BIRTH CONTROL AND ABORTION IN AMERICAN HISTORY Jonathon Erlen

1
BIRTH CONTROL AND ABORTION IN AMERICAN HISTORY
Jonathon Erlen
2
Let me begin today by stating what I do not
intend to deal with, namely the ethical and moral
aspects of the current birth control issue. I
fully realize that there are several highly
sensitive topics that we will be examining today,
and my major objective is not to convince you
about a particular position on these matters but,
rather, to trace the chronological evolution of
these issues in the context of American history,
focusing both on the important themes which
occurred and the prominent people who helped
shape the changing American beliefs about birth
control.
3
In reality, the birth control movement has been
and remains more a question of social values and
contrasting human motives rather than the story
of technical medical advances. We also have to
accept the fact that American sexual norms have
changed radically over the past 2 centuries. In
this lecture I intend to deal with the wide
variety of birth control techniques used for
various reasons by the American public in the
19th and 20th centuries, including the various
methods of contraception, abstinence, marriage
late in life, and abortion.
4
In 19th century America family size was
drastically reduced long before the advent of
large-scale industrialization and urbanization,
as wellas the public health reforms which
occurred near the end of that century. While the
United States birth rate in 1800 was 7.04
children/family, this figure declined to 5.21
children/family in 1860, and by 1900 the birth
rate had been cut roughly in half from the 1800
number to stand at only 3.56 children/family.
These figures show that the American public had
obviously decided that smaller families were
desirable. There were several reasons for this
dramatic downward trend in family-size.
5
One primary reason was that the emerging middle
class in the United States came to see large
families as a threat to their socio-economic
ambitions. Secondly, the shift throughout the
19th century from a rural, agrarian lifestyle to
an urban, industrial society meant large families
were no longer needed to work the farms. Thirdly,
the essential character of the American family
was changing to a unit based more on romantic
love which allowed for the separation of sex and
procreation.
6
Finally, information about available forms
of birth control techniques was more
accessible to the general public than ever
before. Marriage manuals, commercial
advertisements, and lectures by health reformers,
such as Sylvester Graham, who we discussed
earlier in this course when we examined health
fads, provided information about available
contraceptive methods, advised abstinence or late
marriages to prevent unwanted children, or, if
these methods failed, explained the ease of
getting an abortion.
7
Let's begin by examining the abortion issue in
19th century America, as this part of the birth
control picture was firmly settled, at least for
the next 60 years, by 1900. In 1800 American
women were legally free to terminate a pregnancy
via an abortion unti1 the existence of that
pregnancy was incontrovertibly confirmed by the
perception of fetal movement, which was known as
the doctrine of quickening. This legal view
allowing abortion prior to quickening, which
usually occurred late in the 4th or early in the
5th month of pregnancy, was firmly based on
British common law.
8
Traditional physicians of this era, though
powerless to change this public opinion,
basically opposed abortions because it violated
the Oath of Hippocrates, because they rejected
the doctrine of quickening as being unscientific,
and because abortions were often performed by
midwives or irregular doctors, thus giving an
economic edge to the traditional physicians'
competition.
9
Between 1840 and 1860 the American public's
opinion about accepting abortions prior to
quickening was drastically altered by 4 factors.
First, abortions came out into public view as a
social reality. Newspapers of that era widely
advertised commercial abortionists, as well as
covered trials of quacks caught butchering
patients seeking abortions. Secondly, the number
of abortions supposedly sharply increased. It
was estimated that prior to 1840 the abortion
rate was 1/25 to 1/30 live births, whereas, in
the 1850's and 1860's, this rate had supposedly
shot up to 1 abortion per 5 to 6 live births.
Whether these figures are accurate or exaggerated
they were used effectively by the forces pushing
for anti-abortion laws.
10
A third major perceived change in abortion
tendencies in mid-19th century America was in who
was having abortions. As I stated, prior to 1840
the public believed abortions were sought only by
the unfortunate few. However, after 1840 it
became widely accepted that abortions were mostly
being sought by middle and upper class White
Protestant women seeking merely to limit family
size for their own selfish socio-economic
reasons. There was tremendous concern that this
pattern of abortions among old-line American
women would permit Catholics and immigrant groups
to take over as a dominant socio-political force
in the United States.
11
The fourth and most effective factor leading to
changes in both the publics perception of
abortion and the laws dealing with this situation
was the expanding role played by the traditional
medical profession in opposing this practice.
Working through the AMA and state and local
medical societies the American medical community
actively sought to limit the practice of abortion
to a medical procedure carried out only by a
traditional physician.
12
This anti-abortion movement was lead by Dr.
Horatio R. Storer of Massachusetts beginning in
1857. Storer published numerous journal articles
stirring the medical profession to action on the
abortion issue. Through his efforts the AMA, in
1859, adopted a 3-fold anti-abortion report which
rejected the doctrine of quickening and
encouraged both the national AMA, and the state
and local medical societies to lobby state
legislatures for anti- abortion laws.
13
Primarily because of the effectiveness of the
medical comunity's efforts and the publics
growing concern over the supposed changes both in
terms of the numbers of and who were having
abortions, state legislatures between 1860 and
1900 passed stringent anti-abortion laws. By
1900 abortion was officially, legally prohibited
in all states in the U.S.
