The Birth Control of a Nation

Margaret Sanger, 1937 Source: Margaret Sanger Papers Project BirthcontrolislegalatlastintheUnitedStates.Therighttoprovidecontraceptiveinformationand serviceundermedicaldirectionisfinallyrecognizedundertheFederallawasnowinterpreted,andit alsoislegalunderstatelawsinallbuttwoStates,MississippiandMassachusettsandthe Massachusettslawisvulnerableonconstitutionalgrounds. TheRoadtoVictory Theroadtovictoryhasbeenlongandhard.Butthegoalnowhasbeengained,andanewerahas dawnedforbirthcontrol. Itisoneoftheanomaliesofmoderncivilizationthattheforcesofbigotry,reactionandlegalismcouldso longhavekeptonthestatutebooksalawwhichclassedcontraceptiveinformationwithobscenityand wasinterpretedtopreventphysiciansfromprescribingcontraceptives.Yearafteryearthisviciouslaw legallytiedthehandsofreputablephysicianswhilequacksandpurveyorsofbootlegcontraceptivesand marriagehygienearticlesandformulasflourished.ItwasanabsurdsituationinwhichtheFederallaw ineffectnullifiedthelawsofpracticallyeveryState. NowTheyCanBeTold Butnowmotherscanbetold!Thestoryofhowmotherhoodultimatelywasrescuedfrombondageisan absorbingone.ItrequiredtwothirdsofacenturytoremovetheFederalfettersplaceduponbirth controlbyAnthonyComstockandareformgroupwhichinducedatimidandoverawedCongressto passtheoverreachinglaw.Thatfamous,orratherinfamous,lawSection211oftheU.S.Penal Codeandsupplementarylaws,preventedthedisseminationofbirthcontrolinformationevenbya physician,andbarredanythingpertainingtothesubjectfromthemails.Norcouldsuppliesbesentby expressorothercommoncarrier.Othersectionswereevenmorerigid,forbiddingeventhepermission ofanyarticleforpreventingconceptionandtherewerenoexceptions.Whiletheoriginalbillcarriedthe exemption,exceptonaprescriptionofaphysicianingoodstanding,giveningoodfaith,thesewords wereomittedfromthebillwhichfirmlybecamelaw.Violationsofthelawwerepunishablebyfinesof from$2,000to$5,000,orimprisonmentforfiveyears,orboth. Thelawsmadenodistributionbetweencontraceptionandabortion,thoughtheyareasfarapartasthe poles.Birthcontrolistheconsciouscontrolofthebirthratebyscientificmeanswhichprevent conception.Itisnotinterferencewithlifeafterconceptionhastakenplace.

LawsSetBacktheClockofProgress Andthelawhadteeth.Manysuppliesandmuchliteraturewereconfiscatedanddestroyed.Evenifno outstanding,distinguishedphysicianswereactuallyprosecutedforviolatingthelaw,itwasmainly becausetheywouldnotpubliclydoso.Theywereintimidatedandkeptinfearofpersecution. WithFederalandStatelawsisconflictandconfusion,aphysicianmightlegallydispenseinformation underStatestatutes,butitwasillegalforhimunderaliteralinterpretationoftheFederalstatutes,tosend ortoreceivethenecessarytechnicalinformationandmedicalsupplies.Thelawhamperedthe progressivephysician,eagertoadoptpreventivehealthmeasures,andwillingtoadvisehispatients privately,butreluctanttotakeasimilarstandinpublicpracticebecauseofconfusionastohislegalrights inthisfieldofmedicine. TheComstocklawsnotonlythwartedeffortstoprotectmothersfromexcessivechildbearingand childrenfrombeingbornsick,weak,unwantedandunprovidedfor,butwereresponsible,directlyor indirectly,forthedeathsofamillionmothersduringthesixdecadestheywereenforced.Thesedeaths occurredneedlesslyamongmotherswhowerethevictimsofabortionsorofbearingchildrenwhenin unfitphysicalcondition. MaternalandInfantMortality