The historical analysis of abortion prohibition and eugenic sterilization laws illustrates the argument that state policies to control fertility are policies directed at women’s sexual autonomy and reproductive freedom as well as at control of population quantity and "quality." These policies take different forms for women of different classes, yet the denial that any women should be the final arbiters of their relation to motherhood and their sexuality clearly underlies all such policies, whatever their class and racial dimensions. This would seem a potential unifying basis around which feminists might have developed a program that could transcend the barriers of class and race to address the forms of oppression specific to women as a whole. But it was precisely the strength of class and race divisions and the translation of these divisions into the sex-race — class dichotomy of "pure women" and "lustful women" that prevented such unity, or even a perception of common interests. Instead of feminists of the "first wave" ardently supporting legal abortion and expressly opposing compulsory sterilization, the opposite was the case. And the stand they took—opposing abortion and supporting involuntary sterilization of the "unfit"—was a direct product of the classist and racist biases of feminists and their dissociation of sex from the birth control issue.
This was particularly true of the accommodationist leadership of the feminist birth control movement, especially Margaret Sanger. There is no need to retell Sanger’s story. It is her ideas and her political influence, particularly in regard to the medical profession and abortion and to the eugenics movement, that I wish to highlight. Sanger’s early sympathies unquestionably lay with socialism, feminism, and the sex radicalism she learned from Havelock Ellis. In Woman and the New Race (1920), she strongly identifies the "problem of birth control" with the struggle of women for their emancipation and woman’s fundamental need to "own and control her body," sexually and productively. She insists "that no woman should be a mother against her will." "Woman must have her freedom— the fundamental freedom of choosing whether or not she shall be a mother and how many children she will have. Regardless of what man’s attitude may be, that problem is hers—and before it can be his, it is hers alone."65 She condemns "the church’s code of sex morals," which violates women’s "basic sex rights" and condones "lawful rape" in marriage, advocating instead the spread of birth control information as a means of "removing the fear of unwanted children" and helping woman to "know her own body, . . . her sexual nature."66
But Sanger’s main focus throughout the 1920s and 1930s was to win acceptance for birth control and establish its legality, and this single — mindedness made for serious contradictions in her ideology and her politics. On the one hand, she consistently opposed the restriction of birth control to "medical indications," believing that social and economic problems were at least as valid, and far more frequent, justifications. On the other hand, her consuming desire to gain legitimacy and respectability for the movement led her, in the 1920s, to seek the endorsement of "influential doctors," courting their favor and in large measure deferring to a medical model of birth control dissemination. Strategically, this meant: (1) on the level of her own clinic, always referring patients to a doctor for prescribing and fitting birth control devices; (2) on the national level, making political compromises to win medical support for her organization, the American Birth Control League; and (3) on the level of confronting the state, pursuing legal loopholes that seemed to allow birth control if confined to the supervision of licensed doctors for purposes of preventing disease.67
Thus, Sanger’s major legal strategy for years was to push for "doctors only" bills in state legislatures, which would allow birth control dissemination on the condition that licensed M. D.s would be in charge. While the bills failed in most cases, the politics they grew out of were successful in "drawing doctors into the birth control movement."68 In turn, the support of the medical profession undoubtedly contributed to the legitimation of birth control, but on terms that doctors could live with. Paradoxically, the long-standing disdain of the medical profession for birth control led to the proliferation of private birth control clinics, operating outside hospitals and physicians’ offices; yet these same clinics (constantly vulnerable to police harassment) ultimately achieved their legitimacy through deference to a "very strong medical bias," including "a highly conservative attitude toward abortion, sterilization, publicity, and non-medical personnel."69
Sanger’s eagerness to win over the medical profession to birth control helps to explain her persistent opposition to abortion. Her grim experiences as a public health nurse and her rage over the death of Sadie Sachs notwithstanding, a look at what she writes about abortion reveals an uncritical acceptance of the current medical dogma. Like many feminists before her, she sympathized with poor women who were the victims of an experience that was "humiliating, repulsive, painful and too often gravely dangerous."70 But rather than blame the illegal and unhygienic conditions under which poor women’s abortions were performed, she blamed the procedure, characterizing it as intrinsically "horrible" and associating it with the "savage" methods of fertility control, infanticide and abandonment. Citing many medical sources, she claimed that the numerous risks to health and life, such as uterine perforation, sepsis, and subsequent sterility are "always" present in abortion, without specifying factors of age, timing, or the use of antiseptics and sterile facilities. These risks, as we now know, were mainly the result of inadequate conditions and care rather than inadequate technology; and if this "knowledge" was absent in 1920, it was the dominant political discourse, which cast abortion as evil and unsavory, and not the limits of medical science that made it so.
