The 176 Year History Behind Today’s Attacks On Women’s Health.

Posted on | August 18, 2015 | 2 Comments

Mike Magee

In an editorial in this week’s NEJM, editors state, “We strongly support Planned Parenthood not only for its efforts to channel fetal tissue into important medical research but also for its other work as one of the country’s largest providers of health care for women, especially poor women. In 2013, the most recent year for which data are available, Planned Parenthood provided services to 2.7 million women, men, and young people during 4.6 million health center visits. At least 60% of these patients benefited from public health coverage programs such as the nation’s family-planning program (Title X) and Medicaid. At least 78% of these patients lived with incomes at or below 150% of the federal poverty level. Planned Parenthood’s services included nearly 400,000 Pap tests, nearly 500,000 breast examinations, nearly 4.5 million tests for sexually transmitted illnesses (including HIV), and treatments.The contraception services that Planned Parenthood delivers may be the single greatest effort to prevent the unwanted pregnancies that result in abortions.”

This is not the first time the organization has been enmeshed in controversy. The following is an excerpt from my soon to be published book, “Unholy Alliances”, which places current events in context, and shows that the antagonists in the struggle – conservative politicians, the Catholic Church, and others – have been engaged in this struggle for many years.

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“The war against Planned Parenthood and its’ predecessors has a rich history dating back 176 years to 1839. That was the year that Charles Goodyear was controversially credited with the discovery of vulcanized rubber. The chemical process that Goodyear stumbled on involved the introduction of heat and additives to standard rubber gum which induced new cross links and a fundamental alteration in the end product. The new material was more moldable, mechanically stronger, and all importantly, less sticky. The process involved the application of heat, thus the name “vulcanized rubber” after the Roman god of heat, Vulcan.(31)

Fortuitously for Goodyear, his discovery arrived during a twenty year period of intense interest in self-help called the Popular Health Movement beginning in 1830. One prominent figure of the day was Edward Bliss Foote who invented a device he poetically labeled the “womb veil”.(28) This rubber pessary, designed for easy insertion, was the forerunner of the modern diaphragm and cervical cap. It was actively marketed and distributed over the counter and through mail order beginning in 1863, and sold for the princely price of $6. It largely replaced a range of less sophisticated contraptions first available publicly in the 1830’s in the United States. Advertisements of the day promised that the womb veil could be “used by the female without danger of detection by the male”.(29) Interest in the device was reinforced by the actions of the AMA which first publicly opposed all abortions in 1859, followed by the actions of Connecticut, the first state to prohibit all abortions, which prior to this time were generally tolerated in the time period before “quickening” (the sensation of fetal movement by the mother).(30) “If not abortions, then contraception”, was the public mood.

Their ultimate opponent took the unlikely form of a New York City based U.S. Postal Inspector committed to stamping out vice named Anthony Comstock. His organizational vehicle was the New York Society for the Suppression of Vice created in 1873, with Anthony as both founder and chief vice hunter.(35) His efforts were supported by key leaders of the Young Men’s Christian Association (YMCA). The organizations mission was not only to hunt out vice but also to bring offenders to justice. The organization drew its powers directly from the New York state legislature which granted its agents the police authority to search, seize and arrest those who marketed, distributed or sold banned items.

Comstock’s lasting legacy however was not on the streets of New York, but rather in the halls of Congress. On March 3, 1873, he was able to harness the support of enough U.S. legislators to amend the Post Office Act to include the “Comstock Act”.(36) Multiple states followed suit creating together a host of laws collectively called the “Comstock Acts”, many of which remain unenforced on the books today. This legislation made it illegal to transmit “obscene” materials through the mail. Specifically the law declared:

