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Alexander Sanger

The Untold History of Abortion Access in America

Posted: 04/29/2013 10:21 am

Several U.S. states are falling over themselves -- and in some cases failing -- to ban abortion, abortion clinics and access to the few clinics that remain. This is not a new phenomenon.
My grandmother, Margaret Sanger, began the birth control movement in the early 20th century. While early American law allowed for access to birth control and abortion, criminalization began in the 19th century. Then, the campaign to restrict reproductive freedom was primarily founded on the imperatives of organized medicine, the Protestant reaction to Irish Catholic immigration, and the drive for social "purity" in sexual matters.
During the 19th century, physicians began to unravel the mysteries of reproductive biology and fetal development. The ovum was discovered, as was the process of fertilization. The 19th century was also the time when university-trained physicians sought to control the practice of medicine.
Today, it is hard to imagine a time when there were few, if any, restrictions on who could practice medicine. In fact, until university-trained physicians appeared on the scene, midwives and other non-university trained doctors called "irregulars," as well as outright quacks, were the main practitioners. They not only diagnosed medical conditions, but also concocted and distributed all kinds of homemade drugs to their patients.
While official records are scarce, it seems that the first legislative restrictions on access to abortion were enacted as a result of efforts by "regular" physicians to protect the safety of women being treated by "irregulars" who earned a healthy part of their income by providing contraception, abortion and childbirth services. University-trained physicians also had an ulterior financial motive to put their competition -- irregulars, midwives and quacks -- out of business.
Physicians began to pressure legislatures to put the control of pregnancy prevention and termination in the hands of physicians only. The formation of the American Medical Association in 1841 by the physician-regulars accelerated the legislative process. They didn't bother to hide their financial motives. In "Abortion in America," James C. Mohr relates that the Southern Michigan Medical Society in 1875 was reminded by one of its members: "Regular physicians are still losing patients, even long time patients, to competitors willing 'to prevent an increase in their (patient's) families' by performing abortions."
Physicians alone were not able to bring about the criminalization of abortion. At the beginning of their campaign in the 1840s and 1850s, they aligned themselves with the Know-Nothings, a fledging political party of nativists opposed the tide of Irish-Catholic immigration into America, which had begun to increase exponentially with the potato famine. The Know-Nothings wanted to preserve control over the then-mostly Anglo-Saxon, Protestant society. Their platform was a mixture of nativism, temperance and religious bigotry that sought to restrict the voting and political representation rights of immigrants. The Know-Nothings feared that they, the native-born Protestants, would soon be outnumbered and outvoted by the new Catholic immigrants.
It did not escape Protestant notice that immigrant Catholic women had large numbers of children, while native Protestant women were having fewer. Since few new birth control methods had been introduced at this time -- although there were the beginnings of condom and diaphragm manufacturing -- the Know-Nothings suspected that Protestant women were using abortion as their method of birth control. Hence, the Know-Nothing men readily joined the AMA crusade to criminalize abortion. As contraceptive options increased in the course of the 19th century, those who favored the white Protestant hegemony also supported the criminalization of contraception. As one prominent physician said in 1874: "The annual destruction of fetuses has become so truly appalling among native American (Protestant) women that the Puritanic blood of '76 will be but sparingly represented in the approaching centenary."
Even though men took the lead in advancing the medical, political and racial arguments for the criminalization of birth control and abortion, some women were also in favor of this legislation. These women favored other "social purity" campaigns after the Civil War that sought to restrict gambling, drinking, prostitution and other immoral pursuits, including any expression of human sexuality other than that occurring between married couples for purposes of reproduction. Some feminists believed that birth control and abortion did more than enable voluntary motherhood; they also enabled husbands to consort more freely with "other women." These feminists believed that their own voluntary motherhood could be achieved by periodic abstinence and self-control.
The stars were thus aligned for Anthony Comstock, a YMCA official who headed the New York Society for the Suppression of Vice, to persuade Congress to enact his eponymous laws that prevented the publication or mailing of materials "designed, adapted, or intended for preventing conception or producing abortion, or for any indecent or immoral purpose." Individual states followed suit, and by the last quarter of the 19th century, birth control and abortion had essentially been criminalized at both the state and federal levels.
The result was not that birth control and abortion were thereby eliminated from American society; instead they went underground. We can surmise that many women had access to these services because the birth rate continued its century-long decline even after both were criminalized.
One woman who did not was my grandmother's mother, who had 11 children and several more miscarriages. She died at 49. My grandmother never forgot her mother's tragic death. It took her a lifetime to overturn the Comstock Laws, the last one falling after the 1965 Supreme Court Griswold v. Connecticutruling.
It is not just legal abortion and Roe v. Wade but legal birth control and Griswold that today's opponents of reproductive freedom are trying to overturn. The ghost of Anthony Comstock still stalks the land.
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Shame on Shaming

