01:20:10

Hosts: Anna Reser, Leila McNeill, and Rebecca Ortenberg 

Guest: Jennifer Young

Producer: Leila McNeill 

Music: nononoNO

In this episode, we talk about hormonal birth control advertisements from the 1960s and the ways that advertisers catered to a white male medical establishment. Then we talk about the statue of Marion J Sims in Manhattan and what that says about race and power in the history of medicine in the United States. Lastly, we talked with guest Jennifer Young about birth control pioneer, Dr. Hannah Stone. 

Show Notes

 

“Protesters Demand Removal of Central Park Statue of 19th Century Doctor Who Experimented on Slave Women” by Esha Ray and Dennis Slatterly

Scientists wade into the historical monument debate and find themselves in familiar waters by Rebecca Ortenberg

52 percent of men say they haven’t benefitted from women having affordable birth control by Laurel Raymond

Here’s How the New Tax Plan Could Hurt Graduate Students by Ariana Figueroa

Further Reading

Molyneaux, Heather. In Sickness and in Health: Representations of Women in Pharmaceutical Advertisements in the Canadian Medical Association Journal 1950-1970. PhD diss., University of New Brunswick, 2009.

Sarch, Amy. “Those dirty ads!”: Birth Control Advertisements in the 1920s and 1930s,” Critical Studies in Mass Communication 14, no. 1 (1991): 31-48.

Tone, Andrea. “Contraceptive Consumers: Gender and the Political Economy of Birth Control in the 1930s.” Journal of Social History 29, no.3 (1996): 485-506.

Tone, Andrea. “From Naughty Good to Nicole Miller: Medicine and the Marketing of American Contraceptive.” Culture, Medicine, and Psychiatry 30, (2006): 249-267.

Ulrich, Laurel Thatcher. A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812. New York: Vintage Books, 1991.

Washington, Harriet. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Penguin Random House, 2008.  

Transcript

Transcription by Rev.com

Rebecca: Welcome back to the Lady Science podcast, a monthly deep dive on topics centered on women and gender in the history and popular culture of science. With you every month are the editors of Lady Science Magazine.

Anna: I'm Anna Reser, co-founder and co-editor in chief of the Lady Science. I'm a writer, editor and PhD student studying 20th century American culture and the history of the American space program in the 1960s.

Leila: I'm Leila McNeil, the other founder and editor in chief of Lady Science. I'm a historian of science and freelance writer with words and various places on the internet. I'm currently a regular writer on women and the history of science at smithsonian.com.

Rebecca: And I'm Rebecca Ortenberg, Lady Science's managing editor. When I'm not working with the Lady Science team, I can be found writing about museums and public history around the internet and managing research project at the Chemical Heritage Foundation in Philadelphia.

Rebecca: This month we're going to be talking about the history of birth control and reproductive rights. Unsurprisingly, reproductive rights are again under attack in the United States. In early October, the Trump administration made easier for businesses and non profits to deny women birth control coverage on religious grounds. I don't know if it's appropriate or ironic that one of our essays this month is about birth control pioneer Dr. Hannah Stone. A little later in the podcast we'll be hearing from Jennifer Young who wrote that essay for us, and we'll be talking to her about Stone's activism, her work with Margaret Sanger and the history of Planned Parenthood.

Rebecca: But first, the three of us are going to share some work we've done on the history of reproductive rights. Anna and Leila will explain how early advertising for the pill complicates our usual narrative about birth control. And then I will talk a little bit about what a statue of J. Marion Sims in manhattan can tell us about gender, race and power in American history.

Anna: For the past couple of years, Leila and I have been slowly working on a research project about visual culture and birth control in the United States. We first presented research from this project in an advertising panel at the Pop Culture Association Conference in Seattle last year. The heart of the project was combing through all these advertisements in medical journals, advertisements aimed at physicians.

Anna: We used stuff from the Journal of the American Medical Association and a couple of things from advertisements to do some comparative stuff, between 1960 and 1965-ish to see how the pill which was approved for contraceptive use by the FDA in 1960 was being marketed toward doctors, and of course at this time when we say doctors we're talking about almost overwhelmingly white, male physicians, most of them probably a little older.

Anna: What we found in our research was a pattern across all categories of contraceptives, both hormonal and non hormonal. So things like diaphragms and spermicidal jellies, things like that. The pattern is that the advertisers developed this set of strategies that are used for marketing contraceptives specifically to physicians. Advertisements emphasized the importance of physician intervention and control. It's constructing this physician who the patient requires his intervention in order to use birth control.

Anna: They simultaneously construct this ideal patient to whom the ideal doctor is prescribing. The patient is always white, healthy, married, middle-class woman. She's in need of the physician's expertise for family planning. The ads also draw on a set of assumptions that are very common in the 20th century about the dichotomy between nature and reason and utilize rhetoric of medicalization to convince doctors that the best expression of their control and expertise is to prescribe these birth control products.

Leila: The rhetoric of medicalization we found to be very integral and important to these advertisements. It was important in the larger history of women's medicine and contraception so I want to explain what exactly we're talking about.

Leila: In general, medicalization is when we define social ills or human conditions as medical conditions, and then we subsequently try to treat them as such. In healthcare, medicalization also sometimes is called pathologization, and that's the process by which a person becomes defined as their medical conditions and becomes the subject of a medical study. Sociologically, medicalization defines the power relationship between patient and doctor in that the patient becomes a passive agent while the doctor becomes the active, authoritative agent.

Leila: One of the results of this process is that healthy bodies are often pathologized birth control they deviate from a culturally constructed norm, which in the Western world the norm is the cis white male body. In this framework of medicalization, women's reproductive bodies are inherently pathologized as deviant from the male norm.

Leila: In the 1960s with the introduction of the pill, hormonal contraception became yet another way in which reproductive bodies could be medicalized. Menstruation then became a thing that needed to be treated rather than a natural part of the female body. There's actually an advertisement that refers to birth control as therapy. So therapy for what exactly?

