Contraception and Reproduction in Global Conversation

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Journal of Women’s History Book Reviews

Trent MacNamara. Birth Control and American Modernity: A History of Popular Ideas. New York: Cambridge University Press, 2018. 318 pp. ISBN 9781316519585 (cl); 9781108460538 (pb), 9781108564977 (ebook).

Cassia Roth. A Miscarriage of Justice: Women’s Reproductive Lives and the Law in Early Twentieth-Century Brazil. Stanford, CA: Stanford University

Press, 2020. 376 pp. ISBN 9781503610477 (cl), 9781503611320 (pb), 9781503611337 (ebook).

Aiko Takeuchi-Demirci. Contraceptive Diplomacy: Reproductive Politics and

Imperial Ambitions in the United States and Japan. Stanford, CA: Stanford

University Press, 2018. 336 pp. ISBN 9781503602250 (cl), 9781503604407 (pb), 9781503604414 (ebook).

Brianna Theobald. Reproduction on the Reservation: Pregnancy, Childbirth, and

Colonialism in the Long Twentieth Century. 288 pp. Chapel Hill: University of North Carolina Press, 2019. ISBN 9781469653150 (cl), 9781469653167 (pb), 9781469653174 (ebook).

Nicole Bourbonnais

To study the history of reproduction is to be asked regularly about Margaret Sanger. Sanger’s activism in the United States and abroad has cast a long and complicated shadow over the history of contraception in the first half of the twentieth century, prompting debates in both academic circles and the public sphere about the intersections of feminism, eugenics, population control, and imperialism. Thus, the need to engage her legacy continues to be important. However, as illustrated by a wave of local, national, and global studies published in the last decade, there is more to the early birth control movement (both globally and within the United States) than Margaret Sanger, and there is more to reproduction than birth control. The recently published books reviewed here incorporate but also move past the most well-known advocates and points of political friction, allowing us to see the broader landscape of activism, interests, and individual actions that shaped the reproductive continuum in the twentieth century. They take us from the level of world conferences down to the bedroom, providing us with a richer understanding of the dynamics of transnational exchange, the nuances of state power and inequality, the confrontation between “moder-

© 2021 Journal of Women’s History, Vol. 33 No. 4, 222–230.

nity” and “tradition,” and the complexities that shape women’s and men’s agency in the intimate sphere.

Aiko Takeuchi-Demirci’s Contraceptive Diplomacy opens with Sanger’s visit to Japan in 1922. While this approach would seem to maintain Sanger’s dominance within the historiography of the movement, looking at her from the perspective of the Japanese movement—from the outside in—has a decentering effect. As Takeuchi-Demirci shows, although many Japanese intellectuals were interested in Sanger’s advocacy, they did not embrace it naively or uncritically; rather, they engaged selectively with her ideas, integrating the elements they agreed with into preexisting national discussions of socialism, feminism, eugenics, and birth control. Local doctors translated her text Family Limitation into Japanese, but added their own critiques and commentary and taught it alongside local medical texts. These interactions went both ways: Japanese advocates traveled to the United States and contributed to American publications, and Sanger drew on Japanese advocates for emotional and political support. Indeed, Takeuchi-Demirci argues that in spite of the “imperialist logic” (67, my emphasis) with which birth controllers like Sanger approached activism abroad, the actual relationship between advocates in Japan and the United States is better described as one of “mutual interactions and influences” (6).

Contraceptive Diplomacy begins but does not end with Sanger’s involvement in the country. Instead, Takeuchi-Demirci uses her activism as a launching point for a broader discussion of Japanese-American intellectual and political exchange in the twentieth century. She explores how the subject of birth control animated transpacific relations during the American occupation of Japan, in debates over Japanese immigration within the United States, and during the fifth conference of the International Planned Parenthood Federation (IPPF) held in Tokyo, where early findings from research on the birth control pill were presented. In the last case, it is not clearly evident that transpacific relations are the most relevant frame of analysis; the vision of the IPPF and research on the pill presented in Tokyo arguably had more to do with the global dynamics of the family planning movement than anything particular to the Japanese-American relationship. Still, Takeuchi-Demirci’s book provides a rich example of how we can move beyond Euro-American networks in our study of the transnational, while maintaining a deep contextualization of the local. It also raises the question of how many other sites of dense exchange we might find if we look past the United States altogether: between Japan and India, or Japan and Singapore, for example.

