Woman of Valor (40 page)

Most significantly, perhaps, Margaret carefully cultivated Arthur Packard, who was by then the senior and most influential member of the Rockefeller charitable staff and could generally be relied on for small bequests whenever asked. Packard took Margaret's side in almost all of the disputes that arose among birth control factions in the 1930s, and when the Bureau of Social Hygiene formally disbanded, he continued to fund the clinic through other Rockefeller family charities. These anonymous donations constituted a substantial percentage of the clinic's small budget at the time, and were supplemented frequently with personal contributions from Abby Aldrich Rockefeller, which she would send in response to solicitations by mail.

Though critical to the clinic's survival, the annual Rockefeller gifts of $5,000 to $20,000 were, of course, negligible in comparison to the millions of dollars the family subsequently made available for family planning. The postwar population explosion would provide a more compelling rationale for the charity of a new generation than Margaret Sanger had given their parents, with her emphasis on the rights of women, the welfare of families, and even the growing public burden of the poor.

The obstacles Margaret faced, as a woman trying to raise money for what continued to be viewed as an institution dominated by women and of principal concern to women, cannot be overemphasized. Caroline Robinson, a Columbia University graduate student in sociology, betrayed an ivory-tower innocence when in 1930 she criticized birth control clinics for their inferior fund-raising efforts. Robinson may have been correct that the movement's brochures and other public relations efforts needed beefing up, but she was foolhardy at the same time to assume that birth controllers could easily “march with all the other health charities…depending calmly on the first-class arguments they are able to muster as well as on the first-class scientific men who have within the last three or four years become eager to lend their names to the movement.” Male advisers undoubtedly opened some doors to the charitable and corporate world they themselves controlled, but so long as Margaret refused to concede her own authority and the paramount position of women in her organizations, her fund-raising abilities would inevitably be compromised. In this respect, the price of her autonomy was high.

Still, she was tireless as a fund-raiser, even as the economic crisis added to the burden of the undertaking. Refusing to be daunted by the much bemoaned declining fortunes of the rich, she wheedled money out of an extensive mailing list with one letter describing the tragedy of the harassed and anxious wife of a man who lost his job. Knowing of no reliable contraception, the woman ostensibly resorted to an illegal abortion, rather than raise another hungry child. This appeal, though genuinely humanitarian in tone, did cautiously play upon the anxieties of conservative, wealthy donors over the potential costs to them of supporting an increasingly dependent population. As the New Deal's welfare programs expanded, Margaret seemed to be tailoring special appeals to this group, even as Roosevelt sympathizers were being asked to give on the contrary rationale: that birth control constituted benevolent public policy and sound economic planning. She was never the least bit reluctant to target her pitch. At one point, five different texts were prepared, seeming to accommodate contradictory political viewpoints and rationales for supporting birth control. In the dry humor typical of her staff, one of these form letters was simply coded to “Dear Mrs. Generous.”
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Clinic donors, whatever their politics, may also have been genuinely moved. The typical Clinical Research Bureau patient, as profiled in the monumental statistical study published by Dickinson and Kopp in 1934, was the thirty-year-old wife of a laborer in the manufacturing trades who earned from $1,000 to $3,000 a year, unless the Depression put him out of work and onto relief. (The study encompassed the years 1923 through 1931, and the economic breakdown corresponded fairly closely to figures for the city's general population, which was slightly above the national average.) She was native born, and Jewish or Protestant, though 26 percent of the clientele was Catholic, probably owing to the large numbers of Catholic women who were forced to enter the labor force in these years. A woman with only an elementary-school education, she had been married just over eight years and had been pregnant four times. One in five of her pregnancies had been aborted. The likelihood that she terminated her first pregnancy was only one in nine, but by the third, one in three, a figure which demonstrated the widespread motivation toward smaller families and a critical need for reliable contraception among married women, especially as the economic crisis worsened. Preclinical failure rates with prophylactics, jellies, suppositories, and other commercial contraceptives had ranged from 45 to 50 percent, suggesting that patients were fertile beyond average and less likely than average to be successful at contraception, whatever the method they employed. If they continued to use the clinic's diaphragm-and-jelly regimen properly, they could expect a failure rate of only about 7 percent.

The study thus proved the superiority of the diaphragm option over any other but also demonstrated that only 55 percent of the clinic patients, with whom contact was maintained, continued to use the diaphragm regularly after a year. Another 16.7 percent used it irregularly. A substantial number of the rejectors, however, did report a higher rate of success with the methods they had employed prior to visiting the clinic, demonstrating that some value attached to clinic visits, in any event.
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This problematic rate of acceptance substantially undermined claims of the efficacy of the method when properly used and, of course, became a source of considerable controversy. In an effort to better understand the rejection problem, Kopp, the statistician who actually conducted the research, analyzed her data in the context of social, economic, and personal factors, such as family income, education, age, and duration of marriage. The clinic had refused to adopt a policy against accepting well-to-do patients, despite the pressure brought by Dickinson and other physicians who feared competition with private practice. Margaret and Hannah Stone insisted on protecting “the personal preference” of any woman who favored the services and setting of the clinic over her own doctor. Approximately 20 percent of the patients were married to businessmen or professionals, and a small number were themselves so employed. Eleven percent were college educated, though these figures increased in subsequent years as more neighborhood facilities were founded to serve the poor, and the Sanger facility became instead a magnet for middle-class women citywide. Kopp demonstrated positive correlations between socioeconomic indicators and success with the diaphragm and thus underscored the limitations of the technique for young, newly married women—especially those of lower incomes and poorer education. Continuous and successful use of the diaphragm assumed a woman's understanding of basic elements of reproduction and sexual hygiene—her psychological willingness to anticipate and prepare herself prophylactically for sexual intercourse—and such elementary practical considerations as the proximity of a private toilet where she could insert it, remove it, and also keep it clean.
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Reservations about the clinic-diaphragm regimen were underscored as well by Margaret's failure to sustain a satellite clinic in Manhattan's substantially black neighborhood of Harlem. In 1930, she secured a $5,000 grant from Sears, Roebuck's merchandising magnate and philanthropist, Julius Rosenwald, and then raised equivalent matching funds to open the uptown facility. Her old friends at the Holland-Rantos Company contributed supplies, and most of the patients, 83 percent of whom were on public or private relief, were treated free of charge. At its peak of activity, the clinic was open four afternoons and one evening each week. It was endorsed by the powerful local black newspaper, the
Amsterdam News
, and by establishment political and religious leaders in Harlem, including the elder statesman W. E. B. DuBois, who condemned what he called “the fallacy of numbers” and deemed the “quality” of the black race more important to its survival. Margaret was invited to address Harlem's largest and most powerful congregation, the Abyssinian Baptist Church, and, after several years, her clinic moved into a larger welfare facility run by the Urban League. Yet, it never developed a steady following.

