What Perspectives Did African American Advocates Bring to the Birth Control Movement and How Did Those Perspectives Shape the History of the Harlem Branch Birth Control Clinic?


A. Tennyson Beals, New York Urban League building, 136th St — 7th Ave., 1931
Courtesy New York Public Library, Milstein Division of United States History,
Local History & Geneology, New York, N.Y.

Documents selected and interpreted by
Carole McCann, University of Maryland, Baltimore County
June 2006

   On February 1, 1930, Margaret Sanger opened a branch office of her New York City birth control clinic in the center of Harlem, at 2352 7th Avenue near 138th Street. For the next five years, until 1935, the Harlem Branch of the Clinical Research Bureau offered African American and white women clients gynecological examinations by a physician and contraceptive instruction by a nurse. It also sold the requisite supplies (see Document 11). The Harlem Branch clinic also conducted educational programs for the community and carried out fundraising activities to support the clinic's expenses.

   From its inception, the clinic involved the collaborative efforts of both African American and white birth control advocates. The initial idea for the clinic grew out of meetings in the fall of 1929 between Sanger, James Hubert, who was executive secretary of the New York Urban League, and members of the Harlem Social Workers Club (see Document 4). It is unclear from surviving records whether Hubert or Sanger initiated this collaborative effort. But this was not the first time they had worked together. In 1924, one year after Sanger opened the Clinical Research Bureau, Hubert approached her about the prospect of establishing a clinic in the African American neighborhood of Columbus Hill (see Document 4). Whoever initiated plans for the Harlem clinic, the project fit well with the wider political commitments of Hubert and other African Americans who supported the clinic.

   After the clinic opened, Sanger assembled an Advisory Council of African American community leaders to "help direct activities and policies so that our work in birth control will be a constructive force in the community" (see Document 10).[1] Some of Harlem's most prominent African American health professionals, clergy, and social activists participated in the clinic's work. Along with James Hubert, Advisory Council members included Mabel Staupers, executive secretary of the Harlem Committee of the New York Tuberculosis and Health Association and later the executive director of the National Association of Colored Graduate Nurses; Louis T. Wright, medical secretary of the Harlem Hospital, a surgeon who was perhaps the most highly regarded African American physician in New York City; May Chinn, the only African American woman physician in Harlem; Reverend William Lloyd Imes, pastor at St. James Presbyterian Church; and Reverend Shelton Hale Bishop, pastor at St. Philip's Protestant Episcopal Church (see Document 7 and Document 10).

   Home of the writers and intellectuals of the "New Negro Renaissance," Harlem in the 1920s became "the symbol of liberty and the Promised Land to Negroes everywhere."[2] To Harlem's leading citizens, African Americans appeared to enjoy more cultural freedom, political power, and social prosperity in their community than anywhere else in the nation. And African Americans migrated to the area in great numbers. New York City's black population tripled between 1910 and 1930, growing from 92,000 to 328,000 people, and, as a result, Harlem became the largest African American community in the nation.[3]

   Although Harlem may have been a better place for African Americans to live than many communities, nonetheless, Harlemites faced substantial problems. Even before the onset of the Great Depression, living conditions in Harlem were horrendous. In a city of crowded neighborhoods, Harlem was the most densely populated African American community in the nation. Residential racial segregation in the city meant that by 1930, 80 percent of the African Americans residing in Manhattan--nearly 190,000 persons--lived there.[4] Racial segregation coupled with increasing demand led to high prices. In addition, most buildings were owned by absentee landlords who let racial prejudice contribute to their neglect of rental property. As a result, African Americans paid exorbitant rents for deteriorating and crowded living quarters. At the same time, racial discrimination in employment created a job market for Harlem's residents that gave them few options besides low-paying service jobs. The combination of high rents and low wages meant that Harlemites spent a larger proportion of their monthly wages on housing than did other New Yorkers. This situation left many Harlemites with few resources for other necessities such as food and health care.[5] The crowded and unhealthy living conditions contributed to a death rate in Harlem that was 42 percent higher than in other sections of the city. While the overall death rate was high, maternal and infant mortality rates stood out; the rates among African Americans were twice those of whites.[6]

   Harlem community leaders were well aware of the poor living conditions in the neighborhood, and during the 1920s they began to pursue a number of strategies to improve the health care options in the neighborhood. Most of the people who became members of the Harlem Branch Advisory Council also participated in a number of organizations that agitated for better living conditions in Harlem. The perspectives they brought to their community activism incorporated birth control as a part of ongoing efforts to address the health needs of the community.

