F • I • V • E

Margaret Higgins Sanger: The Law Shall Be Broken

Patricia K. Hindin

U.S. postage stamp issued in 1972 honoring family planning.

THE LAW SHALL BE BROKEN

On March 3, 1873, the U.S. Congress passed “An Act for the Suppression of Trade in, and Circulation of, Obscene Literature and Articles of Immoral Use.” This federal law made it a crime to sell products or distribute literature regarding contraception or abortion, to send such materials through the mail, or to import such items from outside of the country. One of the supporters of this bill was 29-year-old Anthony Comstock, who was an organizational leader for the New York Society for the Suppression of Vice. Wealthy New Yorkers formed the backbone of this organization and their money was used to lobby Congress for passage of the bill. The law became known as the Comstock Act and Anthony was appointed special agent to the United States Post Office, with the authority to enforce the new law. He held this position for the next 42 years while he successfully prosecuted 3,600 defendants and destroyed over 160 tons of “obscene literature” (Comstock Law of 1873, n.d.).

Mr. Comstock was successful in the prosecution of Margaret Higgins Sanger (1879–1966) and her birth control movement. But Ms. Sanger proved to be a tireless advocate for women and “broke the law” to defend women’s reproductive freedom. The Comstock Act would restrict women’s reproductive freedom for the next 101 years, that is, until the 1965 ruling of the U.S. Supreme Court, when Griswold v. Connecticut struck down the one remaining contraceptive Comstock law in Connecticut and Massachusetts. It was not until 1972 that the case of Eisenstadt v. Baird extended the 1965 rule to include unmarried persons as well, and the Comstock Act officially ended.

EARLY YEARS

On September 14, 1879, Margaret Sanger was born in Corning, New York, to Michael and Anne Purcell Higgins who were poor Irish immigrants. She was born sixth of 11 children. Her father was a stonecutter who worked in marble and sculpted statues for gravesites and churches. He was quite a radical and was taken with the writings of Henry George, who published Progress and Poverty in 1879, which was a discourse on the inequity of wealth in the United States and proposed a system of fair taxation as solution. The writings of Mr. George were not popular with the local Catholic Church, which owned a large portion of untaxed land in Corning. When Michael invited Mr. George to speak to the town workers, he angered the Church. As a result, the Church stopped providing marble commissions to Michael and it became more difficult to support an already poor family. He had to find work outside of town just to feed his large and growing family. He was an agnostic and had a different philosophy toward religion than his devoutly Catholic wife. The children were not brought up properly in the Church, and when Church members came to visit Anne with food baskets and invite her to attend services, Michael would not accept their assistance and sent them away.

The family could not afford the care of a doctor or midwife and Michael attended his wife during labor and managed the delivery of their infants. As Margaret became older, she was her father’s assistant and helped in the births of her younger siblings. She remembered her mother as always either nursing a child or pregnant, while suffering from the debilitating symptoms of tuberculosis. Her mother experienced 18 pregnancies, 11 live births, and 7 spontaneous abortions during her marriage. Anne suffered from tuberculosis with miserable hacking, coughing, and the expectoration of bloody sputum. These symptoms were greatly exacerbated during each of Anne’s pregnancies. Margaret cared for her mother in the last year of her life. She took charge of the household and managed four siblings under the age of 14 as well as her father. Anne passed away at the age of 42 from complications of her chronic illness, whereas her father, Margaret noted in her biographies, died at the age of 80. Her mother’s multiple pregnancies and chronic health condition had a lasting effect on Margaret’s view of women’s role in marriage and society. Margaret associated her mother’s early death with the toll that 18 pregnancies had taken on her body.

During this time, the major industry in Corning was the manufacture of glass light bulbs for the newly invented electric light developed by Thomas Edison. The owners of the glassworks company had moved from Brooklyn to Corning; they were attracted by the natural resources of water, coal, and sand necessary for glass production. In addition, there was an abundance of poor Irish immigrants and children as young as 12 who were willing to work long hours for low wages. To supplement the family income, Margaret’s brothers attended school in the morning and then worked at the glassworks for the rest of the day.

