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Margaret Sanger and the International Birth Control Movement

By Esther Katz

Margaret Sanger Papers

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   The campaign to control human fertility and manage population growth has through the last one hundred years yielded a growing number of interdisciplinary studies and, as new archives are being opened and made accessible, a burgeoning historical literature. Initially, the literature had focused on eugenics, and to a lesser extent, the neo-Malthusian movement's efforts to determine the composition as well as the size of the population.[1] But a few studies have started looking at these issues from a feminist viewpoint, focusing on the role of women in these movements.

    While most early-twentieth-century feminists were focused on suffrage and the attainment of economic and political equality, a few such as Ellen Key and others concentrated on sex reform. However, when some of the mostly male eugenicists connected notions of "race suicide" with the failure of upper-class women to fulfill their social responsibilities by having sufficient children to keep up with more "undesirable" groups, some feminists shifted their focus to the need for women to control their own reproductive lives. Among the most notable was Margaret Sanger, the American birth control leader who believed that "birth control is the means by which woman attains basic freedom."[2] When her views were rejected by many women's rights leaders as too radical and marginalized by many of her socialist and radical labor colleagues as too feminist, she decided to build a birth control movement that aimed at making contraceptive use legal, respectable and widespread, by forming alliances both with the neo-Malthusian and eugenics movements. She was also a constant, if sometimes irritating reminder that issue of artificially controlling population through the use of contraception was a woman's issue; she eventually formulated an ideology that linked eugenics and population issues to feminism.[3]

   In addition to their focus on issues of women, men, sex, and reproduction, the new population studies of both male and female reformers were also notable for their international, and more recently, their self-consciously global nature.[4] Indeed, Matthew Connelly noted that "population control as a precociously international movement," has "served as a platform for an array of ideological projects."[5] In the early twentieth century, demographic and population studies came to the fore through activists seeking to promote causes such as neo-Malthusianism, feminism, eugenics, population control, and birth control.[6]

   The Malthusian League, founded in England in 1877, was the first organization to focus on the issue of population size and the scarcity of resources, and to promote artificial contraception. The neo-Malthusian movement accepted the classical economic theory that poverty was the result of excessive population. But unlike other population groups, and Thomas Malthus himself, it advocated the need for artificial birth control. Neo-Malthusianists believed people should be educated in sexual matters and contraceptive use.[7] The British League soon joined with similar leagues in France, the Netherlands, and Germany, and in 1900 the First International Neo-Malthusian Conference convened in Paris. These Leagues, joined by one from Belgium, sponsored conferences in Liege in 1905 and The Hague in 1910, this time with representatives also coming from Spain, Switzerland, Sweden and Hungary, and reports included from Portugal and Italy. The fourth conference, held in Dresden in 1912, in association with an International Hygiene Exhibition, concluded with a resolution making a "call [to] the attention of all governments to the evil results arising from the great pressure of population in all civilized countries as regards poverty, unemployment, over-crowding and race deterioration, and hopes they will give the most earnest attention to the matter with a view to reducing the birth rate especially among the poorer and less stable classes."[8]

   At the same time, there was a growing interest in eugenics that was less concerned with the quantity than the quality of the world's population, and quite divided on the issue of birth control. But both the neo-Malthusians and the eugenicists believed their positions rested solidly on the foundations of science, and they recognized the need for an alliance between science and social science. And both groups were alarmed by the sharp decline in birth rates among the educated and prosperous middle classes, especially during World War I. However, the scientists, academics, and medical men involved with eugenics and the demographers and statisticians associated with eugenics were highly suspicious of the lay activists, many of them women, pushing for neo-Malthusian goals through birth control.

    By the interwar years, these movements created more formalized agendas through a series of conferences in which a transnational union of experts and advocates was brought together to discuss issues, goals and methods. The most notable of these meetings were organized by Margaret Sanger. Although Sanger had been fighting since 1914 to guarantee a woman's right to birth control and provide women with the means to determine whether and when to have children, by the end of World War I she understood that for the birth control movement to succeed, it would have to transcend national boundaries. "War has thrust upon us a new internationalism." Sanger asserted, "To-day the world is united by starvation, disease and misery... .We are enjoying the ironic internationalism of hatred... . In the face of this new internationalism, this tangled unity of the world, all proposed political and economic programs reveal a woeful common bankruptcy."[9] She went on to argue that reaching the goal of empowerment and autonomy for women would require more scientific justification for birth control. At the same time, she was convinced that finding a solution to the problem of overpopulation and shrinking resources was not possible without including the issues of sex and reproduction. "Politicians and social scientists are ready and willing to speak ... of a 'high birth rate,' infant mortality, the dangers of immigration or over-population. But with few exceptions they cannot bring themselves to speak of Birth Control."[10] So she was delighted when the words "birth control" were included in the title of the Fifth International Neo-Malthusian and Birth Control Congress in London in 1922.[11] As she said in her address to that meeting, "it is my hope that out of this Conference will come a great awakening of all people, of all creeds and all nations, and that after that we will recognize that we must get to work on the two fundamental urges of humanity—sex and hunger. They must go hand in hand if we are to bring about the great international goal of peace."[12]

   While many of the biologists, economists, statisticians, and other experts were more interested in creating or expanding the disciplines of eugenics, demography and population studies, lay people like Sanger remained determined to pursue their activism in the service of birth control and to broaden its advocacy into a global movement. The uneasy union of these groups and their distinct and evolving agendas marked the early history of a global birth control and family planning movement. Sanger's trips to Europe during and after the war had introduced her to both neo-Malthusian and eugenics rationales, which she joined with her commitment to sexual reform to provide the birth control movement with a more solid intellectual rationale. "Just before the outbreak of the war, I visited France, Spain, Germany and Great Britain," she wrote. "Everywhere I found the same dogmas and prejudices among labor leaders, the same intense but limited vision, the same insistence upon the purely economic phases of human nature, the same belief that if the problem of hunger were solved, the question of the women and children would take care of itself. " But, she concluded, "Civilization could not solve the problem of Hunger until it recognized the titanic strength of the sexual instinct."[13]