If abortion once again in the late nineteenth and early twentieth centuries became a "recourse of the desperate," this had not always been the case. If upper — and middle-class women’s use of abortion declined in that period, and that of poor women became more dangerous, it was largely because of the harsh ideological campaign and the stigma of criminality perpetrated by the medical profession. Sanger’s object in attacking abortion so intensively is forthrightly polemical: to persuade that same medical profession that contraception is the only possible antidote to abortion. The crux of her argument in Woman and the New Race is to portray abortion as the "cruel" and "repressive" alternative to legal contraception, an alternative that no woman would resort to if she were "not denied the knowledge of scientific, effective contraceptives":
The question that society must answer is this: Shall family limitation be achieved through birth control or abortion? Shall normal, safe, effective contraceptives be employed, or shall we continue to force women to the abnormal, often dangerous surgical operation?
"Contraceptives or Abortion—which shall it be?"71
Not all feminist birth control advocates accepted a medically oriented strategy or opposed abortion. Mary Ware Dennett of the Voluntary Parenthood League, for example, expressed a more feminist view than Sanger’s when she argued that "doctors only" bills "removed the technique of birth control from a woman’s own control" and left her susceptible to doctors’ moral censure. Antoinette Konikow, the socialist doctor, argued that the effect was to suppress mass interest in birth control as a popular issue, a women’s issue, and to transform it into a medical interest.72 Indeed, this warning turned out to be prophetic. Constrained in a medical straitjacket to secure legitimacy, birth control and abortion would not again become the focus of a mass movement until the late 1960s. Even in the early twentieth century, however, strong-voiced feminists consistently supported the need for and potential safety of abortion for masses of women, against the feminist mainstream. Stella Browne, the English socialist-feminist and ardent birth control activist, took Sanger to task (without naming her) for her position on abortion. Writing in 1922, Browne unveiled the medical and misogynist politics behind the appeal to "safety" when it was society that denied antiseptics and hygienic facilities to poor women:
… I am profoundly convinced that [abortion] is a woman’s right, and have argued the case for that right in the Press, both in England and America. I am told, however, by one of the leaders of our movement, to whose penetrating judgment and wide nursing experience I give the highest honour, that abortion is physiologically injurious and to be deprecated. It is open, perhaps, to question whether the effects of abortion itself have been sufficiently separated from the appalling bad conditions of nervous terror, lack of rest and lack of surgical cleanliness in which it is generally performed. . . .
It is up to science to meet the demands of humanity. . . that life shall be given. . . "frankly, gaily," or —not at all. Which shall it be?73
In its quest for legitimacy, the birth control movement, under Sanger’s leadership, turned increasingly to the medical profession and the elite professionals who espoused eugenics. The story of the conservatizing influence of eugenics ideology on birth control activism has been told amply by historians. According to the pessimistic judgment of David Kennedy, Sanger’s biographer, by the late 1920s "eugenics dominated birth control propaganda and underscored the conversion of the birth control movement from a radical program of social disruption to a conservative program of social control."74 Linda Gordon recapitulates this theme in her notion that birth control from the 1920s through the following decades shifted "from women’s rights to family planning." Sanger’s strategy, which became that of Planned Parenthood, was to give birth control an aura of scientific and medical respectability by assimilating it within the framework of social engineering ("planning") and public policy. In practical terms, this meant forging alliances with professions closest to organized power in the domains of reproduction and population—physicians, eugenic-minded academics, and administrators of the incipient "social welfare" bureaucracies. Such alliances inevitably meant ideological and political compromises. The costs to a radical (i. e., socialist and feminist) birth control movement were (1) the continued suppression of abortion, (2) the indelible linking of birth control as public policy with racist and class-biased assumptions about who should reproduce and who should not, and (3) the relinquishing of control over the administration and conditions of fertility control to medical professionals and planners. Historically this meant a shift away from a focus on individual women’s right to and need for sexual and reproductive autonomy (i. e., feminist criteria) and toward a focus on "medical necessity" in a narrow sense, populationism, and the fiscal problems of the state.
