Document 36: Marie Levinson Warner, "Birth Control and the Negro," 1934, 15 pp., Box 122B, Margaret Sanger Papers, Sophia Smith Collection, Smith College, Northampton, Massachusetts.
This pamphlet was produced by chief staff physician at the clinic, Dr. Marie Levinson Warner, who replaced Dr. Hannah Stone after a 1932 report by Dr. Midian Bousfield for the Rosenwald Fund noted racial tensions surrounding Stone's leadership of the clinic. This annual report for 1934 provides an example of the formal medical language that was common in research reports written by physician advocates who worked in birth control clinics. In addition, the report shows the imprint of the Advisory Council's influence; Warner framed demographic data in the report in a way that emphasized the similarities between racial groups and stressed the similarities in the sexual habits of African Americans and whites. Warner's data confirmed that both racial groups needed and wanted birth control for similar reasons. She reported that the vast majority of both African American and white women who came to the clinic had already tried to limit their fertility using "make-shift, unscientific and often harmful" methods. When Warner noted racial differences, she attributed them to economics rather than biology. For instance, in comparing family size she stressed the higher infant mortality among African Americans and attributed that difference to high unemployment rates.
STATISTICAL RECORD FOR FISCAL YEAR
November 30, 1933-December 1, 1934
BIRTH CONTROL CLINICAL RESEARCH BUREAU
NEW PATIENT DEPARTMENT
New Patients applying 5655 Patients advised 5515 Patients not advised 140* Patients referred to other medical centers 527 6182 OLD PATIENT DEPARTMENT Individual contacts made with old patients 2656 Old patients consulting doctor (visits) 6236 8892 Patients referred to other medical centers 35 8927 SUPPLY DEPARTMENT Old patients returning for supplies 5760 Return visits of patients 9108 14868 Patients attending Diagnostic clinic 130 Patients attending Cervicap clinic 44 Marital Advice service 70 RECEPTION DEPARTMENT Total number of visitors 2664 Professional 131 Lay 630 General Information 1903 Referred to other clinics 220 2884 TOTAL SERVICES RENDERED 33,105
Birth Control Clinical Research Bureau
202 West 136th Street
New York City
BIRTH CONTROL AND THE NEGRO
By Dr. Marie P. Warner
This symposium on Birth Control, Family Planning, and Depression Problems, is given by the Harlem Branch of the Birth Control Clinical Research Bureau, of which Margaret Sanger is Founder and Director, to make known the medical and sociological need for Birth Control, as it affects not only the mothers of Harlem, but also the fathers and children. We wish to show what the Harlem Branch has accomplished in cooperating with social agencies in a community welfare program.
By giving information concerning the aims of this Clinic, its functions, the sources of its patients, the results of its four years' work, and the beneficial mental and physical health service rendered, it is hoped that more social agencies will refer their needy clients and also that individuals having medical indications will avail themselves of the services of the Harlem Branch.
This Clinic is open in Room 9 of the New York Urban League Building, 202 West 136th Street, New York City, every day from 1 P. M. to 5 P. M. for consultations, appointments and for issuing supplies. Clinic sessions are held Wednesday and Friday afternoons from 2 P. M. to 4 P. M., and Thursday evenings from 7 P. M. to 9 P. M., when physicians examine patients and prescribe birth control methods. The medical director is Dr. Marie Pichel Warner, and the staff physician is Dr. Harold L. Ellis. The staff nurse is Mrs. Dorothy M. Riddick, who also acts as field social worker. Mrs. Helen B. Davis is the secretary. The Advisory Council consists of representative professional men and women whose services are greatly appreciated.
They are as follows:
Mrs. Lois Allen Mrs. Felix Fuld Mrs. Bessye Bearden, Chairman Mrs. Marion Hernandez, R.N. Rev. Shelton Hale Bishop Rev. Horatio Hill Lucien Brown, M.D. Rev. William Lloyd Imes May Chinn, M.D. Mrs. Mabel Bickford Jenkins Mrs. Geraldinge Dismond Mabel K. Staupers, R.N. Harold L. Ellis, M.D. Louis T. Wright, M.D.