   With these trips, as well as her 1922 tour of Japan, Sanger had concretized her conviction that for the birth control movement to succeed, it would have to transcend national boundaries. (See the two documents, "Family Planning Movement in Japan" and "World Trip Journal 1922".) Inspired by all she had learned abroad, and impelled by some of the negative responses from the scientific and medical communities to her own American Birth Control League (ABCL) and her Birth Control Clinical Research Bureau, she set about organizing her own meeting at which scientific, demographic studies and contraception would be the focus. Held at the McAlpin Hotel in New York on March 24 to 31, 1925 under the auspices of Sanger's ABCL, the Sixth International Neo-Malthusian and Birth Control Conference turned out to be among the most significant international birth control conferences to date. Joining the American participants were scientists and physicians from across Europe, as well as the Soviet Union, China, Japan and Mexico, who participated in ten sessions, each of which was chaired by an expert on such topics as "War and Population," "Biological and Allied Problems," and "Contraception."[14] Sanger was delighted with what she termed the "scientific candor" of the discussions and, she noted, "In its correlation of the researches and investigations of scientists, scholars and specialists, this gathering of students of the population and biological problems of the human race has, it is our firm conviction, triumphantly vindicated the efforts of all pioneers of Malthusian science who for more than a century have staunchly advocated individual and racial salvation through the instrument of procreative discipline."[15]

   But to win global acceptance for birth control, Sanger recognized that she would have to win the support of an even broader world scientific community, not just those scientists already interested in population control. To do this Sanger sought an international forum that would give prominence and respectability to discussions about the impact of population-related issues. With funds donated by her husband, J. Noah Slee, and other supporters, as well as a grant from the Rockefeller Foundation, Sanger organized the World Population Congress (WPC) in Geneva, Switzerland, August 31-September 2, 1927. The Congress was attended by over 120 scientists, economists, academics and other population experts, representing thirty-five countries. It featured twenty-five papers spread across six sessions focused on biological aspects of population growth, optimum populations and the food supply, differential fertility rates, issues related to fertility and sterility, and eugenic aspects of the population problem.[16]

   The WPC was conceived initially as the next neo-Malthusian conference. Sanger wanted to reinforce her birth control cause with an even more scientific emphasis and put together an organizing committee composed of respected scientists who were also members of her Clinical Control Research Bureau Advisory Board, including geneticist Edward Murray East, biologists Clarence Cook Little and Raymond Pearl, and psychiatrist Adolf Meyer. Under Pearl's direction, the committee recruited several British scientists, including Julian Huxley, Bernard Mallet and Alexander Carr-Saunders. Together they reconfigured the conference as an international gathering of scientists specializing in population issues.[17]

   Each of the conference's six sessions was set up to include, as Sanger pointed out, "scientific essays by recommended authorities to be followed by critical discussion."[18] However, birth control activists were excluded from participating in the sessions. Indeed, only seven of the 123 conference participants were women.[19] Sanger, along with the other women who largely organized and prepared for the conference, labored in the background and did not receive any formal credit.[20] A rift had developed between the professionals and the amateur "non-scientific" advocates. As Susan Greenhalgh has noted, "What distinguished scientists from non-scientists was not that the former engaged exclusively in the pursuit of knowledge. Rather, scientists did what was regarded as scientific work—analyzing statistical data—usually out of concern with a pragmatic or policy issue, but refrained from energetically advocating any position on the issue. Those whom they labeled non-scientists were outright advocates doing propaganda, organizational, and other work in support of their causes."[21] One could add that the other characteristic of the group labeled non-scientists was that they were women.

   Sanger decided that the movement was more important than her own acclaim and allowed herself, in this instance, to be pushed aside. In providing a global arena for discussion of population growth and its impact, the conference was an unparalleled success despite the behind- the-scenes conflicts. It featured professional experts such as Raymond Pearl ("Biology of Population Growth") and F.A.E. Crew ("Concerning Fertility and Sterility in Relation to Population"), and Edward M. East ("Food and Population "), and was attended by other experts in their fields, including Julian Huxley and John Maynard Keynes. It was the first time so many prominent scientists were willing to discuss the population problem on a global scale. Yet if Sanger's goal for the conference was to push the "population aspects of birth control," it soon became clear that the delegates were not yet ready to reach consensus on the population question.[22] As Sanger noted "the papers of Professors East and Fairchild came perilously near mentioning the forbidden word Malthusianism, but as for birth control, it was edged about like a bomb which might explode at any minute."[23]

   While many of the delegates pushed a national and sometimes international agenda, others, including Sanger, were developing a more transnational view of the population issue. The Geneva conference was significant not just in winning greater scientific acceptance of neo-Malthusian and population issues, but because, as Alison Bashford put it, such a world meeting held "in the interwar 'world city' ... was part of the provenance of thinking not just internationally but globally about population." She further noted that in the absence of birth control as a way to frame a world population conference, "Sanger had to create an alternative governing idea." She found it by framing the issue of population in global terms.[24]

   After the Geneva conference, Sanger decided it was important to bring together clinic workers to focus specifically on the issue of birth control and coordinate the work being done in separate nations. The result was the Seventh International Birth Control Conference held in Zurich from September 1-5, 1930, the first international birth control symposium to focus on practical, medical, and scientific considerations of birth control. "A few of us working in the Birth Control Movement desire to call an International Conference in Berlin in September 1930," she wrote to John Maynard Keynes and others, "We desire to have stressed the economic, sociological and women's side rather than the biological."[25] Her goals were "1. To call together the people of the International Leagues," and "2. To discuss the facts of contraception; possibly to standardize the same and to bring a resolution of those in charge that more research is needed."[26] To redress the problems she faced with scientists at the Geneva conference, Sanger's idea was to focus on scientific, economic and social issues, "but to have the subjects discussed by women & about women more than about general things. It will be better not to make it strictly a woman's conference, (as at first suggested) but to have it as Scientific as Sociology lends itself to be with women much in the lead."[27]

   About one hundred and thirty physicians, clinicians and researchers attended sessions featuring papers and discussions on new contraceptive methods and technologies, and studies on the effectiveness and safety of various contraceptive methods, as well as new statistical information, demographic findings, and an exhibit of contraceptive devices. [28] Participants at Zurich also reported on the work of birth control centers in Europe, Asia and the United States.[29]

   Following the 1927 Geneva conference, British suffragette and feminist, Edith How-Martyn, had organized an international birth control office in London in 1928. After the 1930 Zurich conference, the office was reorganized into the Birth Control International Information Centre (BCIIC) and made a clearing-house for birth control information. Its goal was to cultivate a network of birth control advocates around the world. Sanger became honorary president and How-Martyn honorary director. Appropriating the vocabulary of the eugenics movement, Sanger explained to the British Eugenics Society head that her goals for the centre were "first, to bring to the poorer and biologically worse-endowed stocks the knowledge of birth control that is already prevalent among those who are both genetically and economically better favoured; and secondly, to bring the birth rates of the East more in line with those of England and the civilizations of the West."[30] The Centre published pamphlets, newsletters, bulletins and other information about contraception, new research and clinic updates. It also ran a conference in London in 1932 on birth control in Asia.[31] And it sponsored several birth control speaking tours for Sanger and How-Martyn.[32]

