Margaret Sanger: A Flawed Heroine for Family Planning

The Supreme Court’s decision in the Hobby Lobby case has started a lot of people thinking about how access to contraception Margaret Sanger has changed women’s lives. The Hobby Lobby decision allows some companies to refuse to pay for all forms of contraceptive care for their employees. If all of the owners of a “closely held corporation” declare that they do not approve of some forms of contraception on religious grounds, then they don’t have to pay for insurance coverage for contraception. The talk about this decision and how it may affect healthcare for all Americans has started a lot of people thinking about the struggle to get any form of contraception approved.

When Margaret Sanger (1879-1966) started working as a nurse in New York City, she saw a number of women who were suffering from their inability to keep from becoming pregnant over and over again. Doctors were not allowed to tell women how to avoid unwanted pregnancies; so many families were doomed to poverty and poor health because they could not afford large families. With contraceptives declared illegal and therefore unavailable to any except the wealthy, many poorer women resorted to abortionists or tried to abort a fetus themselves. When Margaret Sanger, who had seen her own mother die at 48 worn out by twelve pregnancies and weakened by tuberculosis, realized how many women were sacrificed because of their inability to control births, she determined to devote her life to changing the law.

By starting a newsletter, lecturing, and then opening the first birth control clinic in America, Sanger tried to introduce contraception to women. Both she and her sister were arrested at their Brooklyn clinic and charged with distributing obscene literature—information about birth control. Margaret Sanger served a short jail term for the crime, but she received a great deal of publicity and the issue was brought before the public.

It is hard today to remember how the lack of birth control affected women’s lives during the years when it was forbidden. Employers discriminated against married women, refusing to hire them because they might become pregnant at any time. Graduate schools refused to admit married women students with the excuse that their education was wasted because an unplanned pregnancy could derail a degree at any time.

Margaret Sanger fought for many years to make contraception available in the United States. It was a long struggle. By 1965 when the Supreme Court finally decided in the case of Griswold v. Connecticut that contraception should be available, Sanger was 85 years old. A year later she died.

Some of Margaret Sanger’s legacy was unfortunate. She believed in eugenics and favored larger families for well-educated, middle class families. The poor and especially nonwhite people, she believed, should strictly limit their family size. Many of the statements she made during her later years were repugnant, and they have been seized upon by conservative politicians to blacken her reputation. But the major battle she fought—to enable women to have some control over their bodies and the size of their families—was an important one. Much of the freedom enjoyed by women today has come about because of the struggle of Margaret Sanger and her associates.

Today, on the Fourth of July, when we celebrate the legacy of our Founding Fathers—a legacy deeply tarnished by the racism and prejudices of their ideas—is surely a good time to assert again that we can celebrate the achievements of many individuals despite their flaws and mistakes. None of our heroes or heroines were perfect, but we can accept the good that they did at the same time that we cast aside the bad.

The Supreme Court is much like our individual heroes. Some of their decisions have contributed decisively to Americans’ welfare and freedom; others have needed to be modified as time revealed their flaws. As for the Hobby Lobby decision, it seems quite likely that the best that can come from it may be the movement toward having single payer healthcare in the United States so that the health and happiness of Americans depend on themselves, through their elected government, and they are freed from the idiosyncratic and sometimes irrational beliefs of their employers.

Elizabeth Blackwell–Changing American healthcare

This week attention has been focused on the Supreme Court and its decision on the Affordable Care Act. People have strong opinions about health care and who ought to provide it. It made me think of the early days of America, before the Civil War, when one of the problems women had to face getting medical treatment was having to discuss their intimate concerns with male doctors. Elizabeth Blackwell an ambitious young immigrant from England became aware of this when a friend of hers died of a medical problem that she was too embarrassed to name.First day cover of Elizabeth Blackwell stamp.

“Would you like to have a woman doctor?” asked Elizabeth. Her friend thought this would be a blessing, but quite impossible to achieve because women could not become doctors. In fact, Elizabeth discovered that the term “lady doctor” at the time meant a female abortionist. Elizabeth, who was a devout Christian, shuddered at the thought of being compared to an abortionist, but she determined that she would become a doctor. It was not an easy task.

The first task was to find an individual or institution that would help her study medicine. When she wrote to one sympathetic doctor friend, he responded in a long letter saying that “it is appropriate that man be the physician and woman the nurse”. Others told her that women would never accept treatment from another woman. A Quaker friend wrote to her when she applied to medical schools, “Thee cannot gain admission to these schools. Thee must go to Paris and don masculine attire to gain the necessary knowledge.” Elizabeth rejected the idea of disguising herself in her pursuit of education and continued to look for smaller medical schools that needed more students.  She would not take no for an answer. Eventually she found a college in Geneva, New York, that accepted her on condition the students would vote to accept her. To her delight, the students proved more accepting than the faculty. They voted unanimously to accept her and pledged that “no conduct of ours shall cause her to regret her attendance at this institution.”

The students kept their word. They treated the 26-year-old Elizabeth with respect, almost like an older sister, she reported. She completed her studies, even being allowed to attend the anatomy classes and dissections that had been considered impossible for women to endure. In January 1849, Blackwell became the first woman in the United States to receive a medical degree.

Gaining a medical degree did not, of course, erase the prejudice that remained against women practicing medicine. Elizabeth and her sister Emily, who also became a doctor, struggled for years to gain acceptance in the medical profession. Eventually they opened an infirmary for women and children in New York City. They practiced during the Civil War and, being strong abolitionists, prepared nurses to work with the Union troops.

In later life Elizabeth Blackwell divided her time between England and the United States. She gradually turned to social reform and spent less time on medicine, but the breakthrough she had made by becoming a doctor changed medicine forever. Another legacy she has left for us today is her book Pioneer Work in Opening the Medical Profession to Women, which is now available free of charge on as an ebook. The book quotes many of her journals and gives us a lively down-to-earth sense of what life was like for one of the pioneers of healthcare in America.