Leila: Further, women were removed as authorities over their own bodily experience and replaced with a physician. In the advertisements that we analyzed, the physician figure is constructed in opposition to a female patient, whose presence is sometimes implied or actually present and real in the advertisement itself. She is represented as uninterested in the medical matter of reproduction and considers pregnancy a mere matter of lifestyle. And in some cases, it's constructed as simple vanity.

Anna: The ideal patient embodied in these advertisements is the "normal" woman of the 1960s and she conforms to certain demographic standards like I had mentioned before, white, married, middle class. These ads reproduce these very common mid century stereotypes about women, and cater to the expectations and prejudices of a male medical establishment.

Anna: Unlike the physician who is defined in these advertisements by his ability to actively intervene, the ideal patient is entirely passive and defers to the authority of her physician in matters of reproduction. Poor women, working class women, single women, women of color, women who couldn't tolerate or suffered from the side effects of hormonal contraceptives were pretty extreme in this period. And women who just simply didn't have access to contraceptives or access to the medical care that became necessary to receive contraceptives, these women are written out of the histories that focus on this idealized patient and the liberatory benefits that she gets from using contraceptives.

Anna: Her story, this ideal patient dominates these histories of women's reproductive liberation but at least in part this ideal figure is a total fiction manufactured by advertisers to sell birth control, and it reflect sexist, mainstream ideas about women, and it appeals to a male medical establishment. Where these advertisers do acknowledge that women other than the ideal, a white middle class patient might use birth control, they do so with really stereotypical imagery of poverty. Embedded assumptions about the role of the medical establishment in stabilizing society.

Anna: One of the images we looked at is a picture of a poor woman who is visually signified as being poor by she's wearing a kerchief and hanging her laundry out of doors which is-

Leila: Oh no!

Anna: In the '60s, you're definitely poor if you put your clothes on a clothes line in the '60s. I don't know. Part of the ad copy talks about the role of the physician in helping these benighted women who don't know what kind of strain they are putting on society by having so many kids and it's up to doctors to be able to fix that. We'll include some of these imagines.

Anna: The positive ads about the lifestyle that you could have are reserved for white women. And the ads about doctors saving the world from over population, that's where you find poor women, women of color.

Rebecca: Both that and Leila your comment before about even for middle-class white women, doctors have to... there's this assumption doctors push birth control on women and that it's a matter of lifestyle or vanity. The crazy thing about all of this is of course the history of activism surrounding birth control that we'll be talking about with Jennifer a little bit later. That both middle class women and poor women and women in all parts of society had to push so hard to convince powerful white men that this was an important thing for them. Now that it's been taken over by the medical establishment, they are taking back that power by saying, "No, these ladies don't know what they are doing, we have to be the ones that teach them about it." It's just maddening. Fascinating and maddening.

Leila: You can't really get away from the eugenic implications of that type of thinking. Remembering again that these advertisements are directed at physicians themselves. It's the eugenic thinking that was very prominent in medical science during this time was actually embedded in these advertisements for birth control too.

Leila: Some of the other advertisements that we looked at infantilized women. One of the ads for Enovid specifically calls women "forgetful" "imperfect patients." By constructing women as these forgetful, scatterbrain people, they are required to refill every five months. Women apparently have all this time on their hands to go back to the doctor every five months to get a refill. The copy on that ad says, "You.." remember the doctor, "can count of in to bring your patient back on time for her six month check up." And it goes on to say that, "She knows that is the only way that she can continue her dosage. It makes for practically perfect therapy."

Leila: There's that idea of this being therapy. They did the prescriptions in this conscious way to bring women coming back every six months. That's ridiculous. I can't even imagine having to go every six months to go get birth control.

Anna: And did that, every fix or six months, did they mean you have to go get a pelvic every five months? Or you just have to go to the doctor? Either way, it ensures that healthy women are seeing a doctor twice a year no matter what, in addition to other regular doctor things that they would be doing, getting a physical or whatever. If you want to use birth control, you're basically signing a contract saying, "I will be investing a huge chunk of my time and money in being at the doctor and participating in the medical establishment." It's going to change my life not insignificant way.

Anna: These advertisements, I think they are interested birth control they are directed at physicians so patients would never see these so they are not coy at all. They are just like, if you want to have more appointments on the books, start prescribing birth control.

Leila: And the way... the quote "She knows that is the only way she can continue her dosage," is that-

Rebecca: It's super creepy.

Leila: The power imbalance. Yeah. This woman is totally and completely reliant on you to not get pregnant when she doesn't want to. The power imbalance is just so clear in these advertisements.

Anna: And this whole issue of women taking a daily medication, healthy women who don't have a chronic condition. First of all it constructs being a woman as a chronic condition that you have to treat basically.

Leila: Yeah, that menstruation is an ailment.

Anna: This is super new and unusual. One of the things we want to look at in the future are patient facing ads and how they justify this would be... for a lot of people would be maybe an intimidating thing to do. To take a pill every day seems kind of extreme. Or to see how the patient is constructed in patient facing ads.

Anna: But I think there is just really interesting stuff here about the medical establishment and the way that birth control is controlled by women which is one of the things that gets lauded about hormonal birth control, about the pill in particular. That women are in control of it, you don't have to ask a man to wear a condom and it gives you much more control. The truth is it also gives your doctor much more control.

Leila: Yeah.

Anna: This idea of a totally liberating women controlled method of contraception is not the whole story because there's another figure there that's exerting even more control over the process and it's a man. It's not the man you're having sex with probably. That's what we're trying to do with this research.

Rebecca: It's such a great example of the way that structures of power can stay the same even if they shift a little bit. The underlying structure of power of men having control over women's bodies maybe hasn't changed that much with the pill becoming widespread. I think also the crazy thing about the ads is building on that idea that because these are doctor facing, they are showing their hand. It demonstrates that it was explicitly set up this way, "Here, we are losing power over here so let's reconstruct this thing over here and we're going to literally do that and make sure that patients are coming in regularly. Oh no, they might not come in those silly ladies for regular check ups otherwise." Or, "They don't know things about their bodies so let's get them in here regularly."