   At the same time, birth control, sterilization, population control and eugenics activists were promoting a broader underlying theme, one that would unite these movements under the more broad-based concept of family planning, and incorporate a whole range of economic and environmental factors into global discussions of population.[33] With the emergence of the racial hygiene policies of Nazi Germany in the 1930s, the focus on family planning, with its emphasis on improving the environment in which children were born and raised, was a less dangerous and more satisfactory approach than the earlier race- and class-based agenda of the interwar eugenics and sterilization movements. This shift, along with ongoing financial and organization problems, led to the BCIIC's union into Britain's newly formed National Birth Control Association (NBCA), which later changed its name to the Family Planning Association (FPA).

   A similar shift toward consolidation took place in the United States, with the formation of the Birth Control Federation of America in 1939 (renamed the Planned Parenthood Federation of America in 1942). As Sanger and her colleagues struggled to build an international movement focused on cultivating a network of family planning advocates and professionals, promoting the institution of safe and effective systems of contraceptive delivery services to women, and removing restrictions on public debate about women's reproductive and health needs, the war in Europe and Asia soon undermined the international movement.

By 1945 this was proving increasingly difficult with dire warnings about the negative impact of declining birth rates in the West and the association of international family planning with the negative eugenics of the Nazis undermined interest in the movement. But emerging concerns about uncontrolled population growth, and America's emergence as the leader of a new world order followed quickly by the onset of the Cold War, fostered renewed interest in international family planning.[34] Rapid population growth in developing countries prompted predictions of food and resource shortages and political instability, leading to grave concerns, especially in the United States, about a population crisis. Population experts began to assert that the same economic forces, medical advances, and scientific breakthroughs that led to higher birth rates and lower mortality rates in the West, would soon spread to the East, leading to greater instability and more conflict.. This, in turn, would make these former colonial possessions rife for Communist takeover. In other words, uncontrolled population growth was a viewed as a potential threat to U.S. security.[35] In the United Nations, some officials began to see controlling population growth as part of their mandate to expand work in global public health and education. Some also warned that uncontrolled population growth would lead not just to war, but the degeneration of the species.[36]

    While Sanger retained her commitment to birth control as a fundamental individual right of women, she pragmatically viewed this post-World War interest in population control as a rallying point for reestablishing transnational advocacy for birth control. "In this country," she told Sweden's pioneer sex reformer, Elise Ottesen-Jensen, "the population problems of the world are arousing greater interest than all our lectures and books combined could do."[37] For Sanger, this was an opportunity to push for the creation of a formalized international family planning organization.[38]

   In 1946 Stockholm hosted a "Conference on Sex Education, Family Planning and Marriage Counseling," sponsored by the Riksfï rbundet fur Sexuell Upplysning (RFSU), the Swedish National League for Sex Education.[39] A modest event, it is only briefly covered in histories of family planning and would have been forgettable if not for the foresight of Ottesen-Jensen, and the attendance of the semi-retired, sixty-six-year-old American birth control leader, Margaret Sanger.[40] Together, these two women rallied together the workers of the prewar birth control movement in Europe and the United States and united them with a new generation of activists to establish what would become the International Planned Parenthood Federation.

   The Stockholm conference, held on August 23-24, attracted about 250 delegates, and enough of them represented countries other than Sweden (primarily Norway, Denmark, the United States, Great Britain, and the Netherlands) to warrant an entire day focused on international concerns. Most delegates spoke about the current state of family planning and sex education programs in their countries. By the end of the conference delegates reached a consensus on the need for an international organization to provide up-to-date information, contacts and resources.[41] Sanger reported to the conference on developments in the United States, and then focused on the international aspects of the population problem and the importance of creating a united international family planning organization. Later, she and her colleague, Birth Control Clinical Research Bureau director, Abraham Stone, spent hours editing the final resolutions which emphasized the right of individuals to obtain contraception and reproductive care, as well as research and development of inexpensive and effective birth control methods. The conference ended with a resolution emphasizing "the need for effective international liaison between all societies interested in population problems and family planning. A resolution was unanimously passed that a conference should be held in England in 1948 to carry out this purpose."[42]

   Two years later the British Family Planning Association (FPA) sponsored the International Congress on Population and World Resources in Relation to the Family, held in Cheltenham, England on August 23-27, 1948.[43] Sanger helped plan, organize and fund the conference, and both she and Elise Ottesen-Jensen served as vice-presidents.[44] At the last session of the Conference, chaired by demographer Frank Lorimar, delegates agreed on a series of resolutions including 1) that family planning information and help be made available in all countries because it is "desirable for the stability of the family and of society"; 2) that there should be thorough encouragement of research in all human fertility problems, "with particular reference to the development of a simple, practical and universally applicable contraceptive method"; and 3) that a Provisional International committee be established "to promote research and education for the furthering of human welfare through planned parenthood and progressive sex education."[45] At the end of the Cheltenham conference, an international secretariat was established at the London offices of Britain's FPA. The secretariat quickly evolved into the International Committee on Planned Parenthood (ICPP).

   The ICPP held its first meeting in London on Sept. 9, 1949 with representatives from the Netherlands and Sweden, along with the United States and Great Britain. The Committee decided on the ICPP as its official name, and outlined its goals as 1) "the collection and dissemination of information on human fertility and its control, sex education, and population problems." But the representatives differed on how to approach these issues, with Sweden and the Netherlands focused on sex education, the British on running clinics and advocating for family planning, while the U.S. delegates sought more comprehensive solutions to address world population problems. Together, they developed a program that attempted to represent all these goals by emphasizing: 1) the "collection and dissemination of information on social and biological aspects of human fertility and its control"; 2) "current developments in sex education and related topics"; 3) "furtherance of research and organizational activities in these fields"; and 4) the collection and dissemination of information on population problems.[46]

