Princeton University Press

Chapter Title: Birth Control Stalled

Book Title: The Birth Control Movement and American Society

Book Subtitle: From Private Vice to Public Virtue
Book Author(s): JAMES REED
Published by: Princeton University Press. (1978)
Stable URL: https://www.jstor.org/stable/j.ctt7ztxwj.20

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CHAPTER 15 Birth Control
Stalled

LAMED for projected declines in

the quality and quantity of the population, birth controllers
fought an uphill battle in the late 1930s and the 1940s. In May
1937, in an effort to take advantage of the acceptance of con­
traception by the American Medical Association in January,
the National Committee on Maternal Health called together a
group of interested demographers, doctors, and educators to
discuss criticism of birth control. Heated debate over "The
Eugenic Effect of Contraception—The Significance of the De­
cline in the Birth Rate" revealed deep antagonism between
eugenicist and feminist, social scientist and physician. The
participants shared concern, however, over the prospect of an
end to population growth and the possibility of public reaction
leading to crude attempts to suppress contraceptive practice.1
Opinion varied as to why the middle classes were failing to
replace themselves. Haven Emerson, professor of public health
at Columbia, took a moralistic position.
What we have got to do . . . is to teach the hazards of universal lib­
erty in the application of biological dynamite. It is a fine thing to
have as the ambition of any society that all facts belong to all peo­
ple . . . but facts which are capable of such destructive effect upon
the individual family and household cannot be thoughtlessly let
loose without accompanying that information with precautions
and with advice to use it with restraint. . . . Enthusiasts in the de­
termination that all their fellows shall know all the biological infor­
mation they can use, have got the front page. . . . There is quite as

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 THE PROSPECT OF DEPOPULATION

much obligation on doctors, nurses, social workers, etc., to urge

people to save their own sanity by having children instead of to
save their own club membership and automobiles by not having
children.2

Emerson was rebutted by the journalist Dorothy Dunbar

Bromley, who observed, "I think it is ridiculous for you men to
sit here and say the things you have said tonight about a
woman's duty to have children. Many of us have found other
interests and compensations very absorbing."3
Frederick Osborn and Dr. Joseph Folsom argued that better
housing, education, cooperative day care centers, subsidized
medical care, and other public investments easing the burden
of parenthood were the only acceptable means of raising the
birth rate. They believed that young people wanted more chil­
dren but hesitated because of fear of economic hardship.4 As
usual, the vaguest suggestion that government should play a
bigger role in providing medical care aroused immediate an­
tagonism. George Kosmak fervently advocated more babies
but denounced any'incentives to higher fertility that involved
socialized medicine. Kosmak declared:
Economists and sociologists look at the big side of the thing, but
we, as doctors, must continue to look at the individuals, and I
hope there will always remain these individual contacts. I, for one,
don't care to live to the time when mass treatment of the sick is
going to be developed as it is in these mass insurance schemes.5

Kosmak's outburst touched on a frequent complaint against

birth control—it was not being delivered to the people who
needed it most, the indigent. The need to spread contraceptive
practice to the lower classes might be used as an excuse for
socialized medicine.
The social scientists were unanimous on the dysgenic effect
of the uneven spread of contraception. As Frank Notestein
explained:
I can't see a time ever when birth control shouldn't be foisted on
some parts of our population. We face the terrible defect that the
lower economic groups are our population reservoir. It seems to
me to be carrying things to a vicious degree when one part [under­
developed rural areas] is supplying the population to other geo­
graphical parts. I think the birth control group should become in-

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Birth Control Stalled

terested in spreading its service to the groups where it is

specifically needed.6

Frederick Osborn, sensitized by the blunders of earlier

eugenicists to the need to avoid invidious ethnic or racial com­
parisons, was quick to distinguish his position from those
who blamed particular ethnic groups or classes for social disor­
der. 'The eugenist is not worried so much about differential
fertility between classes as he is about differential fertility
within the classes." Public health nurses observed that
. . . any nurse who was worth her salt and knew her district knew
darn well which families in that district ought to have fewer chil­
dren and which families ought to have more children. . . . The
question I want light on is how the spread of contraception can be
carried on in such a way that it will give opportunities for con­
traceptive practice to those families who shouldn't have children
without indoctrinating too much those families who should have
more children?7

Osborn thought differences between individuals were more

important than differences between groups. The effects of he­
redity and environment were too closely interrelated to be
measured separately. Too often, however, the people who
should not have children were the ones who lacked both mo­
tivation to practice contraception and access to medical care.
As Osborn and Frank Lorimer explained in 1934,
Those situations in which excessive fertility tends to destroy eco­
nomic balance, to spread family traditions rooted in ignorance, or
to have dysgenic effects are situations in which individuals find
themselves unable to control their own destiny, baffled, and led to
despair or indifference. . . .8

In order to silence some of their critics, birth controllers

would have to reach the millions of Americans who had no
doctors, lacked the courage, will, or motive to visit a birth con­
trol clinic, or were far away from the city-based clinics. Reach­
ing those people seemed to require a vast expansion of medical
care. Organized medicine stood militantly opposed to any­
thing that smelled of socialism, and the American Medical As­
sociation successfully played on the interests of other groups
committed to the maintenance of the free enterprise system to