What is often unseen is that the "professionalization" of birth control, the perversion of its feminist aspects, also involved the desexualization of the birth control issue. Family planning, as propagated by the new coalition of professional birth controllers (in 1942 Sanger’s Birth Control Federation of America became the Planned Parenthood Federation of America), eugenicists, and physicians, attempted to "decontaminate" as it medical — ized and technocracized fertility control. This meant depoliticizing it, removing its sexual connotations by reinforcing a "hygienic" concept of sex as not only strictly marital, monogamous, and heterosexual but also an aspect of "good adjustment" to marriage.75 If birth control were to appeal to the sexually conservative medical profession and their like — minded colleagues in eugenic circles, it could hardly feature woman’s discovery of her "sexual nature," of which Sanger had been among the most passionate exponents.
Feminist activists did not create the essentially eugenic-minded nonfeminist alliance that dominated fertility control politics in the United States from the 1920s to the 1970s. Ironically, however, some feminists, through their ideas and their practical affiliations, served as "midwives" to a configuration of powers that legitimated birth control by (1) extracting from it any feminist or sexual content and (2) linking it to programs of coercive population control. Many prominent birth control advocates, from the 1910s to the 1930s, in England and America, "had strong eugenic backgrounds."76 Like their nineteenth-century predecessors, they participated in the dominant ideology that surrounded them. Sanger’s eagerness to court the middle-class professionals who promoted eugenics sometimes caused her to adopt their rhetoric. "More children from the fit, less from the unfit—that is the chief issue of birth control," she wrote in 1919. And while she "usually strove to avoid an ethnic definition of ‘unfit/ " she occasionally cast aspersions on "foreigners" and allowed rank racists like Paul Popenoe to write in the Birth Control Review.11 The "myth of the menace of feeblemindedness" and the notion of "unfitness" (based on physical rather than class, racial, or ethnic characteristics) had broad currency in the early twentieth century and were uncritically accepted by many socialists, feminists, and progressive reformers. Emma Goldmann certainly had a notion of the "sickly, feeble and decrepit" whose birth ought to be prevented. Caroline Hadley Robinson was not only blatantly hostile to abortion but just as blatantly supportive of eugenic sterilization of the "unfit" (by whom she meant the feebleminded, deaf-mutes, the blind or crippled, and other such "defectives").