Eventodaythesituationisstillappallinginsomerespects.Outofeveryfewmotherswhodiesin America,onedeathisduetoabortion.Outofapproximately15,000motherseachyearwhodiefrom causesduetochildbirthorpregnancy,alargepercentagearepoormaternityrisksfromthestart. Asforinfantmortality,statisticsoftheU.S.Children'sBureautelltheirelegant,butunheededstory. Whentheintervalbetweenbirthsistooshorts,deathratesclimb.Babiesbornoneyearapartdieatthe rateof147perthousandbabiesborntwoyearsaparthaveamortalityrateofonly[96?]perthousand. Thesefiguresareachallengetothenation. TheWinningFight FormanyyearseffortstoinduceCongresstoamendtheComstocklawswereunavailing,butsentiment forchangingthemincreasedrapidlyfrom1880onward.InthecampaignundertakenbytheNational CommitteeonFederalLegislationforBirthControl,Inc.,nearly1,000organizationswithapproximately twentymillionsofmemberseventuallyendorsedtheliftingofFederalrestrictions,and$25,000individual endorsementswerefiledwithCongress.Fewcauseshavewontheadherenceofsuchavastnumberof activesupporters. VictoryforPublicOpinion 2

ThedecisionwhichfinallyfreedcontraceptionfromitsFederalfettersrepresentsbasicallythetriumphof factsandpublicopinionoverarchaiclaw,ignoranceandprejudice.ThroughaliberalCourtthis informedandpotentpublicopinionfinallyfoundexpression.OneoftheJustices,inaseparateopinion, observed:Astatuestandsuntilpublicopiniongetsenoughmomentumtochangeit,whichmaybelong afteramajoritywouldrepealit,ifapollweretaken. TheNationalCommitteeonFederalLegislationforBirthControlhadproceededalongbothlegislative andlegallinesofbattle.Asconfiscationsofbooksandmaterialsincreased,aparticularlystrongtest casewasinstitutedbytheCommitteeinbehalfofDr.HannahM.Stone,MedicalDirectoroftheBirth ControlClinicalResearchBureauinNewYork.TheU.S.Government,throughtheBureauof Customs,hadseizedapackagecontaining120pessariestopreventconception,whichthegovernment allegedhadbeenimportedcontrarytoSection305(a)oftheTariffActof1930,whichoriginatedfrom theComstocklawof1873.ThesepessarieshadbeensenttoDr.StonebyaphysicianinJapanfortrial inherpractice,andshehadbeenaskedtogiveanopinionastotheirusefulnessforcontraceptive purposes.Dr.Stonetestifiedatthetrailthatsheprescribedtheuseofpessariesincaseswhereitwould notbedesirableforapatienttoundertakeapregnancy. EmancipationDecision Itwasinthiscase,onNovember30,1936,thatbirthcontrolundermedicaldirectionwasfinally recognizedaslegal.TheUnitedStatesCircuitCourtofAppealsfortheSecondCircuitrendereda decisionthattheFederalobscenitylawsdonotapplytothelegitimateactivitiesofphysicians,andthat theymayprescribecontraceptivesintheinterestsofthehealthandgeneralwellbeingoftheirpatients. Thatenlighteneddecisionbroughtbirthcontroltothegoalithadlongsoughtthroughlegislationandwas anemancipationproclamationtothemotherhoodofAmerica.Withitsobjectivewon,theNational Committeedisbanded. Withsharp,surgicalprecisionthehistoricdecisioncutthroughthetangledconfusionofFederallaws.It removedtheshadowofillegalityandthestigmaofobscenityandbroughttheFederalstatutesinto conformitywithmostStatestatutes.InthefewStatesremainingwhereoutmodedstatutesstillawait reinterpretationbytheCourts,thedecisionisabeaconlightforotherCourtstofollow. ABillofRights ThedecisionconstitutesaBillofRightsforthemedicalprofessioninthefieldofcontraception,[several wordsillegible].Thenationowesadebtofgratitudetothewisdom,thelogicandthehumanityof JusticesAugustusN.Hand,ThomasW.Swan,andLearnedHand,whosefarseeinginterpretationof theFederalstatuesbroughttoanendthe53yearreignofmuddleandtyrannyinauguratedbythe Comstocklegislation. ItwasonJanuary6,1938,thatJudgeGroverMoscowitz,oftheUnitedStatesDistrictCourt,Southern 3