“Be it enacted… That whoever, within the District of Columbia or any of the Territories of the United States…shall sell…or shall offer to sell, or to lend, or to give away, or in any manner to exhibit, or shall otherwise publish or offer to publish in any manner, or shall have in his possession, for any such purpose or purposes, an obscene book, pamphlet, paper, writing, advertisement, circular, print, picture, drawing or other representation, figure, or image on or of paper or other material, or any cast instrument, or other article of an immoral nature, or any drug or medicine, or any article whatever, for the prevention of conception, or for causing unlawful abortion, or shall advertise the same for sale, or shall write or print, or cause to be written or printed, any card, circular, book, pamphlet, advertisement, or notice of any kind, stating when, where, how, or of whom, or by what means, any of the articles in this section…can be purchased or obtained, or shall manufacture, draw, or print, or in any wise make any of such articles, shall be deemed guilty of a misdemeanor, and on conviction thereof in any court of the United States…he shall be imprisoned at hard labor in the penitentiary for not less than six months nor more than five years for each offense, or fined not less than one hundred dollars nor more than two thousand dollars, with costs of court.”(37)

The target of Comstock’s rage was not only pornography, but more specifically contraceptive equipment and reproductive health materials of the day. Sixty years later, in 1936, the Supreme Court would strike down the ban on contraceptives.(38) In addition, control of condoms would be brought under the auspices of the Food and Drug Administration as part of a national effort to control the spread of venereal diseases.(39)This allowed World War II U.S. soldiers to be supplied condoms, in contrast to their fathers who fought in World War I.(40) In 1937, the AMA also gave its stamp of approval to contraception stating “the intelligent, voluntary spacing of pregnancies may be desirable for the health and general well being of mothers and children.”(41)

As for women, by 1938, well stocked over the counter pharmacies offered over 600 brands of powders, gels, diaphragms and douches for “feminine hygiene”.(42) What all of these shared was a dual use as contraceptives with generally poor results. As for public maternal health, in 1935, the New York City Health Department catalogued an average of 5 to 10 cases of septic abortions per week.(43)

In the early years of the 20th century, however, the battle was full on between Comstock’s raiders and a new brand of aggressive women determined to control their own fates. Chief among them was Margaret Higgins Sanger, nurse and sex activist. Margaret was the sixth of eleven children born into an immigrant Catholic family that had settled in America in the wake of the Irish potato famine. Her mother, Anne Purcell Higgins, managed 18 pregnancies in 22 years, and died at age 49. Her early years were occupied with household duties and the care of younger brothers and sisters. Two older sisters financed her education which led to a Nurse Practitioner degree from White Plains Hospital in New York in 1901. The next year she married architect William Sanger and they had three children of their own.(44)

In 1911, the young family moved to New York City and Margaret took a job as a visiting nurse in the slums on the Lower East Side. After seeing the results of several botched abortions, she began to broadly distribute a wide range of how-to sex education materials as part of an organizing effort to involve the communities she served. Welcoming a confrontation, she published a monthly newsletter titled “The Woman Rebel”. If the title didn’t capture religious leaders attention, the slogan – “No Gods, No Masters” – surely did.(46) In 1914, the monthly led to accusations of violation of the Comstock laws. She fled to Canada and then to Britain to avoid arrest and remained there for a year.(47) Her husband was charged to release the published and yet to be released “Family Limitation”, a 16 page pamphlet with graphic images and descriptions of various forms of birth control. This earned him a visit from Anthony Comstock and 30 days in jail. The resultant publicity elevated both Margaret and her cause to national standing.(48)

She believed and loudly proclaimed that, each woman should be “the absolute mistress of her own body.”(49) In 1916, back in the United Staes, she opened the first birth control clinic in Brooklyn, NY, with two goals in mind. One was to limit the occurrence of dangerous back alley abortions, and the second was to help place women in a more equitable position with men by allowing them to determine whether or not to have children and how many to bear. Nine days after opening, she was arrested and went to trial in January, 1917. She was initially convicted with the judge declaring that women did not have “the right to copulate with a feeling of security that there will be no resulting conception.” But in appeal, Judge Frederick Crane spared her 30 days in the workhouse when he delivered a compromise ruling that included the statement that physicians could prescribe contraception to treat or prevent disease.(50)

Five years later, to further organize the effort, Sanger founded the American Birth Control League, and in supplying her clinic in New York, now complete with a team of all female doctors, directly challenged the Comstock Acts.(51) Sanger had reached out to a Japanese colleague to mail diaphragms and cervical caps to her physician colleague, Hannah Stone.(52) Stone not only provided care but was the Medical Director of a second entity, the Birth Control Clinical Research Bureau, which was engaged in studying, for the first time, the effectiveness of various forms of contraception. The package was intercepted by Customs officials, and Sanger was again arrested.