The town was socially and economically divided between the small population of the wealthy, who lived on the hill in large beautiful homes, and the vast majority of the population, who worked in the glass factory and lived at the bottom of the hill in humble, overcrowded dwellings. When Margaret reflected on her early years in Corning, she recalled that the families living in the poor areas of town had many children, with the women burdened with multiple pregnancies, miscarriages, and children they could ill afford to feed and clothe. In contrast, the wealthy women had few pregnancies, their children were healthy and well dressed, and they lived a social life of comfort and ease.

What did the wealthy and educated women know about reproductive health and methods to prevent pregnancies that the poor women did not? In these early years, unknown to Margaret, her life was to become a journey that would find the answers to this question and ignite the fire for her lifelong passion of reproductive health care for women.

Margaret was to begin her education in class differences when she was allowed to attend a private school, Claverack College and Hudson River Institute, a coeducational boarding school, in Hudson, New York. She was a work–study student, and her two older sisters, who were working, provided some tuition assistance. The influence of the school on her developing philosophy was the first important step in educating her to become a future leader in the controversial area of reproductive health. Maggie Higgins, as she was known at the time, entered the world of the wealthy. Her school was housed in a Greek Revival mansion with running water and electricity. The furniture was beautifully made and she spent hours in the large school library where she studied a wide variety of subjects, from art to mathematics. Maggie appeared as the female lead in plays and she began public speaking, often debating women’s rights issues of the time. She was learning to think critically about important social and political issues and developing her writing and public-speaking skills.

She absorbed the lifestyle of wealthy New Yorkers and learned how to dress and arrange her hair in a more sophisticated way. Maggie attended teas and dances. One of her classmates, a handsome young man from Long Island, became her first boyfriend. She was forming the foundational social skills and grace required for her future public life when she would influence wealthy donors and intellectual men and women in supporting her yet-unnamed cause. According to Baker (2011), Maggie “emerged as a fun-loving leader, organizing activities and, on more than one occasion, illegal escapades off campus” (p. 25). It was at this early point in her development that she stopped using the name “Maggie” and became Margaret Higgins, the unknown, future visionary of a new radical movement. Because money was scarce and she was needed at home to tend to her dying mother and the care of her siblings, Margaret never graduated from boarding school.

After her mother’s death, Margaret rejected the role of surrogate mother to her brothers and father. Because she was an ambitious young woman, she did not want to take on the role of domestic servant, nor was she interested in work as a governess or teacher. Her dream of attending medical school at Cornell University was not possible without the proper undergraduate education, sufficient money for tuition, not to mention the unfortunate circumstance of being a female in a male-dominated profession. New opportunities, however, were opening up for young women in the newly expanding field of nursing.

Hospitals were starting nursing schools based on the principles developed by Florence Nightingale, and Margaret enthusiastically enrolled. In July 1900, she entered a 3-year nurses’ training program at the White Plains Hospital in White Plains, New York. She worked on the women’s ward and was proficient in gynecological care and the art of midwifery. She learned her nursing skills through apprenticeship on hospital wards and nursing theory from a textbook entitled Text-Book of Nursing by Clara Weeks-Shaw, and was lectured to by physicians. The topics of abortion and contraception were missing from her education. The Comstock Act, passed in 1873, was in effect and made the education involving birth control topics and the dissemination of birth control products illegal and subject to fine and imprisonment for anyone who broke the law. It was on the wards of White Plains Hospital that Margaret first heard the disturbing words of women after birth, asking her to tell them the secret of how to prevent more pregnancies. She was to hear these words over and over again throughout her nursing career while caring for obstetrical patients in New York City.