Mrs. Felix Fuld has given the clinic generous financial support. The Rosenwald Foundation, which made a contribution several years ago, has found it necessary, at the present time, to discontinue its support. The Clinical Research Bureau contributes $200.00 a year to the New York Urban League towards the upkeep of the building and assumes the financial burden for maintaining and operating the Clinic.
To have a clear understanding of what is meant by Birth Control it should be stated that scientific Birth Control is a harmless method of avoiding conception by preventing the union of the male sperm with the female ovum. The methods prescribed by this Clinic have been approved by the medical profession as the most efficient birth control methods known at present. The advice can only be given by a physician trained in contraceptive technique after individual pelvic examination of the woman. The New York State law allows a physician to give birth control advice for the "cure and prevention of disease." The use of the birth control method prescribed by this Clinic does not cause discomfort and is merely a temporary means of preventing undesired pregnancies. It never affects the ability of the mother to have children when she so desires.
The usual method prescribed is the use of the vaginal diaphragm pessary combined with a chemical jelly, which the woman easily learns to use after brief technical instruction.
The term Birth Control should not be confused with Abortion. Abortion means the removal of an unwanted pregnancy
by an operation which destroys the life of an already existing embryo, whereas Birth Control means the prevention of conception and in no way destroys a life. Abortion is usually resorted to after inefficient birth control methods have failed and an undesired pregnancy has resulted, or when no birth control methods have been used. It is known that abortions frequently may result in permanent sterility or the inability ever to bear children. The use of scientific birth control methods will do away with the necessity for abortions.
Birth Control must not be confused with sterilization. Sterilization means the permanent loss of reproductive power of either male or female through surgical procedure or X-ray exposure of the reproductive organs. Sterilization is not the method prescribed in birth control clinics. Occasionally patients with a severe incurable medical condition voluntarily request sterilization. In these cases sterilization is approved only when the usual clinic birth control methods cannot be used. This Clinic has had only two such cases, which were referred to recognized hospitals for attention.
We believe that Birth Control should be used to plan families and space children according to the health and economic conditions of the parents by temporary harmless scientific methods. To prevent does not destroy; to control does not limit. To quote Margaret Sanger, "Parents should have children of choice and not of chance."
This Clinic started by Margaret Sanger as the Harlem Branch of her Clinic at 17 West 16th Street, New York City, which is the largest of its kind in the world, is the first such clinic to be organized in the interests of negroes. However, there are no restrictions nor distinctions as to race or religion.
Of the four thousand new patients who have received advice at this Clinic to date, 46% were Negro, 48% were White, and 6% were Porto Ricans. There have been about 15,000 return consultations. Only 6% of the patients were able to pay the full fee of $5.00 for examination, advice,
and supplies. Thirty-eight percent have been treated free, and 56% paid only a very small fee in proportion to their earnings. Upon the recommendation of a social agency, advice and supplies were given free to patients who were unable to pay. Approximately 44% of the Negroes, and 21% of the Whites were totally unemployed, and the average salary of those employed was $16.00 a week for the Negro, and $22.00 for the White. The families were married on the average of seven years at the time of their first visit to the Clinic, and there was an average of four living children and 47% dead per Negro family, and three living children and 23% dead per White family. There is food for thought in the analysis of these figures. It is known that children born closer than every two years have less chance for survival, and mothers having children with this frequency have a higher mortality rate, according to Federal statistics. It should be noted that the Negro families were larger and that their infant death rate was double that of the Whites.
The medical indications for patients being referred to the Clinic showed that 47% had young infants under 18 months of age, 30% had female disorders, and 23% had medical indications, such as malnutrition, anaemia, mental diseases, epilepsy, blindness, high blood pressure, syphilis, nephritis, rheumatism, heart disease, tuberculosis, etc., and anxiety neurosis from fear of unwanted pregnancies.
About 50% of all patients were found to need medical or surgical treatment and were referred to their family physician or to a hospital or clinic for attention. The Clinic acts as a diagnostic clearing house, and as a health measure it urges the patients to have a yearly pelvic examination.
