Margaret Higgins Sanger (1879-1966)

Margaret Higgins Sanger advocated for birth control in the United States and Europe during the late nineteenth and early twentieth centuries. Although people used contraceptives prior to the twentieth century, in the US the 1873 Comstock Act made the distribution of information relating to the use of contraceptives illegal, and similar state-level Comstock laws also classified discussion and dissemination of contraceptives as illegal. Sanger helped to repeal the Comstock Act and similar laws so that women could legally use contraceptives to control their fertility and the sizes of their families. In 1916, Sanger opened the first birth control clinic in the US in New York City, New York. Later in life, Sanger formed several advocacy organizations that promoted access to contraception, including the Planned Parenthood Federation of America. Sanger's advocacy increased women's access to contraception and helped change the United States' social and legal perceptions of birth control.

Sanger was born Margaret Louise Higgins on 14 September 1879 in Corning, New York, to parents Anne Purcell and Michael Hennessy Higgins, both from Ireland. She was the sixth of eleven children born to Purcell, who also endured seven miscarriages. Her father was an artist who crafted marble and granite angels used as tombstones in cemeteries. Sanger later described how instead of playing with dolls, the older girls of her family took care of their younger siblings. In addition to attending a school five miles from their home, Sanger and her siblings performed various chores at home, such as milking the cow, washing the dishes, and mending clothes. Sanger later noted that as a child she attributed happiness to small families and unhappiness to large families, after her personal experience and after seeing the living conditions of poor Irish factory workers who lived along the river in Corning.

In 1896, Sanger attended Claverack College in Claverack, New York, which her two older sisters partly paid for. In her autobiography, Sanger notes that during her time at Claverack College she became interested in women's right to vote, called suffrage. After three years at Claverack College, Sanger became a first grade teacher in southern New Jersey to mostly immigrant children. Shortly after starting the job, she left to return home to care for her mother who was diagnosed with tuberculosis, a contagious respiratory illness. While caring for her mother, Sanger began reading medical books to learn more about her mother's illness. Sanger later said that the experience piqued her interest in medicine and inspired her to become a doctor, although she was redirected to nursing.

Sanger made the career switch in 1900 and started taking nursing courses at White Plains Hospital in White Plains, New York. During her training, Sanger became ill with tuberculosis and underwent several procedures in an attempt to alleviate her symptoms. As a nurse in training, Sanger was often called to the homes of pregnant women to assist physicians with the delivery of infants. She said that those pregnant women begged her for information to prevent future pregnancies. However, at the time, Sanger did not know of any methods to prevent pregnancy other than abstinence from sex.

In 1902, Sanger finished her final year of nurse training at the Manhattan Eye and Ear Hospital in New York City, New York. At a party held by a physician she worked with, Sanger met artist and architect William Sanger. At his insistence they married that same year, August 1902. Six months later, Sanger was pregnant with the couple's first child, and she was admitted to a tuberculosis sanitarium until just prior to her son's birth, after which she returned to their small New York City apartment. Sanger's first son, Stuart, was born in November of 1903.

Still ill from tuberculosis, Sanger recovered without the aid of the sanitarium, settling into a house built in 1902, and designed by her husband, in Hastings-on-Hudson, New York. Four years later, when Sanger was pregnant with her second child, the house burned down in a furnace fire. Her husband rebuilt the house, and shortly thereafter Sanger gave birth to her third child, Margaret, in 1910. A doctor advised her that her tuberculosis precluded her from becoming pregnant again, despite Sanger's wishes for a large family. Sanger later recalled that her husband shared in some of the chores of housekeeping and encouraged her to pursue a career. In 1910, Sanger and her family moved back to New York City, where Sanger returned to nursing.

In addition to working as a nurse in New York City, Sanger joined the Socialist Party. In her autobiography, Sanger describes the group as composed of individuals with radical political ideas who believed in social and political reform. Anita Block, a member of the group and the editor of the women's section in the socialist newspaper New York Call, asked Sanger to fill in for a missing lecturer scheduled to speak to a small group of ten women from the Socialist Party. Sanger agreed and changed the topic of the lecture from labor to health, one of Sanger's first speeches about women's health and hygiene. The second time Block scheduled Sanger, she drew an audience of seventy-five people.

Noticing her audience's interest in sex and reproduction, Sanger began to write a series of articles titled "What Every Mother Should Know," published in the New York Call in 1912. The series discussed how mothers could teach their children about reproduction. Following the popularity of her first series, Sanger subsequently published another series titled "What Every Girl Should Know" that taught readers about the female reproductive system from before puberty to menopause. However, after several weeks of publication, one article from the "What Every Girl Should Know" series was charged with violating the Comstock Act.

