 (12 M arch 1970): H 7415. 51. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (3 M arch 1971) 4 9 5 0 ; N e w Y o r k T im e s , 21 January 1971, 37. To put the statistic in context, W H M C had 1,953 births between 1 O cto ber 1969 and 30 Septem ber 1970. See S e l e c t e d S t a t i s t i c a l S u m m a r y f o r A d m i n ­ i s t r a t o r a t W i l f o r d H a l l M e d i c a l C e n t e r , 1990, in H istory files at W ilford Hall M edical

Center, provided to me by W H M C historian George Kelling, 11 August 1999. 52. U.S. Congress, C o n g r e s s i o n a l R e c o r d 116 (9 O cto ber 1 9 7 0 ):35994. In February

Notes to Pages 199-204

1971 Schm itz introduced HR 4 2 5 7 , concerning abortion in the military, but no action was taken. See U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (10 February 1971), 239 4 . 53. N e w Y o r k T im e s , 17 January 1971, 43. 54. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (1 M arch 1971), 4 4 9 6 ; N e w Y o r k T im e s , 21 January 1971, 37. 55. N e w Y o r k T im e s , 7 April 1971, 43. 56. N e w Y o r k T im e s , 4 O cto ber 1971, 27. 57. Nixon, “Statem ent about Policy,” 5 0 0 . 58. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (20 April 1971): H 11016. 59. Ibid. 6 0 . A m erican Friends Service Com m ittee, W h o S h a l l L iv e ? 61. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (5 O ctober 1971): 35140, 117 (7 D ecem ­ ber 1971): 4 5 2 4 4 . 62. In M arch 1968 Lt. W illiam Calley led A m erican soldiers into the village o f My Lai, where his m en murdered more than two hundred civilians, m ost of them young children, women, and elderly. Three years later a military court convicted him o f mur­ der and sentenced him to life in prison. N ixon reduced the sentence to twenty years and then granted him parole in 1974 after serving only three. See Herring, A m e r i c a ’s L o n g e s t W a r , 212, 236.

63. N e w Y o r k T im e s , 13 April 1971, 38. 6 4 . N e w Y o r k T im e s , 5 April 1971, 32. 65. N e w Y o r k T i m e s , 22 April 1971, 30. 6 6 . N e w Y o r k T i m e s , 13 April 1971, 38, 7 April 1971, 54, 16 April 1971, 73. 67. N e w Y o r k T im e s , 5 April 1971, 32. 68. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (3 M ay 1971): 13155-61. 69. U.S. Congress, C o n g r e s s i o n a l R e c o r d 117 (31 July 1971): 2 8 6 0 8 . 70. U.S. Congress, C o n g r e s s i o n a l R e c o r d 118 (2 M ay 1972): 1 5 3 2 7 -2 8 . 71. W alter quoted in U.S. Congress, C o n g r e s s i o n a l R e c o r d 118 (2 M ay 1972): 15331. 72. Nixon, “Statem ent about the R eport” 576. 73. Haldeman, H a l d e m a n D i a r i e s , 370. 74. Q uoted in W andersee, O n t h e M o v e , 29. 75. W eddington interview, 7 -1 1 ; W eddington, Q u e s t io n o f C h o i c e , 4 4 - 7 0 . 76. W eddington, Q u e s t io n o f C h o i c e , 1 0 2 -6 ; W eddington interview, 1 2 -1 5 , 2 4 - 2 8 , 6 0 ; Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 127. 77. R o e v. W a d e , 166; Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 9 8 - 9 9 . 78. Carm en interview, 7 1 -7 2 ; Goldsm ith interview, 16. 79. Shapiro, P o p u l a t i o n , 23; Petchesky, A b o r t i o n , 117. 80. K olbert and Miller, “Legal Strategies” 99; “Healthier M others” 1809. 81. Executive C om m ittee M inutes, 17 D ecem ber 1968, file 1968, box 2; Executive Com m ittee M inutes, 11 June 1969, 11 Septem ber 1969, and 26 N ovem ber 1969, Board M inutes, 8 May 1969, Executive D irector’s Report, “A bortion and the Law” 8 M ay 1969, file 1969, box 2, all in PPRI Records. 82. M aternal Health C om m ittee Report, Appendix A, 2 4 January 1968, A bortion Reports file, box 39, RIM S, RIHS Library; H 1659, H 166 0 , H 1661 all introduced 12 M arch 1968, F a i l e d B i lls o f 1 9 6 8 , State Archives; P r o v i d e n c e J o u r n a l , 18 M arch 1968, 23;

313

314

Notes to Pages 204-208

H 1400, H 1401, H 1402 all introduced 14 February 1969 and H 1776, 28 M arch 1969, F a i l e d B i lls o f 1 9 6 9 , State Archives.

83. H 1653, 30 M arch 1 966, F a i l e d B i lls o f 1 9 6 6 , State A rchives; P r o v i d e n c e J o u r n a l , 31 M arch 1966, 1, 2 April 1 966, 17, 12 January 1967, 7; H 1069, 11 January 1967, H 1716, 21 M arch 1967, H 1806, 31 M arch 1967, F a i l e d B i lls o f 1 9 6 7 , State Archives. 84. Executive Com m ittee M inutes, 16 February 1970, 20 July 1970, and 16 N ovem­ ber 1970, Board o f Directors M eeting, 20 April 1970, 19 O ctober 1970, file 1970, box 2; Board o f D irectors M eeting, 18 January 1971, 18 O ctober 1971, file 1971, box 2; Board M inutes, 26 June 1972, Staff M eeting, 29 Novem ber 1972, file 1972, box 2, all in PPRI Records. 85. Executive Com m ittee M inutes, 16 February 1970, 20 July 1970, and 16 Novem­ ber 1970, Board o f Directors M eeting, 20 April 1970, 19 O ctober 1970, file 1970, box 2; Board o f D irectors M eeting, 18 January 1971, 18 O ctober 1971, file 1971, box 2; Board M inutes, 26 June 1972, Staff M eeting, 29 Novem ber 1972, file 1972, box 2, all in PPRI Records. 86. Executive Com m ittee, 1 February 1973, 16 July 1973, W ise to Executive Com ­ m ittee, 28 February 1973, W ise to Board M em bers, 20 June 1973, file 1973, box 2, PPRI Records. 87. W ise to Board M em bers, 20 June 1973, Staff M eeting, 25 April 1973, file 1973, box 2, PPRI Records. 88. Board M eeting M inutes, 25 June 1973, 24 Septem ber 1973, file 1973, box 2; Staff M eeting, 4 O ctober 1973, file 1972 [sic], box 2, all in PPRI Records. 89. Staff M eeting, 4 O ctober 1973, file 1972 [sic], box 2, PPRI Records. 90. A n n u a l R e p o r t s 1 9 7 3 , 12, file 1973, box 2, PPRI Records. 91. Staff M eeting, 4 O cto ber 1973, Cost/Profit Projections o f Full O peration in A bortion Services, D ecem ber 1973, file 1973, box 2, PPRI Records. 92. A n n u a l R e p o r t 1 9 7 5 , Executive Com m ittee, 14 April 1975, 12 M ay 1975, Board o f D irectors M eeting, 27 June 1975, 21 July 1975, file 1975, box 2, PPRI Records. 93. Stein to Viola C. Crolius, Executive D irector of PPRI, 12 Septem ber 1975, M im i Frank to Viola C. Crolius, 17 D ecem ber 1975, file 1975, box 2, PPRI Records. 94. D irector o f Social Service’s Report, A n n u a l R e p o r t s 1 9 7 3 , 13, file 1973, box 2; Som e Thoughts on the Planning Process o f PPRI, 1 May 1974, file 1974, box 2; Stein to Crolius, 11 Septem ber 1975, file 1975, box 2; Handwritten Sheet and “Planned Par­ enthood Delivers,” P r o v i d e n c e J o u r n a l , February 1976, file 1976, box 2, all in PPRI Re­ cords. 95. “Sterilization: New Argument,” U .S. N e w s a n d W o r ld R e p o r t , 2 4 Septem ber 1962, 55. 96. James Ridgeway, “Birth Control by Surgery” N e w R e p u b l i c , 11 N ovem ber 1964, 11. 97. “Cruel and Unjust?” N e w s w e e k , 13 June 1966, 4 6 ; “Jail or Sterilization?” T i m e , 3 June 1966, 4 6 . 98. “Cruel and Unjust?” 4 6 ; “Jail or Sterilization?” 4 6 ; W illiam F. Buckley, “Sterilize That W om an!” N a t i o n a l R e v ie w , 12 July 1 966, 6 6 6 . 99. “Sterilization Sentim ent Focuses on the Poor,” S c i e n c e N e w s , 14 M ay 1966, 371; Slater, “Sterilization,” 152.