Religion does not seem to be a factor in Birth Control according to our findings which showed that 37% of the patients were Hebrews, 37% Catholic, and 26% Protestant. Of these, 93% of the whites and 85% of the negroes have already been using some type of make-shift, unscientific and often harmful Birth Control with unsuccessful results, before applying to the Clinic.
FOUR YEARS' STATISTICAL STUDY AND ANALYSIS OF RECORDS OF 3736 PATIENTS;
NEGRO, WHITE, AND PORTO RICAN
Source of Patients:
Other Patients of the Clinic 1606 43% Social Agencies 748 20% Friends 298 8% Nurses 297 8% Publicity, Lectures, Reading Matter, etc. 299 8% Private Physicians 207 5.5% Hospitals 187 5% Health Clinics, Day Nurseries, etc. 56 1.5% Miscellaneous, Ministers, etc. 38 1%
Success of the Methods Prescribed: The Harlem Branch found that both negro and white women learned and applied the clinic birth control methods equally well and with 95% success in the cases which continued to use the methods prescribed for them. This is much more than was reported from any other methods used before coming to the Clinic.
Planned Pregnancies: Assisting in the eugenic aspects of family planning, eight planned pregnancies were reported by the patients of the clinic who temporarily discontinued the use of Birth Control and returned for further advice after confinement.
OTHER ACTIVITIES OF THE HARLEM CLINIC
A Training Course for physicians in contraceptive technique was given by Dr. Marie Pichel Warner, Medical Director of the Clinic. Since its inception in 1933, ten physicians,
eight women and two men, have completed this training. Three of these physicians are now in charge of newly organized clinics. One in Morristown, New Jersey; one in Easton, Pa., and one in Palestine. While the clinic feels that only physicians should prescribe birth control advice, there are special conditions when a graduate nurse can be trained for the purpose of organizing birth control clinics under the direction of a physician. Three nurses were trained at this branch and have since organized birth control clinics at Salisbury, Maryland, and the first birth control clinic in the Philippine Islands, while the third is a travelling secretary for the organization of rural birth control clinics.
Since September, 1933, ten male and thirteen female doctors, in addition to twenty medical students, fifty social workers and twenty-five nurses have visited the clinic for observation of its routine.
An educational campaign is conducted by lectures and by the publication of studies. Sixty talks have been given to lay and medical groups; also to groups of men, women and mixed audiences. Ten of these were in Harlem churches. During the past year Dr. Warner, the Medical Director, has addressed twenty groups in Harlem on Birth Control. Speakers and literature on the various aspects of the subject are gladly furnished without cost.
A detailed report has been prepared for publication comparing birth control methods among Negro and White women. Statistics relating to sexual habits, child bearing, marriage, pelvic findings, abortions, employment, economic status, and methods of Birth Control before coming to the Clinic, methods prescribed, results and reasons for seeking
birth control advice, etc., are included. A preliminary study of 200 women was made and later another study of 1434 cases. The larger study was found to coincide closely with the findings of the smaller group. The outstanding findings concerning birth control was that 85% of the Negroes, and 93% of the Whites were practising Birth Control in some form before visiting the Clinic. Among the Whites the responsibility for limitation of the size of families was assumed by the male, who practised withdrawal or used condoms, and among the Negroes, by the female, who used the douche. There was no difference in the sex habits between the White and Negro, marital relations occurring on the average of twice a week. Both Negro and White were equally successful in the use of the prescribed Clinic methods.
Research statistics of contraceptive methods are gathered and by cooperating with the Research Committee of the Birth Control Clinical Research Bureau the efficiency of new methods and materials are evaluated.
The legal aspects of birth control are clarified to medical and lay groups. A bill has been presented to Congress by the National Committee on Federal Legislation for Birth Control, Inc., of which Margaret Sanger is Chairman, to amend the Federal law which prohibits the sending or receiving of supplies or information by use of the United States mails, so as to exempt physicians, druggists, medical colleges, hospitals, or clinics from the above restrictions.
