What every girl should know about nursing

October 15, 2006 - Today The New York Times published an op-ed by Gloria Feldt about women's health pioneer Margaret Sanger. The piece's hook is the Lower East Side Tenement Museum's ongoing restoration at 97 Orchard Street, which shows visitors the harsh lives of early 20th century immigrants, including their high maternal and infant mortality rates. Sanger, then a nurse serving this poor Lower East Side population, began publishing information about birth control--information that was banned as "obscenity." She also opened the first birth control clinic in the United States, and went on to found the group that became Planned Parenthood. Feldt, a former president of that group, is hardly objective about Sanger; there is no mention of Sanger's troubling views on eugenics, for instance. But Feldt argues persuasively that the movement for "women's reproductive freedom" that Sanger sparked has been "crucial to American progress," and she portrays Sanger as a tenacious, visionary patient advocate who understood the powerful influence of the media on the health of her society.

Feldt's piece, "Margaret Sanger's Obscenity," explains that the women who lived at 97 Orchard Street in 1900 had a 40% infant and child mortality rate. At that time, Feldt says, the maternal mortality rate was about twice what it is today (though statistics say that it was over 100 times today's rate) with 40% of those deaths caused by infection, "of which half resulted from illegal or self-induced abortion." Feldt tells the story of Sadie Sachs,

a mother of three who had been warned that another pregnancy would kill her. When Sadie asked her doctor how to prevent pregnancy, he told her to tell her husband to sleep on the roof. Pregnant again, Sadie self-induced an abortion, contracted an infection and died.

Sanger, a nurse and a socialist, sought to help such women through information. She published a "sex education column" called What Every Girl Should Know. But in 1914, Feldt says, a warrant was issued for Sanger's arrest because, under the 1873 Comstock law, it was unlawful to distribute information about contraception or abortion, which was considered "obscenity." Sanger also published a periodical called The Woman Rebel, which advocated contraception. Sanger "fled to Europe," visiting a birth control clinic in the Netherlands.

In 1916, four years before U.S. women could vote, Sanger established the first birth control clinic in the United States, in Brooklyn. Feldt notes that Sanger's "sister, Ethel Byrne, was the nurse; it would be some time before they could get a doctor to join the effort." They distributed handbills advertising the clinic in English, Yiddish, and Italian. Feldt notes:

The police closed that clinic 10 days and 464 patients later. But Sanger, who would go on to establish the Planned Parenthood Federation of America, had founded something much larger than a clinic: she ignited a movement for women's reproductive freedom.

Feldt does not pursue it, but Sanger remained a leader in international family planning through the 1960's. Feldt does note that the 20th century victories of the movement Sanger sparked include the legalization of birth control and abortion, improvements in contraceptive technology, including the pill, and government funding of family planning for poor women. Feldt says that today, more than 90% of Americans have used birth control. Even so, Feldt links the struggles of Sanger's day to current debates over birth control, abortion, and sex education, arguing that

courageous actions like Sanger's are as necessary now as they were 90 years ago. For if anyone doubts that women's reproductive freedom has been crucial to American progress, I recommend a short walk through the lives of the women of 97 Orchard Street.

Whatever one's views of Planned Parenthood and some of Sanger's other opinions, it seems clear that she was an unusually courageous and savvy fighter for the interests of her patients as she saw those interests. There can be little doubt about the enormous benefits to women and society generally as a result of the widespread availability of family planning goods and services. Almost 100 years ago, Margaret Sanger clearly understood that the media is a critical instrument of nursing, and that some of the most effective patient advocacy occurs far away from the bedside.

We thank Gloria Feldt and the New York Times for this helpful piece.

See the op-ed "Margaret Sanger’s Obscenity" by Gloria Feldt in the October 15, 2006 edition of the New York Times.