Notes to Pages 208-212

100. Slater, “Sterilization" 154. 101. Reilly, S u r g i c a l S o lu t io n , 117. 102. “Sterilization Sentim ent" 371; Slater, “Sterilization" 152. 103. “Sterilization: New A rgum ent" 55. 104. N e w Y o r k T i m e s , 12 Septem ber 1962, 13 Septem ber 1962; “Sterilize Them!" A m e r i c a , 22 Septem ber 1962, 7 64.

105. “Sterilization: New A rgum ent" 55; “A Sterile Issue?" N e w s w e e k , 24 Septem ber 1962, 88; “Sterilize Them !” 7 6 4 ; “Sterilization in V irginia" C o m m o n w e a l , 28 Septem ber 1962, 3. 106. Beal, “Double Jeopardy" in M organ, S i s t e r h o o d I s P o w e r fu l, 3 4 7 - 4 9 . 107. Hutchins interview, 16; U.S. Congress, Senate, C om m ittee on Governm ent O p­ erations, H e a r i n g s (1965), 1768; Ridgeway, “Birth Control by Surgery" 9 -1 0 ; “Voluntary Sterilization" T im e , 15 January 1965, 4 3 - 4 4 . H artm an gave $ 2 5 ,0 0 0 for a similar pro­ gram in several poor Florida counties. 108. The A ssociation for Voluntary Sterilization encouraged sterilization through­ out the tw entieth century, changing its name several tim es before it settled in 2001 on EngenderH ealth to increase funding opportunities. See , accessed 18 Septem ber 2 0 0 6 . 109. Gallup, G a l l u p P o l l P u b l i c O p in io n , 2 0 0 0 ; A ssociation for Voluntary Steriliza­ tion quoted in Shapiro, P o p u l a t i o n , 5 7 - 5 8 , 73; “Voluntary Sterilization Approved by M ajority" S c i e n c e N e w s , 8 O cto ber 1966, 277. 110. Gallup, G a l l u p P o l l P u b l i c O p in io n , 226 2 ; Presser, “Dem ographic and Social A sp ects" 5 2 9 -3 3 ; “O ne M an’s Answer to O ver Population" L i f e , 6 M arch 1970, 4 2 - 4 7 ; Lawrence Lader, “Laws to Lim it Family Size" P a r e n t s M a g a z i n e 45 (O ctober 1970): 5 8 -6 1 ; and W alter Goodm an, “A bortion and Sterilization: The Search for A nsw ers" R e d b o o k 125 (O ctober 1965): 148.

111. U.S. Congress, Senate, C om m ittee on the Federal Role in Health, H e a r i n g s ; Com m ission on Population Growth and the A m erican Future, P o p u l a t i o n a n d t h e A m e r i c a n F u t u r e , 171.

112. D’Emilio and Freedman, I n t i m a t e M a t t e r s , 255. 113. P i t t s b u r g h C o u r i e r , 9 N ovem ber 1968, 1, 24 M ay 1968, FF 857, box 32, Rice Papers. 114. Slater, “Sterilization" 152; Caress, “Sterilization" 4. 115. M easham , Hatcher, and Arnold, “Physicians and C ontraception" 4 9 9 . 116. National A bortion A ction C om m ittee, press release, 12 July 1973, National A bortion A ction C om m ittee Files; N e w Y o r k T im e s , 23 April 1971. 117. M easham , Hatcher, and Arnold, “Physicians and C ontraception" 4 9 9 ; Shapiro, P o p u l a t i o n , 6 - 7 , 9 7 - 9 8 , 116; Petchesky, A b o r t i o n , 1 7 8 -8 2 ; Roberts, K i l l i n g t h e B l a c k B o d y , 9 0 -9 1 ; Schoen, C h o i c e & C o e r c i o n , 108.

118. U.S. Congress, Senate, C om m ittee on the Federal Role in Health, H e a r i n g s , 1 5 6 2 -6 2 ; Richard R. Babcock, Jr., “Sterilization: Coercing C on sent" N a t i o n , 12 January 1974, 51; Judith Coburn, “Sterilization Regulations: Debate N ot Quelled by H EW D ocu­ m en t" S c ie n c e , 8 M arch 1974, 9 3 5 -3 9 ; Slater, “Sterilization" 150. 119. C h i c a g o D a i l y D e f e n d e r , 25 July 1973; B l a c k P a n t h e r , 7 July 1973; M u h a m m a d S p e a k s , 13 July 1973; N e w Y o r k D a i l y C h a l le n g e r , 17 July 1973; P i t t s b u r g h C o u r ie r , 21

315

316

Notes to Pages 212-219

July 1973; A f r o - A m e r i c a n , 28 July 1973. The Jordan colum n was also printed in the P i t t s b u r g h C o u r ie r , 28 July 1973.

120. Babcock, “Sterilization" 51; Coburn, “Sterilization Regulations" 150; Caress, “Sterilization" 1 -1 3 . 121. P i t t s b u r g h C o u r ie r , 21 July 1973, 3; Babcock, “Sterilization" 51; Coburn, “Steril­ ization Regulations" 150; Caress, “Sterilization" 1 -1 3 . 122. B l a c k P a n t h e r , 11 August 1973; A f r o - A m e r i c a n , 28 July 1973; P i t t s b u r g h C o u r ie r , 28 July 1973. 123. U.S. Congress, Senate, C om m ittee on the Federal Role in Health, H e a r in g s , 1 5 6 2 -6 3 ; M u h a m m a d S p e a k s , 31 M ay 1969, 26 D ecem ber 1969; P i t t s b u r g h C o u r ie r , 21 July 1973, 16. 124. Slater, “Sterilization" 152. 125. Dreifus, S t e r iliz in g t h e P o o r , 1 0 5 -7 ; Judith Herman, “Forced Sterilization" S is t e r C o u r a g e (January 1976): 8; Shapiro, P o p u l a t i o n , 9 0 -9 1 ; Velez-Ibanez, “Se M e A cabo"