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 THE PROSPECT OF DEPOPULATION

forestall the rational reorganization of medical care. With birth

control newly established as a medical monopoly, the pros­
pects for the spread of contraception seemed limited.9
Even if they could reach the impoverished, birth controllers
had no effective methods for the poorly motivated. The dia­
phragm and jelly regimen, while close to 100 percent effective
among women who accepted it, was nevertheless rejected after
brief trial by about 60 percent of the women who came to birth
control clinics. Analysis of case records showed that clinic pa­
tients were recruited from women who were already using folk
methods (withdrawal, douche, condom) with considerable
success. These women often returned to the folk methods after
instruction in the use of the diaphragm. Those who rejected
the clinic method used other methods more effectively after
the clinic experience. Nevertheless, for two-thirds of clinic pa­
tients the clinic visit merely reinforced habits gained from
nonmedical sources.10
Robert Dickinson wondered whether "publicity of our ac­
tual paucity of knowledge will help or hinder" the birth con­
trol movement. The harsh truth was that even if governments
decided to offer birth control "to millions of families on relief,
or to the swarming "populations of . . . Oriental countries,
medical science would be in doubt what to advise for most of
these people." Diaphragms seemed "practically out of the
question for the impoverished, for those of low intelligence,
and for the millions out of the reach of skilled instruction."
While all birth controllers agreed on the need for more clinics,
many believed that major progress would have to wait for
breakthroughs in basic science that would provide methods
requiring less motivation or skill from the user.11
Mary McCarthy, in The Group, her evocative portrait of Vas-
sar women from the class of 1933, provided a fictional but real­
istic description of the diaphragm's inherent drawbacks. In a
genital-shy culture, even a Vassar woman had problems man­
aging the gadget:
Dottie did not mind the pelvic examination or the fitting. Her
bad moment came when she was learning how to insert the pes­
sary by herself. Though she was usually good with her hands and
well co-ordinated, she felt suddenly unnerved by the scrutiny of
the doctor and the nurse, so exploratory and impersonal, like the

2x4

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Birth Control Stalled
doctor's rubber glove. As she was trying to fold the pessary, the
slippery thing, all covered with jelly, jumped out of her grasp and
shot across the room and hit the sterilizer. Dottie could have died.
But apparently this was nothing new to the doctor and the nurse.12

Some birth control activists were not willing to wait for sci­
entific salvation in the form of tidy contraception. They as­
sumed, largely on faith, that the poor would limit their fertility
if given access to the methods successfully used by middle-
class Protestants, especially simpler methods. Better jellies,
suppositories, powders, and condoms, delivered by any feasi­
ble means, would work. The masses were simply waiting for
the word. Birth control was not a medical problem after all, but
a matter of giving middle-class secrets to the eager poor. Per­
sistence in that kind of endeavor required the faith of a
missionary.
In December 1932, Doris Davidson (Registered Nurse, New
York) wrote Margaret Sanger asking to be trained in contracep­
tive technique at the Clinical Research Bureau. A native of Fort
Fairfield, Maine, Davidson had come to New York to attend
nursing school and had stayed on as superintendent of Kips
Bay Day Nursery. She began to doubt the usefulness of her
work as year after year more children were brought to her from
the same indigent families.
Davidson decided to give up patchwork and dreamed of
bringing a traveling birth control clinic to rural Maine. After
six months of training at the Harlem clinic, she poured out her
thanks and hopes to Sanger.

I know that without this fundamental training . . . I should

never have been equipped to proceed with the future work of
starting a traveling clinic, the importance and need of which is
constantly and daily in my thoughts. Oh! to reach the women in
the tiny villages and in the backwoods!—and how can it be done
unless we go to them? It seems to me that it must be done, eventu­
ally, all over this country: that someday each State must have its
own traveling clinic. . . . I know you will pardon my enthusiasm,
but I see this thing so clearly, and what it could mean to future
generations.13

Grub-staked with a loan from her father, $20 borrowed from

Florence Rose (Sanger's personal secretary), and a list of birth

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 THE PROSPECT OF DEPOPULATION

control supporters in Maine, Davidson set out for Portland in

October 1933. She recruited a sponsoring group of women,
each of whom pledged $5 a week to get the work started. The
city was "buzzing" about Davidson's presence when she got a
request for a conference from a Dr. Gehring, the president­
elect of the Maine Medical Society. Gehring told her of his
plans to bring up birth control at the next meeting of the soci­
ety and wondered if Davidson would like to teach contracep­
tive technique to local doctors.14 When Davidson wrote back
to New York of Gehring's kindly interest, Rose immediately
sensed danger and warned Davidson to avoid any mention of
teaching doctors about birth control.15
Assured of support by women leaders in Portland, Davidson
moved on to Bangor, where she found the going much
tougher. After several weeks of unsuccessful effort in Bangor,
Davidson discovered the source of her chilly reception there.
Gehring had written to an influential colleague in Bangor that
Davidson was some sort of confidence woman, interested only
in making money for herself. Gehring's poison pen led to the
collapse of plans for a clinic in Bangor and to a campaign of
vilification against Davidson. She was warned that the doctors
were " 'hot on my trail' and that they would make it hot for me
if they caught me practicing without a doctor's license."16
Davidson had volunteered to work for room and board. No
doctor had been asked to contribute to her project, which was
to be financed by interested women. After the debacle the gen­
eral secretary of the Bangor Young Women's Christian Associ­
ation wrote to Rose to express her personal approval of David­
son's character and conduct.

The opposition arising here, I believe, was almost inevitable

. . . and the charge against Miss Davidson, one of convenience
only. There had to be something and this happened to have come
out. My heart is sore for her because the charge is so utterly untrue
and therefore the more hurtful to her. I have tried to make her see
that it'happened to be'this particular handle which they chose. . . .
Miss Davidson must pay the price of a spirit beyond her age
and time.17

Davidson moved on to West Virginia, where she worked as

an organizer for the American Birth Control League, a more

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Birth Control Stalled

cautious and wiser birth control missionary, never again

advertising any desire to teach birth control except under a
doctor's supervision. Her plan of delivering birth control
through paramedical personnel was soon adopted, however,
by other birth controllers, who, being millionaires, were more
successful.

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