14
Interestingly enough organized religion played
little if any part in the 19th century
abortion debate. Even though the
Catholic church in 1869 officially denounced all
forms of abortion, even to save the mother's
life, the Protestant churches refused to enter
this debate. We can therefore say that it was
the medical profession, seeking to extend its
control over this medical procedure, which
effectively lead the anti-abortion efforts in the
second half of the 19th century. The
anti-abortion state laws in place by 1900 would
not be effectively legally challenged or altered
until the 1960's, and not until the landmark l973
Supreme Court Roe v Wade decision were these 19th
century anti-abortion laws finally struck down
and replaced by a more tolerant legal position on
abortion.
15
Turning from the abortion issue we find that
information about other types of birth control
was also widely available in the United States
into the 1870's. Beginning with Robert Dale Owen
's 1831 book entitle Moral Physiology,
non-medical marriage advice manuals had a major
impact by providing interested women with
knowledge about their bodies and how to prevent
pregnancies. Physicians, also, published books
and pamphlets explaining available birth control
techniques to the public. The 2 best known such
works were Fruits of Philosophy by Charles
Knowlton in 1832 and Medical Common Sense, by
Edward B. Foote in 1858.
16
In the 1870's the United States was undergoing a
great crusade, in many ways reminiscent of the
anti-slavery campaign prior to the Civil War.
This new crusade was to make this nation live up
to the supposed sexual ideals of Victorian
society. Conservative businessmen and doctors
joined with the emerging feminists of that time
in opposing not only abortions but also easy
access to birth control information and products.
Into this era ready to accept blatant censorship
in the name of a just cause came Anthony Comstock
to galvanize these factions into effective legal
opposition to all forms of birth control.
17
Comstock, who lived from 1844 to 1915, was born
in New Canaan, CT., and became Americas most
famous, or infamous, anti-vise crusader. At the
age of 18 he broke into a local saloon and
destroyed all its liquor. After serving in the
Union Army during the Civil War he moved to
N.Y.C. to seek economic opportunities. There he
became active in the YMCA and in public crusades
to protect immigrants from the citys lure of sex
and alcohol. Comstock became convinced that
obscene literature was the core of this problem,
as he stated (quote, Cirillo, p. 262).
18
In 1865 and 1872 he went to court against the
circulation of what he judged to be obscene
materials, but he lost both trials. Embittered
by these defeats and now funded by
wealthy, conservative business interests Comstock
lobbied Congress for a new obscenity law and
achieved success with the May, 1873 passage of
the stringent anti-obscenity federal law which
came popularly to be called the Comstock Law.
This law forbid the use of the federal mail to
send out a wide variety of supposed obscene
materials, including anything which even
mentioned abortion or birth control.
19
Thus at the start of the 20th century the
following impediments stood in the way of birth
control advocates. One, state laws prohibited
abortions. Two, the Comstock Law effectively
banned birth control information and products
from the federal mail. Three, there was a lack
of control over the quality of contraceptive
products, as some were blatantly ineffective.
Four, the declining birth rate was perceived by
the public to be a threat to the social order via
differential fertility, thus making birth control
appear as a threat to traditional American
society. Five, the lack of medical research on
birth control techniques meant even those
physicians providing birth control information to
their patients could not be sure of its accuracy.

20
During the first decade of the 20th century the
birth control cause was only openly championed by
a few anarchists and labor leaders, such as Emma
Goldman. Her efforts and those of her radical
colleagues probably brought more discredit on the
birth control movement than helped further this
cause. Yet there were forces in American
society which supported the infant birth control
movement. First, there was a growing problem of
the seeming surplus of children in a rapidly
urbanizing society. Secondly, there was the
concern over the physical hazards of child birth,
as large families were dangerous for both the
mothers' and her childrens health.
21
Into this confusing, highly charged atmosphere,
both prohibiting and promoting birth control,
stepped one of the most influential women in
American and possibly world history Margaret
Sanger, who lived from 1879 to 1966. Between
1914 and 1937 she helped remove the stigma of
obscenity from contraception, lead the fight to
establish a nation-wide system of clinics where
women could receive reliable birth control
services, spearheaded the overturning of the
Comstock Law, and helped lay the groundwork for
organized medicine's acceptance of birth control
in 1937. After WW II Sanger helped in the
creation of the international planned parenthood
movement and the development of the birth control
pill.
22
Sanger was born in Corning, N.Y., as Margaret
Higgins, and grew up with a father who espoused
numerous radical social causes. She attended
Claverack College, then trained as a nurse in a
hospital diploma program. She then married a
young architect, William Sanger, and the couple
had 3 children. After recovering from an attack
of tuberculosis Sanger felt, like many women of
that era, trapped into a life of domesticity. In
1910 she attended a Socialist party meeting in N.
Y. C. which started her on the path to becoming a
militant social crusader.