7 1 -9 1 . 126. Rosenfeld, W olfe, and M cG arrah, H e a l t h R e s e a r c h ; Dreifus, S t e r iliz in g t h e P o o r , 1 0 5 -7 ; Herman, “Forced Sterilization" 8. 127. Torpy, “Native A m erican W om en" 8. 128. Shapiro, P o p u l a t i o n , 6 - 7 , 54, 9 1 -9 2 . 129. Shapiro, P o p u l a t i o n , 111, 117-21. 130. Coburn, “Sterilization Regulations" 936; Caress, “Sterilization" 4; Vaughan and Sparer, “Ethnic Group" 2 2 4 -2 9 . 131. “Sterilization Guidelines: 22 M onths on the Shelf" M e d i c a l W o r ld N e w s , 9 N o­ vem ber 1973; “W hite House N am ed" P i t t s b u r g h C o u r ie r , 21 July 1973, 1. 132. “W hite House N am ed" 133. P i t t s b u r g h C o u r ie r , 21 July 1973, 1; R e l f e t a l. v. W e i n b e r g e r e t a l., 372 F. Supp. 1196 (D.D.C. 1974); N a t i o n a l W e lf a r e R ig h ts O r g a n i z a t i o n v. W e in b e r g e r , Civil A ction no. 7 4 -2 4 3 , 1973. These two cases were consolidated into the Relf case. 134. R e l f e t a l .; Babcock, “Sterilization" 51; Coburn, “Sterilization Regulations" 9 3 5 ­ 39; Slater, “Sterilization" 150; “A W ell-M eaning A ct" N e w s w e e k , 16 July 1973, 26. 135. Coburn, “Sterilization Regulations" 9 3 5 -3 9 ; Babcock, “Sterilization" 5 2 -5 3 . 136. Ibid. 137. Gordon, W o m a n ’s B o d y , 4 3 3 - 3 4 ; Shapiro, P o p u l a t i o n , 9 2 - 9 3 , 107. 138. Hutchins interview, 3 4 - 3 5 . 139. Roberts, K i l l i n g t h e B l a c k B o d y , 91. 140. Shapiro, P o p u l a t i o n , 124. 141. Nelson, W o m e n o f C o l o r , 5 - 6 . 142. Shapiro, P o p u l a t i o n , 142, 148; Gordon, W o m a n ’s B o d y , 435. 143. W illiam s, “Blacks R eject Sterilization" 26; Mudd interview, 254. 144. Annual Report o f M edical D irector for 1963, 17 April 1964, file 196 4 , box 2; M edical D irector’s Report to the Board of D irectors, 31 January 1968, file 1968, box 2; A n n u a l R e p o r t s 1 9 7 0 , 2, file 1970, box 2, all in PPRI Records.

145. A n n u a l R e p o r t s 1 9 7 0 , Board of D irectors M eeting, 19 O ctober 1970, Executive Com m ittee M inutes, 16 N ovem ber 1970, file 1970, box 2, PPRI Records. 146. Board of D irectors M eeting, 18 January 1971, Executive D irector’s Report, 18

Notes to Pages 219-226

O ctober 1971, file 1971, box 2; Board M inutes, 13 M arch 1972, and 16 O ctober 1972, file 1972, box 2; Annual Report 1974, file 1974, box 2; A n n u a l R e p o r t 1 9 7 5 , file 1975, box 2, all in PPR I Records. 147. P r o v i d e n c e J o u r n a l , 20 Septem ber 1970, W 1. 148. Ibid. 149. Ibid. 150. Restrictions in abortion funding and through parental consent led to increasing illegitimate pregnancies among indigent teens. See P r o v i d e n c e J o u r n a l , 13 June 1989, 3. This report found teen pregnancy highly correlated with poverty: birthrates were ten times higher among poor than among high-incom e teens. Moreover, more poor teens carried their pregnancies to term than wealthy teens (31 percent o f indigent versus 71 percent o f wealthy teens aborted).

Chapter 8. Backlash, 1973-2000 1. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g , 2 1 -2 4 , 38, 42, 1 5 6 -5 7 , 162, 2 04.

2. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g ,, 122, 130, 145, 211.

3. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g ,, 1 - 3 , 6, 33, 63, 106, 118, 123, 1 5 6 -5 7 .

4. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g ,, 30, 134, 1 4 0 -4 1 , 144, 146, 157, 162.

5. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g ,, 157, 162, 194, 198, 205.

6. U.S. Congress, House, Com m ittee on Interior and Insular Affairs, O v e r s ig h t H e a r ­ in g ,, 50, 168, 170, 199, 205.

7. Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , ix; Jacqueline D arroch Forrest, “Norplant and Poor W om en" in Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , 2 1 -2 7 ; Julia Scott, “N orplant and W om en of Color,” in Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , 47.

8. Irving Sivin, “N orplant Clinical Trials” in Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , 9; Scott, “N orplant and W om en o f Color,” 41; G ehlert and Lickey, “Social and

Health Policy C oncerns” 3 3 3 -3 5 ; “Hopkins Q&A: Implants, Shots, Effectively Prevent Pregnancy” J o h n s H o p k i n s U n i v e r s i t y / P o i n t C a s t N e t w o r k , 8 July 1999. 9. Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , x -x i; G ehlert and Lickey, “Social and Health Policy C on cern s” 329. 10. “Native A m erican W om en U ncover N orplant Abuses,” M s . 4 (S ep tem b er-O ctober 1993): 69; G ehlert and Lickey, “Social and Health Policy Concerns,” 335; Young, “Reproductive Technologies,” 278. 11. Scott, “ Norplant and W om en o f Color,” 39, 4 1 - 4 5 ; “The N orplant D ebate” N e w s ­ w e e k , 15 February 1993, 4 0 .

12. Beilenson et al., “Politics and Practice” 3 0 9 -1 1 ; “Ending Child Labor” E c o n o m is t , 30 January 1993, 27. 13. Barbara Feringa et al., “N orplant: Potential for Coercion,” in Samuels and Sm ith, N o r p l a n t a n d P o o r W o m e n , 5 9 - 6 0 ; Young, “Reproductive Technologies” 2 6 4 - 6 5 .

317

318

Notes to Pages 226-232

14. Feringa et al., “N orplant: Potential for C o ercion " 5 9 - 6 0 ; G ehlert and Lickey, “Social and Health Policy C o n cern s" 328; Young, “Reproductive Technologies" 268; Roberts, K i l l i n g t h e B l a c k B o d y , 108. 15. Scott, “N orplant and W om en o f Color," 4 4 ; G ehlert and Lickey, “Social and Health Policy C oncerns" 328. 16. Scott, “N orplant and W om en of Color,” 4 4 ; Young, “Reproductive Technologies" 272, 276, 279; G ehlert and Lickey, “Social and Health Policy C on cern s" 3 2 8 -2 9 ; “Shot in the A rm " N e w R e p u b lic , 9 D ecem ber 1991, 16. 17. G ehlert and Lickey, “Social and Health Policy C on cern s" 329; Young, “Repro­ ductive Technologies" 276; A lexander Cockburn, “N orplant and the Social C leansers" N a t i o n , 25 July 1 994, 116-17; Roberts, K i l l i n g t h e B l a c k B o d y , 112.

18. N elson and Nelson, “Fem inism " S 3 0 -3 2 . 19. Feringa et al., “N orplant: Potential for C oercion " 5 8 - 6 0 ; Young, “Reproductive Technologies" 270, 275. 20. Scott, “N orplant and W om en of Color," 4 5; Young, “Reproductive Technologies" 2 7 5 -7 6 . 21. Scott, “N orplant and W om en o f Color," 4 6 ; Roberts, “Punishing Drug A ddicts" 127, 134; G ehlert and Lickey, “Social and Health Policy C on cern s" 330, 332. 22. Feringa et al., “N orplant: Potential for C oercion " 56; Robertson, “N orplant and Irresponsible Reproduction" S23. 23. Young, “Reproductive Technologies" 2 7 2 -7 3 . 24. “Ein V olk" E c o n o m i s t , 1 June 1991, 21. 25. Donald Kaul, “Solution: To Reform W elfare, Consider the Sterilization Bounty" W i n s t o n - S a l e m J o u r n a l , 12 August 1995, A14.

26. “Controversial Birth-C ontrol Program Gaining M om entum N ationw ide" A s ­ s o c i a t e d P r e s s / P o i n t C a s t N e t w o r k , 2 4 July 1999.

27. Petchesky, A b o r t i o n , 180; Shapiro, P o p u l a t i o n , 134. 28. Oudshoorn, T h e M a l e P i ll; IN FO P roject, “M ale H orm onal C ontraception" April 2 0 0 5 , , accessed 26 D ecem ber 2 0 0 5 . 29. Oudshoorn, T h e M a l e P i ll, 6, 2 1 -2 3 , 25, 4 0 , 1 8 9 -9 0 , 2 24; Tone, D e v i c e s a n d D e s i r e s , 2 4 6 , 2 54, 286, 288.

