Margaret Sanger and a Hundred Years of Birth Control

 

This guest post is by Corinne McSpedon, a medical writer and editor living in Hastings-on-Hudson, just north of New York City. She recently wrote for the Hastings Historical Society on the paths and staircases crisscrossing her town. Here, she reflects on the 100th anniversary of the opening of the first birth control clinic in America—and the century of laws and policies seeking to regulate women’s reproductive freedom.–JJ 

 

During the first decade of the 1900s, nurse and women’s rights activist Margaret Sanger lived in the town along the Hudson River where I grew up. Within a few years of arriving, however, Sanger moved with her husband William and three small children back to New York City “. . .to take our part individually or collectively in the great Pageant of Living,” as she described it in her 1931 book, My Fight for Birth Control.

 

I was only vaguely aware of Sanger when I read the quote. I knew she’d helped to make birth control available to American women, but I came of age in the 1980s, and I’d never known a time before Roe v. Wade and the legalization of birth control. And so for a time I remained unaware of the extent of women’s struggles throughout the 20th century to ensure they had control of their reproductive health.

 

I was curious too about why Sanger had left my hometown. On my daily walks, I passed by her former home—a beautiful old house with an acre of land, on an ideal block, with views of the Hudson, in a town so close to New York City. I went to our local historical society and read about Sanger’s time here.

 

I learned that her family’s initial experience in town probably did little to encourage long-term residency. Their new house, designed by her architect husband, caught fire the night they moved in. They escaped unharmed and rebuilt the house, but Sanger grew increasingly dissatisfied with small-town life. The “Living” she mentions in her autobiography may have referred to her work as a nurse, which she’d given up after marriage and childbirth.

 

The move back to the city allowed Sanger to become a visiting nurse on the Lower East Side, where she cared for poor women, many of them ill after multiple pregnancies and illegal, unsafe abortions. This work convinced her that a woman’s health is improved when she can control the size of her family (her mother died early, which Sanger attributed to her 18 pregnancies, including the birth of 11 children). Reproductive freedom, Sanger asserted, could help to break the damaging cycle of poverty.

 

Over time, Sanger transitioned from nursing to advocacy work, fighting for a woman’s right to access safe and effective birth control—a phrase she coined. In 1916 she opened the country’s first birth control clinic in Brooklyn, and others in the Bronx, Queens, and Manhattan followed. A year later she launched the monthly journal the Birth Control Review and in 1921 the American Birth Control League—forming the basis of what would later become Planned Parenthood of New York City.

 

It’s difficult now to imagine how radical Sanger’s work was back then. The Comstock Law of 1873—officially “the Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use”—made it illegal to sell or distribute contraceptives and to disseminate information about birth control, abortion, sexuality, and sexually transmitted diseases. A devout Christian named Anthony Comstock successfully lobbied Congress to criminalize these “moral vices.” About half of the states subsequently enacted their own legislation in support of so-called obscenity laws.

 

Many women’s-health advocates, including Sanger, were jailed for disseminating birth control information or devices. Sanger’s appeal led to a loosening of New York State’s interpretation of its anticontraception law, allowing physicians a limited ability to prescribe birth control when it was deemed medically necessary. Twenty years later, in 1936, Sanger was again arrested, this time for illegally ordering contraceptives through the mail (she’d tipped off the authorities). Her appeal of this conviction resulted in a significant amendment to the Comstock Law, allowing doctors to distribute birth control products and ending the classification of contraceptives as “obscene.”

 

Sanger’s pursuit of greater reproductive freedoms for women led to her role in the development of the first FDA-approved oral contraceptive, Enovid, in 1960, just six years before her death at age 86. But it wasn’t until 1965 that the Supreme Court ruled, in Griswold v. Connecticut, that birth control was legal for married couples to use. In 1972—the year before Roe v. Wade—the Supreme Court ruled in Eisenstadt v. Baird that any American, regardless of marital status, had the right to birth control.

 

The Supreme Court’s decision in Whole Woman’s Health et al. v. Hellerstedt late last month highlights how far women’s health services have come since then and how challenging it can still be to access reproductive care, especially in rural areas. In a 5–3 decision, the Supreme Court voted to reverse a lower court’s decision regarding two Texas state law provisions, one of which went into effect in 2013 and required that abortion providers have hospital admitting privileges within 30 miles of the clinic. The other provision—that all abortion “facilities” meet the same requirements as ambulatory surgical centers, including specifications like room and doorway size—was blocked pending court challenges.

 

Proponents claimed the provisions protected women’s health and safety. Women’s-health advocates asserted there was no evidence the law made women safer. Several medical and nursing organizations, including the American Medical Association, the American Congress of Obstetricians and Gynecologists, the American Nurses Association, and the American Academy of Nursing, voiced opposition to the Texas law.

 

As the Supreme Court noted in its decision, roughly half of Texas abortion clinics closed after providers were required to have admitting privileges. The court also noted that if abortion clinics were held to the same standards as ambulatory surgery centers, fewer than 10 clinics would remain open in Texas—down from 40. The Supreme Court ruled that the burden of these provisions outweighed any potential benefits.

 

A few days after that decision, Texas released information about abortions occurring in the state in 2014, the first full year after the law went into effect. The statistics revealed that 70% fewer women were able to access medication to induce an abortion in 2014. The closure of many clinics meant they had to travel further and wait longer to see a physician. Many simply couldn’t do so in time—Texas law prevented women from receiving this medication if they were more than seven weeks’ pregnant. It also required that they visit the same doctor multiple times. Minorities, especially those living in West Texas and along the Mexican border, have been disproportionately affected by the closures.

 

According to the Guttmacher Institute, 23 other states have adopted similar policies or laws regulating abortion providers. Such legislation prevents many women, especially in rural areas, from accessing safe and legal abortion care, as depicted in figures published in the New York Times. Some of these state laws were blocked until the Supreme Court ruled on the constitutionality of the Texas law and will likely be overturned. But the effect, as in Texas, has already been significant. Clinics that closed under the strains of complying with these laws cannot be easily reopened.

 

With fewer care options, some women may seek unsafe abortions, and those who have the means to access legal care will have to travel further, wait longer, and possibly have abortions later in pregnancy than those living in states with less restrictive abortion laws.

 

Women’s freedom to control their reproductive health has been a given to the generations who came of age after the 1960s, especially in urban areas—and the struggle to attain it seems like long-ago history. But recently enacted state laws and their lasting effects are reminders that this is not the case. They impinge upon a woman’s ability to access care that has been legal for 43 years.

 

More than a century after Sanger left my hometown to advocate for the health rights of women—and exactly 100 years after she opened the nation’s first birth control clinic—many American women still do not have control over their reproductive health.