Trent MacNamara’s Birth Control and American Modernity also seeks to move beyond the focus on Sanger and other prominent birth control advocates, this time within the context of the domestic American movement.

Based on analysis of newspaper and radio debates as well as letters to early birth control clinics, MacNamara argues that the demographic shift to low fertility in the United States was driven neither by birth control advocates nor by advances in contraceptive technology, but rather by “subtle changes in the acting ideas of people with no special interest in birth control as a social cause” (3). While Sanger and others helped open up public debate and dominated the headlines, the advance of birth control was, in practice, the product of “a sprawling mass movement” driven by conversations held in “kitchens, foundries, bars, churches, and picnic grounds, [where] Americans observed and enacted new reproductive codes” (5). MacNamara further argues that the Comstock laws and other state-imposed restrictions on the spread of birth control had much less impact on couples’ decisions than advocates claimed, and did little to discourage an active contraceptive market. When it came to birth control, power was “maddeningly disperse. . . . Birth control’s ultimate success required virtually no access to police power or public space. Key decisions could be made behind closed doors, by otherwise powerless people, for closely-held reasons that were awkward for outsiders to inquire about, discuss, or surveil” (20).

MacNamara’s de-emphasis on the role of the state and the law stands in contrast to Cassia Roth’s treatment in A Miscarriage of Justice. Drawing on medical publications, public health data, judicial documents, newspapers, and police investigations in Rio de Janeiro, Roth illustrates how the early twentieth-century Brazilian state “curbed full citizenship through its regulation of reproduction” (9). Roth takes a more expansive view of reproduction, including pregnancy, maternal health, childbirth, and miscarriage, alongside fertility control. In doing so, she illustrates how laws and discourses surrounding these practices operated on a continuum rather than as binary poles. The expansion of maternal and infant health services went hand in hand with increased prosecution of abortion and infanticide, often initiated by the same actors. All contributed to a broader state project aimed at reinforcing patriarchal rule and harnessing women’s reproductive potential towards national growth. While the expansion of public health services provided some practical benefits for women, it also increased institutional control over pregnancy and childbirth. Police investigations further criminalized poor women’s fertility decisions, and legal processes reinforced civil codes that infantilized women and contributed to the denial of their broader rights.

How can we explain the difference between MacNamara’s and Roth’s understanding of state power? Undoubtedly, this stems in part from the different national contexts: the active involvement of the Rio de Janeiro police force in administrative duties like issuing letters of admittance into public hospitals and providing access to burial service, for example, pro-

vided them with unique access to women’s reproductive lives. But the key factors here might really be questions of class and race. Roth makes clear that the women most affected by state policies were those at the bottom of the social hierarchy; middle- and upper-class women who could afford private services were not as reliant on—or targeted by—state actors. MacNamara’s “otherwise powerless” people were, in fact, largely white and middle class; as such, they held the power of racial privilege and economic agency that protected them from state intervention or dependence on free clinics that were more impeded by legal restraints (20). Indeed, when MacNamara shifts in chapter four to the more rural, poorer populations who drew on early clinics, we see less of the freedom evident in middle-class newspaper and radio debates. Incorporating discussions within African American newspapers in these years—or at least some of the literature on these debates—might also have altered the picture significantly. MacNamara claims that “though birthrates were falling among African-Americans, the poor, and immigrants’ descendants, no equivalent moral panic ensued in those communities” (41). This argument is challenged, however, by the findings of Michele Mitchell’s Righteous Propagation and Dorothy Roberts’ Killing the Black Body, to name a few.1 This literature shows that African American communities were deeply concerned with fertility in the early twentieth century; their sexual lives were more vulnerable to state surveillance and control, and their ability to exercise reproductive freedom was continually undermined by race and class inequality. This is not to say that individual couples within marginalized communities exercised no agency in the bedroom, but rather that their choices were more constrained and impacted by outside actors who displayed little compunction in discussing and surveilling their intimate lives.