30. Petchesky, A b o r t i o n , 173; Oudshoorn, T h e M a l e P i ll, 1 0 9 -1 0 . 31. “Seeking Viagra Equity" A s s o c i a t e d P r e s s / P o i n t c a s t N e t w o r k , 30 June 1999; Rick Hepp, “Codey G ets Coverage on Birth C ontrol" S t a r L e d g e r , 13 D ecem ber 2 0 0 5 , , accessed 31 D ecem ber 2 0 0 5 . 32. “Hopkins Q&A: ‘M orning A fter’ Em ergency C ontraception" A s s o c i a t e d P r e s s / P o i n t c a s t N e t w o r k , 23 July 1999.

33. Tamar Lewin, “A bortion Rate" N e w Y o r k T im e s , 5 D ecem ber 1997; “A Look at the Pill and O ther Contraceptive M ethod s" A s s o c i a t e d P r e s s / P o i n t c a s t N e t w o r k , 8 July 1999. 34. “The Little W hite Bom bshell" N e w Y o r k T im e s M a g a z i n e , 25 July 1999. 35. Goggin, “Understanding" 1 1-12; Guth et al., “Sources of A ntiabortion A ttitudes" 75; Petchesky, A b o r t i o n , 241.

Notes to Pages 232-240

36. Petchesky, A b o r t i o n , 2 4 2 -5 4 . 37. Ginsburg, “Rescuing the Nation,” 229. 38. Ginsburg, “Rescuing the N ation” 2 34, 238; Ginsburg, C o n t e s t e d L iv e s , x i-x ii. 39. N e w Y o r k T i m e s , 18 June 1995, A1. 4 0 . . The Suprem e C ourt upheld the act as constitutional on 16 April 2001. See , accessed 18 O cto b er 2001. 41. Ginsburg, C o n t e s t e d L i v e s , xii-xiv, xvi, xxv iii-xxix. 42. Ibid., 11, 8 3 - 8 4 , 109, 193, 201. 43. Ibid., 78, 170. 4 4 . Wilder, “The Rule o f Law,” 7 3 -7 6 . 45. Black A m ericans for Life, N e w s l e t t e r 1, no. 1, n.d., ms. 76.1, HH 9 84, box 1B, Hall-Hoag Collection. 4 6 . Black A m ericans for Life, N e w s le t t e r . 47. Black A m ericans for Life, U n it in g t h e B l a c k C o m m u n i t y f o r L i f e , 1986, ms. 76.1, HH 9 84, box 1B, Hall-Hoag Collection. 4 8 . Black A m ericans for Life, “A B O R T IO N and SLAVERY: arguments parallel” n.d., ms. 76.1, HH 9 8 4 , box 1B, Hall-Hoag Collection. 49. Black A m ericans for Life, no title, n.d., pam phlet, ms. 76.1, HH 984, box 1B; M BL, no title, 1989, ms. 76.1, HH 1462, box 1B; M BL, booklet, 1990, ms. 76.1, HH 1462, box 1B, all in Hall-Hoag Collection. 50. M BL, no title, n.d., ms. 76.1, HH 1462, box 1B, Hall-Hoag Collection. 51. Fried, “A bortion in the United States,” 212; Ross, “A frican-A m erican W om en” 185, 1 9 2 -9 3 , 199; Bass, “Toward Coalition,” 2 5 1 -5 2 ; Roberts, K i l l i n g t h e B l a c k B o d y , 231, 233. 52. U.S. Congress, C o n g r e s s i o n a l R e c o r d 119 (31 May 1973): 1 7 5 3 8 -4 7 ; U.S. C on­ gress, Senate, C om m ittee on the Judiciary, Subcom m ittee on Constitutional A m end­ m ents, H e a r in g s , 1; U.S. Com m ission on Civil Rights, T h e C o n s t i t u t i o n a l A s p e c t s . 53. M aginnis interview, 152; Blair interview, 7 8 -8 1 . 54. Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 134. 55. Appendix to O pinion of the Court: P l a n n e d P a r e n t h o o d o f C e n t r a l M i s s o u r i v. D a n f o r t h , 4 2 8 U.S. Reports 85 (1976); Mudd interview, 265.

56. Rubin, T h e A b o r t i o n C o n t r o v e r s y , 229; Blair interview, 75. 57. W e e k l y C o m p i l a t i o n o f P r e s i d e n t i a l D o c u m e n t s 12, no. 15 (2 April 1976): 552; Carter, F i r s t L a d y , 164; W e e k ly C o m p i l a t i o n s o f P r e s i d e n t i a l D o c u m e n t s 13, no. 29 (12 July 1977): 9 9 0 -9 1 . 58. Gelb and Palley, W o m e n a n d P u b l i c P o l i c i e s , chap. 6. In O ctober 1989 Congress altered the Hyde A m endm ent to conform to the 1977 version. Bush vetoed it, and Congress failed to override it. 59. Call for A ction, 6 August 1976, file 1976, box 2, PPRI Records 6 0 . N icholson and Stew art, “Suprem e Court,” 1 5 9 -7 8 . N icholson and Stew art fol­ lowed through in “A bortion Policy,” 1 6 1 -6 8 . 61. By the 1980s A m erican Catholics supported abortion and birth control at the same rates as Protestants. M eier and M cFarlane, “The Politics of Funding Abortion,” 92; Berkm an and O ’Connor, “Do W om en Legislators M atter?” 1 0 6 -1 0 .

319

320

Notes to Pages 240-244

62. Barnartt and Harris, “Recent Changes" 3 2 0 - 3 4 ; Corm ack, “W om en and Social Change" 1 0 -1 4 ; Swan, “Gender, the Judiciary" 3 2 3 -4 1 ; Skerry, “Class C on flict" 6 9 - 8 4 ; Tedrow and M ahoney, “T rends" 1 8 1 -8 9 ; Baker et al., “M atters o f Life and D eath" 8 9 ­ 102; Legge, “D eterm inants" 4 7 9 - 9 0 ; Benin, “Determ inants o f O pposition to A bortion " 1 9 9 -2 1 6 . 63. Robbins, “Religious Involvem ent" 3 6 5 -7 4 ; M cFalls and M asnick, “Birth C on­ tro l" 8 9 -1 0 6 ; Com bs and W elch, “Blacks, W h ite s" 5 1 0 -2 0 ; Ezzard et al., “Race-Specific Patterns" 8 0 9 -1 4 ; Hall and Ferree, “Race D ifferences" 1 9 3 -2 0 7 ; M oore, Sim m s, and Betsy, C h o i c e a n d C i r c u m s t a n c e . 6 4 . C Q A l m a n a c (1980), 63-B , 97-B . 65. W eddington, Q u e s t io n o f C h o i c e , 2 0 3 - 8 ; Roberts, K i l l i n g t h e B l a c k B o d y , 118. 6 6 . The House gained twenty-five prochoice votes, and no senators targeted by an­ tichoice forces lost an election. W eddington, Q u e s t io n o f C h o i c e , 2 0 7 -8 . 67. Senate Joint Resolution 3, 98th Cong., 1st sess., 1983; W eddington, Q u e s t io n o f C h o ic e , 2 0 2 -3 .

68. Blackm un quoted in Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 143. 69. A k r o n v. A k r o n C e n t e r f o r R e p r o d u c t i v e H e a l t h , I n c ., 4 6 2 U.S. 416; P l a n n e d P a r ­ e n t h o o d A s s o c i a t i o n o f K a n s a s C ity v. A s h c r o ft , 4 6 2 U.S. 476; W eddington, Q u e s t io n o f C h o i c e , 2 0 1 -2 ; Petchesky, A b o r t i o n , 314. The Court upheld in A s h c r o f t the requirem ent

o f a pathology report for abortion, that a second physician be present during abortions perform ed after viability, and that a m inor secure parental consent or consent from the juvenile court for an abortion. 70. N e w Y o r k T i m e s , 19 July 1984, 21, 18 August 1984, 8, 22 August 1984, 18; C Q A l m a n a c (1985), 55-B , 93-B .