Leila: Yeah. The idea that women can't keep track of their own periods is also a ridiculous thing to think. Just one last thing about this advertisement birth control I want to make sure we get to the next one which deserves a thorough lashing. Is that this is clearly aimed at that married, middle-class woman. Because poor women, working women, they don't have time to take off of work and be under this amount of supervision from a doctor. Most of the women who were working at this time, poor women, immigrant women, women of color were working unskilled labor jobs. It's not like they had a whole lot of good benefits that allowed them to miss a day of work. That missing a day of work could have really bad consequences.

Leila: This implies a lot about who they are assuming has the leisure time on their hands to be making doctors appointments all the time.

Anna: Speaking of thorough lashing, one of the more striking advertisements that we looked at is this full two page spread for Enovid. On the left side you see this non specific, indigenous tribal statue which that's a problem in itself. It's just like, it's primitive. On one side. And then you see a birth control pill pack on the other side. The statue curves to the right in a way that points towards the birth control pack. The copy underneath says, "From ritual to reason."

Anna: It associates this tribal statue with pre-history magic, the primitive. And also by association, women managing their reproduction on their own and that it is much preferable to use reason. In the rest of the ad copy it associates the pill pack with science and ethics, and with intelligent family planning. It's setting up this whole dichotomy between the completely backward and unscientific, primitive way of doing things before in the olden times. And also how women have been doing it for centuries. Contrast with science and ethics and things which are clean and modern and not primitive or whatever.

Anna: I think this ad deserves a little bit of discussion because there's a lot going on here.

Rebecca: So much going on.

Leila: I can't get over how racist this image is because they just picked a nondescript, tribal looking statue to stand in for all backward, indigenous women's knowledge. The racial undertones of this are pretty egregious. And then also associating that image with the copy itself as backwards, pre-history all of that stuff.

Leila: They've created this framework in which anything that is not using modern medical science is automatically framed as being backward. With the indigenous statue with that, then you've got the racist implications with that as well.

Rebecca: Just the wording of "ritual" to just represent everything that anyone knew about nature or women knew about their bodies is all by itself pretty terrible and racist. And then you add the statue on top of it to just be like, in case you didn't get the subtext, we're going to make it text and we're going to make it very clear what we're talking about and just how racist we're being.

Leila: They are really pulling on a lot of embedded ideas that we've had for a really long time that associate women with nature and men with science. The way that the image actually works and how it curves to the right, and the statue turns into the pill pack is that you actually have this implied idea that science is eclipsing natural knowledge. When you have those gendered underpinnings of that with women being associated with nature and men being associated with science, you've got that whole idea of control coming back into it. That the control that women once had is now being completely eclipsed by men and this idea of intelligent family planning and ethical family planning with the pill. You can see that image for yourself in the show notes.

Leila: With this project overall what we're trying to do is to complicate that popular narrative of birth control as a tool of women's liberation by showing that from its beginning it has been yet another tool of modern medicine to exert social control over women's bodies. By theorizing the absences in these advertisements, looking at what and who is missing, we can better critique our modern perspective of reproductive rights, which is often exclusionary still to women of color, immigrant women and especially women with disabilities and trans folks too.

Rebecca: I think it's really interesting how this project of yours represents something that you really have to study a little bit of any history but especially women's history to see that all of our grand narratives about progress moving in one direction just aren't true. And that there's always a lot of complicated ups and downs, but that also something can be both liberating and stifling sometimes simultaneously. It's a really fascinating study so thanks for sharing.

Leila: Yeah. And I want to be clear that we're not saying don't use birth control and don't go to the doctor. I want to be real clear about that. We're just saying that what you've hit on Rebecca, with how some things can be both liberating in one way but then on the other hand also not be. And that we need to not embrace certain things as being uncritically liberating. That's all we're really saying here. Please go get your IUD if you want. Go get your annual pap. Do that.

Rebecca: Great. Yeah, definitely.

Leila: Rebecca, what do you have for us to talk about today.

Rebecca: Yeah, speaking of many things that modern medicine being great, but the way we got here having some problems. I'm sure everyone remembers the summer when a lot of terrible things happened this summer, but one of them was people were talking a lot about statues and public memorials. In particular there was the white supremacist march in Charlottesville, Virginia that sparked a conversation about the presence of confederate memorials in major cities.

Rebecca: It's hardly the first time that I have witnessed a debate over what to do with these kinds of statues. It felt like there was this moment where many more historians and public figures and journalists and other powerful people were being very explicit about what they thought should be done with confederate statues, which was to get rid of them. I thought that was very interesting because in previous conversations there'd been a lot more wishy washiness about it and it just felt like a moment when a lot of things were coming together in, I don't really want to call it consensus, but there was kind of a consensus growing at least.

Rebecca: Bear with me, I promise I'm going to get us back to reproductive rights in a second. Let's face it, America we have memorials to many people who did terrible things, not just confederate generals. One of those memorials is located in Central Park in Manhattan, and it's dedicated to a 19th century doctor named J. Marion Sims. I'm imagining that most people who walk by this statue probably don't even notice it.

Rebecca: Interestingly, there is a statue of Christopher Columbus nearby, and I imagine that many people walking through Central Park are more likely to roll their eyes at that statue. But the Sims statue is significant. In late August, an organization called The Black Youth Project staged a protest in front of the statue. And later an anonymous activist graffitied the word racist across the statue's base. And that's because Sims who has been called the father of modern gynecology was also an Alabama slave owner who regularly experimented on the enslaved women that he owned.

Rebecca: He's most known for figuring out a treatment for a certain kind of fistula that can develop during childbirth. He perfected that treatment in surgeries conducted on these enslaved women without anesthesia and without their consent.