My latest blog post on the Huffington Post

Alexander Sanger


Shame on Shaming

Posted: 04/12/2013 12:53 pm

The Bloomberg administration in New York recently launched a series of subway ads condemning teen pregnancy by trying to shame teen mothers into delaying childbirth.
One ad says, "I'm twice as likely not to graduate high school because you had me as a teen."
"This campaign makes very clear to young people that there's a lot at stake when it comes to deciding to raise a child," said Bloomberg in a statement:
... By focusing on responsibility and the importance of education, employment, and family in providing children with the emotional and financial support they need, we'll let thousands of young New Yorkers know that waiting to [become] a parent could be the best decision they ever made.
The press release accompanying the ad campaign also states that "Decades of research show that children born to young, unmarried parents are more likely to be poor, have emotional and behavioral problems and are less likely to do well in school."
The Bloomberg administration is using the received wisdom on teen pregnancy that early childbearing makes even more problematic the already difficult lives of poor, young people, delays their advancement out of poverty and harms their children. The received wisdom is, however, wrong.
Recent research suggests that poverty in the midst of income inequality, unstable family life, a poor environment, a poor educational system and job opportunities and limited life expectancy are the overriding factors harming young people and their children, not teenage childbearing.
The Bloomberg press release also states, correctly, that while "the city's teen pregnancy rate fell 27 percent in the last decade, there are still more than 20,000 teen pregnancies annually, 87 percent of which are unintended..."
Teen pregnancy is not intractable, and progress has been made -- but progress can be achieved without shaming the teens who do become pregnant. City-wide programs that provide sex education to young men and young women and contraceptive access for teens, including condoms that also protect young people from HIV infection, have been effective in reducing teen pregnancy.
Giving teens the information they need and the contraceptive methods that suit them is the key to eliminating the 87 percent of teen pregnancies that are "unintended."
Researchers, if not politicians, are well aware that "intendedness" around pregnancy is a slippery concept. One researcher stated, "When one focuses on teen fertility, we would argue that it is not generally socially acceptable to report that you 'wanted' to get pregnant as a teenager, either at the time of conception, after pregnancy or after the child is born. So survey rates of 'intendedness' would be biased upward."
A 2010 report on teen pregnancy in New York City schools states:
There is a growing body of literature suggesting that when teens live in poor communities with less advantage and opportunity and more disorganization, they are more likely to engage in sex at an earlier age and to become pregnant. This finding is supported by data from the National Longitudinal Study of Adolescent Health that indicated neighborhood context as a significant factor in differences in rates of sexual initiation, after controlling for family income, parental education, race/ethnicity, age, and family structure. Qualitative studies within financially depressed neighborhoods have linked teens' decisions not to use contraception to feelings of hopelessness or perceived lack of personal opportunity for the future. This research is consistent with our finding of increased pregnancy risk within high need neighborhoods, after controlling for race/ethnicity.
More than 300,000 young women give birth every year in this country. What is the reproductive benefit they see? A teen, of any race or ethnicity, living in a an economically depressed neighborhood, who sees little possibility of advancement, may see her best opportunity to have a child and form a family as better done sooner rather than later. Sooner because her own life expectancy, and that of her parents who can may be in a position to help her raise a child, is shorter than more affluent teens; and sooner because her own health deteriorates more rapidly than more affluent teens, thereby making childbearing more fraught for the teen and her baby. Under these circumstances, to postpone childbearing is to risk forgoing having children at all.
But what about the effect on the babies? Do they end up markedly worse in life than if their mothers had delayed childbearing into her 20s?
There is no doubt that children of poor teen mothers do not fare well, but is this a result of being born to a teen or, rather, to being born to a poor girl in a poor neighborhood? In academic lingo, does correlation equal causation?
As I stated in my book, Beyond Choice, "...just because children of teen mothers may have poor results in school does not mean that these results were caused by these children being born to teen mothers. It may be caused by other factors such as their underlying poverty, differing patterns of maternal care or the poor schools themselves."
Researchers Melissa Schettini Kearney and Philip B. Levine recently confirmed this and stated: "our reading of the most rigorous empirical studies today is that the data reject the hypothesis that the children of teenage mothers would have experienced better outcomes had those same mothers delayed pregnancy until after age 19."
Shaming is not an answer to the issue of teen pregnancy. We need to give teens sexual education and access to contraceptives so that a decision to get pregnant and have a child can be a conscious one and not an accidental one. Shaming them for having children, who are born healthy, and who can be raised to adulthood in a family kin network, is cruel and wrong.
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Conversation with Joan Garry

Here is the link to my 20 minute conversation with non-profit guru, Joan Garry, on reproductive rights, the role of non-profits, board-CEO relationships and other things.
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Alexander Sanger
Alexander C. Sanger, the grandson of Margaret Sanger, who founded the birth control movement over eighty years ago, is currently Chair of the International Planned Parenthood Council.
Mr. Sanger previously served as the President of Planned Parenthood of New York City (PPNYC) and its international arm, The Margaret Sanger Center International (MSCI) for ten years from 1991 - 2000.

Mr. Sanger speaks around the country and the world and has served as a Goodwill Ambassador for the United Nations Population Fund.

Beyond Choice
Beyond Choice
The new book by Alexander Sanger published by PublicAffairs

Purchase from

Click here for full book information

With reproductive freedom in jeopardy, Alexander Sanger, grandson of renowned family planning advocate Margaret Sanger and a longtime leader in the reproductive rights movement, has taken an urgent, fresh look at the pro-choice position—and even the pro-life position—and finds them necessary, but insufficient. In Beyond Choice he offers the first major re-thinking of these positions in thirty years.

“Well researched and readable, Beyond Choice should be required reading for both pro-choice and pro-life supporters.”
—Governor Christine Todd Whitman


» Much more on Beyond Choice, including an excerpt, discussion guides, reviews
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