It is during her time as a nursing student that she became ill with weight loss, fevers, and night sweats—she was diagnosed with tuberculosis of the tonsils and lymph glands. She was treated by one of the physicians at the hospital but would bravely fight intermittent flare-ups of this disease for the next 20 years.

In the summer of 1901, she was sent to continue her education at the New York Eye and Ear Infirmary in New York City. It was at this time that she met a handsome young man at a dance, named William Sanger, who fell in love with Margaret. William was a student at Cooper Union, studying to become an architect, while earning a satisfactory salary working as a draftsman. He studied painting in the evenings and, unlike the men of Corning, he was Jewish and an educated, charming member of the Socialist Party. Margaret was intrigued and was very much attracted to this young man, so different from those she had known in her earlier years.

William began a courtship and soon asked Margaret to leave nursing school and become his wife. He made a good case for her to leave the hard work and stress of nursing for a life of intellectual rigor and pleasant living conditions with him. Margaret accepted this charming man’s proposal, and in August of 1902, they eloped on one of her 2-hour breaks from her nursing duties. Margaret returned to the ward a married woman but the marriage was kept secret. Nursing students were not allowed to marry and were expected to live on hospital grounds with strict curfews and long hours spent working on the wards. Margaret wrote a letter of resignation to the school and left without completing her nursing education.

She and her new husband moved to the Bronx and began married life, living with his family. Margaret soon found herself pregnant with the unfortunate complication of her tuberculosis symptoms returning. Margaret was sent to the Adirondack Cottage Sanitarium under the direction of Dr. Edward Trudeau who was an expert in the treatment of this disease. She lived in an isolated cottage and followed the recommended dietary restrictions and fresh air regimens that were the state-of-the-art treatment of the time. Margaret returned to New York after about 6 months and her first son, Stuart, was born in what was described as a difficult delivery. Her health was again in jeopardy during the postpartum period and she agreed to return to the sanitarium with her infant and a wet nurse. Breastfeeding was contraindicated for women with tuberculosis as it was believed that the disease could be passed on in the mother’s milk. This was a difficult time for Margaret, who spent over a year in treatment. She became depressed and weary of living the life of an invalid. The staff encouraged Margaret in her recovery and her tenacious spirit was revitalized to move forward and reject the invalid role.

She left the sanitarium in remission, and she and her husband built a large home in Hastings-on-Hudson, New York. This was a period of motherhood and middle-class living for Margaret. In her fearless way and against the advice of her physician, she had two more children while remaining healthy and free of disease. Margaret spent her days gardening, taking the children to the playground, and socializing with other mothers. She joined a women’s literary group, and they read and discussed literature just as people do in today’s book clubs. Margaret was rebellious and grew weary of living a life of middle-class privilege. She began searching for inspiring work and intellectual stimulation. Meanwhile, William changed his career path, resigned his job as an architect and draftsman, and devoted himself to full-time painting. Margaret wanted to move back into the city; the house was put up for sale, and the couple began a new direction in their lives.

THE MAKING OF MARGARET SANGER

In the winter of 1910, the couple and their three children moved to 135th Street on Manhattan’s Upper West Side. William spent his time painting in a Greenwich Village studio, working to become an artist. Margaret embarked on two new pathways that would put her career in motion. She joined Branch 5 of the Socialist Party of New York and resumed her nursing work even though she had not completed her nursing diploma.

As a new member of the Socialist Party, she became active in the Committee on Propaganda. She spent time on the streets of New York handing out booklets and newspapers on Socialist ideology and speaking to people, explaining the principles of the movement. Branch 5 was composed of Greenwich Village bohemians who were some of the premier intellectual and radical thinkers of the time, such as Jack Reed, a Harvard graduate and journalist; Bill Haywood, the leader of the Industrial Workers of the World; Emma Goldman, a well-known and early supporter of contraception; Jessie Ashley, a wealthy lawyer who spent her money supporting radical publications and providing bail for her jailed comrades; and Anita and John Block, publishers of the daily Socialist paper, The New York Call. It was with these intellectuals that Margaret began to find her voice. The Blocks were impressed with her logical thinking and asked her to speak at meetings and write for a popular column in their paper called “The Women’s Page.” Always resourceful, Margaret’s first lecture was on the social conditions of the day as seen from the perspective of a trained nurse. Gradually, she began to include in her lecture series the dangerous topic of sex education. She wasted no time in taking the opportunity to challenge the process by directly writing and publicly speaking on this forbidden topic.