Rebecca: I wrote an essay for the Lady Science blog about Sims and his statue and the way that the conversation about problematic public memorials has really shifted. But right now, I want to talk a little bit about Sims in relation to today's topic. With that in mind, there are two issues I want to talk about. The first is the story of Sims' medical contributions and that vaginal fistulas became much more common in the 19th century in women in childbirth in part because of the way that labor changed and more male doctors began using forceps on women in labor.

Rebecca: One of these weird counterintuitive facts of history is that childbirth becomes more dangerous in the early 19th century because more and more women go to male doctors who use these different methods and not midwives who had traditionally taken care of women in labor and tended to actually be more knowledgeable at this time period. There are many books that are written on this. The one that I think is a great read for both scholars and the general public is Laurel Thatcher Ulrich's "A Midwife's Tale," which among other things goes into the historical shift that was happening in the late 18th, early 19th century around obstetrics and gynecology and power shifting from traditional midwives to "educated male doctors."

Rebecca: But the point here that's crazy to me is that Sims is solving a problem that he as a male medical professional is creating at least to a certain degree, creating through their medical practices. It ties so terribly into this very long history of men taking control over women's bodies, especially in issues related to reproductive rights that in so many ways continues to this day.

Leila: I like that you brought up that it is a counterintuitive fact that it was more dangerous for women and infants in the 19th century. A lot of people I don't think know that because we have this idea of modern science being so closely related to progress. If we have all of these modern technologies and tools to help with childbirth and obviously that was progress, but the things that often get written out of those stories are the women who underwent those procedures before we could have progress at all.

Leila: There's one thing that I wrote, the very first issue of Lady Science was looking at this problem with "The Knick," that awful show with... one of the main storylines in the first season was trying to figure out a certain procedure for women. A lot of women died from that. He experimented on women, his procedure that eventually I guess worked. But the whole thing is you don't even get those women's stories. It's all about how he was able to make his procedures work. And what did was leave a whole lot of dead women behind him.

Leila: Those stories are very much often written out of popular histories of medicine.

Rebecca: Yeah. And the fact that they were being actively written out at the time, and that so many doctors are really explicitly dismissing the knowledge that traditional midwives had. Because they are like, "No, we can do it better." And then they cause a lot of problems of their own. They don't go back and go, okay maybe there are some people who know more about this than we do because they have been doing this for a while. Because they get caught up into their own narrative of progress that we often just allow to overwhelm all the ways we talk about history and especially history of science.

Anna: Speaking about narratives, there are Sims defenders out there, contemporary people who argue common arguments that you hear about confederate statues and other bad dudes that we probably shouldn't be honoring. They are like a product of their time. In Sims' case there's a lot of discussion in medical ethics about consent and that in Sims' time there was certainly no such legal concept of informed consent, which is something that we use now. That we use now because of nauseating medical experiments-

Rebecca: People were terrible.

Leila: Because we fought a world war over it.

Rebecca: Yeah.

Anna: Things like the Tuskegee syphilis experiments. There's a lot of awful stuff like that, that you can read about. But the argument that Sims lived in a time when there was no legal conception of informed consent even though the, I don't know human idea of consenting to have someone do things to you definitely existed and has forever.

Anna: But there's all of this controversy about consent and if it's a real thing and if it exists, and if you are enslaved if you can consent. There's these what I think are very disingenuous arguments about that if we say that enslaved people couldn't consent then we are taking away their agency or something. There's a lot of actual philosophical ethical stuff that... in a biomedical ethics course that I TA'd for we use this case. There's a lot of really thorny stuff there.

Anna: I also wanted to say, not to be super explicit or anything but what a fistula is, so we have more material idea of what we're talking about, about what Sims did to develop his procedure. A fistula is a tear between the vaginal wall and the rectum. They can happen in childbirth sometimes and like Rebecca said, more common if you're using forceps. It's extremely painful. That wall is supposed to keep various things separated, and when they are not, you get infections and rashes. It's an extremely uncomfortable thing to live with. But also, being operated on without anesthesia and without being able to properly consent to that procedure is something else entirely.

Anna: Another thing that people always argue about is, "Well of course these women would have wanted to have their fistulas fixed." No one ever talks about the ones that his procedure failed on who just had to endure horrifying pain. Am I right in saying that it was not that anesthesia wasn't available, it was that he made a choice not to use it?

Rebecca: Yes.

Anna: That's right?

Rebecca: Yeah. It was new-ish but available. And in fact, Sims goes on to found the "first women's hospital in American in Manhattan." Which is another, again speaking of narratives, fascinating framing. Because it shows that no one is calling the whatever his medical offices on his plantation weren't a women's hospital. And that says something about the way in which then you frame the operations he was doing on the enslaved women.

Rebecca: But at that women's hospital in Manhattan he did use anesthesia. He perfects this technique, he then uses it in Manhattan with anesthesia, on mostly white women.

Leila: Yeah, he was selective in how he used anesthesia and that was something that was reserved for white women. The idea of consent in these stories of what Sims did, it reminds me a lot of that Teen Vogue article that came out, I guess it's been several months at this point, where it was arguing that slave women were not mistresses. They didn't have the power to deny what was happening to them. That in these contexts, no stop calling them mistresses because that gives them a type of agency that they were by nature denied by the contract of what slavery was. I think that, that applies in this case to medical consent as well.

Rebecca: Yeah. The other thing that relates to the particular medical condition and consent as well is that the other factor that leads to fistulas more often and the factor that makes it in certain very poor areas of the world still a serious issue today, is that it's more likely to occur in women that are malnourished and young. Part of the reason why the women that Sims owned were pregnant when malnourished and young is that they were slaves and part of their expectation is that they were going to breed more slaves. So there was an effort to force women to be pregnant even if they medically should not have been. It's another really important issue.

Rebecca: And I do want to talk a just a little bit more about race in this as well. Sims and many of his medical colleagues had this thought that they had mastery over all women's bodies. But also generally believed that white women's bodies were worth protecting and black women's bodies were disposable. This comes this idea that he goes and he experiments on black women. He perfects the surgery. He then brings those techniques to a hospital catering to white women in Manhattan where he then uses anesthesia and has a lot of success because he has worked out all of the kinks.