   Like other members of the black professional middle class of the period, members of the Harlem Advisory Council identified racial discrimination as the root cause of many problems in the neighborhood and the wider African American community. Often subject to such discrimination in their own personal and professional lives, they were committed to strategies that challenged race-based exclusion.

   This perspective on racial politics underlay two related approaches to health care reform in Harlem. The first approach sought expanded employment opportunities for African American health care professionals, who were often excluded from employment or given only menial jobs in Harlem's medical facilities. For instance, before 1925 no African American doctors were allowed to practice at Harlem Hospital, a city-run facility. In 1925, five doctors were granted special visitors' status (see Document 7 and Document 18). The North Harlem Medical Association, an African American doctors' group, in coalition with the Urban League, the NAACP, several churches, and the Amsterdam News, worked to secure permanent staff positions for Black doctors. They succeeded in 1929.[7] The Harlem Hospital effort was part of a wider movement to challenge local employers to end whites-only hiring practices.[8] During the period 1930 to 1934, as the Depression worsened and unemployment rates in Harlem continued to rise, African Americans became increasingly public and vocal about opposition to racially discriminatory hiring practices.[9]

   The second approach focused on expanding social services available within the community. On the eve of the Great Depression, very few social service organizations operated in Harlem, and one result is that the neighborhood had "fewer [health] clinics per capita than the rest of Manhattan." In addition, even when private agencies operated in Harlem, they served few African American clients, rarely hired African American staff, and almost never included African Americans on their boards.[10] Through the efforts of community leaders, the number of neighborhood facilities where Harlem's residents could obtain health care increased during the late 1920s and early 1930s. One coalition of community groups and medical practitioners founded the Harlem Tuberculosis and Health Committee, which affiliated with the New York Tuberculosis Association to bring tuberculosis awareness programs and clinical care to Harlemites. The Urban League also worked behind the scenes to bring a branch of Lillian Wald's Henry Street Visiting Nurses Association to the community to address the enormous health needs of women and children.[11] Efforts to increase the representation of African Americans among the employees and board members of private health and social services agencies were less successful, however. Few private agencies changed their hiring practices and governance structures to include African Americans; the Harlem Branch was a rare exception.

   The twin efforts of Harlem community leaders--to challenge whites-only employment practices and social services throughout New York City while also working to expand social services by and for African Americans in the neighborhood--reflect the poles of African American resistance to racism in this period. For much of the twentieth century, debates about the best ways to "uplift the race" circulated around the seemingly opposed strategies of parallelism and integration. The best-known example of parallelism, Booker T. Washington's strategy of accommodation to segregation, dominated African American political tactics at the dawn of the twentieth century. In 1905, however, the Niagara Movement formed to forge new strategies aimed at challenging segregation. This movement, which became the National Association for the Advancement of Colored People (NAACP) in 1909, challenged Washington's strategies and argued instead for the integration of African Americans into the mainstream of America's national life. The NAACP's goals gained prominence between 1910 and 1915 as a result of a running public debate between Washington and sociologist, civil rights activist, and NAACP board member W. E. B. Du Bois. In his writings during this period, Du Bois articulated a vision of an America in which African Americans would have social equality, economic opportunity, and full political rights.[12] In the 1920s, the poles of activism continued with Marcus Garvey's United Negro Improvement Association, which rallied the energies of Pan-Africanism, and the further work of the NAACP and the National Urban League, which pursued agendas of full legal and economic integration.

   The relationship between these reform strategies was fluid, though, and parallelism could readily flow into a strategy of integration. For example, parallel professional organizations for medical professionals (such as the National Medical Association and the National Association of Colored Graduate Nurses), which developed in the face of exclusion from the whites-only groups like the American Medical Association and the American Nurses Association, nurtured a network of black activists who formulated strategies to challenge their professional segregation in the 1940s.[13]