Part of the problem may have been the inevitable class and racial tensions between clinic personnel and clients. Part was the indisputable fact that many poor women, then as now, derive critical self-esteem and personal satisfaction from their childbearing. There were also important ideological differences in the black community itself. In the early 1920s, the integrationist philosophy of the NAACP had been sharply attacked by Harlem preacher and organizer Marcus Garvey, whose separatist doctrine rejected fertility control as genocidal. Garvey instead embraced traditional Biblical values and boldly encouraged black women to have babies. Though he was personally discredited by 1929, suspicion of contraception endured, especially in the churches.

Sensitive to this predicament, Margaret hired a black physician to improve patient rapport in the clinic and a black social worker to reach out to community social workers and preachers. Local doctors, who reasonably enough feared the competition of white women professionals and were reluctant to refer patients, were also invited in to observe the operation, but all to little avail. After four years fewer than 4,000 patients had been treated, and half of them were white. Margaret would turn the clinic over to the New York chapter of the American Birth Control League in 1936, which closed it a year later. But she refused to accept the verdict that failure was inevitable, because poor black women would not employ diaphragms regularly. To the contrary, she publicized statistics demonstrating that blacks and whites used the diaphragm with equivalent rates of success. Her data also revealed comparable patterns of intercourse in black and white marriages and undercut prevailing racist assumptions about black sexuality. The value of clinic services for blacks was further confirmed by the finding that the medical examination often had functioned as preventive health care. In a high percentage of patients, pelvic inflammatory disease and other conditions in need of treatment had been uncovered, some of them attributable to a high incidence of undetected venereal disease, which probably functioned as a natural check on fertility. Still convinced of the individual and social benefits of contraception, Margaret kept insisting that the problem was not in client motivation, but in the adequacy and accessibility of services. But once the Harlem clinic closed, the argument carried less weight.
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In view of research findings and the practical obstacles encountered by birth control advocates in places like Harlem, doubts about the large-scale utility of the clinic regimen continued to mount. Most damaging was a subsequent analysis of the patient load at the Sanger clinic by Regine Stix, a physician, and Frank Notestein, then a young Princeton University demographer who had sounded a major alarm about the nation's declining population in a 1930 study. The Stix Notestein study was sponsored by the Milbank Memorial Fund, a prominent social science research institution of the era, then led by John A. Kingsbury, former commissioner of public charities in New York City and a personal champion of Margaret's. In 1928, the fund decided to devote its principal resources to the study of demography and sponsored the first comphrehensive study of differential fertility in America, according to social class. Though extremely cautious about guarding the scientific credibility and objectivity of research projects, it decided to cooperate with the Birth Control Clinical Research Bureau in order to study the effectiveness of contraceptive practice.

The work of Stix and Notestein was especially significant, because it unequivocally demonstrated the role of voluntary artificial contraception—as opposed to biological or other factors—in effecting fertility declines. Their more damaging findings had to do with the liabilities of the diaphragm, when its actual “use-effectiveness” was measured. They claimed that the condom offered greater contraceptive reliability, when the high failure rate of the diaphragm was taken into account, and though Margaret quickly took issue with their conclusions, her letter of protest to the Milbank directors was more inspired for its gift of rhetoric than for the weight of its argument: “I fully concur…that the
acceptability
of methods advised is a proper responsibility of the clinic—but I cannot agree that one can ascribe failure of a method to neglect to use it any more than one can say an automobile is not an effective means of transportation because one decided to walk instead of ride,” she wrote. This disclaimer advanced, she then took pains to point out the many concessions the Clinical Research Bureau had made on its own accord as a result of the high diaphragm failure rate.
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While she continued to promote the diaphragm above all other choices, she also encouraged the research arm of her clinic to experiment with simpler contraceptive methods. “We have, alas, gotten into a rut and are working simply as a contraceptive clinic,” she complained at one point to Hannah Stone and then personally instructed medical staff against bias
in favor
of the diaphragm, cautioning them not to give everything else a “black eye.” But the files also bear testimony to the doctors' frequent rejoinder that the pressures of serving an expanding patient population with reliable goods continually pushed this research behind schedule. Margaret was especially concerned that evaluations be made of the effectiveness of the vast array of commercial contraceptive products that found their way onto the pharmaceutical market during the Depression as demand increased. Thus the clinic conducted laboratory tests on all kinds of commercial jellies, foams, powders, and other allegedly spermicidal compounds. At her direction, the quality of various condoms was also compared and the results offered to medical journals, though, at the same time, she remained sensitive to the linking of her name with commercial products.
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