Woman of Valor (9 page)

Working part-time with Lillian Wald's Visiting Nurses Association in the immigrant districts of New York's Lower East Side, Margaret was exposed to the social pathos of a poverty hauntingly familiar to her from her own youth in its victimization of women and children.
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Unlike Wald and the legions of economically secure men and women who swelled the ranks of the social settlement houses and reform associations of the era, however, she never found working among the poor a personally redeeming experience. She could never understand the rich and colorful “Spirit of the Ghetto,” portrayed in the classic book of that title by her contemporary, Hutchins Hapgood, and immortalized in the compelling photographs of Jacob Riis. Where they saw hope and possibility, she saw only the degradation and despair wrought of ignorance, poverty, pregnancy, abortion, child abandonment, and child labor.
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These contrasting viewpoints derived from differences of background and personality and from the simple fact that where others brought pencil or camera to their work in the tenements, she carried the instruments of the midwife and a strong identification with her clients' plight. An inherent sympathy for the sufferings of poor women—intensified, perhaps, by an unspent grief for her mother and increasing anxiety about her own uncertain prospects—gave coherence to her political indignation. The intimate community she discovered with the women of the Lower East Side became the avenue of her social concern. As she watched groups of fifty women, shawls over their heads, line up outside the office of a $5.00 abortionist, even the small comforts of her own marriage and family life seemed a reproach to her.

What she came to think of as an “awakening” allegedly occurred in the service of a young Jewish immigrant woman named Sadie Sachs, whom Margaret nursed in a Hester Street tenement through the complications of a self-induced septic abortion. Countless times through her fifty-year career, she would repeat the saga of Mrs. Sachs's broken plea for reliable contraception and the doctor's callous rejoinder that she tell her husband, Jake, “to sleep on the roof.” As Margaret always told the story, she had volunteered her personal knowledge of condoms and coitus interruptus, the commonplace contraceptives of the day which she found unacceptable, because they placed a heavy burden of control on men. Three months later she returned to find Mrs. Sachs dying of septicemia and resolved to abandon “the palliative career of nursing in pursuit of fundamental social change.”
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Sadie Sachs may have existed in fact or may have emerged as an imaginative, dramatic composite of Margaret's experience, but the prevalence of maternal mortality and morbidity in the urban ghetto she confronted is indisputable, a situation directly attributable to the absence of effective public health programs that offered prenatal care and to a high incidence of criminal abortion among the poor.

The practice of abortion had been well-established in New York and in other of the nation's cities since the middle decades of the nineteenth century. Commercial abortionists first began advertising their services in the 1830s, when the elimination of fetal life before the perception of movement by the mother—or “quickening” as it was then known—was still considered legal under prevailing common law statutes. Soon thereafter the procedure was criminalized in England, where prohibitions were ostensibly necessary to protect women from medical malpractice, but Americans remained more permissive than the British, with most states here first promulgating statutes that regulated intervention only after quickening. The physical or chemical interruption of fetal development early in pregnancy continued to be widely regarded as a “natural cessation of the menses” and, as such, a relatively safe recourse for married women wishing to terminate a pregnancy. By the 1850s, it was estimated that one out of every five to six pregnancies in America was willfully terminated. So bold and competitive was the market for abortion that journalists began to question, not so much its morality, as its independence from any regulation whatsoever in terms of price, quality and availability to the unwed.
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Journalistic attention to the abortion phenomenon in turn succeeded in arousing the concern of an expanding community of university-trained physicians, who expressed alarm about the potential dangers to women. Fundamental scientific developments were steadily increasing scientific understanding of human physiology and of the etiology of disease, and with these advances, doctors with formal training began to enjoy a professional advantage over allopathic, homeopathic, and other irregular medical practitioners. The physician's status still remained insecure, however, in such routine matters as childbirth, where the benefits of their intervention were not always realized—in fact, where they often did unintended damage—until reliable antiseptic and anesthetic procedures were introduced late in the century. Obstetrics and gynecology thus became an early testing ground for the introduction of professional medical standards and the hegemony of physicians over midwives.

The American Medical Association was founded in 1847 and within a decade began undermining practices widely identified with their less-educated, and in many instances, female, medical competitors. For the next thirty years, it launched a virulent and determined campaign against abortion, which advanced a moral argument for the protection of fetal life at all stages of development from barbaric, primitive interventions and also played upon the class, race, and gender tensions developing as a consequence of the steady erosion of fertility among native white American women. The reputation of abortion—if not its actual practice—was considerably undermined by this campaign and the legislative prohibitions it produced. Abortion nonetheless remained prevalent, especially among the waves of non-English speaking immigrants, who had trouble gaining information and access to contraceptive supplies. A small sampling of immigrants on New York's Lower East Side in 1917 would determine that about a third knew of no birth control methods at all, other than abortion, the practice on which many of them relied. The remainder had used unspecified forms of prevention, but with limited success.
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A 1916 study of more than 160,000 female policy holders in New York by the Metropolitan Health and Life Insurance Company then revealed that one fourth of its claims were puerperal related. Moreover, of these, at least another quarter did not result from normal pregnancies but, instead, involved the complications of admitted abortions, of septicemia probably related to attempted abortion, or of unspecified “acute diseases and conditions.” These bleak numbers propelled the company to sponsor preventive medical programs, including the Visiting Nurses for which Margaret worked, and these private gestures paved the way for an organized campaign for publicly assisted preventive health care programs. For years, it became common practice to display comparative national statistics that showed the United States near the bottom of the chart with a maternal mortality rate of approximately seven deaths per 1,000 live births, a figure comparable to that of developing nations with notoriously low medical standards, and far below that of countries like England and Holland, where urban health and social welfare programs were more advanced. No progress would be made until the 1920s, however, when a national public policy of maternal and infant welfare through the Sheppard-Towner Act briefly funded public health clinics for poor women and children, the only comprehensive federal health program of this nature that existed until the 1960s.
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Lecturing before Socialist Party women in New York in 1910 and 1911, Margaret dramatically evoked the pathos of the lives of poor immigrant women and condemned public prudery for prohibiting open discussion of sexuality and reproduction, leaving them the innocent victims of their own ignorance. Her popularity resulted in an invitation from John and Anita Block, editors of
The Call
, New York's popular Socialist daily, to write on sex education and health for the Sunday supplement's women's page, which was read by Socialist audiences throughout the country.