   In their collaboration with Sanger and her white staff and associates, the African American members of the Advisory Council followed a dual approach: they worked to bring contraceptive services to the neighborhood and they worked to ensure that those services met their standards of racial justice. Thus, the daily operations at the Harlem Branch involved not only contraceptive services but also ongoing negotiations of racial dynamics within the clinic. This is illustrated by the contrasting explanations African American and white advocates gave for the clinic's rate of growth. White advocates and clinic staff attributed the slow growth in the number of African American clients to the Black community's lack of familiarity with modern scientific methods for living and recommended publicity campaigns to educate the community about those techniques. African American Advisory Council members attributed slow growth to the community's justifiable suspicion of the motives behind a birth control clinic run by whites.[14] They recommended that the clinic hire African Americans for its staff, which was initially all white, and pursue an educational campaign framed to offer reassurances that the clinic was neither a segregated establishment nor an effort to promote race suicide within the Black community (see Document 12, Document 14, and Document 22). The views of African American advocates eventually prevailed, and the clinic began hiring African American staff members in 1933 (see Document 27 and Document 31).[15]

   This example gives some hint to the perspectives on race issues African American advocates brought to their work at the Harlem clinic. But what were their specific views of birth control? How did those views engage with and serve their larger purpose of racial justice? How did the Harlem clinic mesh with the larger national birth control movement in the 1930s? Were their perspectives consistent with that of African American birth control advocates nationwide? When and how did their perspectives dovetail with or conflict with those of white birth control advocates?

   When the Harlem clinic opened, contraceptive information and devices were still classified as obscene items that were barred from the mails by an 1873 federal law.[16] This legal prohibition made it difficult for women to obtain accurate information about birth control and effective contraceptive devices. Between 1914 and 1917, a sustained effort to challenge these legal prohibitions coalesced around the activities of Margaret Sanger. Her 1914 arrest for publication of the magazine Woman Rebel (in which the term "birth control" first appeared) and her 1916 arrest for operating a birth control clinic acted as catalysts for a national birth control movement. Sanger, a woman from a working-class background and a veteran of a number of workers' rights campaigns, initially relied on the networks of the radical left to build support for the cause of birth control.[17] She was reported to be a mesmerizing speaker, and she undertook a 20-city speaking tour in 1916 that quickly led to the organization of dozens of local birth control leagues. These groups focused on lobbying for repeal of the legal restrictions against contraceptives, but they made very little headway.[18] In her speeches throughout 1916, Sanger voiced her primary goal for the movement: a national network of clinics where women could obtain safe and reliable contraceptive advice and methods.[19] In October of that year, Sanger took a step toward that goal when she opened the first birth control clinic in the nation in the Brownsville section of Brooklyn. The clinic was short lived, however. Police shut it down after nine days. Sanger and the two women she worked with in the clinic were arrested and charged with and convicted of violating New York State's laws prohibiting dissemination of contraceptive information and devices.

   The court ruling in Sanger's appeal of her conviction helped pave the way for clinics in the 1920s, and she opened her second clinic, the Birth Control Clinical Research Bureau (CRB), in 1923.[20] This clinic, with which the Harlem Branch affiliated, operated until 1974, provided thousands of women with information and contraceptive devices, and was instrumental in the development of knowledge about safe and effective methods of contraception.[21]

   Birth control clinics were not the only source of contraception. Even though it was of dubious legality, a brisk commercial birth control trade sold a range of products that included condoms, douching agents, and vaginal suppositories. The quality of the products sold in the birth control black market varied considerably. Some devices and brands were safe and effective; some were not. Consumers had little way of knowing which was which and had little recourse if methods failed or caused harm.[22] In addition, an illegal trade in abortion flourished. Even though women seeking abortions and illegal contraceptive devices faced considerable risks to their safety and health, the black market of fertility control grew dramatically in the 1930s as the economic pressure on women and families increased during the Depression years.[23] By the middle of the decade, the commercial contraceptive market was estimated to be worth $200 million annually and an estimated 800,000 illegal abortions were performed each year. Abortion was more accessible in the 1930s than it would be in subsequent decades because the public and police sympathized with women's actions in the dire circumstances of the Depression.[24] Nonetheless, the risk of death remained high, particularly in Harlem. African American women were more likely to die as a result of abortion, a primary reason why their maternal mortality rate was higher than that of white women in New York.[25] Harlem Branch Advisory Council member Dr. Louis T. Wright noted that his interest in birth control stemmed from his experience at Harlem Hospital, where he witnessed an "appalling number" of deaths due to botched (illegal) abortions (see Document 11).

