After visiting several contraception-advice centers in the Netherlands during a year-long tour of Europe, Margaret Sanger returned home in October to open the nation’s first birthcontrol clinic, in the Brownsville section of Brooklyn. Sanger had earlier been a midwife and nurse on New York’s Lower East Side and had been astounded by the lack of knowledge about contraception she had encountered among the women there. She had also seen the horrifying results of self-induced abortions, most famously in the tragic case of Sadie Sachs, a woman who had asked for contraception advice only to have her doctor joke that she should make her husband sleep on the roof. Sanger had tried to educate women with instructive writings for The Call , the socialist weekly, and through her own publication, The Woman Rebel . But both her series on syphilis for The Call and the less clinical advice she offered in issues of The Woman Rebel had offended the United States Post Office. An indictment for postal-code violations prompted her visit to Europe, where she found her inspiration for the centers.

Sanger opened the Brownsville clinic with her younger sister, Ethel Byrne. It counseled 488 women in just ten days before the police shut it down on the legal grounds that contraception information passed on by anyone but a doctor was obscenity. The judge ruled against the sisters and left intact the 1873 Comstock Act, the Federal law under which they’d been prosecuted, but he did cite the need for doctors to advise women about contraception if they might be at risk from venereal disease. The Comstock Act would finally be overturned in United States v. One Package , a suit brought by Sanger’s group in 1936. In 1937 the American Medical Association would recommend contraception methods as part of the standard medical curriculum. Sanger, who attributed her mother’s tuberculosis to the strain of having eleven children, introduced the phrase “birth control” and made the issue her life’s work. In 1923 she opened the country’s first birth-control clinic staffed entirely by doctors. By 1938 three hundred such clinics had spread across the country.