   But the Committee did not function well. The representatives accused each other of addressing only those goals each nation promoted, resulting in conflicts that made it difficult to raise funds or attract members. The ICPP secretary, Helen Cohen, did attempt to reach out to physicians and social workers in Germany, India, Israel, and Japan, but this was not enough.[47] By 1950 Sanger and Ottesen-Jensen were pressing the ICPP to re-establish communication with family planning leagues that were torn apart during the war, and to make new connections with family planning advocates and leaders in Asia, Africa, and the Caribbean. They suggested that the organization have representatives from each nation, as well as from international organizations, and that advisory committees be formed in each country.[48]

By the following year, the ICPP had agreed to work toward creating a permanent world organization and to hold a series of international conferences. They proposed India as the site for the next conference. Indian Prime Minister, Jawaharlal Nehru, had indicated his support for family planning, there was a strong history of interest from the All India Women's Conference, and India's Family Planning Association (FPAI) was growing quickly.[49] In December 1951, Sanger asked Lady Dhanvanthi Rama Rau, head of the FPAI, if the organization would be willing to host the next international conference in Bombay the following year.[50] Sanger wanted the conference to have an "equal number of outstanding men and women representing the sciences, public health, medical research, demography, as well as outstanding religious and civic leaders." She hoped to get at least "ten sponsors in each category, from the United States, and the same number from England, India, and Japan," Her goal was "to have an outstanding number of distinguished citizens from all walks of life from countries throughout the world to act as sponsors."[51]

   The Third International Conference on Planned Parenthood opened in Bombay on November 24, 1952, attended by 487 delegates and observers from 14 countries.[52] Prime Minister Nehru kicked off the proceedings with a message asserting that the approach to family planning should be scientific, but the aim was to further the social good. And while he believed contraception would help address India's and indeed the world's social and economic problems, he understood it was not a panacea. For Sanger, the important thing was that a permanent organization be formed from the Conference. "Such an organization," she wrote, "must be sound in concept, must have worldwide horizons. It must include not only the educational and the technical, clinical setup, but research facilities and plans and procedures."[53]

   The conference concluded with the passage of five resolutions, which included the suggestion that the ICPP invite nations with national planned parenthood associations to join as members of the new organization, which was named the International Planned Parenthood Federation (IPPF); that individuals without such organizations be invited to join the IPPF as associate members; and that Regional Offices and Committees of the IPPF be established in India, London, and New York, with additional regional offices to follow.[54] Each Regional Committee was to appoint a credentials committee which would consider applications from countries within the Region to join the IPPF.[55] It was also agreed that there would be two Honorary Presidents, who would work to draft a constitution. The IPPF was formally founded on November 29, 1952 with Margaret Sanger and Lady Dhanvanthi Rama Rau as co-presidents.[56]

   In the same year, the unexpected postwar baby boom had raised concerns among a group of population experts, many located at Princeton University, about these demographic trends. They were particularly alarmed about unchecked population growth in the underdeveloped world. With backing from the Rockefeller Foundation, they formed the Population Council, with John D. Rockefeller, III as president and eugenicist Frederick Osborn as vice-president. The Council focused on contraceptive research and support for studies in genetics as part of its focus on eugenics and demographic research.[57] Osborn also attempted to create a close working relationship with the IPPF, which unlike the Council, was led by lay people, not experts.[58] Nevertheless, it was the IPPF that sought and received the support and participation of various national and local governments, while the Population Council collected most of the grant awards from private foundations.

   In the months following its founding, IPPF representatives focused on fund raising and organizational issues. When the IPPF leaders returned to Stockholm in 1953 for the Fourth International Conference on Planned Parenthood, the Federation's organizational structure was solidified and its constitution ratified.[59] The IPPF was divided into four regions: 1. Europe, Near East and Africa, 2. Indian Ocean, 3. Far East and Australasian (including Indonesia), 4. Western Hemisphere (including North and South America and West Indies).[60] Separate Africa and Arab World Regions were created in 1971. The constitution established a Governing Body made up of volunteer officers, and a Council comprised of at least one elected member from each full-member organization and from each regional organization. Sanger was elected president and Rama Rau chairman.[61]

   The aims of the IPPF went beyond maternal welfare issues, and focused on helping to reduce economic and social tensions, and the resulting risk of war due to population pressures. Sanger claimed that she wanted the aims of the IPPF to be "emphatic on World Peace, but she wanted, first and foremost, that the purpose of the IPPF was to provide birth control services."[62] Certainly, one of its primary goals was contraceptive research, and it encouraged member organizations to establish medical and research committees. Its other priority was to educate and build support for the safety and effectiveness of contraceptive use through the establishment of clinics. The IPPF Governing Body also agreed that clinics and other educational programs try to adapt their family planning procedures and methods to the communities in which they operated. It decided that its activity in any location should always be in response to a request within that nation—that it should never impose its efforts upon a community. And finally, IPPF leaders would seek to work closely with the United Nations (UN).[63]

   In 1954, the UN, with help from the International Union for the Scientific Study of Population, sponsored a World Population Conference in Rome. Attended by some five hundred specialists, including Dorothy Brush and Elise Ottesen-Jensen as IPPF observers, its object was not to create policy, but to gather information on population trends. An IPPF Governing Body meeting was held at the conclusion of the conference.[64] The Rome conference demonstrated that the population issue had begun to supersede even religious concerns. When Margaret Sanger Research Bureau director, Abraham Stone, who presented a paper on the use of contraceptive measures, argued that abstinence was physiologically and psychologically unhealthy, and that sexual relations within marriage were important not just for procreation, the Roman Catholic delegates did not object.[65] IPPF leaders became convinced that arguing for the relief of population pressures was publicly more effective in promoting family planning than the less controversial grounds of maternal and child health.