71. U.S. Congress, House, C om m ittee on the Judiciary, O v e r s ig h t H e a r in g s , 6 M arch, 12 M arch, and 3 April 1985 and 17 D ecem ber 1986, 1 - 2 , 3 9 -4 1 , 6 0 - 6 5 ; Gordon, W o m ­ a n ’s B o d y , 4 1 2 -1 3 .

72. T h o r n b u r g h v. A m e r i c a n C o l le g e o f O b s t e t r i c i a n s a n d G y n e c o lo g is t s , 476 U.S. 747 (1986); Petchesky, A b o r t i o n , 315; W eddington, Q u e s t io n o f C h o i c e , 2 0 8 - 9 . 73. Rubin, T h e A b o r t i o n C o n t r o v e r s y , 277; U.S. Congress, House, C om m ittee on G overnm ent O perations, Human Resources and Intergovernm ental Relations Sub­ com m ittee, M e d i c a l a n d P s y c h o l o g i c a l I m p a c t o f A b o r t i o n , 1 9 3 -9 6 ; “A bortion Experi­ ence Does N ot Appear to Reduce W om en’s Self-E steem " F a m i l y P l a n n i n g P e r s p e c t iv e s 24 (November 1992): 2 8 2 -8 3 ; Lunneborg, A b o r t i o n , chap. 4. 74. U.S. Congress, House, C om m ittee on Small Business, Subcom m ittee on Regula­ tion, Business O pportunities and Energy, H e a r i n g s , 1 -3 . 75. B o s t o n G l o b e , 10 April 1989, 1. 76. B o s t o n G l o b e , 7 April 1989, 3. Sixty percent o f those surveyed in M arch 1989 did not believe R o e should be overturned. 77. B o s t o n G l o b e , 27 April 1989, 1. 78. Eighty-eight percent died in com m ittee, 7 percent died on the floor, 1 percent were vetoed, and 4 percent passed. Berkm an and O ’Connor, “Do W om en Legisla­ tors M atter?” 112. O ne prochoice example is W ashington State, which adopted a new am endm ent to the state constitution that upheld R o e . 79. Dellinger quoted in “The Family vs. the S tate" N e w s w e e k , 9 July 1990, 23.

Notes to Pages 244-253

80. Fried, “A bortion in the U nited States" 215. 81. W a s h in g t o n P o s t , 2 4 M ay 1991, A1. 82. W a s h in g t o n P o s t , 2 4 M ay 1991, A1; David A . Kaplan, “A bortion: Just Say No A dvice" N e w s w e e k , 3 June 1991, 18. 83. W a s h in g t o n P o s t , 26 June 1991, A1, 27 June 1991, A8; Tatalovich and Schier, “Per­ sistence of Ideological Cleavage" 135. Bush vetoes occurred on 21 O ctober 1989, 27 O c ­ tober 1989, 20 N ovem ber 1989, 17 August 1991, and 19 Novem ber 1991. George Bush, “President Bush on the Right to Life" 14 April 1992, in Bush Cam paign Speeches. 84. W om en Exploited by A bortion, H e a l i n g in H is W in g s , ms. 76.1, HH 1471, box 2C, Hall-Hoag Collection. 85. S is t e r l ife 10, no. 4 (1990): 2 - 3 , ms. 76.1, HH 1239, box 1B, Hall-Hoag C ollec­ tion. 86. George Bush, “President Bush on the Right to Life" 22 January 1992, and “A bor­ tio n " 3 M arch 1993, both in Bush Cam paign Speeches. 87. “W om en on the Run" N e w s w e e k , 4 M ay 1992, 2 4 - 2 5 . 88. W illiam J. Clinton, Remarks on Signing M em orandum s on M edical Research and Reproductive Health, 22 January 1993, , accessed 18 June 2 0 0 7 ; Rubin, T h e A b o r ­ t io n C o n t r o v e r s y , 2 8 5 -8 6 .

89. Ginsburg quoted in Greenhouse, B e c o m i n g J u s t i c e B l a c k m u n , 225. 90. Rubin, T h e A b o r t i o n C o n t r o v e r s y , 287; N e w Y o r k T im e s , 25 January 1994, A1. 91. N e w Y o r k T im e s , 16 June 1995, A19. 92. W in s t o n - S a l e m J o u r n a l , 3 August 1995, A7. 93. Black illegitim acy was 22 percent in 1 960, 7 0 .4 percent in 1994, 6 8 .4 percent in 2001, and 68 percent in 2 0 0 2 . W h ite illegitim acy increased from 1.9 percent in 1956 to 16.9 percent in 1990 to 22.5 percent in 2001 to 22.9 percent in 2 0 0 2 . Steve Sailer, “Black Illegitim acy Rate D eclines" 27 June 2 0 0 3 , , accessed 28 July 2 0 0 5 ; H ernstein and Murray, T h e B e l l C u r v e ; Kline, G e n d e r , S e x u a lit y , a n d E u g e n ic s , 159.

94. “A Listening Law" N e w s w e e k , 6 Septem ber 1999, 10; L o s A n g e le s T im e s , 17 Sep­ tem ber 1999. 95. James Vicini, “Suprem e Court Invalidates A nti-A bortion Laws" 28 June 2 0 0 0 , ; Linda Greenhouse, “Court Rules That Governm ents Can’t Outlaw Type o f A bortion " 29 June 2 0 0 0 , , both accessed 7 July 2 0 0 0 . 96. Dayton, “‘Taking the Trade’” 5.

Chapter 9. Conclusion 1. W in s t o n - S a l e m J o u r n a l , 5 Novem ber 2 0 0 5 , B7. 2. “W elfare Reform," , accessed 15 N ovem ber 2 0 0 5 ; , ac­ cessed 15 N ovem ber 2 0 0 5 . 3. “Senate Approves Cuts, but N ot Drilling," W a s h in g t o n P o s t , 22 D ecem ber 2 0 0 5 , , accessed 22 D ecem ber 2 0 0 5 .

321

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Notes to Pages 254-256

4. Roberts, K i l l i n g t h e B l a c k B o d y , 4 , 10, 2 48, 2 5 4 - 5 5 ; Feldstein, M o t h e r h o o d in B l a c k a n d W h it e .

5. “A M ouse That Roars Turns 25: A n Interview with CFFC President Frances K issling" M ay 1998, , ac­ cessed 1 D ecem ber 2 0 0 5 . 6. G retchen Cook, “The Battle over Birth C ontrol" 27 April 2 0 0 5 , , accessed 31 D ecem ber 2005. 7. N ancy M cVicar, “M orning-after Pill Becom es Flashpoint in A bortion D ebate" K a n s a s C it y S t a r , 28 D ecem ber 2 0 0 5 , , accessed 31 D ecem ber 2 0 0 5 .

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pany, 1861. A c t s a n d R e s o lv e s o f t h e G e n e r a l A s s e m b l y o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n . Providence: A. Crawford Greene, 1861. A c t s a n d R e s o lv e s o f t h e G e n e r a l A s s e m b l y o f t h e S t a t e o f R h o d e I s l a n d a n d P r o v i d e n c e P l a n t a t i o n . Providence: Providence Press Company, 1867. A c t s a n d R e s o lv e s P a s s e d b y t h e G e n e r a l A s s e m b ly . Providence: E. L. Freem an and Sons,

1897. A m erican Friends Service Com m ittee. W h o S h a l l L iv e ? M a n ’s C o n t r o l o v e r B i r t h a n d D e a t h . New York: Hill and W ang, 1970.

