Pregnancy, Motherhood, and Choice in Twentieth-Century Arizona 0816528462, 9780816528462

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pregnancy, motherhood, and choice in twentieth-century arizona

Women’s Western Voices Series Editor Laura Woodworth-Ney Board Members Kimberly Alido Miorslava Chávez García Jennifer Nez Denetdale Dee Garceau-Hagen Michael J. Lansing Laurie Mercier Colleen O’Neill Barbara Reyes Sandra K. Schackel

Pregnancy, Motherhood, and Choice in Twentieth-Century Arizona mary s. melcher

© 2012 The Arizona Board of Regents All rights reserved www.uapress.arizona.edu Library of Congress Cataloging-in-Publication Data Melcher, Mary S., 1955–   Pregnancy, motherhood, and choice in twentieth-century Arizona / Mary S. Melcher.    p. cm. — (Women’s western voices)   Includes bibliographical references and index.   ISBN 978-0-8165-2846-2 (cloth :alk. paper)  1.  Birth control—Arizona—History— 20th century.  2.  Family planning—Arizona—History—20th century.  3.  Pregnant women—Services for—Arizona—History—20th century.  4.  Prenatal care—Arizona— History—20th century.  5.  Mothers—Services for—Arizona—History—20th century.  I. Title.   HQ766.5.U5M476 2012  363.9'609791—dc23 2012007459 Publication of this book is made possible in part by the proceeds of a permanent endowment created with the assistance of a Challenge Grant from the National Endowment for the Humanities, a federal agency. Manufactured in the United States of America on acid-free, archival-quality paper containing a minimum of 30% postconsumer waste and processed chlorine free. 17 16 15 14 13 12  6 5 4 3 2 1

Contents

Illustrations vii Acknowledgments ix Introduction 1 1 “You’re My Miracle”: Babies, Birth Rates, and Health Care, 1910– 1940 18 2 Saving the Babies: Lowering Infant Mortality in the Southwest  38 3 Margaret Sanger and the Arizona Birth Control Movement  57 4 “Tis a Sobering Experience”: Providing Contraceptives for the Rural and Urban Poor  77 5 Battling Poverty and Isolation to Improve Mothers’ and Infants’ Health 95 6 “Rhythm Babies,” Birth Control, and Planned Parenthood: Years of Growth and Change  111 7 Arizona and Abortion Reform: Conflict without Resolution  135 8 Providing Reproductive Health Care in a New, More Politicized Era 161 9 Pregnancy and Choice: Reproductive Health in Twentieth-Century Arizona 178 Notes 187 Bibliography 227 Index 241

Illustrations

Figures Elizabeth Hanks Curtis  32 Margaret Sanger with clients and volunteers, Mothers’ Health Clinic  66 Tucson clinic party at Margaret Sanger’s home  68 Migrant family, outside of Chandler, Arizona  79 Migrant mother, Buckeye, Arizona  83 FSA migrant camp, near Eloy  85 Bishop Daniel Gercke  90 Annie Wauneka  102 Dr. Pearl Tang with a young patient  105 Antiabortion protest  165 Tables 1.  Arizona population by ethnic group  11 2.  Children under age of 5 per 1,000 women (age 15–45)  22 3.  Arizona infant mortality rates, 1924  46 4.  Arizona infant mortality in the 1920s  51 5.  Migrant women and baby spacing  81 6.  Indian infant deaths, Arizona and New Mexico, 1959–1960  100 7.  Birth rates (live births per 1,000 population)  113

vii

Acknowledgments

Many different people have contributed to this book, including those who shared their experiences and stories through oral history interviews, archivists who found documents and photos, as well as professors, friends, and colleagues who read earlier drafts and chapters. My work on this topic began in the early 1990s when I wrote a graduate seminar paper on Montana women and issues related to reproduction at Arizona State University in Mary Rothschild’s class. Later, she also directed my dissertation at ASU, which included a chapter on reproduction related to Arizona ranch and farm women. Mary’s enthusiastic support and encouragement throughout the years have been invaluable. Many people have generously provided oral histories, sharing their ideas and experiences concerning women’s reproduction, the birth control movement, and political controversies related to these issues. These oral histories are extremely important to this work because written sources about the history of reproduction are limited. The interviewees provided valuable commentary on this vital part of women’s lives. Many thanks go out to them for agreeing to be interviewed. Meeting and getting to know these people has been a wonderful experience. This is one of the reasons that I love doing a large history project—you meet such fascinating people along the way. Archivists and collections specialists at several institutions have provided assistance over the years including the following: Kim Frontz, Kate Reeve, and Jill McLeary at the Arizona Historical Society, Tucson; Ashley Smith, Arizona Historical Society in Tempe; Melanie Sturgeon, State Arix