These points are further reinforced by reading MacNamara alongside Brianna Theobald’s Reproduction on the Reservation, which focuses on the experiences of Native American women on the Crow reservation in southern Montana.2 Like Roth, Theobald explores the full reproductive continuum and sees a powerful role for the state. As in Brazil, maternal health campaigns on American reservations facilitated heightened scrutiny and surveillance of women’s bodies. Theobald further points out that even policies that were not directly aimed at reproduction affected women’s experiences of fertility control, pregnancy, and childbirth. The state’s reservation, assimilation, and termination policies, for example, created dire social and economic conditions that continually undermined Native American women’s reproductive health, despite attempts to blame poor outcomes on “maternal ignorance.” The high sterilization rates on reservations that would eventually spark national protest in the 1970s must also be seen within the context of the state’s lack of provision of temporary contraceptives, failure

to outline clear policies around sterilization, and general underresourcing of services and denigration of Native American populations. All of these factors created a situation that allowed individual physicians to exercise “tremendous discretionary power” and made them “well positioned to blur the lines between ‘therapeutic’ and ‘eugenic’ sterilizations” (10, 95). In other words, the state can play a powerful role both through its direct intervention, and through its negligence; the state’s power, too, is maddeningly disperse.

“The state,” of course, is not an abstract entity, and the books reviewed here provide a nuanced understanding of the subtler dynamics and individual actions that shape the translation of policy into practice. TakeuchiDemirci notes how the American occupying government in post-World War II Japan attempted to work quietly to promote birth control, inviting officials to “stimulate” or “encourage” the local population by facilitating research projects aimed at tracking demographic trends and family size preferences (131). Theobald breaks down the long chain of actors involved in reinforcing the reproductive policies of the Office of Indian Affairs (OIA), “from agency farmers to lowly clerks to boarding school teachers and ultimately to field relocation officers in urban centers” (6). Roth focuses on police officers, public prosecutors, and physicians as key agents of state patriarchal rule, but recognizes that “all had their own ideas about women’s reproduction, and they brought those with them when performing their daily jobs” (20). Public health nurses and hospital matrons were also key actors from Japan to the United States to Brazil, tasked with leading maternal health campaigns in practice. As Roth and Theobald stress, these female frontline workers injected a maternalist narrative into patriarchal state structures, preaching domesticity and middle- and upper-class family norms alongside “modern” health practice.

Midwives held a more ambivalent position in this structure, often viewed as traditional cogs in the modernization wheel. In the United States, direct efforts were taken to eliminate traditional midwives; Black and Native American midwives were subject to particular scorn, portrayed as unhygienic and ignorant. The occupation of Japan carried this sentiment eastward, where American officials challenged the longstanding social position of local midwives. Although Japanese doctors recognized the importance of midwives’ labor, the latter were eventually largely replaced by public health nurses. In Brazil, doctors both acknowledged and resented the appeal of midwives, working to incorporate some through registration and training while delegitimizing others who were associated with malpractice and clandestine abortion. Ironically, these attacks on midwives reached their height in all three contexts in the early twentieth century, a time when few institutions actually had the medical manpower and infrastructure to provide the superior care they touted. Theobald quotes a state inspector, for

example, who admitted that the Crow reservation’s hospital was “unfit for the purpose used and most certainly should not bear the title of Hospital” (87). Roth and Theobald further point out that many of the deaths blamed on midwives’ “ignorant” practices would also have occurred if births had taken place in the hospital at the time. Although a hospital delivery had some advantages in hygiene and management of complications, major advances in childbirth care would not come until the 1940s, with the invention of penicillin and blood transfusion. Hospitals’ marketing of their “modernity” in the early twentieth century “far surpassed demonstrated outcomes” (Theobald, 57).