Atkinson, Thom as G. “Sociological Status of the Fetus in U tero" M e d i c a l S t a n d a r d April 190 6 : 1 8 2 -8 6 . Babcock, Richard R., Jr. “Sterilization: Coercing C on sent" N a t i o n , 12 January 1974, 51. Baehr, Ninia. A b o r t i o n w i t h o u t A p o lo g y : R a d i c a l H i s t o r y f o r t h e 1 9 9 0 s . Boston: South End Press, 1991. Baker, Ross K., et al. “M atters o f Life and Death: Social, Political, and Religious C orre­ lates of Attitudes on A bortion " A m e r i c a n P o l i t i c a l Q u a r t e r l y 9 (1981): 8 9 -1 0 2 . Baraka, Im am u Am iri, ed. A f r i c a n C o n g r e s s —A D o c u m e n t a r y o f t h e F i r s t M o d e r n P a n ­ A f r i c a n C o n g r e s s . New York: W illiam Morrow, 1972.

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355

Index

ABCL, 61, 6 4 -6 6 , 67-74, 82-86, 89, 92, 93, 98-99, 105, 123, 130 Abortion, 2-3 , 7-10, 4 0 -4 3 , 119, 231-32; African Americans, 23, 231-32; antiabor­ tion campaign, 19-28; federal government, 198-202, 232, 236-39, 242; and feminists, 28-30; illegal, 75-79, 187-88; judicial re­ view, 9-10, 202-4; military bases, 198-99; nineteenth-century, 15-17; opposition, 232-34, 235-36, 241-42, 246; postwar, 138-41; reform, 188-98; religion, 25-27; Rhode Island, 30-42, 106-7, 188, 2 0 4 -6 ; state laws, 9, 23-24, 27-28, 30, 37-38, 237, 239, 244, 256; teenagers, 195, 221, 239, 244, 248-49; therapeutic, 76, 140-41, 194, 204 Abzug, Bella, 200-201 ACLU, 89, 191, 209, 214, 235 ACOG, 192, 196, 207, 223, 242 AFDC, 6, 117-18, 154, 156, 159, 161, 163-67, 175, 178, 187, 190, 194, 211, 252, 256 African Americans, 47, 52, 55, 65, 83-84, 88-90, 113, 128, 153; abortion, 23, 42, 188, 197, 234-36, 240; birth control, 95-99, 123, 156, 167-77, 218; Rhode Island, 125, 145; sterilization, 115, 209-12, 215, 218, 230. S e e a ls o Genocide ALI, 8 -9 , 189, 191, 194 AMA, 5, 9, 108, 194, 196, 272n48; antiabor­ tion campaign, 14, 19-28, 36-38, 41, 43; birth control, 63-65, 71, 73, 77, 79-80, 87, 92, 93, 98, 99-100, 105-6, 108, 130, 165, 223 American Eugenics Society, 66, 112-13, 130 Anglo-Saxon Clubs of America, 6 5 -66 Avery, Ephraim K., 30-35, 39 Baby Boom, 4, 119, 128-30, 139, 141, 147 BCCRB, 67, 74, 98, 101 BCFA, 97-98, 123 Beisel, Nicola, 7, 21 Bethune, Mary McLeod, 98, 123, 125 Birth control, 44, 57-70, 84, 149-53, 230-31;

black market, 5, 30, 58, 92, 106; courts, 60-61, 92-93; experiments, 133-38, 150, 224; federal involvement, 92, 131-33, 147, 153-60, 163-64; legislative campaigns, 71-74, 86-91; nineteenth-century, 14-15, 40, 57-58; public funding, 94, 148-49, 155, 160, 163-67, 180, 249, 253; teenagers, 11, 162, 179, 184-85, 226, 235, 239. S e e a ls o Condoms; Depo Provera; IUD; Norplant; Rhythm method B irth C o n tr o l R eview , 60, 61 Black Americans for Life, 235-36 Blackmun, Harry, 10, 12, 203, 238, 241, 244, 246 Black Muslims, 169 Black Panthers, 169, 212-13 Black Power, 173-75 Blair, Beatrice, 130, 176-77 Boughton, Alice, 64, 74 B o u r s v. U n ited S tates, 4 Briggs, Laura, 116, 133-34 Bureau of Social Hygiene, 56, 63, 67, 97, 112, 281n86 Buck, Carrie, 1, 56, 212 B u c k v. B e ll , 1, 55-56, 80 Burch, Guy Irving, 90, 120, 127, 287n26 Bush, George H. W., 158, 160, 243-47, 319n58, 321n83 Bush, George W., 251, 253, 254 Calderone, Mary S., 129-30, 136, 139, 141, 146, 150 California, 9, 54, 93, 111, 189, 192-93, 207, 228-29, 230, 286n11 Campbell, Loraine L., 82, 130, 131, 141 Campbell, Sarah Bradford, 172-74 CAP, 171, 173-74, 306n91 Carter, James, 237-38, 240 Catholic Church, 6, 11, 26, 35, 41, 52, 57, 63, 73, 80, 91, 163, 300n99; abortion, 26-27, 40, 41, 108, 189, 193, 195, 202, 204, 237, 239; birth control, 80, 8 8 -9 0 , 94, 95, 121, 133-34, 138, 141, 165-68; sterilization, 110

358

Index

Catholics, 3, 14, 18, 25, 37, 40, 44, 46, 76, 128; abortion, 187, 189, 191, 194, 196, 197, 198, 199, 201, 202, 232, 237, 239, 240, 242, 243, 255, 273n64; birth control, 63, 73, 75, 76, 84, 86, 88, 90, 91, 99, 100, 101, 113-14, 122, 129, 131-32, 133, 153, 155, 156, 160, 165, 166, 168; Pittsburgh, 170, 171, 172, 174; Rhode Island, 123-26, 137, 143-45, 147, 177-79, 181-82, 2 0 4 -6 ; sterilization, 207, 215 Catholic Welfare Conference, 73, 88 Census data, 37, 45, 46, 62, 83, 95, 102, 127, 220 Children's Bureau, 122, 130, 154, 158 Chisholm, Shirley, 195, 196, 213 Clinics, 5, 11, 61, 63, 75, 78, 81, 84, 93, 98; African American, 97-98; in Rhode Island, 99-106; in Pittsburgh, 170-74; statefunded, 94 -9 5 Clinton, William J., 234, 246, 253, 254 CMH, 64, 67, 74, 111 C M J & R, 16, 17, 20, 24, 40 Commander, Lydia Kingsmill, 46, 48 Commission on Population Growth, 187, 197, 210 Communism, 86, 88, 101, 126-28, 131 Comstock Law, 3, 4, 12, 21, 40, 57, 60, 61, 62, 70, 75, 86, 92, 154, 155 Condoms, 4, 15, 61, 92, 106, 119, 121, 147, 151, 180, 225, 226, 231, 256, 286n8, 287n23 Congress, 6, 57, 61, 62, 71-74, 86-91, 109, 121, 132-33, 153-60, 163-64, 198-99, 216-17, 222, 2 38-46, 253; investigations, 152, 212, 215, 222-23, 241, 243 Connecticut, 19, 36, 53, 117, 124, 142, 145-46, 178, 239, 294n7 Cook, Constance, 194-95 Cooper, James, 64 -6 5 , 69 CORE, 176, 178, 182 Cornell, Sarah, 30-35, 39 Cox, Nial, 212, 215, 255 Critchlow, Donald, 5, 154, 167, 180 Cummine-Vaile Bill, 70-71 Davenport, Charles, 49, 51, 53, 55, 66 Davis, Katherine, 56, 66, 74 Democratic Party, 199, 202, 237, 240 Dennett, Mary, 60, 70-71 Depo Provera, 211, 221-25, 230-31, 245, 249, 252, 256 DHEW, 154-59, 163, 179, 185, 215-18

