Newsletter #6 (Winter 1993/1994)

"Sanger's Role in the Development of Contraceptive Technologies"

From the start of her career, Margaret Sanger recognized that if birth control was to be accepted and widely used, women would need access to contraceptives that were safe, effective, inexpensive and easy to use. Sanger's interest in the development of effective birth control methods both directly and indirectly shaped the way contraceptive research is pursued in the 20th century.

Sanger began her own education on birth control methods by surveying what was available. Finding little in the U.S., she went to France in 1913 where she discovered among the working-classes the use of simple, home made contraceptive recipes. In 1914, she published many of these in her groundbreaking pamphlet, Family Limitation, which provided instructions and evaluations of the range of available contraceptive techniques. The pamphlet listed syringes filled with foam acid powders; vinegar-soaked sponges to absorb sperm; and spermicidal douches made of such easily purchased ingredients as vinegar, boric, citric, tartaric acids, copper, nitrate of silver, or Lysol; recipes for vaginal suppositories made of cocoa butter or quinine (later manufactured and labeled as Quinseptikons); and Mizpah cervical caps.

While Sanger favored the Mizpah pessary, she learned of an even more effective barrier method during a 1915 trip to Holland, where she was introduced to the spring-form diaphragm developed in the 1880s by Dr. Wilhelm Mensinga. Sanger was excited by this new product and sought to promote the use of the Mensinga diaphragm in the U.S. But there were obstacles. First and foremost, she needed to obtain a supply of these devices. Because U.S. law banned the importation of contraceptives, Sanger relied on the international business contacts of her second husband, J. Noah Slee, who headed the 3-in-1 Oil Company. During the 1920s Sanger had quantities of the diaphragms hidden in 3-in-1 oil drums which were shipped to the company factory in Montreal, and then smuggled into the U.S. for use in Sanger's Birth Control Clinical Research Bureau. In 1925, at her instigation, several of Sanger's associates formed a company called Holland-Rantos to manufacture the diaphragms in the U.S.

Sanger also had to contend with the fact that many physicians opposed the use of diaphragms fearing that continued use would cause sterility and other gynecological problems. The prolonged use of some spermicides was also believed to be risky. Sanger's course of action was to conduct scientific tests to prove that the diaphragms were both safe and effective. Ten thousand patients at the Clinical Research Department of the American Birth Control League were studied providing the first clinical trial of birth control methods. Of the patients monitored over an extended period of time, the safety and effectiveness of the diaphragm was clearly demonstrated. These studies, coupled with the educational programs she established enabled Sanger to convince the profession that diaphragms were both practical and safe.

The diaphragm, however, did not sufficiently fulfill Sanger's search for a cheap, reliable and convenient contraceptive. Women found diaphragms on the whole effective, but complicated and unpleasant to use, requiring proper measuring and fittings by physicians, and entailing returning to the clinic or physician for follow-up fittings. For poor women this was particularly burdensome. Sanger was determined to find a better technique. During the 1930s-1940s, Sanger promoted research into less expensive and more accessible methods such as foam powders and jellies. She also redirected the efforts of her Margaret Sanger Research Bureau to clinical trials of the new products, while pressuring for government support of contraceptive research.

Despite her support of this research, Sanger was increasingly less interested in barrier methods and spermicidal solutions. Her ideal was a more permanent form of contraceptive, one which could be used apart from the sex act. During the 1930s she provided funds to encourage scientific research into spermatoxins and pursued experimental research in methods that would immunize women against sperm. She also became interested in scientists doing hormonal research aimed at inhibiting ovulation. But none of this resulted in the practical birth control method she sought.

After World War II as fears of global population growth began to emerge and Sanger stepped up her efforts to find a viable method. The work of Dr. Gregory Pincus, of the Worcester Foundation for Experimental Biology, seemed particularly promising. In 1951 Sanger set up a meeting with Pincus and a wealthy friend, Katharine Dexter McCormick. Sanger had contributed a small amount of her own money to support the work of Pincus and his associates, but by 1951 preliminary work on the creation of a hormonal contraceptive that could be taken orally required a far more significant infusion of funds than Sanger could provide. Encouraged by Sanger, McCormick invested approximately $3 million in this research, eventually enabling clinical tests of the anovulant to be undertaken in Puerto Rico. In 1960, the FDA formally approved Enovid, the first birth control pill.

Whatever its limitations, the pill has revolutionized modern society. In her efforts to fulfill the goal of providing women with an effective, convenient and relatively safe form of birth control, Sanger presented a rare instance of how a generally indifferent scientific community can be pressured to respond to the needs of women.