The 1873 Comstock Act authorized the US Post Office to censor any material passing through the mail for obscene or sexually explicit language. The law granted Anthony Comstock the power to decide what constituted obscene language. He regularly opened mail in his position as a special agent of the postal service and reported material he considered in violation of the law. Comstock considered Sanger's discussions in her "What Every Girl Should Know" article of gonorrhea and syphilis, both sexually transmitted infections, to be obscene. Sanger continued writing articles and both series were later published in pamphlet form.

While she continued to write and speak on topics of health, Sanger continued as a nurse. She regularly worked in the poorest part of New York City, the Lower East Side, to deliver infants. As before, women and men appealed to her for contraceptive methods to prevent future pregnancies, citing extreme poverty as the primary motivation. While providing at-home care, Sanger observed women die and grow ill from abortions induced by women drinking turpentine, by causing trauma to their abdomens, by inserting instruments into their wombs, or if they could afford it, by illegal abortionists who were often untrained and performed the surgery in unsanitary conditions.

In her autobiography Sanger recalls one woman who illustrated the desperation motivating women to control their fertility. In July of 1912, Sanger cared for a twenty-eight-year-old mother of three, Sadie Sachs, who had self-induced an abortion. Sanger and the physician treated Sachs for blood poisoning and returned her to health. When Sachs asked for a method to prevent becoming pregnant again, Sanger recalls the attending physician laughing at the question and offering no advice. Three months later, Sanger was called back to the home of Sachs, who was in a coma after another attempted abortion. Sachs died within ten minutes of Sanger arriving. In her autobiography, Sanger states that Sachs's death and her own inability to provide contraceptives influenced her decision to quit nursing and find a way to help women control when they become pregnant. From her experiences as a nurse in the Lower East Side, Sanger concluded that much of the burden placed on poor families was caused by having more children than they could support.

At the end of 1912, Sanger left nursing to advocate for birth control and sex education. Sanger asked women's rights activists for help, but found little support for her cause among competing issues such as the right to vote and access to more education. When she approached physicians, Sanger was told that distributing contraceptive information was a violation of the federal Comstock Act and of New York State's Comstock laws.

To learn more about contraception, Sanger spent over a year learning in various libraries. One of Sanger's friends suggested that she visit France, where citizens used family planning, the practice of families using contraceptives to control when to have children. Sanger and her family sailed to Europe in October 1913. In Paris, France, Sanger discovered that the government did not ban discussion about contraception as the US government did. Women she interviewed women, they told her that they had learned about family planning from their mothers and grandmothers. On 31 December 1913, Sanger and her children started the return trip to the United States, leaving her husband in France to continue his artwork. That was the last time the couple saw each other in person. They divorced in 1914.

On the ship traveling back to the US, Sanger decided to start a magazine called The Woman Rebel, which focused on empowering working women and emphasizing their rights, such as the right to control their pregnancies. Upon her arrival in New York City in January 1914, Sanger settled on the term birth control to describe a woman's right to control the number of children she birthed. According to Sanger, she and a group of friends started the National Birth Control League in 1914 to produce The Woman Rebel and to increase awareness about the importance of birth control. Sanger, the editor of The Woman Rebel, advertised the magazine in several newspapers and soon received several hundred subscriptions for the magazine, numbers that later increased to thousands. Sanger published the first issue in March 1914.

After publication, Sanger received a notice from the US Post Office stating that the first issue of The Woman Rebel could not be distributed through the mail because it violated the Comstock Act. Sanger ignored the warning and continued publishing and distributing her magazine. In her autobiography, Sanger states that while her magazine advocated for a woman's right to control the birth of children, she carefully excluded specific information about contraceptives to avoid violating the Comstock Act. However, her defiance led the Post Office to also ban the May and July issues of The Woman Rebel.

As she wasn't allowed to include specific information about contraceptives in The Woman Rebel, Sanger wrote a pamphlet called Family Limitation in 1914. The pamphlet included all the information that she had learned in France about types of contraceptives, such as spermicides. In August 1914, the Post Office began formal legal proceedings against Sanger for continuing to distribute The Woman Rebel in violation of the Comstock Act. Sanger faced possible jail time or a fine if found guilty, because violating the Comstock Act was considered a felony. Sanger's lawyer, Simon Pollock, suggested that she plead guilty to avoid a jail sentence. However, Sanger refused to plead guilty and a few hours before she was to stand trial, she left the US for Europe in October 1914. She sent a note to the judge for the trial, John Hazel, explaining that she had left the US because she needed more time to construct her case. Prior to leaving the US, Sanger arranged for her friends to distribute copies of her pamphlet, Family Limitation, after her departure.