The case, United States v. One Package of Pessaries, narrowed the power of the Comstock Acts by deciding that the legislations intent was not “to prevent the importation, sale or carriage by mail of things which might intelligently be employed by conscientious and competent physicians for the purpose of saving life or promoting the well-being of their patients.”(53) This reinforced Judge Crane’s prior ruling.

These decisions pointed Sanger to a narrow corridor that she and her colleagues would pursue over the next 15 years. The price they paid was the “medicalization” of a movement that had begun as a “women’s rights” effort.(54) Her organization went to work defining a wide range of medical conditions that would justify the use of contraception including everything from multiparity to hypertension to tuberculosis to poor housing conditions. By the time they finished, nearly everyone qualified.

By the 1930’s, Sanger’s American Birth Control League was working hand in hand with another New York organization, the International Workers Order (IWO). This was a Jewish fraternal organization with strong Communist leanings that by 1935 had 100,000 members.(55) It provided sport and culture, and for the first time in America, prepaid medical care. The goal was to distribute the financial burden. They provided basic generalist health care services, discounted specialty care, dental care and discounted medications at 90 contracted pharmacies. In 1937 they added mass screening for syphilis and in 1939 instituted low cost chest X-rays to detect tuberculosis. That was three years after they had added a Birth Control Center in conjunction with Margaret Sanger. Over those first three years, 1200 women received service. The annual fee of $4 ($60 in today’s currency) covered all gynecologic exams, unlimited visits and all prescribed contraceptive supplies.(56)

As 1938 rolled around, Sanger’s American Birth Control League was growing in leaps and bounds. There were now 347 birth control clinics nationwide with 1/5 supported by public funds and the remainder supported by philanthropy and patient fees. The growth was fueled by a strong shift in public opinion.(57) A 1938 poll conducted by the Ladies Home Journal revealed a 79% support for birth control.(58) As impressive were the figures coming out of Sanger’s research arm. An American Birth Control League 1937 survey of 29,000 patients from 170 clinics demonstrated a 92% effectiveness of physician fitted diaphragms in conjunction with spermicidal jelly. This success contrasted with the 72% effectiveness of over-the-counter diaphragms and the 29% effectiveness of store bought douches. As for condoms, which were used by only 4% of the clients.(59) The American Birth Control League shied away from their use not because they were ineffective, but “because the woman is more likely than the man faithfully to carry out the method of control, the means may better be in her hands.”(60)

It is important to note that leaders of the American Birth Control League and the International Workers Union and others did not see Birth Control Clinics as their end game. Rather, as their experience grew with their understanding of their patients needs, they saw women’s services as part of a general move, as the IWO unabashedly proclaimed, toward “socialized medicine”.(61)

Noticeably absent from the original Social Security Act, FDR had gone so far as to organize a 1938 National Health Conference to confer with his Technical Committee on Medical Care to examine a “program of medical care…to serve the entire population.”(62) The proposals would appear in the Senate’s Wagner bill of 1939. But FDR’s unwillingness to expend political capital in the lead up to a possible war, coupled with strong AMA opposition, collapsed the effort. The AMA would be there as well in 1943 to help defeat the Wagner-Murray-Dingell bill seeking universal coverage, and FDR’s “economic bill of rights” with health care services in 1944, and Truman’s “single system “ efforts a few years later.(63)

By the time Truman made his push, America was deeply entrenched in the “Cold War” and the Iron Curtain was about to be drawn. The IWO was on a 1947 list of “subversive organizations” prepared by US Attorney General Tom Clark.(64) Senator Joe McCarthy from Wisconsin had launched “McCarthyism” in a speech in 1950, and the search for American Communists was on. In that same year, the New York superintendent of insurance declared the IWO to be “a recruiting and propaganda unit for the Communist Party”. In June, 1953, Julius Rosenberg and his wife Ethel went to the electric chair convicted of espionage. They never proved Julius to be a Communist, but he did acknowledge having an insurance policy with the IWU, which was felt to be incriminating. With fear all around, membership in the IWU rapidly declined, and in 1953, the IWO was liquidated.(65)

As for Margaret Sanger, she lived to fight another day, in part due to skillful maneuvering in 1942. After accommodating to “medicalization” and benefitting from the subsequent AMA endorsement of contraception in 1937, she felt the winds of change and renamed her Birth Control Federation of America as the Planned Parenthood Federation of America.(66) This literary power shift dropped the notion of “birth control” with its implications of struggle and replaced it with the more congenial “family planning”.