Scientific birth control removes the fear of untimely pregnancies, thereby resulting in improved mental health, better marital adjustment, and more perfect family harmony. The physical health of mother, father, and children is improved by regulating the size of the family by means of spacing and planned pregnancies, which relieve the economic burden and allow a higher living standard. Marriage
is made possible at an earlier age when fear of unwanted pregnancies is removed, thus preventing promiscuity, prostitution, and veneral disease. Marriage is also made possible for chronically diseased persons for whom pregnancy is contra-indicated but to whom marriage need not be denied. Higher educational standards can be obtained by making it possible for persons to marry and lead a normal sex life while completing their education and professional training even though each has to assume individual economic responsibilities. Birth control allows voluntary parenthood, eugenic human breeding, spiritual, physical, and emotional fulfillment.
Health requires knowledge and the practice of scientific contraception during marriage, regardless of race, color, or creed, for the good of the individual mother, the family, and the race.
THE RECREATION ROOMS AND SETTLEMENT BRANCH
Birth Control Clinical Research Bureau
84 East First Street
New York City
HISTORY AND OBJECT
February 15th, 1933, through the assistance of Mrs. Margaret Sanger, a six months demonstration birth control clinic was started for the lower East Side of New York. Dr. Marie Pichel Warner was appointed as physician in charge. The Birth Control Clinical Research Bureau gave the services of the doctor and furnished the supplies while the Recreation Settlement donated the room and equipment. Mothers from the community came for pelvic examinations, for advice as to how to regulate the size of their families and space their children and to discuss their marital problems. Many came for diagnosis of pregnancy or for referral to other clinics or hospitals for treatment. This clinic has continued
to function (1933—five months, 1934—eight months, 1935—three months) except for summers, when there is not available room due to camp and play school activities.
Patients are examined and prescribed for on Wednesdays from 11-1 P.M., by the physician, at 84 East First Street, New York City. Appointments can be made and supplies received daily from nine to five, through Miss Caroline Thien, the Supervisor of Medical Social Service of the Settlement who also serves as nurse for the birth control clinic.
One physician, Dr. Marie Pichel Warner, Medical Director; Miss Caroline Thien, graduate nurse, Director of Medical Social Service of the Settlement, and an additional graduate nurse serve at clinic sessions. Mrs. Ruth Morgenstern, Social Worker, volunteers her services to take histories and do the necessary clerical work. The same staff have worked together continuously since the inception of the clinic, February 1933.
The first year was only a four months' clinic period at which time 71 women were prescribed for. The following year (eight months) 139 patients were instructed in contraceptive methods. In the two years of its existence the Recreation Rooms Branch Clinic in fifty clinic sessions has advised 337 mothers up to April first. The increasing number of patients seen at each session indicates a growing Clinic.
SOURCE OF PATIENTS
All patients come voluntarily and unsolicited from any source. The nucleus of the clinic patients is made up of mothers who come to the prenatal or health clinic; whose children are in the day nursery school at the Settlement or who are brought in by friends or patients of the clinic.
While the Settlement has a larger proportion of Jewish clients, the Clinic showed 77% Catholic patients, 15% Jewish, and a smaller percent Protestant. 81% of the patients are of Italian birth, 35% having become Americanized. Upon questioning the younger Jewish mothers, it was found that many of them already were practicing birth control.
92% of the wage earners were unemployed. Study of the records showed that over 70% were on public relief, almost 13% were on private relief, and only 8% were fully employed.
Most cases were entirely free. A few paid from 25c to $1.25. Social agencies referring cases paid $1.25. Supplies are given free whenever cases are known to be needy.
INTERESTING SOCIAL FACTS
Average age of patient is 29.5 years, for the husbands 34.5 years. Average duration of marriage is 9.8 years before asking for help to regulate the size of their families. Average number of pregnancies is 4.3 per family. Of 50
patients known to relief agencies from one to seven years, 29 of these mothers had 38 children after being supported by a relief agency, increasing an already existing family of children, most of whom the mothers admitted were unwanted additions.
Talks were given by the Medical Director to Mothers' Clubs at the Settlement and to other settlement groups in the neighborhood, as well as to groups of Social Workers.
Annual statistical reports are furnished. Likewise, a Study of Birth Control in the Lower East Side Tenement District of New York City was prepared and will soon be published. This is a detailed resume of sex habits, sociological facts, birth control and marital habits, etc., of 71 patients of the Recreation Rooms Clinic during its first year.