   The Fifth International Conference on Planned Parenthood held in Tokyo, Japan on October 24-29, 1955, was sponsored by the Japan Planned Parenthood Federation, which became a full member of the IPPF in 1954. The theme of the conference, attended by over five hundred delegates and observers from more than twenty different countries including China, was "Overpopulation and Family Planning." However, many of the papers focused on the link between overpopulation and war.[66] Included in the program was a report by Gregory Pincus on progress in the development of an oral contraceptive, which Sanger claimed, "will make a milestone in man's search for harmless, simple, and cheap contraceptive, the key to almost all the world's and Asia's population problems."[67] According to Sanger, the importance of the conference "was the bringing together for the first time of anatomists, biologists, biochemists, and other research workers for the discovery of a biological method of conception control, the miracle tablet, maybe. Some ten top-level scientists from Great Britain, India, Israel, Japan, Sweden, and the United States made available to the conference their findings."[68]

   Significantly, this was the first time since World War II, that China had participated in such a conference, an indication, Sanger said, "that the population-control movement was international in scope without regard to politics."[69] The U.N. she pointed out had found Malthusian theory to be in effect—in that the world population rate was rising too quickly compared to nutritional resources, and that most of the world was not getting enough to eat to maintain normal standards of health and efficiency. "If birth rates are not balanced with death rates in the individual countries," she proclaimed, "there can be no fundamental planning for the separate countries or at the global level." She called upon U.N. agencies to provide more help on the population problem.[70]

   On the surface the IPPF had a formal structure that seemed to privilege decentralization by resting a good deal of control in the various regions and localities. But in practice this was not the case. Its constitution vested much power in its Governing Body which was composed of representatives appointed by each national affiliate. In addition, there were representatives from the four regions which had become 1) Western Hemisphere, 2) Europe, Near East, and Africa, 3) Indian Ocean, and 4) Far East and Australasia, each of which had its own governing body, budget and staff. Because of overlapping memberships, leaders of national associations were also leaders of regions with the same person sometimes occupying more than one voting position. Sanger, who never supported the regional structure, because she thought it was ineffective to have only one or two people in charge of vast areas, had begun charging that the IPPF had become too centralized.[71] "I feel that proper service from the IPPF in birth control must be provided for the peoples of Canada, Mexico, Central America, South America, and the islands of the Caribbean—as well as all other countries of the world—by separating them into individual country sub-centers with a Medical Field Director stationed in each area, reporting to and getting aid and guidance directly from the London Office through a Field Service Manager in the Headquarters Office, who will be under the Executive Secretary and General Director."[72] As always, Sanger was as impatient with the bureaucracy and administration of the organization as she was concerned that the women who needed or wanted it most, got access to contraceptive education and services, swiftly, cheaply, and effectively. But the IPPF leadership did not agree.

   The tension in Washington over Planned Parenthood funding increased in the late 1950s. Sanger and others wanted the IPPF to be funded by government programs, but not through the individual regions. But many U.S. government officials, most notably President Eisenhower, were opposed to government funding of international family planning. When the Draper Committee on Foreign Aid, which Eisenhower commissioned in 1958, recommended that the United States, as part of its Mutual Assistance Program, fund those developing countries that established fertility control programs, Eisenhower objected.[73] In part, his stance was a result of pressure from the Catholic Church, but that opposition does not fully explain the reluctance of American leaders to recognize the importance of supporting efforts toward family planning. In 1957, Margaret Sanger, reporting on a recent meeting of the Europe, Near East, and Africa Region held in Berlin, and the meetings of the IPPF's Governing Body and the Executive Committee, wrote, "I was much encouraged by the great increase in world-wide interest in birth control reported by the delegates from every country. On the other hand, I was somewhat depressed by the conduct and attitude of some delegates, including Americans, showing their lack of a real international viewpoint and their failure to understand the need for a more efficient world-wide functional organization for the IPPF to take on the expanding work which should be our program!"[74] As a result, it was left to the women activists leading groups such as the IPPF who continued to take the lead in pushing for a global commitment to planned parenthood.[75]

   With the Planned Parenthood Federation of America unwilling to sponsor the Sixth International Conference in Washington, D.C. in 1957,[76] that meeting was postponed until February 14 to 21, 1959 and held in New Delhi. The theme of the conference was "Family Planning: Motivations and Methods," and included updates on India's family planning program, and papers by leading demographers, social scientists, biologists, research workers, clinicians and sociologists on topics ranging from population in an atomic age to oral contraceptives.[77] That same year, Sanger finally relinquished the presidency of the IPPF to Elise Ottesen-Jensen. By this time, the organization had grown into the largest, private international organization devoted to promoting family planning. Its efforts to introduce family planning programs in countries across the world now intersected with work of demographers, including Frank Notestein, to push for direct government intervention to achieve lower birthrates in Third World nations. In the tense atmosphere of postwar bilateralism, demographers were convinced that advocating intervention in the form of national family planning programs was the only practical way to reduce birth rates.[78] Meanwhile Sanger and her associates continued to focus on overcoming lingering inhibitions about the morality of birth control, by subsuming birth control into family planning aims and concentrating on limiting birth rates.

   But while Sanger and the IPPF were making some progress in trying to help women control their fertility, the United Nations was less successful. Though women's rights were recognized as integral to the United Nations Universal Declaration of Human Rights (UN 1948), the concept of women's sexual and reproductive rights was not. The U.N. Population Commission had for the most part concentrated on demographic research and technical issues. Not until 1974, when the United Nations convened the first of three intergovernmental population conferences (Bucharest in 1974, Mexico City in 1984 and Cairo in 1994) was women's ability to limit their fertility and meet their nations' need to control population a central part to the discourse.[79] By the 1984 Mexico City conference the link between improving the status of women and reducing family size was evident, but it was not until the 1994 U.N. Conference on Population and Development, chaired by IPPF President Dr. Fred Sai, that a direct connection was made between improving women's status and population size. There was less concern over population size and growth, and greater focus on women's health and reproductive choices.[80] A year later, following the Cairo Conference, the IPPF published a new charter on sexual and reproductive rights that articulated twelve human rights regarding sexual and reproductive health.

   Sanger welcomed post-World War II concern over the negative impact of uncontrolled population growth not only because she believed it would help revive the international family planning movement, but also because it seemed to be a vindication of her Malthusian-based arguments about the necessity of limiting family size. But, as she fought to keep the needs of women in the forefront of the IPPF, she once again came up against the reality that incorporating broader social or economic imperatives into the movement undermined the feminist goals of reproductive freedom and autonomy for women. She found herself not so much fighting for the right of women to determine their own reproductive lives, but rather fighting to encourage or even insure that women have the right to make, what someone like Sanger, or more ominously the state had already decided was the correct reproductive choice — in Sanger's case it was family limitation.