Dickinson, Robert L., 64, 67, 74 Division of Negro Service, 97, 123 Doctors, 5, 7, 8, 12-14, 35; antiabortion campaign, 19-28; contraceptives, 58, 64, 65, 74-75, 92, 95, 100, 117, 151, 222-23; nineteenth-century abortion, 16-18, 33, 36-38, 4 0 -4 3 , 255; sterilization, 54-55, 114, 210, 211, 213-14, 216, 217; twentiethcentury abortion, 76-78, 97, 106, 108-9, 122, 139-41, 189, 194, 196-97, 203, 233, 245, 248 D o e v. B o lto n , 10, 202-3, 237, 238 Draper, William H., 131-32 DuBois, W.E.B., 96-98, 115, 123 Eisenhower, Dwight D., 131, 133 E is e n s ta d t v. B a ir d , 4, 10

Ellis, Havelock, 59-60 Enovid, 5, 136-37, 149-50. S e e a ls o Pill Epperson, David, 171-72, 174 Eugenicists, 6, 49-55, 57, 59, 65-68, 70, 77, 79, 82-83, 94, 110-13, 115-16, 255 Eugenics, 6, 49-54, 59, 65-71, 79, 110-13, 116, 117, 130, 216 Eugenics Record Office, 49, 51, 67, 111, 116 Family planning, 6, 98, 116, 136, 149, 167, 169, 190, 199, 203, 220-22, 227, 244-45, 246; African Americans, 173-77, 196, 225; Baby Boom, 129-30; federal govern­ ment, 153-60, 163-64; Rhode Island, 145, 179-84, 20 6 -7 ; sterilization, 210, 212-13, 215-17; World War II, 122-25 Farm Security Administration, 93 FDA, 93, 136, 137, 150, 152, 188, 198, 211, 222-24, 231, 243, 256, 298n73 Federal Council of Churches, 88, 89, 127 Feminism, 48, 61, 108, 195, 203, 232 Feminists, 2, 7, 9, 15-29, 52, 58, 59, 68, 69, 87, 95-99, 106, 109, 117, 123, 134, 138, 192, 193, 202, 203, 213, 214, 217, 218, 230, 231, 233, 234, 236, 242, 243, 246, 249; nine­ teenth-century, 28-30 Fetal rights, 39, 232, 235, 249, 251, 253 Ford, Gerald, 237 Free love, 29, 60, 88 Fulbright, William, 132, 160 Gamble, Clarence J., 94, 133, 134 Gardner, John, 156-59, 168

Index

Garvey, Marcus, 65-66, 96 G. D. Searle, 137, 149-50, 298n73 Genocide, 134, 149, 168-76, 182-83, 187, 196, 207, 218, 226-27, 235-36 Gilman, Charlotte Perkins, 87, 286n22 Ginsburg, Faye, 7, 8, 11, 232-24 Goldman, Emma, 59 Goldsmith, Sadja, 162, 184, 189-90, 203 Greenlee, Charles, 169-73, 305n81 G risw o ld v. C on n ecticu t, 4, 5, 9, 10, 154, 178, 243 Gruening, Ernest, 95, 133, 155-58 Guttmacher, Alan F., 122, 195 Haden, William, 170-74, 306n99 Hasian, Marouf A., 49, 50 Hispanics, 190, 214, 230, 255 Hodge, Hugh L., 17, 19 Holmes, Oliver Wendell, 1, 55-56 Homeward Brushton, 170-73, 182, 306n91 Human Betterment Foundation, 110-12 Hutchins, Louise Gilman, 82, 209, 217 Hyde Amendment, 12, 236, 238, 319n58 Illegitimacy, 109, 156-57, 159, 161-62, 164-66, 185, 188, 190, 192, 195, 220, 248 Illinois, 165-66, 193-94, 208, 239 Immigration, 1, 14, 21-22, 25, 28, 4 5 -4 6 , 62; in Rhode Island, 37 Indian Health Service, 214, 222, 225 IUD, 15, 58, 151, 179, 180, 215, 224, 230, 231 Jews, 41, 46, 126, 197, 202, 240, 284n139 Johnson, Lyndon B., 153-54, 158, 160, 167, 168 Jones, Eleanor, 82, 85, 105 Kennedy, Anne, 63, 64, 71, 73 Kennedy, John F., 131-33 Kline, Wendy, 51, 116-17 Know Nothing Party, 19, 28, 30, 37 Kopp, Marie, 101, 139 Ku Klux Klan, 62, 66, 72, 247 Laughlin, Harry, 56, 67-68 Louisiana, 19, 73, 156, 176, 210, 239 L o v in g v. V irginia, 10, 268n24 Maginnis, Patricia, 150, 189, 193 Marcus, Sarah, 75, 101, 130

Margaret Sanger Research Bureau, 129, 296n41 Maryland, 64, 72, 74, 166, 194, 208, 210, 225-27, 239 Massachusetts, 19, 21-22, 24, 36, 45, 117, 124, 133, 135, 141-42, 145, 146, 178, 204, 233, 236, 267n3 Massachusetts Blacks for Life, 236 McCormick, Katherine, 133, 135 Medicaid, 12, 144, 149, 203, 216, 217, 224, 227, 230, 237, 253 Midwives, 7, 8, 15, 17, 18, 41, 76-79, 139-41, 255 Milbank Memorial Foundation, 82-83 Miller, Henry, 22, 23, 36 Miller, Kelly, 95 Mississippi, 94, 207, 208, 211, 227 Mohr, James, 19 Mudd, Emily H., 75, 82, 83, 218 NAACP, 97, 168, 170, 171, 173, 176, 213, 234 NARAL, 11, 194, 200, 234, 240 National Academy of Sciences, 132, 153, 154, 163 National Birth Control League, 60, 67 National Women's Health Network, 223 National Women's Political Caucus, 202 Native Americans, 214, 217, 222, 223, 225 Nativism, 3, 14, 19, 25, 28, 37-38, 61-62, 251 NBWHP, 225, 236 NCFL, 86, 87, 90-91, 92 New York City, 34, 60, 61, 64, 67, 69, 101, 140, 156, 194-96, 203, 217 New York state, 9, 27, 36, 60, 61, 67, 68, 85, 92, 139, 160, 166, 189, 191, 194-97, 204, 286n11 NIH, 133, 198, 246 Nixon, Richard M., 163-64, 187, 197-203, 210, 215 Norplant, 221, 224-31, 245, 249, 252, 256 North Carolina, 42, 62, 66, 75-77, 87, 94, 156, 164, 188, 194, 208, 209, 211, 212, 215, 251 Norton, Mary T., 86, 88, 90 NOW, 192, 194, 201, 247 NUL, 97, 98, 168, 213, 234 NYCCSA, 189-90, 194 Office of Economic Opportunity, 153-54, 156-57, 159-60, 163, 170-72, 181-82, 190, 209-12, 215-16 Osborne, Frederick, 66

