An Emancipation Proclamation to the Motherhood of America
No one in the birth control clinic expected to be raided that day. It was early on a Monday morning in April 1929, and the Birth Control Clinical Research Bureau, housed in a nondescript brownstone on New York's West 16th Street, had just admitted its first patients of the week. Without warning, the clinic's doors burst open, and Detective Mary Sullivan, leading a group of plainclothes officers from the vice squad, strode into the waiting room. Patients sat quietly, some crying, as police seized patient records and stuffed them into a garbage can they were using to collect evidence. Police also grabbed books and pictures off the walls and removed medical instruments out of sterilizers in a frantic bid to prove that the clinic was unlawfully distributing information about birth control. They arrested the clinic's stately, soft-spoken medical director, Dr. Hannah Meyer Stone, as well as another doctor and three nurses, and dragged all five women onto the street in front of dozens of onlookers. As the clinic's founder, birth control activist Margaret Sanger, watched, her clinical staff were loaded into a foul-smelling police wagon and transported to the West Twentieth Street police station.
A month after the traumatic raid, all charges were dropped. The judge ordered the return of all patient files, although patients with Catholic names reported receiving threatening phone calls afterwards, warning them that their private lives would be exposed if they returned to the clinic. Despite the vice squad's best efforts to prove otherwise, the doctors who prescribed contraceptives were well within the law.
Thanks to a 1918 New York Court of Appeals ruling in People v. Sanger, licensed physicians could legally provide information on contraception, as long as it was used primarily for the "cure or prevention of disease." As venereal diseases such as syphilis and gonorrhea spread rapidly through the general population, especially via returning World War I servicemen, the courts followed the lead of public health officials in loosening restrictions on contraception as a strategy for reducing rates of infection. The ruling provided a significant legal loophole for women's healthcare providers and enabled Sanger and her colleagues to open the Birth Control Clinical Research Bureau in 1923. It was the first legal birth control clinic in the United States. By the 1930s, the clinic served over 10,000 patients a year and trained thousands of doctors and nurses in contraceptive methods and clinical techniques.
While birth control activist Sanger was the most famous name associated with the Birth Control Clinical Research Bureau, even she admitted that the clinics' guiding light was Dr. Stone. Born in Brooklyn to Jewish immigrant parents in 1893, Stone earned a degree in pharmacology from Brooklyn College and began working at Bellevue Hospital in 1912. When the United States entered World War I, Stone began her training as a physician at New York Medical School. She received her M.D. in 1920 and then began working at the Lying-In Hospital on Second Avenue. When Stone took her position at the Birth Control Clinical Research Bureau in 1925, her supervisors at the Lying-In Hospital considered her clinic work a conflict, and they forced her to resign from the hospital.
In just few short years of practice, Stone had already witnessed the desperate need for clinical research and care for childbearing women. She eagerly took on the work of running the clinic, which required both intensive data collection and patient-centered work so that the clinic's work could be published and shared in the wider scientific community. In an era when reproductive health was based more on myth than scientific data, Stone's clinical research was essential in establishing protocols for sexual education based on evidence. After recording a wide variation in the length of women's menstrual cycles, for example, Stone argued that doctors should not counsel using a "safe period" approach to birth control, since there was no universal method for everyone. In her 1928 article "Therapeutic Contraception," she found that use of diaphragm with spermicide was the most effective birth control method.
Stone approached birth control as a public health measure that needed to be clearly understood by medical practitioners as well as ordinary men and women. She made sure that women who visited her clinic were properly educated on their own reproductive systems by demonstrating the biological processes of sex and birth with three dimensional models of the pelvis and sexual organs.