Rebecca: And that's where he makes a name for himself. He treats wealthy white women from various wealthy Manhattan families. He travels around Europe and he operates on princesses. And that's how he becomes famous and that's how he becomes a very successful doctor. Because of his fame and success among wealthy people, that's why he has a statue. He doesn't have a statue for helping womankind in general. He has a statue for helping a certain kind of woman. If he had just focused on helping poor women, women of color, he probably wouldn't have gotten a statue.

Rebecca: I think that, that's important to the way that we think about these memorials is why were they memorialized at the time and how does that relate to the way that we tell people's stories and who really benefits and doesn't when medical breakthroughs are happening.

Leila: Yeah, I think that is a really great point. And also, it comes back to some of the stuff that me and Anna are trying to do with our project is theorizing these absences. Who is absent from that story of Sims, really? Who is absent from that progress? It reminds me of the birth control trials that were in Puerto Rico in the 1950s. Those were started by Gregory Pincus and John Rock. They tested the pill at a extremely high dosage on women who barely spoke English. Even if they could somehow argue informed consent, you've got the power dynamic of the colonizer coming into a colonized country and persuading women who barely speak English to partake in this medical trial.

Leila: They suffered extremely bad side effects from such a high dosage of the pill. And then by the time it gets approved in 1960 for women in the United States, we've been able to adjust the dosage and whatever to where some of the side effects aren't quite so severe. It hasn't been until recently that we even acknowledged that, that story happened. Who benefited from that? It was white women. Who was the fodder for progress? It was the women of color in Puerto Rico.

Leila: Now is a good time to switch over to Jennifer Young who is going to join us to talk about her essay that she wrote for the November issue. Jennifer wrote about Dr. Hannah Stone and her work in activism in women's health at the Birth Control Clinic Research Bureau, which we now know as Planned Parenthood. Welcome to the podcast, Jennifer. If you could tell everyone a little bit about yourself and maybe give us a quick run down of your article.

Jennifer: Sure. I am a museum educator, I currently work at the New York Historical Society, and I'm also a freelance public historian and writer. My favorite thing to do is to go into the archives and find stories like this one that tell about the lives of men and women, particularly women, of the past several centuries, and to investigate and to tell their stories. Not only because they are worth knowing for their own sake, but because there is so much the past can tell us about the present.

Jennifer: And this story in particular is about Dr. Hannah Stone, who was one of the pioneering figures of the birth control movement. And she's someone that you don't hear much about. She's not a real public figure or a name within the history for most people of the birth control movement. She was the medical director of the first legal birth control clinic in the United States, which opened in New York City in 1923.

Jennifer: Dr. Stone worked closely with more public figures like Margaret Sanger. But Dr. Stone's work was a clinical practitioner. She was over 10,000 patients a year and published in journals as was well known within medical circles for her work, but she was less known in the public sphere. I thought that was interesting approach to the topic, is to talk about someone who was doing this work and really hasn't been recognized as much as other people.

Rebecca: In your essay you talk about how Hannah Stone worked with Margaret Sanger. Can you talk a little bit about how Sanger's formidable reputation shrouded others like Stone who were really invested in the work of public health and activism.

Jennifer: I think I wouldn't use the word shrouded but I think that social movements need a lot of different kinds of people. Margaret Sanger was very good at being on the front lines and getting arrested and knowing all the right people and knowing who to call. She knew the judges, she knew people in the political and social establishments in New York. That was crucial for doing the kinds of behind the scenes work that needed to get done.

Jennifer: But Sanger herself knew that in terms of the actual goals of the birth control movement of serving women, particularly the most vulnerable women and working class women, that you needed doctors and medical professionals to do that work. That was not Sanger's role, she was not a doctor. She sought out people like Dr. Stone who were able to do that work and she really cultivated those relationships and tried to bring those people into her orbit because without them, her work would be nothing.

Leila: You write in your essay that the inner war periods, the period between World War I and World War II was, "A watershed moment in the history of birth control." Can you explain a little bit about what was going on during this time that made it such an important historical period.

Jennifer: Yeah. It's really interesting because we have this moment where in 1916, Sanger opened her first birth control clinic in Brooklyn actively to challenge the New York State law. The clinic was almost immediately closed because it was considered illegal. Sanger was arrested and spent time in jail. But she knew that there had to be a way to challenge those laws. This was the height of a certain period of the women's movement right at the time where it was just right on the cusp of women in New York getting suffrage. There was a lot of power in the women's movement and a lot of interest both in suffrage and issues like birth control. They were very much tied together in terms of the rights of women and tied into these discussions of motherhood and agency.

Jennifer: Sanger kept pushing at these legal boundaries and taking her case to court. In 1918, the New York Court of Appeals ruled that a licensed physician could provide information for the cure or prevention of disease. That provided the precedent for doctors in New York State to provide birth control. It's interesting, it's kind of a back door way to provide birth control because this was of course right at the end of World War I and there was a lot of concern about service men coming home with sexually transmitted diseases, and there was a huge issue with syphilis at the time. The medical establishment was quite concerned that for the health of men, that syphilis was going to be a public health crisis.

Jennifer: They believed that birth control was a way to get around that, particularly condoms. This really was a backdoor way to find licensed physicians like Dr. Stone who would be able to work with the birth control movement in these clinics to provide contraceptives and contraceptive advice.

Jennifer: So Sanger took, that ruling and in 1923, she financed and organized the Birth Control Clinical Research Bureau headed by this female physician Dr. Stone. They were advising and instructing patients, which was within the law and that was legal. So that was how they got started.

Leila: Cool. I want to give a little bit of context about the 1918 court case, because that was important in helping Hannah Stone bypass charges from the raid on the clinic in 1929, right. It was that ruling that allowed her and her staff to get off.

Jennifer: Exactly. Because she and her staff were licensed medical professionals, they were allowed to provide information for the prevention or cure of disease. What happened in 1929 is that the New York Vice Squad raided the clinic and arrested all of the doctors and nurses. But the charges couldn't stick because even though they were actively looking for any kind of gray area where the clinic would have been prescribing birth control because the law was interpreted in such a way that it was broad enough that what they were doing was legal.