DistrictofNewYork,inaveryluciddecision,heldthatcontraceptivesimportedforalawfulpurpose didnotcomewithintherestrictionsofthestatue. Thegovernmentappealedthecase,butJusticeMoscowitz'sdecisionwasaffirmedbytheUnitedStates CircuitCourtofAppealsfortheSecondCircuit,whichheldthatphysiciansimportingsucharticles,in ordertousethemforthehealthoftheirpatients,wereexemptedbyimplicationfromtheliteraltermsof thestatute. Themostsignificantpassageofthisdecisionread: ....WhilewemayassumethatSection305(a)oftheTariffActof1930exemptsonlysucharticles astheActof1873exempted,yetweare[convinced?]thatthisstatue,aswellasalltheactswehave referredto,embracedonlysucharticlesasCongresswouldhave[denounced?]asimmoralifithad understoodalltheconditionsunderwhichtheyweretobeused.Itsdesign,inouropinion,wasnotto preventtheimportation,sale,orcarriagebymailofthingswhichmightintelligentlybeemployedby conscientiousandcompetentphysiciansforthepurposeofsavinglifeorpromotingthewellbeingof theirpatients. HomerS.Cummings,AttorneyGeneraloftheUnitedStates,announcedthatthegovernmentwouldrest itscaseandnotcarryittotheUnitedStatesSupremeCourt.ThusthedecisionoftheCircuitCourtof Appealsbecamethelawoftheland,andtheTreasuryDepartmentthereuponissuedinstructionsto Customsauthoritiestoadmitcontraceptivesuppliesaddressedtophysicians. FortheultimatevictorywearealsodeeplygratefultoMorrisL.Ernst,counselforDr.Stoneandthe Committee,forhisgallantandsuccessfulfight,aswellasforhisconstantchampionshipofcivilliberties andclarificationofobstructivelaws. PhysiciansApprove Medical,aswellaslegalsanctionforbirthcontrolatlastexists.Lessthanayearafterthelegaldecision, andfollowingalonginvestigationbyaspecialcommittee,theAmericanMedicalAssociation,inJune 1937,approvedbirthcontrolasanessentialpartofmedicalpracticeandeducation,andurgedthe necessityforinformingphysiciansoftheirlegalrightsinrelationtotheuseofcontraceptives.Aresolution declaredthat ...itseemsfair...toassumethattheStateCourts,ifcalledupontoconstruethestatuesrelatingtothe disseminationofcontraceptiveinformation,willadoptlinesofreasoningsimilartothesefollowedinthe casecited(U.S.vs.OnePackage)andinothercasesdecidedbytheUnitedStatesCourts,leaving physiciansfreetogiveinformationconcerningcontraceptionwhenrequiredtomeetthemedicalneedsof patients. ThisreferencewastotheDr.HannahStonecase.ThepublicmaynowlooktotheAssociationtocarry 4

onresearchincontraceptionandtopromotetheteachingofbirthcontrolinmedicalschools. StateStatutes Birthcontrol,therefore,fromanationalstandpointisatlastfreed.TheFederalstatutesarenolongera stumblingblock. However,thereisneedforclarificationofStatestatutesinthefewStateswheretheliteralwordingof thelawmaystillbeinvolvedunlesspublicopinionmakestheforcefelt. InthepastsomeStatesfollowedthelandoftheFederalGovernmentinenactingandclingingto obsoletestatutesrestrictingthedisseminationofcontraceptiveknowledge,but,fortunately,these statutescontainexemptionsofmanytypesanddegreesasregardsthemedicalprofession.Thereare24 