359

360

Index

Packwood, Robert, 198, 201 Pap smears, 142, 143, 145, 177 Parran, Thomas, 120-21, 123 Paul, Diane, 49 Pearl, Raymond, 70, 8 3 -84 Pill, 5, 119, 133-38, 149-52, 158, 164, 167, 170-71, 174-75, 177-80, 185, 187, 199, 211, 215, 219, 220, 222, 224, 226-27, 230-32, 256 Pincus, Gregory, 133, 135-36 Popenoe, Paul, 55 Population control, 2, 3, 4, ,9, 12, 44; early twentieth-century, 51, 62, 63, 69, 75; 1930s, 82, 88, 97-100, 109, 110, 117-19; 1940s50s, 121-23, 127, 128, 130-34, 136-38, 146-49; 1960s-70s, 150-51, 153-55, 158, 160-63, 176, 178, 185, 187, 190, 192, 198, 200, 203-7, 212-15, 217, 218, 221; 1980s-90s, 223-26, 229, 234, 243, 249, 251; twenty-first-century, 252, 254-56 Population Council, 130, 153, 155, 210, 224 Population Reference Bureau, 87, 90, 120, 130, 132, 287n26 Potter, Charles, 139, 143, 219 PPCP, 169-74, 307n108 PPFA, 8, 13, 119, 123-24, 129-33, 136-37, 139, 141-43; 145-46, 150-53, 158, 160, 177-78, 182, 191, 194, 2 0 4 -6 , 223. S e e a ls o ABCL PPRI, 12, 149, 151, 164, 177-85, 187, 2 0 4 -6 , 218-20, 219, 220, 238. S e e a ls o RIBCL; RIMHA Press, 15, 30, 83, 89, 121, 131-32, 149, 150, 157, 207, 255-56; genocide, 169, 173, 212; individual publications, 20, 22, 42, 43, 85, 90, 96, 97, 114, 115, 129, 153, 166, 167, 171, 190, 200-201, 208, 209, 212, 220 Prochoice movement, 11-12, 205, 213, 232-34, 236-37, 240, 2 43-44, 246-47, 253, 320n66 Prolife (antichoice) movement, 11-12, 109, 205-6, 221, 232, 236, 244, 246, 251, 253, 255, 320n66 Protestants, 3, 19, 25, 27, 41, 44, 46, 51, 111, 126, 128, 144, 155, 197, 240, 251, 255, 284n139 Providence Lying-In, 99, 140, 179, 183 Psychiatrists, 8, 52, 113-14, 141, 189, 192-94 Public Health Service, 61, 83, 94, 122, 133, 157, 238, 242

Public Opinion, 25, 46, 83, 91, 109, 122, 149, 155, 160, 176, 190, 197, 206, 209, 218, 229, 232, 240, 246, 256, 297n54 Puerto Rico, 53, 94-95, 114, 119, 133-40, 215 Quickening, 3, 7, 19, 28 Race suicide, 3, 42, 4 4 -4 9 , 51, 57, 58, 64, 66, 69-70, 77, 79, 82, 90, 95, 96, 105, 124, 168, 248 Randolph, A. Philip, 97, 125 Reagan, Leslie, 8, 41, 78, 106, 138, 139, 140, 254 Reagan, Ronald, 9, 2 40-42, 247, 254 Relf family, 211-12, 215-17 Relief families, 82-86 Religion, 26-27, 31, 34-35. S e e a ls o Catholics; Jews; Protestants Rentoul, Robert R., 47 Republican Party, 11, 199, 202, 227, 240-43, 246-47, 253-54 Restell, Madame (Ann Lohman), 16 Rhode Island, 12, 41, 47, 71, 81, 85, 135; clin­ ics, 99-106; nineteenth-century abortion, 30-42; postwar, 141-47; sterilization, 56-57, 218-20; twentieth-century abor­ tion, 77-79, 2 0 4 -6 , 139; World War II, 123-26 Rhode Island Medical Society, 12, 36-38 Rhythm method, 6, 15, 35, 84, 126, 137, 167 RIBCL, 12, 99-106. S e e a ls o PPRI; RIMHA Rice, Charles Owen, 170-73, 306n99 Rice-Wray, Edris, 136 RIMHA, 123-26, 135-47, 150-51, 177; Medi­ cal Advisory Committee, 137, 142, 146, 177 Roberts, Dorothy, 229, 254 Rock, John, 133, 135 Rockefeller, John D., III, 130-32, 156, 197 R o e v. W ad e, 9-12, 188, 202-5, 215, 221, 232, 234-38, 241-47, 251, 254 Rogers, Mary, 27 Roosevelt, Eleanor, 89, 122, 123 Roosevelt, Franklin D., 89, 122, 286n13 Roosevelt, Theodore, 4 6 -4 8 , 58, 66, 95 Ross, Loretta J., 97, 98, 236 Sanger, Grant, 60, 71, 91 Sanger, Margaret, 59-62, 64, 67-71, 73-74, 79, 86-87, 89, 91, 92, 99, 110, 123, 129, 133, 146, 151, 176

Index

Schoen, Johanna, 84, 98, 115 Shriver, R. Sargent, 157, 168 Sixth International Neo-Malthusian Confer­ ence, 69-70 Slabey, Evelyne, 146, 179, 180 Smith-Rosenberg, Carroll, 36, 38, 40, 275n108 Social Purity, 7, 20-21, 40 Social Security Amendments, 154, 156, 158, 159, 164, 179, 217 Social workers, 13, 67, 68, 79, 85, 94, 103, 104, 106, 126, 143, 160, 166-67, 169, 176, 178-79, 180, 211, 216 South Carolina, 17, 22, 24, 39, 94, 98, 165, 194, 211, 213, 227, 228 South Carolina Medical Society, 16, 22-23, 24-25, 27-28, 3 9 -4 0 , 42 Sterilization, 2, 6, 12, 13, 152; early twentiethcentury, 49-57, 69, 71-72; 1930s, 80-82, 95, 109-18; 1940s-50s, 127, 134-35, 138, 140, 148; 1960s-70s, 169, 184-87, 206-21; 1980s-90s, 223-26, 228-30, 232, 234, 239, 243, 245, 249; twenty-first-century, 251-56; state laws, 55-56; voluntary, 207-9, 315n108. S e e a ls o Eugenics Storer, Horatio, 14, 20-28, 36-39, 119, 122, 261 Supreme Court, 1, 4, 9-10, 55, 92-93, 116, 154-55, 197, 202-4, 234-35, 237-45, 247-248, 254. S e e a ls o in d iv id u a l c a se s Teenage births, 161-62, 187, 195, 212, 220, 225-26, 317n150

TFR, 14, 17-19, 29, 72, 99, 128 Thalidomide, 9, 188, 198 Tone, Andrea, 101, 151 Truman, Harry S., 120, 133 Tubal ligations, 112, 210, 211, 214, 219, 227 Tydings, Joseph, 157, 158 ULRI, 125, 145, 182 U n ited S ta tes v. O n e P a c k a g e , 4, 92, 95 U n ited S ta tes v. V uitch, 9

Vasectomy, 12, 54-55, 112, 187, 189, 211, 215, 218-20 Venereal disease, 4, 15, 33, 34, 41, 52, 61, 64, 93, 119-21, 169, 183, 293n5 Vietnam, 198-201 Virginia, 1, 10, 66, 94, 98, 194, 207, 208 Voluntary Parenthood League, 70-71 Watkins, Elizabeth Siegel, 5, 152, 184 Weddington, Sarah, 188, 202-3 Weinberger, Casper, 213, 216 Welfare, 2, 4, 6, 9, 11, 62, 85, 105, 111, 117-18, 125, 144, 188, 192, 194-95, 198-99, 201, 203, 205, 207-13, 216-18, 220, 222, 223, 226-31, 238, 243, 247, 248, 252-53, 256 WHO, 138, 199, 223 Wise, Anne, 177-78, 181-84, 204-5, 215 World War I, 52, 60-61, 62 World War II, 4, 6, 49, 93, 106, 117, 120-26, 128, 138 Wright, Henry C., 15, 28-29

361

S im o n e M . C aro n is ch a ir and a sso cia te p ro fesso r o f h isto ry at W ak e F orest U niversity. The au th o r o f a rticles dealing w ith b irth co n tro l and g en o cid e in th e A frican A m e rica n co m m u n ity and w ith a b o rtio n during th e N ixo n p resi­ dency, she is cu rren tly w orking on unw ed m o th e rs fro m th e late n in e te en th cen tu ry to th e post-R oe p eriod . S h e lives in W in sto n -S a le m , N o rth C arolin a, w ith h e r husband and tw o children.