   Across the nation in the 1930s, the birth control movement intensified efforts to make contraception more readily available.[26] All of those efforts relied on rhetoric that was meant to persuade politicians and the public that contraception was a legitimate practice of modern life. That rhetoric used arguments based on woman's rights, economic security, and racial progress. Taken together, these arguments embodied the enduring tension within U.S. population politics between birth control as a social right and birth control as a social prescription.[27] The scope of these three strands of argument was expansive enough to attract supporters from a broad range of political perspectives and racial groups.

   Women stood at the center of birth control rhetoric in the early years of the movement. This line of argument made the claim that because women faced the personal risks of pregnancy and childbirth, they had the right to decide whether and when to have a child without any interference from the government. Legal prohibitions on the necessary means to exercise this fundamental liberty were thus illegitimate. As families grew larger than parents could support, women's health, marital happiness, and their very lives were destroyed by the drastic measures they were forced to take to control their fertility. Sanger's earliest arguments also spoke of women's right to sexual freedom; she pointed out that the legal prohibitions against contraception harmed women because the fear of unwanted pregnancy often destroyed their ability to engage in healthy marital relations. But by the 1930s, such sexual freedom arguments were muted.[28]

   The pro-birth control rhetoric African American advocates offered relied on many of the same ideas. Black birth control advocates also talked about women's right to preserve their health and well-being by limiting their fertility. But women's sexual rights, even for married women, were not mentioned directly. In two articles included here, W. E. B. Du Bois commented on this taboo against public discussion of sexual matters (see Document 1 and Document 17B). The endorsements of birth control published by African Americans, most of which were written by men, instead positioned it as a tool by which women, through good mothering in stable families, could fulfill their duty to help uplift the race. In Du Bois's view, marriage was the proper setting for women to enact that role. He emphasized the rights of children by arguing that "without marriage there can be no properly guarded childhood" and concluded that illegitimacy produced "poor little, innocent waifs, homeless and half-cared for" (see Document 1). As did all of Sanger's clinics, the Harlem clinic provided services for married women only, a practice that Advisory Council members seemed to accept.[29]

   Printed sources seldom recorded African American women's perspectives on the place of birth control in their lives (see Document 17H and Document 20). But where those views are recorded, birth control was endorsed as necessary for happy marriages and a healthy family life. In one article included here, Constance Fisher, an African American social worker from St. Paul, Minnesota, specifically discussed birth control as a means to support marital success. She noted, in the staid professional language of social work, that "sex maladjustment" was often the root cause of "infidelity, desertion, and generally broken homes," and she encouraged social workers to provide information and referrals to their clients upon request. She argued that the need for birth control was especially acute because of the economic hardships of the Depression, which "stretched" the "existing tensions" to the "breaking point" (see Document 17H).[30]

   While the opinions of African American women may have been recorded infrequently, the records of their organizations demonstrate that they participated actively in efforts to provide contraceptive services within their communities.[31] The Harlem clinic benefited from the contributions of a number of African American women who served on the Advisory Council. Bessye Bearden, a reporter for The Chicago Defender, an African American newspaper, helped publicize the clinic. She arranged a number of debates through the Business and Professional Women's Club of Harlem, one of which is reported in Document 19. May Chinn, the only woman physician practicing in Harlem at this time, could not be persuaded to work at the clinic. Out of deference to her parents' sensibilities, she limited her participation in the clinic to a more informal role on the Advisory Council.[32] Nurses Marion Hernandez of the Henry Street Visiting Nurses Association and Mabel Staupers also played important roles in the clinic. Staupers, who in subsequent years would play a decisive role in efforts to integrate the nursing profession, regularly argued that the African American staff would improve the success of the clinic within the community (see Document 14). Meanwhile, Hernandez worked to persuade social service agencies to refer clients to the clinic. Emmy Jenkins, who was hired as the Harlem clinic social worker in 1933, also spent a good deal of time and effort visiting with social service groups and churches to urge them to support the clinic.[33]

   The second line of argument in favor of birth control relied on the economic argument that persons have a right (and a responsibility) to limit the size of their families to that which their economic circumstances would support. This argument, which derived from the writings of eighteenth-century economist Thomas Malthus, hinged on his claim that if unchecked, population would always grow to exceed the food supply. A context of perpetual scarcity mandated that responsible parents and citizens exercise careful control of their fertility. For Malthus, this management rested on sexual restraint. Otherwise, nature would check population growth through famine, war, and misery.