Stateswithstatutesofthischaracter.Someofthemareconfused,outmodedconglomerationsof provisionsaimedindiscriminatelyatbirthcontrol,obscenity,indecency,abortion,miscarriage,lotteries, nostrums,drops,pills,tinctures,compounds,poisons,drugs,prophylactics,lust,crime,andsex excitingdevices. DaguerreotypeDays SomeoftheStatesarestillinthedaguerreotypedaysinthephrasingoftheirlawsaboutbirthcontrol. UndertheIndianaandWyomingStatelawsdaguerreotypesandstereoscopesareliterallyverbotenas mediaofcontraceptiveinformation!Almostasquaintphraseologymeetstheeyeinsomeoftheother Statestatutes,andnorhymeorreasonisdiscernableintheirprovisions.Nevertheless,thesestatutory relicsofthepastdonotimposeanyobstaclesforthemedicalprofession.Thesituationmaybesummed upasfollows: TheSituationToday Thereare21States,aswellastheDistrictofColumbiaandtheTerritoriesofAlaska,Hawaii,Philippine IslandsandtheVirginIslands,wherethepreventionofconceptionhasnotbeenclassedwithobscenity. AmodernlawpermittingcontraceptionwasrecentlyenactedinPuertoRico.The21Stateswhose codesdonotrefertocontraceptioncompriseAlabama,Arkansas,Florida,Georgia,Illinois,Kentucky, Maryland,NewHampshire,NewMexico,NorthCarolina,NorthDakota,Oklahoma,RhodeIsland, SouthDakota,Tennessee,Texas,Utah,Vermont,Virginia,andWestVirginia. TenStateshavelimitedlaws,butphysiciansareexemptanddrugstoresarepermittedtosell contraceptives.TheseareColorado,Indiana,Ohio,Delaware,Iowa,Montana,Wisconsin,Wyoming, OregonandIdaho. ThreeStatespermitphysicianstoprescribecontraceptives,butdruggistsarenotmentioned.Theyare 5

NewYork,NevadaandMinnesota.TheNewYorklawhasheldbyadecisionoftheCourtofAppeals in1918tobebroadenoughtoprotectthephysicianwhoingoofaithgivessuchhelporadvicetoa marriedpersontocureorpreventdisease...theprotectionthusaffordedthephysicianwouldalso extendtothedruggist,orvendor,actinguponthephysicians'prescriptionororder.Asimilarruling existsinMinnesota. SixStateshavestatutesaimedatagainstadvertisingandtheindiscriminatedistributionofmaterial.They areArizona,California,Louisiana,Maine,MichiganandWashington. OneState,NewJersey,allowsthedisseminationofcontraceptiveinformationforjustcauses. OneState,Kansas,exemptsmedicaltextbooks,andbyimplicationthemedicalprofession. ThreeStates,Missouri,NebraskaandPennsylvania,exemptcharteredmedicalschoolsandmedical textbooks,andbyimplication,themedicalprofession. ThreeBackwardsStates Thereremainsthen,threeStates.Inone,Connecticut,theuseofcontraceptiveisforbidden.This statute,incapableofenforcement,haslongsubjectedConnecticuttoridicule,butthisbluelawrelichas remainedaspartofthecode,despiteearnestandrepeatedeffortsbytheenlightenedcitizensof Connecticuttoamendit.Nevertheless,sevenbirthcontrolclinicsareinoperationinConnecticut. Mississippimakesnoexceptionsinitsstatutes,whichbanevenoralinformation. InMassachusettstheStatelawshavebeenchallenged.Whiletheymakenoexceptionofanykind,eight birthcontrolclinicsdirectedandsponsoredbyoutstandingmedicalandciviclendersoftheStatehave servedthepublicformanyyearswithoutlegalhindrance.Meanwhile,repeatedeffortshavebeenmade tomodernizetheMassachusettslaws,butwithoutsuccess.Inthesummerof1937threeMassachusetts birthcontrolclinicswereraided.Doctors,nurses,socialworkersandofficialswerearrested,convicted andfined.Theircasesarebeingappealedtothehighercourtsandpendingdecisionallclinicsinthe