While embracing elements of eugenic ideology, did white middle- class feminists in some ways transform that ideology? Like the proponents of "voluntary motherhood" in the late nineteenth century, feminists such as Sanger and Charlotte Perkins Gilman took strands of the dominant ideology—in this case, eugenics—and fashioned them into a peculiarly feminist variation that combined the notion of individual choice with the notion of moral duty. In her vision of a "new race" Sanger distinctly avoids racist or biological determinist arguments to explain the "social handicaps" of the poor, arguing instead that "the cell plasms of these peoples [immigrants] are freighted with the potentialities of the best in Old World civilization."78 Yet, while Sanger seems to blame the conditions and not the poor for the horrors that oppress their lives, the antidote she envisages is the standard eugenic one: "The most immoral practice of the day" is not economic exploitation but "breeding too many children."79 Thus, birth control and woman’s "right to choose" become vehicles toward bettering "the race" and achieving the ideal of a "melting pot"; motherhood, freely chosen, is eugenic:
We know that in each of these submerged and semi-submerged elements of the population there are rich factors of racial culture. Motherhood is the channel through which these cultures flow. Motherhood, when free to choose the father, free to choose the time and the number of children who shall result from the union, automatically works in wondrous ways. It refuses to bring forth weaklings; refuses to bring forth slaves; refuses to bear children who must live under the conditions described. It withholds the unfit, brings forth the fit; brings few children into homes where there is not sufficient to provide for them. Instinctively it avoids all those things which multiply racial handicaps. Under such circumstances, we can hope that the "melting pot" will refine. . . .80
The appeal to "maternal instinct" and "responsible" childbearing became a central element of eugenic ideology, just as it had been of Malthusian ideology in an earlier period. Feminists such as Sanger and Gilman may well have played a key role in fabricating this ideological synthesis and thereby in softening the eugenic creed and winning it broader legitimacy. In so doing, however, they were demanding that maternity become a realm of individual self-determination and full human dignity, and this was far from the aims of eugenicists like Davenport and Popenoe. Indeed, eugenicists became disenchanted with birth control when it seemed to be having a greater impact on middle-class women’s fertility and sexual practices than on the poor.81 Despite political and institutional alliances, the tension between sexual control and population control remains deep, and so does that between feminists and populationists.
In the final analysis, the deradicalization of the birth control movement in the interwar period did not result from the failures of feminism or individual feminists, but from a much broader set of conditions that contained the power of radical social movements as a whole and kept birth control radicalism, feminism, sexual liberation, and socialism from coming together in a single movement. Sanger’s reliance on the medical profession and eugenicists was not the result of opportunism or ambition but of the absence of a mass feminist and working-class movement that wholeheartedly struggled for sexual liberation and reproductive freedom. Gordon attributes this absence in the pre-~World War I period in part to the deliberate "silence" of the American left on the subject of birth control. Socialists such as Kate Richards O’Hare and the male-dominated organs of the Socialist Party accepted a traditional Victorian view of woman’s place in the family and the primacy of her childbearing function. The major feminist organizations—the National American Woman Suffrage Association, the Woman’s party, and the Women’s Trade Union League—also shied away from an active commitment to birth control, to say nothing of abortion. This reticence grew out of feminists’ acceptance of "race suicide" and "maternal instinct" dogma and still more, at least for the older generation of suffragists and feminists, out of their fears of the sex radicalism and "promiscuity" they associated with birth control politics.82 These two tendencies—the sexual puritanism of first — and second-generation feminists and their sense of class and racial superiority— were deeply connected.
Thus, feminist sexual conservatism and socialist antifeminism combined to effectively cut off the birth control movement from links with broader socialist and feminist organizations. In the next two decades, what had been serious lapses in consciousness among feminists and socialists—a failure to transcend barriers of race and class and divisions of gender—were compounded by, first, political and ideological repression and then an economic depression that swept up all radical forces into the struggle for jobs, social welfare, and industrial unionism. The now professionalized birth control organizations existed completely separate from this struggle, and separate too from the lives and identities of poor and working-class women. Harboring a missionary, eugenic purpose vis — a-vis the poor—a purpose that would be assisted but never fully taken over by the state from private agencies—these organizations reflected the split in reproductive services and policies between the dispensing of population control to the poor and the private market in services for the middle class and the wealthy.
This capitalist dualism, which the state upholds through laws and institutions that codify the dichotomy between "private choice" and "public service," itself contradicts a feminist vision. It precludes a concept of control over reproduction that unites the needs and conditions of all women, as a common social question, and assumes that all women are fundamentally capable of exercising "choice."83 The dominant population organizations in twentieth-century America have, to their credit, disseminated birth control among women throughout the world. But they have done so in a way that is consistent with the interests of the capitalist state by maintaining a class-divided system of distribution and a professional doctrine that divorces fertility control from women’s need for sexual self-determination. This is the foundation of the fertility control policy adopted by the state in the mid-twentieth century.