   While she and her colleagues tried to use the population control movement to serve their goals of broadening contraceptive access and improving the health and economic conditions of women, the population lobby was focused on controlling fertility to reach the broader goals of economic development, social stability, the destruction of communism and world peace. And the pursuit of these goals would invite the use of some degree of state-mandated persuasion, regulation, inducement or coercion by the state in women's reproductive decisions for the greater good of the society. "Given existing preferences in family size," Notestein argued in 1969, "governments must go beyond voluntary family planning. To achieve zero rate of population growth governments will have to do more than cajole; they will have to coerce."[81]

   Sanger did not want to hector, or even lecture the poor to stop reproducing. She wanted to educate women in reproduction, and in the possibilities and consequences of controlling their fertility, in taking responsibility for their reproductive lives. She believed that organizations such as the IPPF should focus on finding or developing the best contraceptive tools, offering educational services in reproduction and birth control, and creating a favorable environment in which to do this. Moreover, the initial principles guiding the IPPF included the concept that any IPPF educational or organizing work in family planning must be in response to a demand from within a country. The IPPF's affiliates included large national associations in nations like India and Japan with close connections to the highest level of the government, but also smaller groups which worked despite the threat of prosecution or suppression by the state. But it also included international and non-governmental organizations working with enormous power to subject their citizenry to surveillance and control.

   But as the American government's commitment to population control escalated, the negative implications of this policy were becoming dangerously apparent. A growing chorus of critics decried the structural imperialism and racism that underlay US-led population policies, casting them as another instance in which the needs of the West were being privileged at the expense of the Third World. Soon the chorus of critics grew larger and included the newly-revived women's movement. Initially reluctant to criticize what some women still viewed as a troubled but strategic alliance with the population controllers to further the goal of reproductive freedom, feminists were increasingly outraged at the omission of any discussion of the health risks to women from the contraceptive methods being promoted by international family planning organizations. They were also highly critical of agencies like the IPPF and the UN Fund for Population Activities for promoting or even tolerating the use of permanent contraceptive techniques, notably sterilization, which so easily lent themselves to implementation by coercion.

   Clearly, Sanger's commitment to giving women access to a greater range of family limitation choices, was muted somewhat as she yielded, however reluctantly, to post-war population controllers' efforts to promote family planning for the greater social good, even if this required subsuming the rights and desires of individual women. Yet she tried to uphold her original feminist goals. As she noted in 1957, "We must always remember to stand firm for the truth of our cause, Birth Control….We must constantly express to all the world the importance and meaning of Birth control services to the child, the family, and civilization."[82] There remains an ongoing debate over whether Margaret Sanger, who died in 1966 could have made a greater impact both before and after World War II by trying to keep her alliances free of control by the so-called "experts" in science, demography, economics or population, or was it thanks to Sanger that women had any voice in the international family planning or population movements at all. I would argue both are true. What remains clear is that we need more and deeper studies not only of the history of the population movements and the differing, sometimes conflicting rationales of those trying to direct them, but of women's roles in nongovernmental family population organizations, both national and global, as well as studies of how the decisions by elite policy-makers were received by those groups at which they were aimed.[83]

____________________________________

Notes

[1] For a good analysis of eugenicists and the neo-Malthusianists, see Richard Allen Soloway, Birth Control and the Population Question in England, 1877-1930. (Chapel Hill: University of North Carolina Press, 1982) and Rosanna Ledbetter, A History of the Malthusian League, 1877-1927 (Columbus: Ohio State University Press, 1976).

[2] Margaret Sanger, Women and the New Race (New York: Brentano's, 1920), p. 5.

[3] Dennis Hodgson and Susan Cotts Watkins, "Feminists and Neo-Malthusians: Past and Present

Alliances," Population and Development Review 23:3 (Sept. 1997): 472-73.

[4] Genevieve Burnett, "Fertile Fields: A History of the Ideological Origins and Institutionalization of the International Birth Control Movement, 1870-1940" (Ph.D. diss., University of South Wales, 1999). See also Matthew Connelly, "Seeing beyond the State: The Population Control Movement and the Problem of Sovereignty," Past & Present, No. 193 (Nov. 2006): 201-02, in which he points out that "the fields of international and global history ... offer alternative frames to analyze transnational phenomena such as migration, social movements and new forms of governance." Investigating the history of these transnational networks, he argues, would be enhanced by making use of the "neglected archives of international and non-governmental organizations," which "can reveal how people organized across borders to advance agendas that would not work or even fit within exclusively national frameworks."

[5] Matthew Connelly, "Population Control Is History: New Perspectives on the International Campaign to Limit Population Growth," Comparative Studies in Society and History, 45:1 (Jan. 2003): 123.

[6] Susan Greenhalgh, "The Social Construction of Population Science: An Intellectual, Institutional, and Political History of Twentieth-Century Demography," Comparative Studies in Society and History 38:1 (Jan. 1996): 34. Greenhalgh claims, "The early history of the discipline was one of active efforts by these researchers to construct demography as a science, thereby separating it from activism and advocacy, and to enlarge the market and funds for demographic work."

[7] Ledbetter, A History of the Malthusian League.

[8] Sanger, "Introduction," International Aspects of Birth Control: The Proceedings of the Neo-Malthusian and Birth Control Conference (New York: American Birth Control League, 1925), pp. v-xi.

[9] Margaret Sanger, Pivot of Civilization (London: Jonathan Cape, 1923), pp. 124-25.

[10] Sanger, Pivot of Civilization, pp. 126-27.

[11] New Generation League. Report of the Proceedings of the Fifth International Neo-Malthusian and Birth Control Conference, Kingsway Hall, London, July 11th to July 14th, 1922, Raymond Pierpont, ed. (London: William Heinemann [Medical Books], 1922).

[12] Margaret Sanger, "Individual and Family Aspects of Birth Control: President's Introduction," in Report of the Proceedings of the Fifth International Neo-Malthusian and Birth Control Conference, p. 32.

[13] Sanger, Pivot of Civilization, chap. 1.

[14] Matthew Connelly, Fatal Misconception: The Struggle to Control World Population (Cambridge, MA: Belknap Press of Harvard University Press, 2008), pp. 64-65; Sixth International Neo-Malthusian and Birth Control Conference, International Aspects of Birth Control, Volumes I-4, Margaret Sanger, ed. (New York: American Birth Control League, 1925-26) and "Who's Who of the Conference," Appendix, Vol. 1, pp. 228-40.

[15]Sanger, An Autobiography (New York: W.W. Norton, 1938), p. 354; Sanger, "Introduction," International Aspects of Birth Control.

[16] For an excellent assessment of the Congress, see Alison Bashford, "Nation, Empire, Globe: The Spaces of Population Debate in the Interwar Years," Comparative Studies in Society and History 49:1 (2007): 177-79.

[17] Bashford, "Nation, Empire, Globe," p. 177-79.

[18] Margaret Sanger, ed. Proceedings of the World Population Conference, held at the Salle centrale, Geneva, August 20th to September 3rd, 1927 (London: E. Arnold, 1927), p. 5.