Jennifer: The case was infamous in New York at the time because the police confiscated medical records. They just took boxes and boxes of confidential medical records out of the clinic. Even the members of the medical establishment who were not in favor of the clinic or with birth control in general were absolutely horrified that this was an absolute violation of doctors and patients rights. It was illegal but it also had a lot of... the case had a lot of public sympathy for the birth control movement. It was clear that the judge was not going to proceed with the case and the charges were dropped.

Rebecca: Because yes they got off, but the clinic was raided. There was this whole idea of they took the records and they made them public. Even though it was technically legal, it was still frightening and dangerous to do this kind of work. That's just really fascinating to me and it shows that legal watersheds only give you so much.

Jennifer: That's for sure. One of the things that I found really interesting about this story, one of the reasons I got interested in it is because I was interested in general in the way that women, medical professionals ended up becoming activists almost without realizing it or without going consciously in that direction because the work they had to do involved such precarious situations.

Jennifer: Dr. Stone was not entirely a political person to begin with, but she ended up becoming an activist and getting arrested and having her picture in the paper. She did all this work actually for free. She worked for Sanger's clinic for 16 years and never took a salary because she started out as an idealistic, young doctor who wanted to provide access to health for women, particularly working class women. That was almost impossible to do within the mainstream medical establishment. It was only clinics like this, or often times... my work started out looking at the birth control clinic that existed on 14th street and 5th avenue that was run by a communist insurance cooperative called the International Workers Order. They ran their clinic there from 1936 until about 1950.

Jennifer: Of course, it was an amazingly progressive clinic that served thousands of women, but it was communist affiliated so it was shut down. So the doctors who worked there, also Dr. [inaudible 00:52:48] who was the director of that clinic, also very committed to women's public health was totally anti communist, but the work that she wanted to do had to be done in these marginal contexts, because that's where women's public health was being served and not in the mainstream medical establishments. I think that's really interesting and speaks a lot to what we're going through today.

Anna: I wanted to ask about eugenics. In the inner war period, one thing that's not as marginal as people may assume is the eugenic movement in the United States. You write that Dr. Stone was anti-eugenic, and even if she didn't directly oppose Sanger who was much more in favor of eugenics, she integrated anti-eugenic stance into a book called "A Marriage Manual: A Practical Guide-book to Sex and Marriage" that she co-authored with her husband Abraham Stone. I was just wondering if you could tell us a little bit about that book and about Dr. Stone's stance on eugenics and how it worked with Sanger's more well known stance on eugenics.

Jennifer: Yeah. This was an aspect of Dr. Stone's story that I found quite fascinating because apparently if you delve into the history of the marriage counseling movements in the United States, Dr. Hannah Stone and her husband Dr. Abraham Stone were quite instrumental in this. They weren't just thinking about the clinical factors of health and reproduction, they were also really thinking about what makes a good relationship, what makes a healthy relationship. A lot of that of course has to do with having control and agency over your own knowledge of your own body.

Jennifer: That was what they worked on was this marriage manual, practical guide book to sex and marriage, which came out in the mid 1930s. You can look at it on archive.org it's available. The book is written as a hypothetical dialogue between a married couple and a doctor. They based it on thousands of conversations they'd had with couples at the birth control clinic and in their marriage counseling. It's written with these young people in mind who really have no idea about their own bodies or about the reproductive system, reproductive health.

Jennifer: They ask a whole bunch of questions that might be embarrassing like can a woman have an orgasm? Does penis size matter? All these kinds of things and they patiently go through and explain in very accessible language all the answers to these questions. And then in the middle of the book, they have a whole section about eugenics. The question is, how do we know, the couple asks, if we are fit to breed?

Jennifer: Of course, this ties in very much to the whole issue of eugenics that was going on. At the time eugenics was both a scientific movement and of course a really populist, social movement that really stressed social engineering. Margaret Sanger was very much a part of that. This is a major difference between Sanger and Stone. Sanger wrote a lot of publications in the '20s and '30s where she talked about what it meant to be fit or unfit and moved away from a scientific understanding of that to a social understanding, particularly with regards to immigrants and racialized language around immigrants.

Jennifer: What's interesting about this marriage manual is that it very much without speaking against Margaret Sanger directly goes against that. The Stones say that fitness or unfitness could only be described as a medical category that would need to be determined by doctor. And that in some cases there are groups of people who should be restricted from reproduction such as people from epilepsy. But even say even in those cases, care should be taken to distinguish between environmental and hereditary factors.

Jennifer: They are trying to be very clear that there is maybe a tiny medical basis for these eugenics categories. But really overall, we are talking about social categories. And they say that once eugenics moves from a strictly medical discourse, evidence based discourse to categorizing people as inferior or superior, their claim to the eugenics movement become subject to serious criticisms.

Jennifer: They stress overall that social and economic factors are more important than genetics when it comes to understanding fitness and unfitness and who should be allowed to reproduce and who should not. It's just a small section of the book, but it is very telling because it does in many ways go against what Sanger was saying and writing. Again, from a very evidence based medical perspective.

Rebecca: One thing, it's interesting in hearing you describe that because obviously it's still a very ableist way of looking at reproduction. But you can see the way that Stone is trying to find a kink in that conversation that was so popular around eugenics and trying to stave off the way that it was becoming wildly popular, even if there is still things that are problematic in that conversation. That's really interesting.

Jennifer: Yeah, absolutely. She was very much of her time so there's obviously a lot to critique in terms of the book overall and then that section in particular. But it's interesting that she was trying to carve out a space where she was challenging these really overwhelmingly prevailing ideas.

Rebecca: In 1942 the American Birth Control League changes its name to Planned Parenthood as we know it today. You write this change, "Reflected an orientation towards nuclear families and the private sphere and away from activism and public health." Why do these changes matter and how do you think it ultimately affected women's healthcare?

