Although she is often given credit for being the earliest to broadcast family planning in the USA, Margaret Sanger was not the first. However, perhaps she was the bravest since she was arrested eight times while trying to help women.
You may remember Sanger as the woman who started family planning clinics in New York; she spent time in jail for this audacious act. She persisted despite adversity, with the end result of a series of clinics that were the start of Planned Parenthood. Currently there are over 600 Planned Parenthood clinics in the USA. Her family planning work was greeted internationally as well as in the USA, with the International Planned Parenthood Federation providing reproductive health service in more than 145 countries.
Trained as a nurse, Sanger worked in a clinic for poor women in New York City early in the 20th century. She realized that having children too close together was bad for the mothers’ health—and also for the children. Growing up with 10 siblings probably interested her in family planning!
Unfortunately, Sanger got on the eugenics bandwagon, which was common in that era. Her name is somewhat besmirched because of that. It is very concerning that we seem to be experiencing a rebirth of eugenics in the USA, with discontinuation of programs to help poorer people and those among us with disabilities.
There were at least two male physicians who helped pave the way for Sanger. Dr. Robert Dale Owen wrote “Moral Physiology; or, A Brief and Plain Treatise on the Population Question”, (1831). He wrote: “Is it in itself desirable, that man should obtain control over the instinct of reproduction, so as to determine when its gratification shall produce offspring, and when it shall not?” He suggested using withdrawal to limit family size and suggested that a tubal ligation could be done at the time of a (then, very rare) Cesarean section.
Owen also espoused an electrical devise to control fertility: “…considerable opportunity has been afforded by the sale of the Electro-Galvania alluded to in this work, for testing its efficacy as a preventive of conception.” The primary message of his book is furthering the message of Malthus—that overpopulation would bring on famine. He also advocated celibacy until “a late age”.
Dr. Charles Knowlton’s “Fruits of Philosophy: The private companion of young married people” (pictured above) appeared a year later, in 1832. Again, his primary message is a concern about overpopulation, but he gave more information about family planning. Knowlton recommended the rhythm method, or douching shortly after intercourse to prevent pregnancy.
The book described another means of birth control. The woman should insert a small, moistened piece of sponge in her vagina before intercourse. A thin ribbon attached to the sponge would aid its removal. This method is similar to what Francis Place, a British activist advocated in a pamphlet published 10 years earlier, and was commonly used by the upper classes.
Both of these books argue that family planning was not immoral. Unfortunately, Knowlton, a citizen of Massachusetts, spent 3 months in prison on obscenity charges. Apparently, the officials didn’t agree with his views on morality.
Forty years later, strict laws were enacted to prevent the mailing of obscene or abortion-related matter—the Comstock Act. Most of those laws have been overthrown, except for the part about mailing abortion information. Although it is now possible to mail information about family planning or get birth control pills by mail, now anti-choice forces in the USA are considering using this archaic Act to prevent prescription of medication abortion by telemedicine.
©Richard Grossman MD, 2025