Upon her arrival in London, England, Sanger rented rooms near the British Museum where she researched the history of family planning to prepare for her court case in the US. In her research, she learned that the US had high maternal mortality rates compared to other industrialized nations, which she attributed to the lack of accessible contraception. While in England, Sanger joined the Malthusian League, which had changed its name to the Neo-Malthusian Society prior to her arrival in Europe. That society, led by a Charles Vickery Drysdale and Bessie Drysdale, argued that contraceptives helped control population growth. That society was founded on the principles of England's Thomas Malthus, who had argued at the turn of the nineteenth century that the world's population would surpass its ability to produce food if population growth was not controlled. In December 1914, Sanger met Havelock Ellis, who studied the social psychology of sexual behavior. Sanger and Ellis became friends and he influenced her views on how birth control provided women greater freedom to enjoy sex without fears of pregnancy.

Sanger was also influenced by the eugenic claims of birth control advocates and Neo-Malthusians, such as Ellis and Drysdale. Sanger had observed that poor women and families lacked access to contraception that wealthy families did not. That lack of access often caused those in poverty to have larger families. Proponents of eugenics made a connection between poverty and large families, but often sought to reduce the large lower class through government-mandated, compulsory sterilization. In that respect, Sanger's claims about contraception differed from those of many eugenicists in the early twentieth century, as Sanger argued that women should use birth control to choose how to limit their fertility instead of the government forcing women and men to be sterilized.

Sanger's European travels continued and in January 1915, she visited the Netherlands, the first country with modern birth control clinics. While the Netherlands established the first women's clinics that offered information about contraceptives, the country also had the fastest growing population compared to other European countries. Sanger later said that the discovery shocked her, as she believed that birth control would contribute to a decrease in population, not an increase. Sanger reported that her trip caused her to conclude that instead of fighting only for free speech to inform individuals about birth control, she also needed to advocate for the creation of clinics where women could learn from physicians about birth control.

While in Europe, Sanger received a letter from her ex-husband in 1915 stating that he had been placed on trial for distributing her pamphlet Family Limitation in December 1914. His letter detailed how, after he had returned to New York from France, a stranger had arrived at his house and asked for a copy of the pamphlet. Sanger's ex-husband provided the stranger, who turned out to be a member of the New York Society for the Suppression of Vice, with a copy, and Comstock arrested Sanger's ex-husband several days later. After he admitted that he had provided the pamphlet, the judge sentenced him to one month in jail or a $150 fine. In her autobiography, Sanger recalls that her ex-husband chose jail as an act of protest in support of her cause to legalize contraceptive information.

In September 1915, Sanger returned to the US to face trial for violating the Comstock Act. Upon her arrival, she wrote a letter to the judge of her trial informing him of her return. She also learned that the National Birth Control League had been reorganized and reestablished by birth control activists Mary Ware Dennett, Clara Stillman, and Sanger's friend Anita Block from The New York Call. The organization supported the removal of contraception from the list of obscene items banned under the Comstock Act. When Sanger approached the women for support during her trial, they informed her that the National Birth Control League did not support what she had done or her actions afterwards because she had willfully broken the laws that they were attempting to legally dismantle.

While Sanger prepared for her trial without organizational support, she learned that her daughter had contracted pneumonia, and on 6 November 1915, Sanger's daughter died. After the death, Sanger's supporters sent her sympathy letters and money for her trial. Sanger states in her autobiography that her supporters advised her to plead guilty to avoid a jail sentence. However, while she had violated the law, Sanger reports in her autobiography that she believed that the material she circulated was not obscene and therefore she refused to plead guilty. She also mailed a copy of Family Limitations to one of the judges assigned to her case after he requested a copy. On 18 February 1916, the court dropped Sanger's case and cleared her of all charges. According to historian Vern Bullough, the public's sympathy towards Sanger influenced the court's decision.

After the dismissal of her case in 1916, Sanger spent three months speaking in various states to promote her ideas about controlling reproduction and the necessity of establishing birth control clinics. Sanger then decided to challenge the state of New York's Comstock laws and on 16 October 1916, Sanger opened the first birth control clinic in the US in the Brownsville section of Brooklyn in New York City. The clinic aimed to dispense information about contraceptives. However, nine days later, police officer Margaret Whitehurst arrested Sanger and confiscated the clinic's records, informational pamphlets, and materials. Sanger tried to reopen the clinic after her bail was paid, but it was once again shut down by local police and she was arrested. Sanger and her staff, including her sister and fellow nurse, Ethel Byrne, were charged with violating the State of New York's Comstock laws.