If the division between the “traditional” and the “modern” was somewhat obscure in terms of actual practices, it bore more weight as an ideology or an identity marker. Indeed, MacNamara convincingly argues that “‘modernization’ was never just an analyst’s retrospective category; it was also a central idea to Americans making reproductive decisions during the fertility transition” (29). Men and women self-consciously linked their decision to have fewer children with a desire to “be modern,” to keep up with the times. The spread of smaller families became “an expression of every change that separated the present world from the half-remembered ancestral one” and “a sign of the modern spirit of individualism,” portrayed either as positive progress or as “selfishness” depending on the commentator (53, 41). On the Crow reservation, “modernization” carried the additional trauma of colonization. To limit family size and to deliver in the hospital was a sign not only of modernization but of assimilation, in the eyes of many government officials as well as some Crow residents. Younger women who had attended boarding schools, for example, were overrepresented among hospital maternity parents in the early twentieth century, and some explicitly expressed a desire to have their babies “in the new way” (Theobald, 66). But others moved more flexibly in and out of the so-called modern and traditional spaces, utilizing hospital services selectively, combining them with traditional healers, or bringing Native cultural practices into the hospital (much to the chagrin of many doctors and nurses). This pluralism is illustrated particularly well through Theobald’s riveting narration of the personal history of Susie Walking Bear Yellowtail in chapter three. Yellowtail underwent training to become the first Crow registered nurse in 1927 but later shifted to midwifery practice; she alternated between giving birth to her own children at the hospital and at home; and she lobbied for access to “modern” healthcare while increasingly engaging in Crow “traditional” dress and self-presentation. One of her contemporaries noted that Yellowtail’s refusal to situate herself neatly on the modernity-tradition binary might point to the need for a third category: “The Susie Category” (136). In fact, it seems likely that most people fell into this third category, illustrating

the wider ambivalence shaping the modernity-tradition continuum, even as an ideology.

Although Theobald is careful to stress that we should not romanticize women’s choices and actions within this continuum, in practice she does not present many cases of women acting in non-benevolent ways. She mentions, but somewhat minimizes, gendered tensions within the community. This likely reflects the extreme difficulty of discussing harmful practices and community conflict in a context where Native American women and communities frequently were—and continue to be—described as neglectful and disordered, a discourse that justifies a whole host of intrusive interventions and colonialism in general. Roth’s Miscarriage of Justice, however, provides a rich example of how historians can confront such fraught internal dynamics with depth and sensitivity. Drawing on the Latin American historiography on gossip and rumor and Gramsci’s concept of hegemony, Roth illustrates how ordinary people contributed to the disciplining of women’s sexual and reproductive lives through denunciations and engagement with police investigations. These interactions provided poor men and women with temporary access to the social power they were otherwise denied, but at the expense of those they accused. Roth also faces head-on the intimate details of infanticide cases in her sources. Drawing on Nancy Scheper-Hughes’s influential study of maternal neglect in Death Without Weeping, she stresses the importance of understanding women’s actions within the context and logic of their time.3 She draws our attention to the way low wages, job instability, sexual violence, the cultural emphasis on sexual honor, and structural inequality, may have made infanticide a “logical” choice for some women at the bottom of the social hierarchy. In others cases, women appear to be experiencing the psychological disassociation brought on by trauma. So situating these actions, Roth clarifies, “does not mean saying they are ‘right’”; rather, it is a matter of giving women “the historical attention and analysis they deserve,” whether they are acting heroically, benevolently, in desperation, or in ways that harm (25).