Though they may appear cautious by contemporary standards, Margaret's graphic descriptions of the reproductive process and of sexuality in childhood, adolescence, and adulthood, presented in 1912 and 1913 under the column head “What Every Girl Should Know,” aroused a furor among many reticent
Call
readers. Journalistic restraint about sexual subjects was still the norm. The pioneering case studies of British sexologist Havelock Ellis had been published here only in limited-circulation medical texts. Freud had just recently made his first visit, and his work was just being translated, but his ideas were only beginning to permeate the public consciousness. For a woman to write about sex was especially provocative. To tackle such subjects as pregnancy and abortion, masturbation, menstruation, and defloration, the material of Margaret's first forays as a columnist, demanded considerable courage, even though she took a traditionally Victorian and conservative view of sexual excess, especially with respect to masturbation, which she condemned as harmful on the grounds that it made the experience of sexual gratification in conventional intercourse more difficult.

In fact, the series provoked a full page of letters in response, ranging from the one reader who said she “blushed” but found the articles “indicative of a higher, purer morality than whole libraries full of hypocritical cant about modesty,” to another who canceled her subscription to the paper, taking offense over Margaret's candor and her incendiary ideas. In a coda to the series, Margaret insisted that existing economic and social arrangements fundamentally compromised and degraded women by forcing them to rely on men for support. She set forth a rudimentary but nonetheless radical argument demanding economic and social freedom for women so as to permit greater autonomy in choosing a mate and bearing children.

It took several articles that dealt explicitly with the subject of venereal disease, however, to provoke a direct confrontation with the still vigilant public censor, Anthony Comstock. Comstock banned the column early in 1913, and the following week the paper ran an empty box in its place headlined “What Every Girl Should Know—Nothing; by order of the U.S. Post Office.” The action provoked another round of more sympathetic responses from readers, who defended Margaret on First Amendment grounds.
The Call
challenged the post office action, and following machinations with local officials that are not documented, the censored column on syphilis was published several weeks later.
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In an interview in
Harper's Weekly
in 1915, Comstock would boast that in his long career he had convicted enough people of sexual misconduct to fill a sixty-car passenger train and had destroyed hundreds of tons of obscene materials. The lore of his censorship was surely enormous, even if his bold claims vastly overstated the truth.
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Born in rural New England in 1844, Comstock first developed his appetite for righteous moral indignation as a Yankee soldier in the fight against slavery. He then found employment as a dry goods salesman in New York City, where an increasing alarm over the temptation put in his way by local merchants of drink, gambling, prostitution, and vice led him to the Young Men's Christian Association, an organization founded to provide wholesome recreational alternatives for the city's similarly rootless and disaffected. Even after his marriage, however, obscenity remained something of an obsession for him, and with the YMCA's backing, he quit his job to devote himself full-time to saving America's youth from the devil's temptations. “Satan lays the snares and children are his victims,” he wrote. “His traps, like all others, are baited to lure the human soul.”
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Comstock's campaign prospered as a result of a conservative social backlash that followed the Civil War, and its intensity reflected the deep distresses that had been unleashed by the dislocations of that bloody conflict. During the 1870s, native white Americans concerned about the apparent threat to their hegemony from European immigrants and free blacks took refuge under a banner of social purity and religious orthodoxy. They were joined by religious fundamentalists, physicians looking to secure their status, and self-proclaimed feminists who believed they were promoting their own autonomy by regulating sexual behavior and by attacking pornography, alcohol, and vice. Class and gender tensions were thinly disguised in these crusades, which saw zealous reformers calling for the wholesale transformation of culture and baldly associating drinking and vice with poverty, ethnicity, and race.
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Obscenity until this time had not been an indictable offense under common law, but in England in 1868, criminal sanctions were introduced with the provision that the “tendency of the matter charged as obscene was to deprave and corrupt those whose minds are open to immoral influences.” A year later, Anthony Comstock helped secure a similar measure in New York State, one that expressly prohibited traffic in contraception and abortion, and soon he was able to bring federal legislation to bear on the moral pollution that had become his personal demon. With evangelical fervor he committed himself to root out sin wherever he could find it, and to reassert the virtue of biblical imperatives about sexuality and social conduct. So prestigious was the backing of the YMCA, and so effective were his lobbying efforts, that he prevailed on Congress in 1873 to pass the broad but vaguely defined federal obscenity statute, which thereafter informally carried his name. The act vastly expanded existing legislation that narrowly prohibited the transport of obscene literature via the public mails. Comstock cleverly displayed piles of pornographic literature, contraceptive and abortifacient devices, and other allegedly “vile” materials at committee hearings on his new proposal, and without establishing any real evidence, linked them to hysterical allegations of rampant immorality in the nation that no politician risked disputing. His bill was passed by voice vote, with only two Senators and one Congressman objecting to the absence of any floor debate whatsoever.
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