[19] Sanger, ed. Proceedings of the World Population Conference, pp. 363-68.

[20] Indeed she was asked by conference chairman, Sir Bernard Mallet, to remove her name and those of her (female) assistants from the official program on the grounds that "the names of the workers should not be included on scientific programs." It was only in the proceedings, edited by Sanger published in 1927, that she finally claimed some of the recognition she had earned. (Sanger, ed. Proceedings of the World Population Conference; Bashford, "Nation, Empire, Globe," pp. 198-99.)

[21] Greenhalgh, "The Social Construction of Population Science," pp. 35-36.

[23] Ibid., 387

[24] Sanger, ed., Proceedings of the World Population Conference, p. 5.

[25] Sanger to John Maynard Keynes, Jan. 15, 1929, Margaret Sanger Papers (MSP), Library of Congress Microfilm Edition (hereinafter LCM), reel 14, frame 876.

[26] Sanger to Clinton Chance, Apr. 3, 1930, LCM, reel 124, frame 76.

[27] Sanger to Edith How-Martyn, Feb. 15, 1929, in Esther Katz, et al., eds. Margaret Sanger Papers Microfilm Edition: Collected Documents Series (hereinafter MSME), reel 90, frame 7.

[28] Margaret Sanger and Hannah Stone, eds. The Practice of Contraception: An International Symposium and Survey from the Proceedings of the Seventh International Birth Control Conference, Zurich, Switzerland, September 1930 (Baltimore: Williams & Wilkins, 1931).

[29] Hannah Stone, "The 7th International Conference," Birth Control Review, 14:11 (Nov. 1930): 317.

[30] Sanger to C. P. Blacker, November 14, 1935 (MSME-C 5:972).

[31]Program of the Conference on Birth Control in Asia. Esther Katz, et al., eds., Margaret Sanger Papers Microfilm Edition: Smith College Collection (hereinafter MSME-S, reel 188), frame 67; Michael Fielding, Birth Control in Asia: A Report of a Conference Held at the London School of Hygiene & Tropical Medicine, November 24-25, 1933.

[32] Margaret Sanger and Edith How-Martyn, Round the World for Birth Control with Margret Sanger and Edith How-Martyn: An Account of an International Tour (London, 1937), pp. 5-6; Mildred Adams, "Margaret Sanger: Crusader," Delineator (Sept. 1933), pp, 15-49. Many of the BCIIC records are in the British Family Planning Association Collection at the Wellcome Library in London. Additional records and copies of the BCIIC newsletters can be found on the Margaret Sanger microfilm at the Library of Congress, and the MSPME. For coverage of Sanger and How-Martyn's trips to Asia and the Middle East, see the BCIIC newsletters and The Eugenics Review, XXVII: 1 (January 1936): 328.

[33] For a more fully developed discussion, see Connelly, Fatal Consequences, pp. 102-05.

[34] See Greenhalgh, "The Social Construction of Population Science," p. 34.

[35] Ibid, pp. 38-39.

[36] For an excellent analysis of UN policy on population, see Connelly, Fatal Consequences, pp. 120-30.

[37] Margaret Sanger to Jensen, April 22, 1949, Records of the IPPF, IPPF Headquarters, London. A search for "Ottesen-Jensen" in the database indicates she is mentioned about thirty times in eleven documents.

[38] In the database there are two reports that speak to the growing interest in family planning in Asia. See Margaret Sanger, "Address Before the First Inaugural Meeting of the National Family Planning Association (Japan)," 18 April 1954, 18 April 1954; Avabai B. Wadi, "Family Planning Association of India," in Wadia, The Light Is Ours: Memoirs and Movements (2001), pp. 682-84.

[39] Doris H. Linder, Crusader for Sex Education: Elise Ottesen-Jense (1886-1973) in Scandinavia and on the International Scene (Lanham, MD: University Press of America, 1996), pp. 172-75; Elise Ottesen-Jensen to Elna Orrman and Margaret Sanger, Nov. 20, 1945, (MSME-S, reel 25, frame 262).

[40] Beryl Suitters, Be Brave and Angry: Chronicles of the International Planned Parenthood Federation (London: International Planned Parenthood Federation, 1973) ; Linder, Crusader for Sex Education.

[41] Suitters, Be Brave and Angry, pp. 19-20.

[42] Program of the International Congress on Population and World Resources (hereinafter (ICPWR), August 1948 (MSME-C, ree1 14, frame 527).

[43] (no author), "The Cheltenham Conference," Population Index 15:3 (July 1949): 215; Lord John Boyd Orr, Nobel-prize-winning nutrition expert and Director General of the U.N. Food and Agriculture Organization, was vice chairman of the Cheltenham Congress, which was hosted by Lord Horder, president of the British Family Planning Association (FPA), and chaired by Lady Gertrude Mary Denman, chair of the FPA. Program of the ICPWR (MSMEC, reel 14, frame 526).

[44] FPA, Proceedings of the International Congress on Population and World Resources in Relation to the Family, 1948, Cheltenham (London: H.K. Lewis and Co., 1949).

[45] FPA, Proceedings, pp. 236-39.

[46] Suitters, Be Brave and Angry, pp. 36, 39.

[47] Helen Donington Cohen, Report of Work of International Secretariat, Oct. 1948-Oct. 1949 (MSME-C, reel 13, frame 43). Many of the ICPP reports can be found among the Family Planning Association records at the Wellcome Institute for the History of Medicine in London, as well as on the Margaret Sanger Papers Microfilm Edition: Collected Documents Series.

[48] Helen Donington Cohen, "Memorandum to the International Committee," 1950?, MSME-C, reel 13, frame 60.

[49] ICPP, "Report of Meeting of International Committee on Planned Parenthood: 29th and 30th August, 1951," MSME-C, reel 13, frame 74.

[50] Suitters, Be Brave and Angry, p. 47.

[51] Sanger to Lady Rama Rau, May 19, 1952, MSME-S, reel 37, frame 483.

[52] See Suitters, Be Brave and Angry, chap. 3.

[53] Sanger to C.P. Blacker, Sept. 4, 1952, MSME-S, reel 37, frames 489-91.