She fearlessly moved on to write and publish in the New York Call “What Every Mother Should Know, or How Six Little Children Were Taught the Truth.” Margaret urged mothers to teach their children age-appropriate sex information using nature (the birds and the bees) as a metaphor for human physiology. She attended evening gatherings at Mabel Dodge’s home on Fifth Avenue. Ms. Dodge was a wealthy intellectual and Jack Reed’s lover. At Mabel’s evening salons, the group discussed the radical ideas of the day, including the dangers of capitalism and religion, the concern over the government’s censorship of art and literature, and the importance of sexual liberation.

During these evening salons, Margaret passionately discussed her ideas on sex education, which was the emerging discipline known as “sexual hygiene.” Margaret explained to the group the significance of educating women in methods to prevent pregnancies as well as infections of sexually transmitted diseases, in particular, syphilis and gonorrhea. She shared her views on sexuality as a pleasurable component of human love and not just for the purpose of procreation. She instructed her friends in methods to simulate and prolong sexual enjoyment for personal fulfillment and satisfaction. These Greenwich Village intellectuals of 1912 were engaged in the exploration of “free love” and experimented with alternative relationships, taking multiple sex partners and lovers, or partners and lovers of the same sex. They were the rule breakers who laid the foundation for the Beat Generation of the 1950s and the hippies of the 1960s, who moved into Greenwich Village and espoused the same principles of free love.

Margaret, always a shrewd propagandist, was searching for an alternative to the word contraception in order to give her lectures and writings a signature phrase. It was during one of these gatherings at Mabel’s apartment that the term birth control was conceived (pun intended) and she now had a new name for her evolving work. She educated herself in the important human sexuality literature of the day. Margaret read the works of the English Malthusians, especially the writings of Havelock Ellis, a renowned sexologist and the author of a group of works entitled Studies in the Psychology of Sex and Edward Carpenter’s Love’s Coming of Age. Malthusianism is a philosophy that is grounded in the work of Reverend Thomas Robert Malthus as described in his 1789 book, An Essay on the Principle of Population. Reverend Malthus was concerned with the continuous growth of populations and the notion that this growth would not keep pace with the supply of food. He believed that population growth should be restricted by moral restraints such as abstinence, delayed marriage, and limiting marriage among people living in poverty or with mental deficiencies. Population limitation would ensure a sufficient food supply and a strong genetic pool. As a man of religion, the Reverend was not a proponent of artificial means of contraception; he believed in the principle of self-control. English Malthusianism was an outgrowth of this movement. It was composed of people who believed in the importance of population control and the relationship between too many people and a decreasing food supply. As opposed to the Reverend Malthus, however, this group was very interested in the use and development of artificial means of contraception and not in favor of limiting sexual intercourse in an effort to prevent pregnancy.

Simultaneously, as Margaret was expanding her knowledge of sexuality and forming new ideas on reproductive health, she needed to supplement the family income, so she resumed her nursing career. She worked as a public health nurse for the Henry Street Settlement House founded by Lillian Wald (Chapter 9). The Lower East Side of Manhattan had a large and poor immigrant population and was an area targeted by public health nurses. In this dirty and overcrowded environment, the disease of tuberculosis was uncontrolled. Much of the public health nurses’ work was dedicated to teaching hygienic practices to the population in an attempt to stop the spread of infection.