23
Sanger began her birth control crusade by trying
to publish a newsletter and pamphlets describing
available contraceptive techniques. These
efforts brought her into immediate conflict with
the Comstock Law and its main proponent, Anthony
Comstock. In 1914, facing a possible 45 year
jail sentence for mailing supposed obscene
material on birth control, Sanger fled to Europe,
where for 2 year she lived with and learned from
some of the European leaders in the birth control
and sexual freedom movements, including Marie
Stopes and Havelock Ellis. She returned to the
United States, now convinced that to win her
birth control crusade she needed to win the
support of the wealthy social elite and to gain
acceptance of birth control from the medical
profession.
24
From 1921, when she created it, through 1927,
when internal politics created a division within
its ranks, Sanger ran the American Birth Control
League. Her major weakness was that she always
demanded to be recognized as the sole leader of
the American birth control movement, and her
inability to be a team player in national birth
control organizational politics caused
considerable friction with other birth control
advocates. In 1936 she finally was able to have
the Comstock Law declared unconstitutional in the
famous court decision, U.S, One Package, that now
permitted the mailing of contraceptive
information and devices. Still it was not until
1971 that it became legal for an individual to
bring a contraceptive device into the United
States from abroad.
25
This individual was Dr. Robert L. Dickinson,
a highly respected Brooklyn obstetrics and
gynecological expert who lived from 1861 to 1950.
Prior to his efforts the traditional medical
community had refused to recognize birth control
as a legitimate function of physicians because it
might jeopardize their acceptance by upper and
middle class Americans, because physicians were
concerned about retaining women's traditional
role in American society as the bearers of
children, and because many physician saw birth
control as the realm of the quack, the midwife,
or the ignorant lay reformer, such as Margaret
Sanger.
26
Dickinson left his profitable Brooklyn medical
practice to work full-time promoting the cause of
and researching in the field of birth control.
At first he rejected the plea from Sanger to work
with her and her colleagues. Instead of using
Sanger's early birth control clinics Dickinson,
in 1923, created the Committee on Maternal Health
(CMH) composed of noted physicians to study the
feasibility of the then current contraceptive
devices on the market. It soon became clear to
him, however, that a combination of conservative
physicians and hospital administrators would
prohibit this research so, in 1930, he officially
joined Sanger's Clinical Research Bureau run by
the American Birth Control League.
27
Since 1925 Dickinson and his allies had attempted
to have the AMA officially endorse birth control
as a legitimate medical activity. Finally, in
1937, the AMA accepted a report which 1. called
for AMA sponsored research on contraceptive
devices 2. urged medical school
instruction about birth control 3. omitted any
criticisms of lay-run birth control clinics, thus
tacitly accepting Sanger's work, and 4. told
physicians to give contraception advice based
primarily on the wishes of their patients.
Organized medicine had now legitimized
contraception and Dickinson had been the
mediator through which this had occurred, and his
pioneering work in sexology was the example for
Alfred Kinsey and other later sex researchers.
28
Even with the successes by Sanger and Dickinson
which we have already mentioned, birth control
advocates faced 5 major obstacles in 1940 in
their continuing drive to make safe, effective
birth control available to all families who
sought this type of information and products.
First was the serious concern about depopulation
in the United States. During the Great
Depression the American birth rate in 1936
actually dropped below 2 children/family, or the
replacement level. There was also the continued
strong concern over differential fertility rates,
as American eugenicists feared that birth control
would allow inferior groups within America to
become predominant.
29
Between 1940 and 1960 occurred a major new
impetus to the birth control movement with the
world-wide population explosion. Although after
W. W. II the Communist and the Catholic nations
blocked initial efforts for world-wide birth
control activities, the free-Western nations saw
the desperate need for action on the birth
control front.In 1942, 2 of the competing
American birth control groups merged to created
the still prospering Planned Parenthood
Federation of America, thus removing the stigma
of the term birth control from its title. In
1952, through the inspiration of Margaret Sanger,
the International Planned Parenthood Federation
was launched at a Bombay, India conference.
30
Sanger was very anxious for the success
of this work but realized that neither the
medical nor the pharmaceutical industries would
adequately fund this research. She therefore
persuaded her long-time ally in the birth control
crusade, Katherine Dexter McCormick, to provide
the necessary funds. McCormick was a graduate of
MIT and had married into the wealthy McCormick
family of International Harvester fame and
fortune. Between 1953 and 1960 she poured
millions of dollars into the research which
produced the anovulant pill.
31
The actual research which developed the birth
control pill was spearheaded by a brilliant
scientist and shrewd politician, Gregory Goodwin
Pincus. Pincus received his Ph.D. in the biology
of genetics from Harvard and headed a major
laboratory studying hormonal physiology. Besides
gaining the financial support, via Sanger, of
McCormick, Pincus also received much needed
supplies, equipment, and expertise from G. D.
Searle and Co., a major pharmaceutical firm.
After successful clinical trials in Peurto Rico
in 1958/59, and dogged lobbying of the FDA, the
first commercial contraceptive pill was approved
for marketing in May, 1960, thus opening up an
entire new era in birth control.
32
Contraception was now easy and aesthetic for both
the public and for physicians. Today millions of
women world-wide are using the pill. The major
drawbacks in birth control today are the lack of
either education about or motivation to use
available birth control resources.