Birth Control on Main Street: Organizing Clinics in the United States, 1916-1939 (review)

Hajo set out to correct historians' overemphasis on the maverick nature of local birth control clinics in relation to the desires of national organizations such as the American Birth Control League (ABCL) and the Birth Control Clinical Research Bureau (BCCRB). These latter groups aspired to create a national movement controlled at the top with standards for all clinics to maintain, fearing that unclean or unorganized local clinics could reflect badly on the national movement.

Clinics at the bottom did not play along, but they did not have to do so. Anyone could open a clinic; no permission from a state or national affiliate was necessary. National groups provided inspiration but little else. Many clinics refused invitations to affiliate with a national group, preferring to keep policy decisions and scarce funds at the local level. Activists realized they were better positioned to secure financing from Community Chests and volunteers among community leaders—as well as forge alliances with local doctors, ministers, and political leaders—if they stressed maternal health rather than accentuate connections to controversial groups such as the ABCL or BCCRB. Thus the success of clinics rested far more on efforts by local activists than by national groups.

Local freestanding clinics were not the ultimate goal of the national movement. Leaders such as Margaret Sanger envisioned the incorporation of clinics into existing institutions such as hospitals, settlement houses, and public health clinics. Contraception, however, was not the priority of such establishments. They were not interested in charity work or in publicizing divisive services such as birth control that could alienate donors. Most women, therefore, received contraceptive aid from independent clinics. Although the latter were more costly to run than institutional clinics, women preferred the atmosphere there and local activists were better able to maintain control over services than in institutions where boards and officers, many of whom could be Catholic, had to approve all policies.

In independent clinics, the staff controlled policies. Most clinics did not allow wealthy, single, or pregnant women to attend, the latter for fear of association with abortion. Staff dispensed diaphragms because women controlled their use and they were highly effective. Nearly all clinics were overwhelmingly white. No national leader comparable to Sanger emerged in the African American community to focus on birth control: while black activists realized it could improve maternal health and reduce infant mortality, racists could use it to control African American women's fertility. The ideal patient according to birth control activists was a married white woman with several children who was intelligent enough to use contraceptives to improve her health and marriage and to mimic middle-class family norms, not the "new woman" seeking birth control for career purposes nor the "unfit" woman of color eugenicists criticized.

Local activists rejected hereditarian eugenics, believing instead in environmental causation. While eugenic rhetoric may have influenced many doctors and social workers to recommend clients to clinics, there was no concerted effort on the part of clinic staff to decrease so-called "unfit" populations. Unlike forced sterilizations during this time period or Norplant and Depo-Provera later in the twentieth century, no one could compel women to use a diaphragm against her will.

Hajo's important contribution comes in the last chapter of the book dealing with the relationship between local clinics and national organizations. Her work places recent local studies in a better understood historical context. Other sections of the book become a bit repetitive. In particular, chapters on "Clinic Activists" and "Eugenics and Race" pose overlapping ideas and some conflicting arguments. Blending these two chapters into one strong examination of the impact of race and eugenics on clinic activists would strengthen the book. The class analysis throughout needs to be more nuanced: Hajo uses "poor" and "working class" interchangeably to refer to the clients at clinics. Despite the narrow temporal...