FAMILY PLANNING. Cleveland's first documented program to control childbearing, the privately funded Maternal Health Assn. (MHA, see PLANNED PARENTHOOD OF GREATER CLEVELAND, PPGC), began in 1928 to provide birth control (but not abortion) to married women only. By 1994 major hospitals, city health clinics, and the CUYAHOGA COUNTY DEPARTMENT OF HUMAN SERVICES, as well as PPGC, served thousands of Cleveland women, without age or other limitations. Such services, usually identified with the control of fertility, have also addressed infertility and/or abortion (after 1973). The steady decline of the American birthrate throughout the 19th century, especially in mid- to upper-class white families, suggests that women and men used a wide variety of birth control methods, including sexual abstinence, condoms, and homemade preparations. The unreliability of such methods led to many unwanted pregnancies, however, which some individuals resolved illegally with abortion or infanticide. Both to halt the declining birth rate (perceived by some as threatening America's social fabric) and to reinforce restrictive sexual mores, Congress passed the Comstock Law in 1873. This followed earlier stringent statutes against abortion, once legal until the time of "quickening," when the fetus showed signs of life. The statute classed family limitation information and preparations or devices with those relating to abortion as pornography and barred them from the federal mails. States and cities passed and sporadically enforced similar laws against birth-control distribution (including importing and shipping), and occasionally, its use. Ohio LAW, clarified in a legal opinion written in the 1920s by Jerome Fisher of THOMPSON, HINE & FLORY, restricted the distribution of birth control information to physicians.
An early 20th-century movement led by left-wing radicals challenged the restrictions on family limitation, but not abortion. National activist Margaret Sanger coined the term "birth control" in 1914. Local involvement in the early movement included Cleveland social worker Frederick Blossom, who left ASSOCIATED CHARITIES to serve a short stint as editor of Sanger's Birth Control Review (1916-17). Police arrested Sanger and other national crusaders, such as Mary Ware Dennett and Emma Goldman. Sanger spoke in Cleveland in April 1916; in December that year, activist Ben Reitman was jailed in Cleveland for distributing birth control literature at a local rally featuring Goldman. In 1918, however, a New York court of appeals decision permitted doctors to distribute contraceptives "for the cure or prevention of disease."
Between 1930-40, birth control gained respectability, evolving into the modern Planned Parenthood. Although contraceptive methods (now including the popular diaphragm for women) had not improved in effectiveness, the movement ignored abortion. Still used by many women across class lines, the practice remained illegal, relegated to private homes, back alleys, and the offices of a few sympathetic midwives and physicians. Federal court cases in 1930 and 1936 legalized limited shipping of contraceptives (but only for the prevention of venereal disease) and upheld physicians' right to provide contraception to preserve health. Sales of birth control devices rapidly soared. In 1942 the U.S. Public Health Service approved state use of federal health-service funds for birth control programs. Such loosening of the legal bonds, combined with earlier activism and the poor ECONOMY of the Great Depression, spurred the founding of birth control clinics, such as Cleveland's MHA, across North America by upper-middle- and upper-class women such as DOROTHY HAMILTON BRUSH. Private donations, memberships, fees, and a few FOUNDATIONS such as the BRUSH FOUNDATION supported these efforts. Clinic physicians (such as SARAH MARCUS and RUTH ROBISHAW RAUSCHKOLB) broadly interpreted the law and prescribed contraceptives, not to prevent venereal disease but to preserve women's health by limiting childbearing. In an unpredictable legal climate and facing formidable religious opposition from the Roman Catholic Church (see CATHOLICS, ROMAN), for example, founders, clinic physicians, and clients still risked public censure and arrest.
After WORLD WAR II, growing concern about a rapidly increasing world population renewed the impetus for family planning. The Intl. Planned Parenthood Federation organized in London in 1948, with the aid of Clevelanders Rufus Day, Jr. and Dorothy Brush and the Brush Foundation. By the mid-1960s, this concern was compounded by the interrelationships between poverty, uncontrolled fertility, and the unavailability of medical services in many neighborhoods. In 1960 the endorsement of family planning by the White House Conference on Children & Youth represented its increasing acceptance in POLITICS. Beginning in 1965, federal funds for local family-planning programs required wide availability of services, especially to welfare recipients and the medically indigent. In 1971 the words "for the prevention of conception" were finally removed from the federal obscenity statute. In 1973 the Supreme Court, in Roe v. Wade, permitted abortion with the advice of a physician in the first trimester of pregnancy, but allowed states to regulate abortion in the second and third trimesters. The same year, a new Cleveland city ordinance permitted abortion in licensed facilities, such as free-standing abortion clinics and hospitals. Although the Supreme Court decision originally allowed public payments for abortions for Medicaid recipients, the 1978 Hyde amendment prohibited such use of federal funds.
Planned Parenthood of Greater Cleveland (formerly the MHA), expanded, with new projects supported by the CLEVELAND FOUNDATION and INDUSTRY. In 1971 the newly established METROPOLITAN HEALTH PLANNING CORP. began distributing federal funds for family planning in Cuyahoga and 3 adjacent counties. The FEDERATION FOR COMMUNITY PLANNING, which had endorsed family planning a decade earlier, took over this responsibility in 1976. By 1994 this effort, entitled the Metropolitan Cleveland Family Planning Program, included 9 providers at 30 sites across a 5-county area. Public recipients of federal funds included Metropolitan General Hospital and city-run health centers; private recipients included PPGC, MT. SINAI MEDICAL CENTER, BOOTH MEMORIAL HOSPITAL, and UNIV. HOSPITALS. The CUYAHOGA COUNTY DEPARTMENT OF HUMAN SERVICES also provided contraceptive information and referrals for welfare recipients. In the 1980s newly available state funding offset to some extent federal reductions in monies for abortion and birth control efforts. In the early 1990s, the U.S. Supreme Court overturned another potential threat, the "gag rule," which forbade federally funded birth control clinics from giving any information about abortion. In 1993-94 an estimated 32,000 clients in 5 counties (Cuyahoga, Lake, Lorain, Ashtabula, and Geauga) received family planning counseling in Federation-supported projects, while PPGC served 14,047 in Cuyahoga County (1992-93). Anti-abortion activism mobilized in the 1980s-90s, with a major local protest in 1993, but in 1994 Cleveland had thus far escaped the violence escalating at other abortion clinics. Clearly, the politically charged issues around the legitimacy of birth control and abortion remain unresolved.
Marian J. Morton
John Carroll Univ.
Meyer, J. "Birth Control Policy, Practice, and Prohibition in the 1930s: The Maternal Health Association of Cleveland, Ohio" (Ph.D. diss., CWRU, 1993).
Morton, M. Emma Goldman and the American Left: "Nowhere at Home" (1992).
Reed, J. The Birth Control Movement and American Society: From Private Vice to Public Virtue (1978).