Statehaveclosed. LegalWitchery ContraceptivesareforbiddeninMassachusettsunderabluelawentitledCrimesAgainstChastity, Decency,andGoodOrder.CommentingontheclosingoftheclinicsinSalem,Dr.HannahStonesaid: Thedayofwitchhuntinghaspassed.Itisnomorepossibletostemtheflowofcontraceptive knowledgethentostemthetidesoftheoceanthatwashtheshoreofMassachusetts. ThereactionarysteptakeninMassachusettsisawarningtoallwhocherishliberty,thatwhile prohibitorylawsofthetypeexistinginthatStateremainonthestatuebooks,theyconstituteacontinuing 6

threattothefreedomofthemedicalprofessionandthewelfareofmothers.Thereforetheoutcomeof theappealswillbeawaitedwithinterestthroughoutthecountry. ProgressiveStateLegislation OregonholdsthedistinctionofbeingthefirstStatetodivorcecontraceptionfromabortionand obscenity.ItisthefirstStatealsotoattempttosafeguarditscitizensbysettingupacontrolof contraceptiveproductsandadvertisingunderitsStateBoardofPharmacy.ToNorthCarolinagoesthe honorofbeingthefirstStatetoprovidebirthcontrolclinicalservicethroughitsStateDepartmentof Healthandcountyphysicians.Asabovestated,PuertoRicohasalsoenactedprogressivebirthcontrol legislation. NextSteps Whatliesahead?ItisnotenoughmerelytoestablishtherightsofphysiciansthroughtheCourts.This ethicalgainmustbeused.Wehavetakenagreatstepforward,butotherhurdlesmustbecleared.With birthcontrollegalizedbynationalstatutes,allStatesshouldnowcompletelycatchupwithpublic sentiment,judicial___interpretationandthedemandforcontraceptiveservicesbyclarifyingand modernizingthelaws.AllStatelawsshouldbepositive,notvagueornegative.Theyshouldclearlyand affirmativelydeclareandassuretherightofmedicalbirthcontrol,notmerelyfailtoforbidit,orlimitit. ANewCalltoArms ThereforeIaskallwhohavesoloyallymadeourlegalandmedicalvictoriespossible,tojoineffortswith usagaininthemostimportantobjectivetheinclusionofbirthcontrolserviceinlocal,Stateandnational healthprograms.Inthiswayonlycanthosemothersmostdesperatelyinneedofthisinformationsecure itthroughreliable,medicalchannels.Helpmakeitknowntohospitals,reliefagencies,philanthropicand publichealthofficials,thattheFederaldecisionhasfreedtheirhands.Challengeallplansforthe reductionofmaternalandinfantmortalitythatignorethebasicneedforincludingcontraceptiveservicein suchprograms. WeMustMoveFast Wemustmovefast,forwomenandchildrenaredyingneedlessly.Individualandgroupeffortcanpoint theway,andcandoimmeasurablegood.Butthoseguidingourprogramsforrelief,forthereductionof maternalandinfantmortality,andforthecontrolofsyphilis,mustrecognizethattheprovisionof scientificbirthcontrolinformationisessentialtothesuccessofallsuchprograms.Nextstepsinmaking contraceptiveinformationandserviceactuallyaswellaslegallyavailabletothemothersofAmericacall formodernizationofStatelawsandtheincorporationofbirthcontrolintomedicalpractice,preventive

medicineandpublichealthadministrationeverywhere. Todaytherearemorethan380birthcontrolcentersinthecountry.Tentimesthatnumberarerequired tomeettheneed.Thereare7,000hospitalsand10,000otheragencieswheremedicalaidissoughtby motherstoopoortopaythefeesofprivatephysicianswhichoughttoprovidecontraceptiveservice. Andmedicalchargingserviceoughttobringbirthcontroltothousandsofforgottenwomenonfarms andinisolateddistrictsremotefrommedicalcenters.Theirplightandpleasareamongthemostpoignant ofall.