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

Whereas previous studies of birth control in the United States have focused on leaders of the movement, examined national organizations, or provided case studies of a particular clinic, Birth Control on Main Street attends to the hundreds of clinics scattered across the country beginning with Margaret Sanger's Brownsville clinic in 1916 and extending through the Great Depression, just before the establishment of Planned Parenthood in 1942. In this meticulously researched book, Cathy Moran Hajo, associate editor of the Margaret Sanger Papers, argues for the importance of examining birth control activists' actions over their ideologies, and her study shows the many differences between national activists' efforts to accomplish the movement's goals and local activists' efforts to provide birth control to their communities. National organizations like the American Birth Control League, the National Committee on Federal Legislation for Birth Control, and the National Committee for Maternal Health developed and attempted to implement organizational strategies from the top down, but local activists provided grassroots clinical services and were more attentive to local politics than national ones.

Hajo makes several important contributions to the field. First, she finds that while female leaders of national organizations in the 1930s deliberately brought men into the fold and into leadership positions in an attempt to gain respect for their cause, clinic work at the local level remained female-dominated, and thus when national activists were displaced by men, local female activists remained in positions of power. Second, she finds that independent clinics run by laywomen were more successful than institutional clinics. Although she identifies diversity across clinics, Hajo determines that the majority of clinics existed in urban areas, were created and run by wealthy, white women with grown children whose reputations often shielded them from accusations of immorality, and catered to a primarily white, working-class (rather than destitute), female clientele. Clinic activists are the main subjects of this study, and Hajo carefully unpacks their work and their relationship to the national movement. Third, when examining the controversial issue of eugenics, Hajo maintains that local activists may have spoken the eugenic language employed by national activists, but they did not use their clinics to practice eugenics. Hajo convincingly shows that the vast majority of activists treated patients with respect and approached each patient as an individual. Finally, Hajo determines that local activists resisted national organizations' efforts to create a structured, hierarchical movement. They found inspiration in national leaders, especially Margaret Sanger, but once they had created a clinic, local activists focused on local rather than national goals and resisted or ignored national activists' efforts to influence their work.

Hajo is well aware of the limits of her sources, which include journals, clinical records, newspapers, medical journals, and records of national organizations and leaders, especially in relation to their ability to shed light on the patient experience. But she compensates by making smart use of the sources available, particularly statistical reports of clinics, letters from patients before they arrived at the clinic, and clinic activists' internal correspondence to convincingly argue for patients' agency. Hajo describes patients as "discerning consumers" who "accepted the rhetoric of the birth control movement when it suited their needs and rejected those who did not" (124). Hajo had an even more difficult time locating the voices of women of color as organizers and patients in clinics. Most birth control clinics catered to a white clientele, and their founders believed that the creation of clinics for nonwhite women should come from nonwhite activists, not a surprising sentiment during the Jim Crow era. Hajo concludes that most black female reformers did not view birth control as a priority and therefore did not develop these institutions in their local communities.

Given the current debates over birth control and insurance coverage as well as federal funding of Planned Parenthood, Hajo's book is a timely one. She successfully takes a...