x  •  Acknowledgments

chivist, Wendi Goen, Nancy Sawyer, and Don Langlois, Arizona State Library, Archives, and Public Records; Christine Marin and Rob Spindler, Archives and Special Collections, Hayden Library, Arizona State University; Linda Whitaker, Rebekah Tabah and Susan Irwin at the Arizona Historical Foundation; and Karen Underhill, Northern Arizona University Cline Library. Without these wonderful archivists, historical work in Arizona would grind to a halt, and their dedication and skill in preserving Arizona’s archival resources is much appreciated. Friends and colleagues have read various chapters of the manuscript, providing helpful comments, criticism, and ideas. They include Melanie Sturgeon, Christine Marin, Mary Rothschild, and Gwen Harvey, all from Arizona, as well as Julene Schlack of Seattle, Washington, and my sister, Joan Melcher, a writer and editor from Missoula, Montana. Thanks also to those who provided encouragement and advice over the years, such as Elizabeth Horan, Keith Miller, Heidi Osselaer, Joan Meacham, Jean Reynolds, and Laura Stone. My husband, Tom Post, has provided technological support and good humor, while our grown children, Jesselyn, Jeremy and Katie, have contributed laughs along the way. This book is dedicated with much love to my mother, Ruth Klein Melcher, who gave birth to six children and to my grandmother, Josephine Klein, who gave birth to eight. These women were/are exemplary mothers, who have coped with their families’ ups and downs with great courage.

pregnancy, motherhood, and choice in twentieth-century arizona

Introduction

In 1938, thirteen-year-old Christina Ellington helped her mother, Anna Mae Ellington, to give birth when the midwife was delayed.1 Living outside of Casa Grande, Arizona, this African American family dealt with the difficulties of childbirth like many other women in the rural West. They made do. Anna Mae sent for a midwife, but she was delayed. Young Christina, who had taken first-aid courses and had assisted several doctors, followed her mother’s instructions exactly, turning the emerging infant over to make sure the umbilical cord was not wrapped around its neck. “She just told me what to do,” Christina later recalled in an oral history interview. Her mother’s birthing story is representative of that of many mothers who were delivered by midwives, husbands, friends, neighbors, or doctors, depending on who was available and the woman’s own choice, traditions, and income level. Although this birth occurred at a time when many Arizona women were having babies with physician assistance, some women in rural areas continued to rely on midwives and relatives for aid.2 Women in Arizona and throughout the West made a very late transition to medically managed childbirth, due to lack of qualified medical personnel, poor transportation, cultural preferences, and great distances between ranches, farms, and towns.3 The isolation and primitive conditions existing in Arizona when Christina delivered her mother’s baby were not new. Arizona women began the twentieth century in a sparsely populated territory that was one of the last settled in the Rocky Mountain West. Arizona’s population in 1900 was lower than that of most states in the region, except for New Mexico and 1

2  •  Pregnancy, Motherhood, and Choice

Wyoming.4 The roughness of the desert and canyon country, as well as the family’s economic means of support, affected the lives and reproduction of women from all ethnic groups in Arizona. But geographic location was not the only factor that influenced reproductive health care. Whether giving birth, caring for babies, trying to limit one’s family, or securing an abortion, a woman’s cultural background, religion, race, class, and ethnicity all played a role in her decisions and options, as did the laws and political situation in the state and nation. Arizona women’s experiences in relation to reproduction and mothering are in many ways representative of those of other western women. This study illustrates that the West as a region shaped women’s repro­ ductive lives, especially during the early twentieth century, when lack of medical personnel, poor roads, as well as the region’s rocky mountains, canyons, and deserts limited women’s ability to find adequate care in childbirth. The rural nature of the region, along with the lack of infrastructure, harsh climate, and the land’s features, made the procurement and delivery of all health care services difficult and sometimes hindered the health of infants and mothers. Later, as the century progressed, roads improved, the population multiplied, and public health care began to meet the needs of more women and babies, resulting in lower maternal and infant death rates. Although there are important similarities between Arizona women’s experiences and those of women in other western states, differences also exist. Margaret Sanger moved to Tucson in 1934 and organized an active birth control movement in Tucson and Phoenix, which did not exist in nearby states. Although Sanger supported and funded a mothers’ health clinic in Santa Fe, strong opposition from Catholic Church leaders limited the clinic’s distribution of birth control. In Utah, the powerful Church of Jesus Christ of Latter-day Saints (Mormons) forbade the use of contraceptives until the 1990s.5 These Arizona birth control clinics developed at a time when many in the United States viewed motherhood as woman’s central role. According to this ideal, marriage, sexuality, and reproduction went hand in hand. In addition, the means to control fertility were limited; birth control was illegal throughout the nation until 1936, and abortion was illegal in most states until 1973.6 At the same time, certain religious and cultural groups frowned on the use of contraceptives. As the decades passed, new options became available in fertility control for those in Arizona and throughout the United States; at the same time, a gradual shift occurred beginning in