Jennifer: It's interesting because birth control really does go mainstream after the mid 1930s. By 1937 the American Medical Association, which is not a progressive organization, which is very mainstream medical establishment actually endorses birth control prescribed by physicians for married couples. Moving away from all this language of the early birth control movement about women's rights and about "voluntary motherhood," we move into this realm where we're actually moving into the post war baby boom and it's just assumed that having children is good and important. That's the pro-natalism of the Cold War period which a lot of scholars have written about.

Jennifer: Increasingly, the birth control movement uses that language and speaks in those terms to talk about birth control. What this meant a lot of the time was Sanger and her colleagues reaching out to state public health departments and providing them with information about birth spacing. Again, it's notion of we assume that women are going to get married and have babies, but we want to provide for their health and wellbeing while they do that. The best way to do that is to tell health professionals as well as women that they should not have more than one baby a year, and that they should focus on statistics on infant mortality rates for children that are born too close together and things like that. It really is a significant change in the focus on what women's health is about.

Leila: Okay. That is a good place for us to wrap up today. Thank you Jennifer for joining us. Her piece is titled An Emancipation Proclamation to the Motherhood of America. We'll be including that in the show notes so you can read the full piece there. But thanks Jennifer for joining us and going a little bit deeper into some of the issues that you explored in that essay so thanks.

Rebecca: Awesome, thanks so much.

Jennifer: Take care.

Rebecca: It was really great to talk to you, bye.

Leila: Before we wind down the show with our own annoying thing, we'd like to thank everyone who donated during our October fundraising campaign. Each donation has helped us fund the magazine and podcast for another year. We raised a total of $3205 which is $200 more than our goal, and we gained $65 in monthly pledges. We wouldn't have been able to do any of this without our excellent supporters. Linda Windorf, Shannon Supple, Pamela Gossin, Julie Pigano, Cheryl Muck, Kendra West, Patty and Richard McNeill (thanks mom and dad). Robert Hesselberg, Milissa Acosta, Brian Sletten, Lydia Pyne, Brian Burnham, Irma Mason, Sheila Liming, Victoria Curnut, Samuel Cohen, Carrie Atkins, Chris Martiniano, Megan Formato, Lisa Abott, David Castillo, Jenna Tonn, Kathleen Sheppard, Eileen McGuinis, Michelle Nordwald, Jane Davis, Joseph Klet, Chealsye Bowley, Allan Ray Baw, Megan Ravey, Caitlin McDonough, Joanna Berhman, Catherine Koil, Shirley Hesselberg Wagner and Lara Bergers.

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Leila: Again, thank you all so, so much.

Anna: At the end of every podcast, hosts will unburden themselves with one thing in the news, their work or the world in general that's just annoying the crap out of them. This is one annoying thing.

Leila: This month I'm annoyed at the 52% of men that say they haven't benefited from women having affordable birth control. A Think Progress-

Anna: Boo. Sorry.

Rebecca: Seriously though.

Anna: Boo.

Leila: The Think Progress article with that exact article made the rounds on social media recently. Even though it was published back in March after the first zombie corps of Obamacare repeal, staggered into the house changed, consuming Planned Parenthood and Medicaid funding in its wake.

Leila: When this article first came out, I tweeted out the article with something to the effective of, and 100 percent of women don't give an F what men think. I still stand by that sentiment. But I also want to unpack some of the stuff here because what I said doesn't really get to the larger problems at play.

Leila: The research in this article comes from the non partisan poling firm, PerryUndem who conducted a survey on a representative sample of registered voters. Before the article gets to that 52 percent figure of the conducted survey, it breaks down how voters believe affordable access to birth control affects families and communities at large. This is how that breaks down.

Leila: 72 percent of voters in the survey believe that access affects the financial situation of families. 69 percent said it affects stress in relationships. 62 percent believes it affects women's ability to have financial ability, 68 percent said that it affects the well-being of families, not just the financial aspect but overall well-being. 67% said it helps the economy, so the economy at large. And then 70 percent said that it helps their community at large.

Leila: Beyond the interpersonal benefits of a woman having access to birth control, most of the people in this survey believe that it does benefit the larger economy and community. That's good. It does do all of these interconnected things. But here's where that 52 percent comes in. From this same survey that found most people believe birth control access benefits personal relationships as well as the larger economy and community, 52 percent of men still don't think that they benefit from women having access to birth control. And it's like they don't see themselves as living in society with the rest of us. Sharing and benefiting from these communities and this economy.

Leila: I'm annoyed that the men in this 52 percent don't seem to have the critical thinking skills to make these connections. The failure to do so could influence the way that they vote and the amount of effort they put into stopping Obamacare repeal efforts. We already know that women are the ones making the majority of the phone calls to the representatives when we have this massive pleas to our representatives to not kill us by taking away our health insurance. Women are already doing more of the work in this regard anyway.

Leila: It shouldn't have to take a piece of legislation affecting you personally to care about it, but often times it does. If men don't see birth control as personally benefiting them, they might fight for it a little less even if they do think women should have birth control. For men on the right, it's clear that unless they are trying to provide birth control from our cold dead hands, that they aren't going to prioritize it as a necessary part of healthcare at all. That's why I'm annoyed.

Rebecca: It's a reminder to me that so many issues that are seen as related to women are just invisible to a lot of men. Like they are just not paying attention and that is infuriating.

Anna: I don't even have anything to... I can't even... I don't have anything to add. That ridiculousness.

Leila: Well, what's annoying you, Anna?

Rebecca: Like you said earlier, boo.

Anna: What's annoying me, I don't know if annoying is the right word or just I've now tumbled into a pit of despair. Apparently, there is a provision in the new proposed Cut, Cut, Cut tax bill. That's what our esteemed president wants to call it. I mentally crunched the numbers this morning, and if it passes I'll probably have to quit my PhD because I won't be able to afford the tax bill on my waiver.