Margaret soon became impatient with this work, and, with her usual self-confidence, began her own nursing practice. She focused on obstetrical and gynecological care and delivered babies with the midwifery skills she learned as a nursing student. While attending home visits to these poor women, Margaret would be transported back to the wards of White Plains Hospital. She would hear the same questions again, the pleading voices of women, asking for advice on how to prevent more pregnancies.

It was not uncommon for her to attend gynecological cases in which women suffered from the consequences of abortion, including complications such as excessive bleeding or unresponsive uterine infections. In spite of abortion not being allowed by law, women had information on ways to abort pregnancies even with the knowledge that they risked disastrous outcomes. Women used folk remedies, such as applying hot mustard plaster compresses to the lower abdomen or using over-the-counter herbal preparations, sold in pharmacies or newspapers to “bring on the monthlies.” Abortions cost $5 and were performed by both knowledgeable practitioners, such as midwifes and physicians, and untrained local people found in the neighborhood. To save money, poor women used household items to induce self-abortion, such as wire coat hangers, knitting needles, crochet hooks, hairpins, scissors, and buttonhooks (Reagan, 1997).

In the summer of 1912, Margaret was called to care for Sadie Sachs, a young woman recovering from a uterine infection after an abortion. Sadie asked the same question that Margaret had been hearing since nursing school, “How can I prevent any more pregnancies?” The doctor, who attended her, offered the same unsatisfactory and routine answer, telling the young woman to have her husband “sleep on the roof” (Baker, 2011, p. 50). It was illegal for physicians and nurses to provide contraceptive and abortifacient information to patients as a result of the Comstock Act. In addition, the Act made it illegal to use the U.S. Post Office to send contraceptive equipment, such as diaphragms, condoms, or educational materials describing contraceptive methods, through the mail. The special agent in the U.S. Post Office had the authority to not allow distribution of censored materials and to arrest and imprison anyone involved in sending this material.

A few months later, Margaret was called back to Sadie’s apartment; she had had another abortion and this time she did not recover. Sadie Sachs, at the age of 28, was dead from complications of septicemia. The death of Sadie and Margaret’s inability to prevent this tragic occurrence was a defining moment for Margret. She walked throughout the city that night reflecting on the needs of poor women and the unnecessary death of Sadie. Returning to her apartment defiant, she decided to challenge the process, which did not allow reproductive decision making and family limitation to be a choice for women. She would defy and confront the Comstock Act and rebel against religious teaching. She was determined to prevent pregnancies and avoid the practice of illegal abortion. She would become the visionary who would stop women from dying by preventing unwanted pregnancies so no more abortions would be performed; she would be the risk-taker who would give women their reproductive freedom; and she would be the fearless one to distribute birth control education in spite of the Comstock Act. She would use her passionate writing and speaking abilities to inspire a shared vision among her intellectual and wealthy friends. Armed with the monetary resources of her liberal Greenwich Village friends, together they would bring important birth control education to the women of New York City. But Margaret would not stop at the local level; she would travel throughout the United States and Europe and make her movement, her birth control movement, accessible to all women.

Contraceptive science had its limitations when Margaret entered the field of birth control education. A survey conducted by Dr. Clelia Mosher on the contraceptive practices of married women of the upper middle class between the years 1892 and 1920 provides insight into the state of the science of the time. Dr. Mosher’s qualitative sample size was small (N = 41). She asked women to describe the methods of contraception they used during their marriage. Women reported the following in order of the most frequently used method to the least frequent: (a) douche, (b) safe period/rhythm method, (c) withdrawal or coitus interruptus, (d) condoms, (e) cervical caps/diaphragm, (f) suppository jelly or foam powder, (g) abstinence, and (h) no method of pregnancy prevention at all (David & Sanderson, 1986).

