The Birth Control Clinic in a Marketplace World by Rose Holz (review)

Rose Holz’s new book contributes to the recent trend among birth control historians to get outside of New York and below the national organization’s perspective to investigate the practices in local Planned Parenthood clinics. Holz focuses on the clinics of Illinois, especially Chicago, augmented by accounts of clinical practices from other locations, and she composes a portrait of the wide variety of practices captured by the phrase “birth control.” In particular, she asks readers to reconsider the relationship of the twentieth-century “charity birth control clinic” (p. 2) and business, arguing that the distinctions between them are far less clear than “birth control propaganda” (p. 4) “would have us believe” (p. 49). Building on work of Linda Gordon, Andrea Tone, and Cathy Moran Hajo, Holz reexamines birth control history to highlight “the materials and ideological intersections” (p. 2) between charity clinics, “bootleg entrepreneurs” (pp. 20–26), and “irregular providers” (p. 55). She argues that the conflicts between charity clinics and patent medicine manufacturers in the 1920s and 1930s and the congenial relationships between Planned Parenthood and pharmaceutical manufacturers in the 1960s and 1970s are as important to understanding this history as are the birth control movement’s conflicts and alliances with the medical profession.

Holz quite effectively argues that the distinction between clinics and commerce has been overstated in the historiography. Charity clinics always participated in the marketplace to some extent. In the 1920s and 1930s they distributed commercial products in the form of diaphragms and spermicidal creams and jellies. She reminds readers that Margaret Sanger helped establish the Holland-Rantos company to ensure a regular supply of high-quality diaphragms. In the 1960s and 1970s, Planned Parenthood clinics bought, tested, and distributed a variety of brands of hormonal pills. Holz also provides accounts of irregular clinical establishments, such as the Lanteen Company, which in the 1930s set up a network of non–medically sanctioned clinics throughout the Midwest. Her principal argument is that the charity clinics derived their legitimacy in part from how they positioned themselves in relation to the marketplace. Their derision for commercial contraceptives in the 1920s and 1930s helped charity clinics to gain legitimacy with the medical profession. During the 1960s, charity clinics greatly expanded their connections to the pharmaceutical industry by conducting research on the efficacy and side effects of the pill. This new relationship reflected the changing attitude of the medical profession to the pharmaceutical industry. For Planned Parenthood, these connections met both practical and political purposes, helping to defray the cost of supplies and bolster the legitimacy of its claim to authority in the field of contraceptive services.

Birth control history is always contentious terrain; competing views of Planned Parenthood represent it as a source of women’s greater freedom or as a cause of the nation’s moral decline. Given this, it is very useful that Holz makes her analytic stance clear throughout her engaging, highly readable narrative. She notes that a trip to the Historical Fraud and Alternative Medicine Collection of the AMA archives led her to reconsider the bright line distinguishing the clinic and commerce. Instead, she found herself growing “more suspicious” of all birth control providers, “charity clinics included,” and at the same time “believing every word, including every word found in commercial feminine hygiene advertisements and also every word in the literature put out by the irregular birth control movement” (p. 49). Her suspicion of charity clinics is exemplified by her characterization of their publications as “propaganda” (pp. 4, 17, 32–33, 70, 75). The trust she places in the market is exemplified by the uncritical presentations of the claims of efficacy and medical backing made by irregular providers and feminine hygiene sellers, such as Lysol. Some readers may find that this analytic stance leads her to present an overly generous reading of the value and motives of commercial contraceptive providers and an overly disparaging view of charity clinics. Even...