SUCCESS OF METHOD PRESCRIBED
There were 49% continuing to use the method successfully. There are no known failures reported among the patients who use the advice. Discontinuance of the use of the method prescribed is due to indifference, neglect, or to its being "too much trouble" in a few cases.
REFERRAL TO OTHER CLINICS FOR TREATMENT
45% were sent to Hospital clinics or their family physician for treatment for conditions found on medical examination. Over 90% of the women suffered from lacerations of the pelvic floor and cervix.
There were two planned babies born to mothers who were clinic patients.
Case A—Birth control advice was requested and furnished a grandmother of fifty-four years of age, who has regular menstruation periods, and who had an abortion six weeks before coming to the clinic.
Case B—Mothers (Italian) of eighteen and nineteen with three or more pregnancies and appearing like women of forty or older, are most grateful patients.
Case C—Tragic cases of young mothers with nursing infants of two and three months of age, who are found to be pregnant at the time of their first visit—too late for contraceptive advice.
Case D—Italian mother 36 admitted to fourteen pregnancies, nine living, 4 dead, one spontaneous miscarriage; large colloid goitre, badly torn pelvic floor with prolapsed uterus, the mouth of the womb hanging outside the vagina. This patient could not be fitted with any birth control device and the husband refused to cooperate. She refused surgical repair and removal of her goitre. She also refused to consider sterilization by X-ray castration, even after she was admitted to Mt. Sinai Hospital. May 30, 1933—the family was supported by Association for Improving the Condition of the Poor who reported the woman pregnant again May 3rd, 1934. What a problem!
Case E—Patient Polish-Jewish woman 33 years old, husband Italian, six living children. Epileptic until 12 years of age, paralyzed right arm and leg, varicose veins, torn pelvic floor. Mother diabetic, had pessary fitted but was unable to use and husband refuses cooperation. Became pregnant after visiting clinic while using no contraceptive, sixth baby was born December 12th, 1934. Patient reapplied to clinic for advice—requests sterilization due to paralyzed condition. Temporarily fitted with aluminum cervicap which has to be removed by the clinic doctor monthly. Clinic is attempting to arrange for some city hospital to sterilize this case. Four children born while on public relief.
BIRTH CONTROL CLINICAL RESEARCH BUREAU
17 WEST 16th STREET
NEW YORK CITY
MARGARET SANGER, Director
HANNAH M. STONE, M.D., Medical Director
J. NOAH H. SLEE, Treasurer
FRANCES B. ACKERMANN, Asst. Treasurer
HAZEL ZBOROWSKI, Executive Secretary
Cheri Appel, M.D. Lena Levine, M.D. Jeanne Carbonnier, M.D. Marion Tyndall, M.D. Lillian De Muth, M.D. Marie P. Warner, M.D. Christine Gruggel, M.D. Frances J. Weiser, M.D. Advisory Council Leon J. Cole, Ph.D. Adolf Meyer, M.D. L. C. Dunn, Sc.D. Stuart Mudd, M.D. E. M. East, Ph.D. William F. Ogburn, Ph.D. Henry Pratt Fairchild, Ph.D. John B. Solley, Jr., M.D. John Favill, M.D. Benjamin T. Tilton, M.D. C. C. Little, Sc.D. Ira S. Wile, M.D. Clinical Research Committee Margaret Sanger, Chairman Hannah M. Stone, M.D. Marie P. Warner, M.D. Lena Levine, M.D. Frances J. Weiser, M.D. HARLEM BRANCH 202 West 136th Street New York City Marie P. Warner, M.D., Chief of Staff Harold L. Ellis, M.D. Advisory Council Mrs. Lois Allen Mrs. Marion Hernandez, R.N. Mrs. Bessye Bearden Rev. Horatio Hill Lucien Brown, M.D. Rev. Wm. Lloyd Imes May Chinn, M.D. Peter M. Murray, M.D. Harold L. Ellis, M.D. Miss Mabel K. Staupers, R.N. Mrs. Jane Fisher James L. Wilson, M.D. Mrs. Felix Fuld Louis T. Wright, M.D.
* Not eligible for admission under New York State Law.
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