The Birth Control Clinical Research Bureau, founded in 1923, was the first legal U.S. birth control clinic and an influential model for the spread of clinics in the United States. It was founded by Margaret Sanger and was called the Clinical Research Bureau (CRB) to meet the requirements of a New York State law that held that doctors could prescribe contraceptives to married women only “for the cure and prevention of disease.” The bureau operated under the license of its medical director, Dorothy Bocker, but Sanger, as the director, determined the policies and oversaw operations for the clinic. Sanger’s goals in creating the clinic were several: to provide birth control to NewYork City women who could not afford or obtain it, to prove through detailed record keeping that contraceptives could be both safe and effective, and to create a model for other cities to follow. Because the American Birth Control League (ABCL) as a membership organization could not operate a medical dispensary, the solution was to have Bocker open a private practice in the same building as the ABCL.The CRB retained this link to Sanger’s ABCL until 1928. The CRB rapidly succeeded in its first two objectives.
Patients at the bureau were interviewed by lay workers, who questioned them about their reproductive history, family size and income, and education level. Doctors then examined the patients to determine whether by law they could be treated. Women who were already pregnant or who could not present a medical indication for contraception (and the clinic stretched the definition as broadly as possible) were turned away or referred to a private physician who might help. Those who were accepted were fitted for diaphragms and instructed in their use by a nurse and the doctor.
Careful records were kept on the success rates of the treatment. Bocker, however, was not seen by Sanger to be the right person to carry out the necessary research. Bocker had tried a number of different contraceptive regimens with 1,208 women seen, but it was not clear what the success rate was. Her contract was not renewed and in 1925, with the appointment of Hannah Mayer Stone as medical director, the CRB began producing convincing evidence of the effectiveness of the diaphragm when combined with contraceptive jelly. Sanger fostered statistical studies, including two independent analyses, Birth Control in Practice (Marie Kopp, 1931) and Controlled Fertility (Regine Stix and Frank Notestein, 1940) that confirmed her own findings.
After Sanger’s 1929 resignation from the ABCL, the CRB was reconstituted as an independent entity. Sanger expanded her work by opening a Harlem branch to cater to African American patients. Run essentially along the same lines as the downtown clinic, the Harlem clinic was never as successful. It was born during the depression in 1930 and securing funding was a continual problem. Finally, in 1936 the clinic was taken over by the ABCL and closed shortly afterward.
Though Sanger hoped to use her clinic as a model for other cities, it was unique. Because of the press that Sanger and the CRB received, it served to convince the public that birth control was a medical and social issue rather than a moral one. The public images of birth control clinics drew on the example of the CRB: professional and caring female doctors, a clinic that served any woman regardless of her ability to pay, and a guarantee that the methods prescribed were the best and most effective. In fact, however, the CRB was in many ways an anomaly. Everything about the CRB was bigger and costlier than other clinics—from the size of its paid staff to its research department, which analyzed various contraceptives sent by manufacturers; or its correspondence and literature departments, responsible for answering the thousands of requests for aid sent annually to Sanger.
Because most of Sanger’s staff, doctors, social workers, and nurses were on payroll, she was able to retain far more personal control over the clinic’s policies and practices than the majority of clinic reformers, who relied on volunteer work at almost all positions. Sanger’s clinic was opened daily, with multiple doctors on duty, whereas most clinics were open between once and twice a week, for short two- to four-hour sessions. Many of the clinics in other cities restricted patients based upon income, desiring to serve only those who could not afford a private physician. In contrast, the CRB had a sliding scale of charges based upon the income of the patient and used the larger fees paid by wealthier patients to subsidize the treatment of the poor. In one important way, however, the CRB was more restrictive than clinics in other cities. Because of its location in New York State, the CRB could see patients only when they had a medical reason for avoiding pregnancy, such as tuberculosis, heart disease, or previous gynecological damage. In other cities, patients could be seen without any difficulty for economic reasons, child spacing, or eugenic reasons, in addition to health concerns.
In April 1929, the CRB was the center of a controversy when it was raided by police. Four physicians were arrested and several patient records and 150 patient names were seized and never returned. The charges against the clinic were quickly dropped when it was found that the undercover policewoman whose treatment had been the basis of the case was found to have the proper medical indications for contraception. Investigations into the raid also showed that it had been instigated by Catholic officials and that one of the aims was to gain access to names of Catholic patients of the CRB. When physicians from the prestigious New York Academy of Medicine rallied to the defense of the CRB, birth control clinics had turned an important corner in their improving relations with the medical profession.
In the 1930s, the CRB began taking a more formal lead in helping other birth control organizations found clinics. It provided guidelines, samples of case histories, and organizers and in 1935 began a formal affiliation program whereby clinics that met certain standards could join a data exchange and receive startup grants and other benefits. In this and other aspects of the work, the CRB began to compete with the ABCL, and after almost ten years of independence, the two organizations merged in 1939. As part of the new organization, the
The Birth Control Review, founded by Margaret Sanger in 1917, was the first publication in the United States advocating ways for women to control their fertility; it was taken to court by Postmaster General Anthony Comstock for promoting “obscenity.”
Birth Control Federation of America (BCFA), the CRB focused on research and the development of new contraceptive methods. In 1940 the CRB was renamed the Margaret Sanger Research Bureau (MSRB) in honor of its founder, but by then Sanger was less involved in the day-to-day operations. Despite its merger, the CRB was only loosely affiliated with the BCFA (which changed its name in 1942 to the Planned Parenthood Federation of America) and continued as the largest provider of contraceptive and fertility services in the world. It fostered research and testing of new forms of contraceptives, including the anovulant pill and intrauterine devices. Under the direction of Abraham Stone after 1940, the MSRB expanded its services into fertility treatment; marriage counseling; and increased educational services for physicians, medical students, and nurses. At the forefront of clinic development, the MSRB was offering patients the birth control pill as early as 1961. By the 1950s, the MSRB was brought more closely under the supervision and budgetary control of Planned Parenthood, and as contraceptives became more widely available, attendance began to fall. In 1973 the MSRB merged with Planned Parenthood of New York City and was renamed Margaret Sanger Center.
The Margaret Sanger Papers contain the records of the Clinical Research Bureau and are located at the Sophia Smith Collection, Smith College; and the Library of Congress. They are also available on microfilm: Esther Katz et. al, eds., The Margaret Sanger Papers Microfilm Edition (Bethesda, MD: University Publications of America, 1996-1997). Clinic records can also be found in the records of the Margaret Sanger Research Bureau and the Planned Parenthood Federation of America, both located at the Sophia Smith Collection, Smith College.
