With an uncanny feel for the power of a well-communicated idea in a democracy, Sanger through the 1920s wrote bestselling books, published a widely read journal, held conferences, circled the globe giving lectures, organized a network of clinics and built a thriving advocacy movement. To this end, she had no choice but to mobilize men of influence in business, government, labor, academia, science and the emerging professions, but her most active recruits always remained women. Under the best circumstances her pioneering clinics provided a range of health and counseling services in a sympathetic environment and became laboratories for her idealism, but, as often as not, the experiments failed, and even Sanger herself grew disillusioned.

The birth-control movement stalled during the long years of the Depression and World War II, stymied by the cost and complexity of reaching those in need without public funding, engulfed by internal dissension and overwhelmed by a barrage of opposition. The ever-fragile alliance Sanger tried to forge with the country's social and business establishment became a distinct liability. She resigned from the American Birth Control League, which later became Planned Parenthood, because of the eugenics leanings of some of its leaders, who boldly advanced contraception as a means of slowing birthrates among the poor during the Depression. Eugenics, which addresses the manner in which biological as well as environmental factors affect human health, intelligence and opportunity, was once embraced enthusiastically by many on the left but quickly deteriorated into excuses for the sterilization and control of "undesirables" on the basis of race and class.

Sanger always disdained the idea of a "cradle competition" between rich and poor, native and immigrant, white and black. She preached an ethic of individual self-improvement that would "come from within." She advanced public health and welfare policies fostering universal health and fitness and providing essential economic safety nets, and she spoke out against immigration prohibitions and other stereotypes. Having worked as a midwife, she was particularly sensitive to the adverse biological consequences of inadequate nutrition and healthcare for pregnant women.

But by bemoaning the burden of the "unfit" and by joining other progressives in refusing to condemn involuntary sterilizations of the institutionalized, Sanger left herself vulnerable to attacks of bigotry. Her reputation has been seriously compromised in recent years by an unlikely alliance of opponents of abortion on the far right and those on the far left who wholly reject her pragmatic political strategies, or condemn all family planning as covert ethnic and racial genocide.

Undermining Sanger's character as a way of undermining her message has long been an effective political strategy. Though she had enjoyed the personal friendship and professional endorsement of Franklin and Eleanor Roosevelt in New York, they refused to publicly ally themselves with her self-consciously transformed and sanitized "family planning" message when they reached Washington and became captive to the New Deal's dependence on an alliance of Catholic voters in the Northern cities and fundamentalist Protestants in the rural South.

Embittered by her failure to win support at home, and disenchanted with the country's increasing pronatalism after years of deferred fertility during the Depression and World War II, Sanger grew increasingly irritable, conservative and rabidly anti-Catholic as she grew older. Having previously traveled to Japan, China and India, leaving rudimentary family-planning advocacy and service organizations in her wake, she again turned her attentions abroad. In 1952 she founded the International Planned Parenthood Federation, an umbrella for national associations that remain today in most countries. In recent years most of these groups have been reinvigorated by a feminist movement that has given resonance to Sanger's original claim that women have a fundamental right to control their own bodies. They are recommitted to a doctrine that once again weds population and development goals to improvements in women's status.

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