Sanger's trial, People v. Sanger, started on 29 January 1917. The judge, John Freschi, ruled that Sanger had violated the state's Comstock laws by running a birth control clinic and disseminating information about contraceptives. Sanger was represented by Jonah J. Goldstein, who argued that the laws Sanger was charged with violating were unconstitutional because they violated her freedom of speech, and more broadly a women's right to exercise sound decision-making, impacting her pursuit of happiness. The court found her guilty and sentenced Sanger to thirty days in Queens County Penitentiary, a workhouse in New York City, which she served.

After her release, Sanger appealed the court's decision and at her subsequent trial her lawyer ignored the evidence presented against her in favor of attacking the legality of the decision. In addition to her lawyer's published briefs, Sanger published a book-length brief for the court, The Case for Birth Control: A Supplementary Brief and Statement of Facts. In January 1918 the New York State appeals court ruled that physicians could legally prescribe contraception when presented with justifiable health concerns. That ruling did not reverse the previous court's ruling, but it advanced Sanger's goal of improved access to birth control, because before physicians in New York couldn't legally dispense contraceptives to their patients.

In the midst of her trial and its appeal, Sanger published several works on birth control. In February 1917, Sanger started publishing a new magazine called the Birth Control Review. Articles in the magazine discussed the birth control movement, but not birth control methods. At the end of 1917, Sanger wrote the book Woman and the New Race, which argued for women's rights to birth control and their role in limiting family size by using birth control. On 10 November 1921, Sanger founded the American Birth Control League in New York City. Sanger established the organization to promote birth control education, reform, and research. The organization assumed authority of the publication of the Birth Control Review in 1923.

In November of 1921, Sanger spoke about birth control and her developing views about eugenics at an event in New York City. In her speech titled "The Morality of Birth Control," Sanger argued that people could raise the living standard of the human race by controlling family size through contraception. She said that there were three categories of people, those who were wealthy and educated and regulated the size of their families, those who were intelligent and wanted to regulate their family sizes but lacked access to contraception, and those who were irresponsible and chose not to regulate the size of their families. Sanger argued that the irresponsible people, who chose not to regulate their procreation, were often mentally ill, impoverished, or diseased. She stated that often those people depended entirely on others and therefore should not bear children they were unable to care for. Sanger argued that the reproduction of those unfit individuals should be controlled through contraception. Sanger differed from many eugenicists because she stressed not that the government should force sterilization or contraception use, but rather she argued that individuals should be responsible for choosing to use contraception to limit their own procreation.

Sanger left the US in February 1922 to visit Asia and give a series of lectures in Japan on birth control. Sanger traveled via ship to China, Japan, Korea, and Singapore. In 1922, Sanger married Noah Slee, who worked in the oil industry. Slee helped fund Sanger's activities to promote birth control and together, they built a house in Fishkill, New York.

In 1923, Sanger opened the Clinical Research Bureau, later called the Birth Control Clinical Research Bureau, in New York City. Sanger requested the help of physician Dorothy Bocker to legally help women with their questions about birth control. At the Bureau, Bocker evaluated patients and taught them about contraceptives. To stay within the confines of the law, first she had to diagnose them with medical conditions that would make pregnancies dangerous, such as kidney trouble. In December 1925, after several disagreements with Bocker, Sanger hired physician Hannah Stone as physician at the Bureau. Sanger also met and hired physician James F. Cooper, who supported teaching other physicians about contraception in 1925. While at the Bureau, Stone and Cooper invented a contraceptive jelly that women could use in addition to a pessary, a type of diaphragm inserted into the vaginal canal that caps the cervix to help prevent sperm from entering. Sanger later noted that at the time, the federal Comstock Act prevented the importation from other countries of diaphragms, and that she and her team had to search for other means by which to obtain their contraceptive materials.

Throughout the 1920s, Sanger campaigned against federal laws that curtailed individuals' access to birth control. She resigned as president of the American Birth Control League in 1928. In April 1929, Sanger formed the National Committee on Federal Legislation for Birth Control. The committee aimed to convince legislators to repeal or amend federal obscenity laws that classified birth control and contraceptive education as illegal. As president, Sanger and the National Committee spent the early part of 1930 lobbying in Washington, D.C., for the federal government to legalize access to birth control.

