Contraception Controversies: The Clinic, the Pill, and the Birth Control Movement

The history of birth control continues to capture the interest of American history scholars and students alike. Specialists in gender and women’s history, as well as the history of medicine, have produced important scholarship on the history of abortion, sterilization, and contraception. Cathy Moran Hajo, in Birth Control on Main Street: Organizing Clinics in the United States, 1916–1939, and Elaine Tyler May, in America and the Pill: A History of Promise, Peril, and Liberation, provide the latest additions to the history of reproduction. They illuminate some of the key contraception controversies of the past and among historians, reminding us of the significance of the fight for reproductive rights to the history of modern America.

In Birth Control on Main Street, Cathy Moran Hajo explores the development of birth control clinics, arguing that they were the center of the birth control movement in the early twentieth century. Hajo is an adjunct assistant professor in the Archives and Public History Program at New York University and an associate editor of the Margaret Sanger Papers Project. In her book she draws on a rich set of primary sources to provide details about the birth control movement at the local level across the U.S., focusing on the 1920s and 1930s. Evidence from more than 600 clinics reveals what birth control activists did, not just what they said. It reveals the birth control movement from the perspective of clinic workers and local activists who served approximately 300,000 clients. Hajo suggests that, to date, historical studies have either painted merely the broad strokes of the national story or they have provided detailed case studies of a single location. In this work she reveals the nationwide story of how birth control activists put ideas into practice.

Hajo explores the constant debates at the local level over who should organize and control the clinics, who should be served there, and what should be provided to clients. Like historian Rosemarie Holz, Hajo turns to the clinics and finds a variety of clinic models, admission policies, and clinic activists. Hajo identifies three major types of birth control clinics: clinics within institutions, such as hospitals and public health agencies; clinics within settlement houses; and independent clinics. The independently run, freestanding clinics made up over half of the 654 clinics that she found. Clinics went by a number of names. According to Hajo: “Clinics in the 1920s and 1930s called themselves ‘Birth Control Clinics,’ ‘Maternal Health Clinics,’ ‘Family Relations Centers,’ ‘Sex Hygiene Services,’ or ‘Mothers’ Clinics’” (p. 184). No doubt this variety added to the confusion for clients attempting to locate birth control services. In all three settings, the clinics served as a medical facility that disseminated birth control information and provided contraception. In the interwar years, the clinics promoted the diaphragm with spermicidal jelly as the solution to women’s contraceptive needs. These community-based centers were usually founded and funded by laywomen, with working-class women as the target client for clinic services.

Hajo devotes one chapter to addressing the impact of eugenics and racism on the work of birth control clinics. First, she examines how the concepts of “fit” and “unfit” played out in clinic practices, arguing that birth control activists provided services to all white women, despite the eugenic rhetoric they sometimes employed. She indicates that eugenic language was evident, but not eugenic practices. Clinic workers neither denied access to contraception to those deemed fit nor forced contraception on those women deemed unfit to be mothers.

Second, the chapter demonstrates that the clinics discriminated against African Americans through neglect, exclusion, and segregation. In line with other scholars, Hajo finds that white activists sought to aid European immigrant women but not poor black women. Instead, she...