The texts examined here also pay fresh attention to men’s roles in the reproductive sphere. While both Theobald and Roth reaffirm that childbirth was the traditional domain of women, men were not absent. As Roth clarifies: “while women dominated the delivery itself, men’s and women’s understanding of patriarchal power within the family often dictated women’s health outcomes” (85). For example, a husband would most likely decide where a woman would deliver or when a doctor would be called to a home birth facing complications. MacNamara also argues that men played a more active role in the American fertility decline than has traditionally been recognized. This is an important and often overlooked point. Indeed, the widespread reliance on withdrawal, condoms, and periodic abstinence in

the early twentieth century is clear evidence that men used contraceptives actively and made reproductive decisions. Still, MacNamara’s claim that “historians have partly mistaken the importance of birth control to women and feminists for the importance of women and feminists to birth control” goes a bit too far (25). It is not really necessary to diminish women’s importance in order to recognize men’s importance in this process. MacNamara’s understanding of “mutual consent” could also use some further nuance (12). He gives the example that “a wife might insist that her husband practice withdrawal, or a husband that his wife induce abortion” (12–13). True, but these were hardly equivalent practices in the early twentieth century: one involved the slight limiting of sexual gratification, the other the illegal insertion of objects or swallowing of poisons that may very well cause morbidity or mortality. Men and women rarely were empowered equally in relationships to make these kinds of demands, something MacNamara acknowledges but passes over fairly quickly. MacNamara also claims that men’s engagement with sex workers was a way of “separating sexual gratification from reproduction,” but in fact this practice simply shifted the burden of contraception and pregnancy to a different woman (13). A deeper engagement with women’s history and gender theory might have helped contextualize these dynamics more deeply, and enrich the otherwise valuable intervention made by this book.

Turning to this literature might also help us answer the quandary posed in MacNamara’s conclusion: whether, in light of renewed concerns over declining fertility rates in many countries around the world, it is possible to combine a liberal concept of individual rights with “some sort of communitarian vision” to promote intergenerational continuity (180). MacNamara suggests that this form of “liberal pronatalism” might involve a level of “familism,” including family-friendly policies like tax breaks, subsidized childcare, parental leave, child allowances, and measures to improve work-life balance (185). Arguably, much of this vision is already captured in the concept of “reproductive justice, ” developed by women of color at the end of the twentieth century.4 As Theobald and Roth note, the reproductive justice framework demands that women and families have the right and ability to decide “how they will give birth, whether they will give birth, and who will be present during the birthing process” (Theobald, 181), while also calling for the resources needed to ensure that families can raise the number of children they want in a safe physical and social environment. This framework arose out of the struggles of women of color and responds to their desire to merge reproductive rights with a critique of invasive reproductive control from the state and medical community, while also addressing the broader social and economic conditions that undermine reproductive health. Indeed, if panic over “race suicide” is a somewhat ironic

concern coming from President Roosevelt in the early twentieth century (as documented by MacNamara) and from the largely elite commentators who dominate discussions of low fertility rates today (whose position at the top of the global social and political hierarchy has never really been in danger), it has been something more of a felt reality for marginalized communities around the world. Their experiences—and theorizing—are crucial to any discussion of reproduction in the past, present, and future.

Notes

1Michele Mitchell, Righteous Propagation: African Americans and the Politics of Racial Destiny after Reconstruction (Chapel Hill: University of North Carolina Press, 2004); Dorothy Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Pantheon Books, 1997). 2Since Theobald uses the word “Crow” throughout her work, so have I, but the “Crow” are also known as and call themselves the Apsáalooke. 3Nancy Scheper-Hughes, Death Without Weeping: The Violence of Everyday Life in Brazil (Berkeley: University of California Press, 1993). 4As documented, for example, in Jael Silliman, Marlene Gerber Fried, Loretta Ross, and Elena R. Gutiérrez, Undivided Rights: Women of Color Organizing for Reproductive Justice (Cambridge, MA: South End Press, 2004) and Loretta Ross and Rickie Solinger, Reproductive Justice: An Introduction (Berkeley: University of California Press, 2017).