Her origins were grimly ordinary. Born in 1879, the sixth child of eleven, Margaret Higgins saw her middle-aged mother die in 1899, debilitated by childbearing and the struggles of caring for a large family on the meager income of an irresponsible husband. Though she longed to be a doctor, she settled for a career in nursing, which proved to be an education in the suffering caused by unsafe abortion. She married young, to the Jewish architect and aspiring artist William Sanger, got pregnant quickly and endured a difficult delivery while suffering from tuberculosis. For a while, Margaret Sanger played the housewife in upstate New York, a role she found stultifying. She began to thrive in 1910, when she and her husband moved to New York City, throwing themselves into the exhilarating ferment of radical politics. Working part time with Lillian Wald’s Visiting Nurses Association in the immigrant ghettos of the Lower East Side, Sanger was “exposed to the social pathos of a poverty hauntingly familiar to her from her own youth in its victimization of women and children,” as Ellen Chesler explained two decades ago in her landmark biography Woman of Valor.
It was in 1912 in these ghettos that Sanger supposedly encountered Sadie Sachs, a Jewish immigrant who sparked her “awakening” to the necessity of birth control. In speeches and books, Sanger later described nursing Sachs, a 28-year-old mother of three, through the complications of a botched abortion. Sachs had begged the doctor who initially treated her for advice about preventing another pregnancy, saying, “Another baby will finish me.” The doctor’s response was callous: “You want your cake while you eat it too, do you? Well it can’t be done. I’ll tell you the only sure thing to do….Tell Jake to sleep on the roof.” Months later, Sanger returned to the apartment and found Sachs suffering from septicemia, the result of a self-induced abortion.
“I was now finished with superficial cures, with doctors and nurses and social workers who were brought face to face with this overwhelming truth of women’s needs and yet turned to pass on the other side,” wrote Sanger, promising, “I would tell the world what was going on in the lives of these poor women. I would be heard.” As Chesler noted, the portrait of Sachs may have been apocryphal, a composite of many women Sanger had encountered. Even so, its account of the widespread maternal misery that Sachs represented was indisputable.
Speaking publicly about such matters was not easy. Federal and state obscenity laws essentially prohibited the public discussion of contraception. Physicians would quietly counsel their patients about birth control, but poor women without private doctors were left in the dark, forced to depend on back-alley abortions or patent medicines sold under euphemisms like “feminine hygiene.” In 1912 Sanger broke the silence by writing “What Every Girl Should Know,” a series of sex-education articles published in the Sunday supplement of the New York Call, a popular Socialist daily. In 1913 the column was censored by the Post Office, and in response the paper ran the “What Every Girl Should Know” headline over a black box with the word Nothing beneath it.
In 1916 Sanger opened a birth control clinic—the nation’s first—in the Brownsville section of Brooklyn, offering sex education and counseling about contraception, which it stressed as an alternative to widely available illegal abortion. “Mothers!” shouted handbills printed in English, Yiddish and Italian. “Can you afford to have a large family? Do you want any more children? If not, why do you have them? Do not kill, do not take a life, but prevent.” Demand for the clinic’s services was huge—on its first day, more than 100 women and twenty men lined up for consultations. After a week and a half, though, it was raided by the NYPD vice squad, which arrested Sanger and one of her employees, impounded the clinic’s supplies and confiscated its case histories. Later, Sanger’s sister Ethel, who worked in the clinic, was also arrested. Sentenced to one month’s imprisonment, Ethel went on a hunger strike and was force-fed; Sanger later served a month in prison as well. Undeterred, she went on to found a magazine, The Birth Control Review, and two organizations, the American Birth Control League and the Birth Control Clinical Research Bureau, which in 1942 would merge to become the Planned Parenthood Federation of America.