   In the twentieth century, birth control advocates tended to accept Malthus's economic argument. But they rejected his notion of responsible management, saying that the level of sexual restraint required in the modern world made it an insufficient, impractical, and unhealthy solution to population pressures. The legal prohibition on contraception, which had a far greater impact on the poor, made no economic sense, in this view, because it unfairly deprived those who needed it most of the means to limit fertility. According to this line of argument, women of means could afford black market birth control or would be able to persuade medical practitioners to assist them with these matters; women without economic resources could not. Differential fertility rates between social classes were cited as the principal result of unequal access to safe and effective contraception. According to this line of argument, regardless of one's view about the underlying cause of poverty (be it indolence or inequality), everyone could agree that it was not in the nation's best interest for those with the least resources to have the largest number of children. Yet this argument could easily be turned against the poor to suggest that not everyone would be willing and able to manage their fertility, using differential birth rates as evidence. Such rates seemed to suggest higher fertility in poor communities. In this view, birth control was a social prescription rather than an individual woman's right or a tool for good health, and proponents of this economic justification sometimes made disparaging judgments about those who did not seem to limit their family size.[34]

   African American birth control advocates often noted differential fertility rates within the Black community in their arguments. Du Bois declared that "of all who need" birth control, "we Negroes are first" because the African American community was "becoming sharply divided into the mass who have endless children and the class who through long postponement of marriage have few or none." In his view, this bifurcated pattern robbed the community of stable childbearing families that would ensure racial progress, because children were "the only real Progress, the sole Hope, the sure Victory over Evil." His language engaged Malthusian logic in noting that "children should come into the world at intervals which will allow for the physical, economic and spiritual recovery of the parents" (see Document 1).

   African American advocates often used Malthusian logic to counter the pro-natalist claim that high fertility was a source of power for the African American community and the related claim that restricted fertility invited race suicide. [35] For example, Dr. W. G. Alexander stated, "Mass production of Negro babies, therefore, has become an anachronism--an economic fallacy with a correlated living problem, that is both a racial and a community liability" (see Document 17I). When children were born too often and too close together, community and family resources would be stretched too thin. Birth control could help ameliorate this situation. The economic security arguments African American advocates made positioned their claims within a wider culture of opposition to racism. The anachronism Alexander referred to was produced by racial politics in which generations of "high pressure methods in the slave business meant the encouragement of prolific reproduction" (see Document 17I).[36] Fewer children who were well reared would do more to ensure the future of the race. With these statements, Alexander represented his race's high fertility as a legacy of slavery rather than an inherent biological trait.

   The third line of argument circulating within the birth control movement relied on biological theory to argue that birth control brought important social benefits. This argument focused not on individuals but on the nation as a whole, particularly its size and ethnic character. Over the course of U.S. history, demographic trends in population have often been read as markers of the nation's strength. That is, the vital statistics of the nation's population are often seen as indicative of the nation's vitality, a way of thinking that confuses bodies of persons with the body politic. This concern with demographic trends has recurrently fixated on differences in the vital statistics of America's ethnic groups. An indelible connection between race, population, and the nation was set up at the country's founding when political power was apportioned among the states based upon number and kind of people within each state.[37]

   In the 1920s, anxiety focused once again on the question of the different rates of growth among America's ethnic groups. Public debates swirled around the questions of whether "old stock" Americans were committing race suicide by having too few children and whether or not higher fertility and rapid immigration threatened to undermine American democratic institutions by changing the character of its people. In the view that prevailed, the solutions to these potential problems were legislation to enact immigration restriction and compulsory sterilization laws.[38] Both efforts rested on the biologically deterministic arguments of eugenics, which linked race, character, competence, and family size.