Products were advertised in newspapers and pharmacies and sold as health-promotion items to maintain female hygiene. The words “contraceptive” and “birth control” were never used or implied in the product endorsements. Cleanliness was advertised as a virtue, the advertised goal to keep women free of germs with the unsaid words and, it was to be hoped, free of sperm. These products included vaginal jellies, antiseptic douches, suppositories, foaming tablets, and sponges. The bases of the products were antiseptic chemicals, which had no effect on destroying sperm. Nonoxynol-9, an effective spermicide, had not yet been developed.

A common recommendation was for vaginal douching either before or after intercourse with homemade preparations of water with salt or vinegar to maintain feminine hygiene. We know today that neither of these preparations functions as a spermicide. Lysol antiseptic soap was a product actively marketed for women, as a must for female hygiene, with the unstated implications that it was an effective spermicide. The pre-1953 formula contained cresol, a phenol compound reported in some cases to cause inflammation and burning of vaginal tissues. Douching with Lysol was an inexpensive method of birth control that could be purchased over the counter as a hygiene product to assure “dainty feminine allure.” Unfortunately, information from a 1920 to 1930 survey shows a very high failure rate for douching as a contraceptive (Pasulka, 2012).

It is interesting to note that the recommendation by health professionals and the Church was for couples to practice the safe period/rhythm method and it was the second most common method reported by the women in this study. Reproductive endocrinology was in its early days of building knowledge and information regarding hormone ebbing and flowing and the actual timing of ovulation was not known until the mid-1930s. This method did not perform well as a contraceptive in the early 1900s because the science of when ovulation occurs was not understood (David & Sanderson, 1986).

Condoms are the oldest method of barrier contraception with evidence of use in ancient Egypt. In 1564, an Italian anatomist, Gabriello Fallopio, made a linen sheath to fit the penis and this was used as protection against syphilis. History claims that he used this application on 1,100 men and all of this population stayed free of the disease (Youssef, 1993). In the memoirs of Casanova, it is noted that he used the condom as a contraceptive with much success. The early condoms were made from the intestines of sheep, calves, and goats. It was not until the development of rubber by Charles Goodyear in 1839 that condoms became more user-friendly; the introduction of latex in the 1930s allowed a stronger product with a longer shelf life. Condoms were marketed as a health promotion product to prevent sexually transmitted diseases (Youssef, 1993).

Cervical caps and diaphragms have a long history as contraceptives. In 1823, a German gynecologist, called Wilde, noticed that women in a particular farming area had only two or three children instead of the usual rates of one pregnancy every 2 years. A midwife in this region had found that putting an object in front of the cervix prevented pregnancy. Wilde took this practice idea and made a wax form of a woman’s cervix. From this, he made a rubber cap to fit the cervix perfectly and developed an effective barrier method of contraception. Diaphragms, invented in 1880 by another German physician, were promoted by the Dutch family planning movement. Dr. Aletta Jacobs opened the world’s first clinic in Amsterdam in 1882 and introduced the Mensinga diaphragm to the Dutch population. Diaphragms and cervical caps were available and legal in Europe and were effective means of preventing pregnancies; however, a physician was required to properly fit the device (Cervical Caps and Diaphragms, 2010).

Margaret was a strong advocate for the cervical cap and diaphragm as birth control methods but had to overcome a number of obstacles before she could bring this method to the United States. In the fall of 1913, Margaret, William, and their three children moved to Europe, arriving in Liverpool, England. Margaret would educate herself regarding the English and Dutch practices of reliable contraception. Margaret soon became a part of the group of intellectuals who gathered regularly in the Clarion Cafe. Her new friends in Liverpool introduced her to the London Neo-Malthusians, under the leadership of Dr. Charles Vickery Drysdale and his wife, Bessie. One of the activities of this group was to publish a monthly journal entitled Malthusian. The journal supported contraceptive practices during sexual intercourse in order to prevent pregnancy, not just the use of abstinence. The Drysdales introduced Margaret to the renowned sexologist Havelock Ellis, whose work she had read back in New York. Margaret found a mentor and like-minded spirit and teacher in her relationship with Mr. Ellis. They became companions and lovers and enjoyed an intense intellectual and sexual relationship. They agreed on the inappropriate role of government and religious censorship of contraception and the banning of literature and products related to the prevention of pregnancy.