[54] The more recent IPPF records are located at IPPF Headquarters in London. The early records might also be there (they cannot currently be located), but many can also be found on the MSPME. (Baltimore: University Publications of America, (now Proquest), 1996, 1997. http://cisupa.proquest.com/ws_display.asp?filter=upa_leaf&item_id={045AB6D6-ABC6-439D-ACFB-F7A37718D427}

[55] Suitters, Be Brave and Angry, p. 50-51 ; The ICPP also began publishing a monthly newsletter, Around the World News of Population and Birth Control, edited by Dorothy Brush. The first issue was published in January 1952.

[56] Ibid, 55-56; FPAI, The Third International Conference on Planned Parenthood: Report of the Proceedings, 24-29 November, 1952, Bombay – India (Bombay: FPAI, 1952).

[57] Ibid.

[58] Dennis Hodgson and Susan Cotts Watkins, "Feminists and Neo-Malthusians: Past and Present Alliances," Population and Development Review 23:3 (Sept. 1997): 480.

[59] See IPPF, Constitution of the International Planned Parenthood Federation, Proceedings of the Fifth International Conference on Planned Parenthood, Tokyo, Japan, October 24-29, 1955 (IPPF: London, 1955), Appendix 1, pp. 265-67.

[60]International Planned Parenthood Federation, Rules of the Governing Body, "Jan. 15, 1954 (MSME-S reel 63, frame 80. See also IPPF, Report of the Proceedings of the Fourth International Congress on Planned Parenthood, Aug. 17-22, 1954, Stockholm, Sweden (IPPF: London, 1954). Today, the IPPF has regional offices in Nairobi, Kenya for Africa, Tunis, Tunisia for the Arab World,Brussels, Belgium for Europe, New Delhi, India for South Asia, and Kuala Lumpur, Malaysia for East, South East Asia and Oceania.

[61] Suitters, Be Brave and Angry, pp. 67-71.

[62] Ibid. p. 183; Sanger to Kan Majima, head of Japan's Birth Control Federation, Nov. 16, 1953 (LCM reel 128, frame 155b).

[63] Suitters, Be Brave and Angry, pp. 69-73.

[64] Suitters, Be Brave and Angry, p. 83-84 ; United Nations, Department of Economic and Social Affairs, Proceedings of the World Population Conference, Rome 31 August-10 September 1954 (New York: United Nations, 1955).

[65] "Family Planning Upheld in Rome," New York Times, Sept. 3, 1954, p. 14.

[66] Proceedings of the Fifth International Conference, p. ix. ; "Overpopulation Held War Peril," New York Times, Oct. 25, 1955, p. 16.

[67] Birth Control Parley Meets in Tokyo Today," Chicago Daily-Tribune, Oct. 24, 1955, p. 11.

[68] Sanger, Forward to Proceedings of the Fifth International Conference, p. ix.

[69] "Red China to Attend Birth Control Talk," New York Times, Oct. 21, 1955, p. 3

[70] Sanger, "Planned Parenthood: A Cultural Civilization Will Bring World Peace," Proceedings of the Fifth International Conference, pp. 3-8 ; see also World Population Conference (United Nations) Proceedings. (New York, 1954).

[71] Suitters, Be Brave and Angry, p. 183.

[72] Sanger to C. P. Blacker, July 18, 1957, IPPF Records, MSME-C, reel 11, frames 249-51; Sanger released a set of guidelines for establishing contraceptive services in new countries, which advised having a medical doctor native to the country and trained in contraceptive service organize local medical groups before trying to broaden support for birth control. This was especially important, she believed in Catholic countries where opposition was likely to be more forceful. See Sanger, "Basic Procedure for Establishing Birth Control Services in a New Country," July 18, 1957 (MSME-S, reel 63, frame 157).

[73] U.S. Study of Military Assistance Report," Vol. 1 Composite Report of the President's Committee to Study the United States Military Assistance Program (Washington D.C., Aug. 17, 1959): 96-97; commenting on the Draper Commission's recommendation that the government should distribute birth control as part of its foreign aid program, Eisenhower said, "I cannot imagine of anything more emphatically a subject that is not a proper political or governmental activity or function or responsibility.] "Transcript of the President's News Conference on Foreign and Domestic Matters," New York Times, Dec. 3, 1959, p. 18.

[74] Sanger to Ellen Watumull, Nov. 15, 1957, MSME-S, reel 52, frames 1105-06.

[75] Matthew Connelly, "Seeing beyond the State: The Population Control Movement and the Problem of Sovereignty," Past & Present, No. 193 (Nov., 2006): 199. Also see, Donald T. Critchlow, Intended Consequences: Birth Control, Abortion, and the Federal Government (New York: Oxford University Press, 1999).

[76] Katherine DuPont to Margaret Sanger, May 16, 1956, MSME-S, reel 49, frame 1118.

[77] Proposal for the Sixth International Conference on Planned Parenthood, February 14, 1959, MSME-S, reel 67, frame 702; IPPF, Proceedings of the Sixth International Conference on Planned Parenthood, New Delhi, 1959, (London: International Planned Parenthood Federation, 1959).

[78] Greenhalgh, "The Social Construction of Population Science," p. 39.

[79] Database documents relating to these population conferences include The Situation and Status of Women Today: Some Essential Facts (1974); From Vienna to Beijing: The Cairo Hearing on Reproductive Health and Human Rights (1994).

[80] Report of the International Conference on Population, Mexico City, 6-14-August 1984 (United Nations: New York, 1984; Report of the International Conference on Population and Development, Cairo, 5-13 Sept. 1994 (United Nations: New York, 1995); Jason L. Finkle and Barbara B. Crane. "The Politics of Bucharest: Population, Development, and the New International Economic Order," Population and Development Review 1:1 (Sept. 1975): 87—114; Finkle and Crane, "Ideology and Politics at Mexico City: The United States at the 1984 International Conference on Population,"Population and Development Review 11:1 (March 1985): 1—28; C. Alison McIntosh and Jason L. Finkle, "The Cairo Conference on Population and Development: A New Paradigm?" Population and Development Review 21:2 (June 1995): 223-60.

[81]Frank Notestein, Dudley Kirk and Sheldon Segal, "The Problem of Population Control," in Philip Hauser, ed., The Population Dilemma, 2nd ed. (Englewood Cliffs, N.J.: Prentice-Hall,, 1969), p. 165

[82] Sanger to Vera Houghton, July 18, 1957 (MSME-S, reel 52, frame 327).

[83] For a good survey of issues in the study of population control, see Matthew Connelly, "Population Control Is History: New Perspectives on the International Campaign to Limit Population Growth," Comparative Studies in Society and History 45:1 (Jan., 2003), pp. 122-47.