   The evolutionary view of progress is a supple concept, and it was taken up by a wide range of early-twentieth-century social movements as they sought to apply scientific solutions to social problems. But at the same time, an evolutionary view of progress could also support the view that biology determined character, personality, and fertility rates, as it did in eugenics[39] Following the assertion by nineteenth-century social Darwinists that fertility declined as intelligence evolved, eugenicists read large family size as evidence of biological inferiority[40] They disparaged high fertility among the poor, recent immigrants, and non-European ethnic groups as a grave threat to the nation's progress, claiming that their higher fertility meant that each generation contained a higher proportion of "unfit" individuals.[41] Eugenicists argued that implementing public policies to control reproduction among "unfit" social groups was essential for the nation's well-being. Those who subscribed to eugenic arguments believed that fertility control was a means by which the nation could control the growth and character of its population.[42] But, not trusting those they saw as "unfit," eugenicists favored compulsory sterilization by the state over other, more voluntary forms of fertility control. For many in the birth control movement, eugenic policies were too prescriptive. Nonetheless, birth control advocates used eugenic logic--such as the idea that balancing the rate of growth between different ethnic groups and social classes would promote national progress--to legitimate their goal of legal and readily accessible contraceptives (see Document 17D and Document 23).

   African American intellectuals such as Du Bois, Charles S. Johnson, and E. Franklin Frazier adamantly opposed biologically determinist views of race (see Document 1, Document 17B, Document 17C, and Document 17F). They argued that intensive research had failed to demonstrate the existence of biological races, let alone inherent differences between races. In fact, scientific evidence pointed to the finding that there were no races. Du Bois wrote that "no measurements of human beings, of bodily development, of head form, of color or hair, of psychological reaction, [had] succeeded in dividing mankind into different recognizable groups." Scientific research instead showed that observed differences between the races were the result of their different social and economic circumstances, in particular the centuries of oppressive exclusion from mainstream society African Americans had endured.[43]

   Thus, African American birth control advocates tended to see demographic differences between the races (such as fertility rates and maternal and infant mortality rates) as the outcome of historical and contemporary patterns of racism. African American advocates linked birth control to a political notion of racial progress; it became one more tool in the ongoing struggle of African Americans against a racist society. As Du Bois stated, when children were "brought with thought and foresight into intelligent family circles and trained by parents, teachers, friends, and society," the African American community would achieve "Eternal Progress and Eternal Life. Against these, no barriers stand; to them no Problem is insoluble" (see Document 1).

   African American birth control advocates believed that birth control should be voluntary. They were sensitive to and often shared the concerns expressed within their community about the potential for ill treatment in health services backed by whites, including birth control services. They opposed compulsory sterilization laws, fearing that they would unfairly target those who were already disenfranchised. Du Bois was concerned that advocates of compulsory sterilization often confused economic circumstances with racial difference and warned his community that "the thing we want to watch is the so-called eugenic sterilization." In 1936, he urged readers of The Pittsburgh Courier to oppose such laws.[44]

   Despite the caution African American birth control supporters felt about coercive policies to control fertility, their own rhetoric sometimes contained prescriptive elements; they felt that there were "proper" standards of voluntary birth control. African Americans advocates, who tended to be members of the middle class, endorsed the Malthusian logic that fertility should be consciously limited to accommodate an economic calculus based on family resources. In this way, birth control would promote economic progress for both individual African Americans and the larger community. But this rhetoric often had a double edge. Although it opposed eugenic appraisals of the Negro race, it sometimes described the fertility patterns of poorer segments of the race in disparaging terms reminiscent of the rhetoric of eugenics.

   Du Bois observed that "the increase among Negroes, even more than the increase among whites, is from that part of the population least intelligent and fit, and least able to rear their children properly" (see Document 17B). He was not alone. Other authors observed the differential pattern of fertility where "the Negro who, in addition to the handicaps of race and color, is shackled by mental and social incompetence serenely goes on his way bringing into the world children whose chances of mere existence are apparently becoming more and more haphazard" (see Document 17D). Such disparaging remarks went hand in hand with denunciations of U.S. racial politics that deprived African Americans of equal opportunity.

   This combination of clear insight into the consequences of racism and condescension toward the poor was apparent in Harlem. For example, the National Urban League, which supported new residents as they adjusted to urban life, offered social uplift programs that were double edged. The League provided needed instruction in city living to rural immigrants, but it also promoted "proper standards" of cleanliness, appearance, and deportment for those who were "ignorant" of urban customs.[45] Document 23 provides an example of resistance to racism and adherence to elitism in a pro-birth control article written by a Harlem Clinic Advisory Council member.