Anna: This is a really good way to kill higher education. It's basically a guided missile to blow up the PhD pipeline and it's going to crush so many people. And it's going to ensure that the only people who can go to grad school are independently wealthy. All of the privilege and narrow perspective that comes with that is just going to be exacerbated by those being the only people who are allowed to get PhDs, the only people who are allowed to go to grad school.

Anna: It's perfect for republicans who hate higher education, and who have a chip on their shoulder I guess about not being smart or something. And so they just want to torpedo everyone else's chance of higher education and blow up the ivory tower.

Anna: I'm really bummed because I've spent four and a half years going through my Master's and then the first part of my PhD. I just got back from a really productive research trip for my dissertation and there's a possibility that I just won't be able to finish any of that. I'm sure as some of our listeners know, the academy is not particularly friendly to you if you don't have a PhD. I can't get a job in it without that.

Leila: Yeah.

Anna: Like I said, not so much annoyed as just a little bit devastated. Call your senators and your congressmen and tell them that I want to keep going to grad school.

Leila: I was annoyed at some of the conversations that I saw... I didn't actually participate in any of the conversations about this on Twitter. I just watched them creepily adding in my own mental notes. And there was one that I saw... everyone just immediately started thinking about how this affects people in STEM and that was really annoying because they already get paid more as PhD students than those of us in the humanities. So, that was annoying.

Leila: And I was also annoyed at a tweet that I saw and I don't think that it was ironic and I don't think that it was joke. I think this person was serious when they said, well this is a way to solve the hiring crisis for humanities majors.

Rebecca: What? Oh my God, what?

Leila: And it's like, what? I'm sorry. That's a terrible thing to say. Yes, there is a hiring crisis for people in the humanities. Taking people's chances away entirely is not a solution even a little bit.

Anna: Even if that was meant ironically, that's just such a cruel joke to make. Being... yeah. People in the job market in the humanities right now are... everybody is in therapy, people can't feed themselves. They have to fly across the country six times a year to do interviews that go nowhere. It's awful. It's not funny to make a joke like that even if it was a joke.

Anna: What you said about the conversation being dominated by STEM, in addition to what you said about the fact that they get paid way more than humanities graduate students do, it contributes to this really problematic assumption or popular understanding of who is in grad school and what they do. It's just another way that people who aren't scientists or aren't engineers or who aren't doing something that society I guess had decided is worthy, just don't matter anymore.

Leila: Yeah. They frame it in terms of usefulness.

Rebecca: Yeah.

Anna: Right. If they were less humanities PhDs, well that's not that big a deal but we need more engineers. And in fact, we don't need more engineers. We are at capacity on engineers too.

Leila: Right. Yeah.

Rebecca: That comment about, "This will solve the crisis." There are lots of people who get PhDs who don't get tuition wavers and what they do is take out loans and make the also student loan crisis worse. Because it's not like that's going to stop universities from pushing to try and get as many students as possible it will just continue to be a hot mess that just harms even more people.

Leila: Yeah. Well that was more of one depressing thing than an annoying thing.

Anna: Sorry.

Leila: It's okay.

Rebecca: There's a lot of overlap. This is just our chance to be furious about stuff.

Leila: Yeah. So, what's annoying you Rebecca?

Rebecca: I am going to circle us back to birth control. Of course as we mentioned at the top of the show, in recent months there has been renewed efforts to limit or to expand actually the kinds of businesses and organizations that can deny birth control coverage. That means that a lot of these arguments defending birth control that we have to continue to have, have returned. They often follow a similar pattern and they followed a similar pattern this time. Which is that a group of people start saying, birth control is super important not just to women who are having sex, but to women with many different kinds of health issues for which birth control is often prescribed. We need to defend birth control because it's not just about morals and ethics and behaviors, it's also about these other health issues.

Rebecca: And then we see a backlash to that, that says, well all reasons for taking birth control are valuable. Women don't say it's only okay if you're doing it for certain reasons because we [inaudible 01:15:46] controlling women and taking birth control. These two camps are getting into a fight. They are both true and they are both important. It represents that anytime discussion of women's sexual behavior becomes part of the conversation, women are going to end up being shamed for what they do.

Rebecca: Women who are taking birth control because they want to be sexually active are being shamed. Women who are taking birth control and are not sexually active but have other reasons for taking birth control are being shamed. We refuse to treat hormonal birth control like a medical treatment, even though the medical establishment are the ones who turned it into, as we were talking about earlier, medicalized a lot of women's reproduction. We get all the bad parts of that, but then we also can't just treat it like a objective medicine without all of these crazy "ethical conversations" that are infuriating.

Leila: Yeah. The troubling part to this is how women's health is seen as some sort of public debate. That my medical choices are public debate, and I have to bear my soul about why I need birth control in order to be legitimate for some asshole on the internet.

Rebecca: And it's none of your business. It's none of anyone's business.

Anna: Yeah, we don't have conversations about why people take aspirin. Maybe they take aspirin because they are sore from having too much sex. You don't know. But we don't have that conversation.

Leila: And that's the whole idea of pathologizing certain bodies, is that those bodies that we pathologize are the ones that their health choices are up for public debate. It's one of the things that Roxane Gay talks about as being a fat woman is that everyone tells her to go see a doctor. Eat better. That everyone disposes medical advice or assumes that she doesn't have a doctor that she sees anyway. These bodies that don't conform to that cis, white male body becomes pathologized, and then we get to discuss their medical choices and their private conversations with their doctor in the internet.

Leila: Anyway, sorry that got me all hot and bothered.

Rebecca: No, I think that, that's, it's all part of the big point. Someone's medical choices being up for debate is infuriating.

Leila: Well, I think that's a good place for us to stop. We circled back around to the beginning of our episode.

Rebecca: Everything is connected.

Leila: Everything is connected in a really awful way.

Rebecca: Yeah. In that everything is terrible.

Leila: So, we are dedicated to making Lady Science accessible, and we are looking for someone to donate their time to help us transcribe our episodes each month. If you are interested in that, please us an email at ladyscienceinfo@gmail.com

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