Havelock, educated as an anthropologist and scientist, introduced her to the world of sexual literature. She read Male Continence; or Self-Control in Sexual Intercourse by John Humphrey Noyes, and Karezza by Alice Stockham, in which the male partner satisfies the female and then ejaculates outside of the vagina. Havelock encouraged Margaret to spend time in the reading room of the British Museum library, where she educated herself in statistics and the new field of demographics. She read widely on topics related to reproduction, sexuality, and contraception. Armed with more knowledge, a new project was taking form in Margaret’s mind.

The complication to her relationship with Havelock was that they were both married to other people. The troubles of the Sanger marriage were now out in the open. The couple separated and eventually divorced. William moved to Paris to continue studying his painting while Margaret returned to New York with the children. Once settled back in New York, she was ready to start her campaign, which would include writing, speaking, education, and the opening of a birth control clinic for poor women. She was to publish a radical monthly magazine that presented information on ways to prevent pregnancy and educate women, especially poor and working-class women, on sexuality.

PUBLIC SERVICE AND PROGRESS IN BIRTH CONTROL

Margaret was a resourceful woman who was not concerned that she had no money to finance her birth control project. According to Baker (2011), “She made a list of possible subscribers, found sponsors, pleaded for loans from friends, and asked for grants from a special fund of the Free Speech League, set up by the University of Pennsylvania-trained physician, Dr. Edward Bliss Foote” (p. 75). She worked very hard and raised the funds to start her publication.

In March 1914, the first edition of The Woman Rebel, covered in brown wrapping paper, was available on the streets of New York for 10 cents per copy and sent via the mail. The U.S. Post Office was monitoring the publication and stopped its delivery. In August of 1914, Margaret was served a warrant by the Post Office inspector for violation of four counts of the Comstock Act. She was arrested and indicted for sending birth control information through the mail. Margaret posted bail, thus making the decision not to go to jail. She left the country through Canada, returned to Liverpool, and toured the Netherlands for the next year.

She traveled to the clinic of Dr. Johannes Rutgers at The Hague, who was a socialist and member of the Dutch Neo-Malthusian League. She was instructed in the anatomical variations in women’s pelvic structures and learned to measure and fit cervical caps and diaphragms. She toured clinics throughout the country and was impressed by the attention and instruction given to women regarding contraceptive use and the successful practice of this model of contraceptive care. This was the model she would use for her new clinic. She decided it was time for her to go home and face the consequences of the Comstock Act violations. Being Margaret, however, she smuggled diaphragms and cervical caps on board the ship as she traveled back to the United States. Shortly after her return, her young daughter Peggy came down with a virulent form of pneumonia and died from the infection.

Public support was with the grieving mother and the prosecutor decided to drop the old Comstock Act charges against her. Margaret proceeded with her plan and opened the first birth control clinic in Brooklyn, New York, on October 16, 1916. She modeled the way with her premier hygienic and private clinic for women in New York. The purpose of this quiet space was for women to learn from trained nurses about their own reproductive physiology and safe methods of family limitation. She set high standards for this clinic based on her time visiting and learning from excellent clinics in the Netherlands. This singular clinic was the practice model for clinics that she would eventually open throughout the country. A report of the event appeared in the March 1917 edition of The Birth Control Review. The staff consisted of four women: Margaret; her sister, Ethel Bryne, a trained nurse; Miss Fania Mindell, the clinic interpreter, who spoke English, Yiddish, and Italian; and the receptionist, Miss Elizabeth Stuyvesant. Weeks before the clinic opened, the women had flyers made in three languages, including English, Yiddish, and Italian, and walked from building to building in the neighborhood, handing out invitations that read:

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