Sanger was an adept politician and fund raiser. She received extensive funding from the Rockefeller’s, but always anonymously, so as to protect the career trajectory of Nelson Rockefeller who feared public support of Sanger could lead to formal opposition to his future campaigns by the Catholic Church.(67)

The Church’s advances in the immediate post-World War II period had convinced the hierarchy that bigger was better than smaller. Their numbers were on the steep incline as soldiers returned from the war, and the Church was committed to keeping it that way. The bishops believed that family planning was mission critical and should be a Church-down affair. They would need to be well organized and would need to include Catholic doctors like my father.(68)

As the Church stayed true to it’s roots, Sanger responded in kind. She leaned back on her clinical interests and brought together philanthropist Katharine McCormick and biologist Gregory Pincus. He would use the money he received from McCormick wisely linking up with his old fiend John Rock at the Free Hospital for Women in Boston, to create the first U.S. birth control pill, Envoid (a combination of mestranol and norethynodrel), developed and distributed by G. D. Searle & Company, after its FDA approval on June 10, 1957.(69)

The Church could see this coming for a while. Way back in 1930, a Catholic doctor from the Netherlands, John Smulders, had developed the first calendarized scheme designed to avoid pregnancy.(70) His work took advantage of early discoveries in 1920 by Austrian gynecologist Theodoor van deVelde and Japanese gynecologist Kyusaku Ogino, who independently proved that ovulation occurs about 14 days before menstruation.(71) Ten years later, Smulders published his “rhythm method” which drew wide usage in Europe. In the U.S. however, it remained highly controversial, even after Leo Latz published his book, The Rhythm of Sterility and Fertility in Women, describing the method in 1932, and John Rock opened his Rhythm Clinic in Boston to teach Catholic parents the technique.(72)

The American Catholic Church and its’ leadership could easily predict the next step. As the science of maternal health and its’ natural rhythms were increasingly exposed to examination, it was only a matter of time before pharmaceutical companies and their allied physicians would figure out how to manipulate and destroy this miraculous system. Clearly, God’s rights to decide when and where to deliver His children was under attack, and the Church must defend, defend, defend. As Pope Pius XI had said in his famous Encyclical, Casti Connubi, on December 31, 1930: “…every attempt of either husband or wife in the performance of the conjugal act or in the development of its natural consequences which aims at depriving it of its inherent force and hinders the procreation of new life is immoral; and that no ‘indication’ or need can convert an act which is intrinsically immoral into a moral and lawful one.”(73)

But what to do now with science on the rise? The Church faced a choice. Embrace the new “Rhythm Method” which at least emphasized restraint and periodic abstinence, and might dampen the march toward use of horrid preventatives, paganism, and sins of the flesh; or stand strong and face the possibility of being overrun by modernity. In the end, the bishops sided with this new semi-natural method. But a vocal minority labored on, and not in silence. As late as 1948, popular preacher and radio broadcaster, Father Hugh Calkins had this to say, “Catholic couples have gone hog-wild in the abusive employment of rhythm…A method meant to be a temporary solution of a critical problem has become a way of life, a very selfish, luxury-loving, materialistic way of life. But heaven, not security, is the goal set for the babies God sends…Every couple should have the children God wants them to have.”(74)

Margaret Sanger would live and work for another decade, as founder of the International Planned Parenthood Foundation. By the time she died on September 6, 1966 at the age of 86, her Planned Parenthood Federation of America was the largest government provider of reproductive health services.(75)”

For Health Commentary, I’m Mike Magee.

References:
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Comments

2 Responses to “The 176 Year History Behind Today’s Attacks On Women’s Health.”

Kevin Henning
August 19th, 2015 @ 11:58 pm

Very interesting and important reading, Mike. I look forward to reading your book.
Mike Magee
August 20th, 2015 @ 7:26 pm

Thanks, Kevin!