   The documents in this project offer a window on the views and actions of African American birth control advocates associated with the Harlem clinic. The impact of the clinic in the community is difficult to assess from the extant records. We do know that in the five years it operated as a branch of the CRB, the Harlem Clinic served about 1,000 women annually, half of whom were white. In addition, clinic staff and Advisory Council members gave dozens of public lectures in the community each year.

   Intertwined, and sometimes conflicting, elements of women's rights, economic security, and racial progress laid the ground for cooperation and conflict between the Advisory Council and Sanger and the white clinic staff. Both groups shared a concern about the high rates of maternal and infant mortality, and both supported birth control as a basis for promoting women's health and the health and well-being of their families. At the same time, disparaging attitudes about the poor ran through the perspectives of both groups, although the Advisory Council disputed any suggestion that biologically based racial traits accounted for the problems the poor of Harlem faced.

   Where they differed from Sanger, the Advisory Council members were able to influence her management of the clinic, as is evident in the council's effective campaign to persuade Sanger to hire more African American staff for the Harlem Branch clinic (see Document 16, Document 21, and Document 22).[46] The council's influence was apparent as well in the clinic's publications and educational programs. In publicity pamphlets and public lectures and speeches, clinic staff and Advisory Council members took care to address suspicions that the clinic was a segregated effort and/or that it promoted permanent or nonvoluntary methods of fertility control (see Document 13, Document 29, and Document 36). In both of these examples, the Advisory Council's efforts reflected their commitment to racial justice based in equal opportunity through full integration.

   As the Depression worsened, it became increasing difficult to fund the clinic. Like the main clinic in Manhattan, the Harlem Branch was supported by a combination of private donations, client fees, and Sanger's personal resources.[47] Reticence about public discussion of sexual matters and controversy about the religious morality of birth control hindered fundraising efforts. In particular, government agencies and private philanthropies avoided any association with birth control. The fundraising success birth control groups did have came largely from the personal resources of wealthy and middle-class women. The decline in charitable giving during the Depression--a result of the dramatic decline in wealth caused by the stock market crash--exacerbated funding problems. This was not unique to facilities that provided birth control services; the level of need for simple survival services nearly overwhelmed charitable agencies across the nation. Like many other social service institutions, clinics experienced an increase in demand for their services even as people's ability to pay decreased.[48] New Deal policies began to provide some relief by 1934, but those resources did not cover birth control services, and birth control groups struggled to maintain their programs.

   The Rosenwald Fund, which was operated and funded by Julius Rosenwald, founder of Sears, Roebuck, and Co., gave Sanger a grant of $5,000 for the Harlem clinic in 1930 and again in 1931. The fund, whose stock holdings declined in value by almost 50 percent between 1929 and 1932, did not renew the grant in 1932. In 1933 and 1934, Mrs. Felix Fuld, a longtime supporter of Sanger's work, provided up to $5,000 in matching funds to support the Harlem clinic. The Harlem community had little wealth of its own, and its charitable resources were very limited. Moreover, these resources were allocated primarily for survival services. By one estimate, churches in Harlem fed several thousand people a day during the period 1930 to 1934.[49] In addition, the higher levels of unemployment and poverty in Harlem meant that most of the clinic's clients could not afford the fee for services.[50] The combination of the loss of the Rosenwald funds, the limited charitable resources in the Harlem community, and the inability of most clients to pay for services left Sanger with few options for financing the Harlem Branch. The clinic moved to the New York Urban League building in 1933 in an effort to reduce costs (see Document 30, Document 34, and Document 35).

   Although the continuing high level of unsupported costs was unsustainable in the long term, Sanger did not want to close the clinic, and in mid-1935 an alternative arose. The American Birth Control League (ABCL) contacted Sanger to tell her that it had received funding to open a clinic in Harlem. It wanted to assume management of the existing clinic rather than duplicate efforts in a time of financial crisis. Sanger agreed.[51] However, she stipulated that "the same principles of cooperation and equality be maintained" and that she, Stone, and the Advisory Council be retained as members of the new clinic advisory board (see Document 41). The takeover plans appear to have been made with minimal input from the Advisory Council, whose members raised some objections (see Document 38, Document 39, and Document 40). Detailed records of the Harlem clinic are sparse after the clinic's transfer to the ABCL auspices. The few existing documents indicate that after closing briefly in 1936, the clinic continued at least until 1945, when the ABCL hosted a tenth-anniversary celebration.[52]


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