For health reasons, Sanger moved to Tucson, Arizona, in the early 1930s. Sanger and her son both suffered from tuberculosis and at the time, doctors said that warm, dry climates like those in southern Arizona alleviated the respiratory symptoms of tuberculosis. While in Arizona, Sanger pursued her goal of making contraception available to women, although her motivation shifted based on the problems facing Arizona women. In the 1930s, Arizona had high rates of infant mortality, especially in rural areas and among minority groups. Sanger endeavored to bring contraception to Arizona women to assist in lowering the mortality rate.

While in Tucson, Sanger sought out wealthy philanthropic women interested in founding a birth control clinic. In the fall of 1934, Sanger organized a meeting with almost sixty women about the birth control movement to gauge interest in forming a clinic. In December of 1934, Sanger and the other women opened Clinica Para Madres, or Clinic for Mothers, to provide birth control information and services to Tucson women.

To remain involved in the national and international birth control movement, Sanger split her time between Arizona, New York, and Washington, D.C. Despite her work lobbying with the National Committee on the Federal Legislation of Birth Control, Sanger couldn't convince legislators to legalize contraception. Instead, Sanger decided to use the justice system to overturn the federal Comstock Act.

In 1936, Sanger arranged for a package of Japanese pessaries to be mailed to the Clinical Research Bureau in New York City. The package was intercepted in transit by the US Post Office. As the package had not yet reached the Bureau, a case was filed against the package of pessaries itself. In United States v. One Package of Japanese Pessaries, the government argued that importing pessaries violated the Tariff Act of 1930, which was based on the Comstock Act and made importing contraceptive devices illegal. After an initial trial and several appeals, the US Appellate Court for the Second Circuit, which included New York, ruled that physicians had the authority to import contraceptive materials and distribute them through the mail when necessary for the well-being of a patient. Following that court decision, Sanger disbanded the National Committee on the Federal Legislation of Birth Control in 1937, because the committee had achieved its goals.

Sanger returned to Arizona in February 1937, and she began to work also in Phoenix, Arizona. There she organized a meeting of Phoenix women to discuss how to expand the birth control movement in Arizona. Following the meeting, many women sought Sanger's guidance to open a birth control clinic in Phoenix. With Sanger's support, the Mother's Health Clinic opened in October 1937 in Phoenix.

In January of 1939, two organizations that Sanger had founded, the Birth Control Research Bureau and the American Birth Control League, merged to form the Birth Control Federation of America. Sanger served as the honorary chairman of the organization and assisted as an advisor and chief fundraiser. In 1942, the Birth Control Federation of America changed its name to the Planned Parenthood Federation of America, despite Sanger's disagreement with the decision. With the name change, members of the Federation sought to place greater emphasis on the benefits of planned families and less on contraception to make the organization more socially acceptable and to broaden its support base. Sanger disagreed with the change, arguing that the organization should not remove itself from controversial issues such as women's rights, sexual freedom, and birth control, which she said were inherently linked to the organization's goals. Despite her opposition to the initial change, Sanger remained involved in the organization, serving on the board of directors and acting as the honorary president.

By the 1940s, birth control began to gain social acceptance and had received some support from by the US government. Sanger retired from many of her leadership roles, but she continued to advise birth control leaders and organizations. In 1946, Sanger worked with leaders in the Planned Parenthood Federation of America and with family planning advocates across the world to create the International Committee on Planned Parenthood. The organization aimed to bring birth control advocacy and access to countries across the world, especially in developing nations. By 1952, the committee had evolved into the International Planned Parenthood Federation. Sanger served as the organization's president until her retirement in 1959.

Throughout the 1950s, Sanger sought to advance the technology of birth control by creating less costly and more accessible forms of contraception. In the early 1950s, Sanger encouraged Massachusetts philanthropist Katharine McCormick to fund the research of biologist Gregory Pincus, also in Massachusetts, to create a birth control pill. In 1960, the FDA approved the birth control pill, Enovid, for contraceptive use.

According to historian Rachel Furey, Sanger's lifelong work in birth control advocacy culminated in the June of 1965 US Supreme Court decision in Griswold v. Connecticut, which overturned the remaining state-level obscenity laws, making birth control legal at both the state and federal levels. Sanger received many awards for her advocacy work in reproductive health and contraception. In 1966, the Planned Parenthood Federation of America established the Margaret Sanger Award in her honor. The award is given each year to recognize distinguished individuals who furthered reproductive health and rights. On 6 September 1966 at the age of 86, Sanger died in Tucson, Arizona, from congestive heart failure.

Editors Note: This article replaces the biography of Sanger authored by Kimberly A. Buettner and published in this encyclopedia in 2007.