The interwar period in which Stone worked proved to be a watershed moment in the history of the birth control movement. As historian Linda Gordon noted in her now-classic history, The Moral Property of Women, the women's rights movement advocated "voluntary motherhood," which emphasized choice and autonomy in the late 19th century. In the early 20th century, the term "birth control" emerged as an expression of social transformation, which was closely tied to the socialist movement. In the 1920s, birth control was eagerly adopted as a strategy of the eugenics movement, binding contraception to social engineering. Sanger first developed eugenics themes in Woman and the New Race (1920) and again in The Pivot of Civilization (1922). She warned that the illiterate and degenerate might destroy the American way of life, and in 1932, she recommended a mass program of sterilization. While many of Sanger's colleagues, including Stone, held serious doubts regarding eugenics, they recognized that Sanger's tireless advocacy was instrumental in gaining legitimacy for birth control within the medical establishment.
Stone developed her own response to eugenics in her 1937 book A Marriage Manual: A Practical Guide-Book to Sex and Marriage, co-authored with her husband, Dr. Abraham Stone. Written in the form of a hypothetical dialogue between a doctor and an engaged couple, the book covered questions ranging from penis size and the female orgasm to concerns about infertility and inbreeding. When asked the question, "How can one tell whether one is fit to have normal and healthy children?" the doctors Stone cautioned that the question of "fitness," while an urgent concern of the eugenics movement, could not be fully supported scientifically. The Stones stressed that environmental factors such as economic and educational levels were more likely to affect birth outcomes than heredity alone. "It is very likely that an improvement or change in the economic and social conditions of humanity may result in considerable regrouping of our social strata," they concluded. "Perhaps such an improvement may accomplish more for social advance than any system of strict eugenic selection which may be applicable at the present time." While Stone would not criticize Sanger's support for eugenics outright, her own work demonstrated that she was not swayed by eugenic approaches to public health.
Although Stone began her career primarily as a clinician with a strong interest in women's health as public health, the political implications of her work turned her into an activist. After the 1929 raid, Sanger enlisted Stone’s help when she began to seek out a test case to challenge the 1873 Comstock Act, which prohibited the circulation of contraceptive devices through the mail. In 1932, Sanger ordered a package of diaphragms, commonly known as pessaries, to be shipped directly from Japan to Stone at the clinic. The package was intercepted by customs officials, which led to a protracted court case and an eventual ruling by the U.S. Court of Appeals for the Second Circuit in U.S. v. One Package of Japanese Pessaries in 1936. The court found that since the pessaries were imported by Stone for "experimental purposes" relating to the cure or prevention of disease, sending them through the mail was legal.
The 1936 decision ultimately reinforced the ability of doctors to prescribe birth control to married women, and it entitled doctors to use their own judgement and discretion in prescribing contraceptives. Sanger called the victory “an emancipation proclamation to the motherhood of America.” The following year, the conservative American Medical Association endorsed the idea of doctor-prescribed contraception, which further signaled the mainstreaming of the birth control movement.
In 1937, writing in The Nation, Stone argued that 1936 had proven to be a major turning point in the history of the American birth control movement. The pioneer era was over, she announced, giving way to an era of clinical research and practice. Due to the Court of Appeals decision in the pessaries case, she declared, "From now on hospitals, clinics, and public-health centers will have to face frankly the responsibility and opportunity of including information on contraception as a part of their health services to the community." Ultimately, Stone looked forward to the "beginning of an era of extensive practical service" and the transition of birth control from a field of controversy to a field of science —"from the platform and the pulpit to the laboratory and the clinic."
After Stone suddenly died in 1941, Sanger's organization, the American Birth Control League, changed its name to Planned Parenthood in 1942, a change that reflected an orientation towards nuclear families and the private sphere, and away from activism and public health. Stone, however, proved instrumental in helping birth control enter mainstream legal, political, and social discourses. While she began her professional career as an advocate for women's health, rather than as an activist, she became an integral player in the interwar drama that shaped the birth control movement and its victories, thereby, fundamentally reshaping the future of women's health in the United States.
Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America. University of Illinois Press, 2007.
Melissa Klapper, Ballots, Babies and Banners of Peace: American Jewish Women's Activism, 1890-1940. NYU Press, 2014.
Image credit: From left to right: Sigrid Brestwell, Antoinette Field, Elizabeth Pissort, Margaret Sanger, Hannah Mayer Stone, and Marcella Sideri via Margaret Sanger Papers Project