Introduction  •  3

the 1960s as younger generations of Arizona women embraced contraceptives, although many of their mothers and grandmothers had not. After birth control became available, women did not reject the role of motherhood, but instead redefined it by spacing or limiting their families. Women’s movement into the paid labor force led to this change for some, which occurred to some extent among all groups, including those who had the highest fertility during the early twentieth century, such as American Indians, Mexican Americans, and Mormons. Although older generations of women from these groups continued to frown on contraceptives and abortion, many younger women took advantage of these means of controlling their fertility. By the end of the twentieth century, changing ideals regarding motherhood and sexuality, along with access to contraception and abortion, and public health measures for mothers and babies had resulted in immense changes in Arizona women’s reproductive health. However, political and philosophical conflicts related to abortion reform continued through the 1990s. This book illustrates how these varied factors—environmental, political, and cultural—influenced the pattern of change related to reproduction during the twentieth century. At the same time, it will demonstrate that the women’s own agency and self-determination played a vital role in determining the outcome of this story. How and why these changes occurred can teach us a great deal about women’s lives and history. Women’s fertility and child-bearing roles have had a major impact on females throughout time. Securing adequate care in childbirth, the means to control fertility, health care for infants, and general reproductive health has been a continuous struggle for many women in Arizona and throughout the West. At the same time, these health care measures and women’s reproductive experiences have influenced and continue to affect all areas of women’s lives, including their roles as mothers, family members, workers, citizens, and community organizers. Indeed, women’s ability to reproduce and control reproduction influences all aspects of their lives.7 This story begins in 1900, when Arizona’s towns were small, its ranches were separated by great distances, and the only reliable form of womancontrolled birth control was abstinence. The influence of the Catholic Church and the Church of Jesus Christ of Latter-day Saints resulted in a higher birth rate in Arizona than in most other states.8 New Mexico and Utah also contained large Catholic and Mormon communities and had some of the highest birth rates in the nation. Additionally, New Mexico

4  •  Pregnancy, Motherhood, and Choice

and Arizona held the dubious distinction of possessing the highest rates of infant mortality in the nation during the 1920s and 1930s, while Utah had one of the lowest.9 During the first third of the century, Arizona’s rural nature and low population influenced women’s choice in childbirth attendants, access to contraceptives, and general health care. By the 1930s, their ability to control fertility improved in cities due to new birth control clinics in Tucson and Phoenix. Migrant women also learned about contraceptives through Farm Security Administration nurses who distributed birth control information and contraceptives in cotton camps from 1939 to 1941. Birth control became available for women from all ethnic groups who could access the clinics, but many did not want to limit their fertility due to religious or cultural ideals that defined motherhood as their primary role. Additionally, women from some religious groups believed birth control was sinful. While some did not embrace fertility control, all Arizona women struggled for improvements in reproductive health and to lower the infant ­mortality rate, which was still one of the highest in the country in the midtwentieth century.10 Public health measures and work among tribal com­ munities gradually lowered the infant death rate, but not until the 1970s was improvement seen among some American Indian tribes. In both rural and urban Arizona, women gained expanded access to contraception and better reproductive health care by the 1960s, but abortion remained illegal, resulting in court cases and convictions for some who performed them, along with high maternal death rates. Some western states, such as California, Colorado, and Washington, embraced abortion reform in the late 1960s and early 1970s, but change did not occur in Arizona until 1973 when the U.S. Supreme Court decision Roe v. Wade legalized abortion throughout the nation.11 By the 1970s, conditions in Arizona were like those in the rest of the nation due to this decision and improved public health care. Following the 1970s, the issue of abortion continued to ignite debate in Arizona as social conservatives attempted to cut access to the procedure. Despite fierce conflict in the polls and public demonstrations, the right-to-life movement did not make huge gains in Arizona because many of the state’s Republicans believed in personal freedom and frowned on government intrusion into issues related to reproduction. Very little has been written about women’s reproduction, health, and access to contraception in the West.12 The study of women and reproductive health in Arizona and the Southwest illuminates women’s history for the entire West, but it is also a unique multiethnic story of women in the

Introduction  •  5

rural southwestern desert. Creating an inclusive history of the multifaceted experiences of women in the West is essential; a multicultural approach illuminates the differences and similarities among the ethnic groups, all of which play out in reproduction.13 This book, along with other recently published western histories, illustrates that many different peoples met and interacted in the Southwest, each carrying their own perspectives and worldviews.14 Women of Native, Mexican, African, Asian, and European descent had differing ideals and traditions related to their fertility, childbirth, and motherhood, which gradually shifted during the twentieth century. During this time, these different groups played off of each other, sometimes sharing ideas and assistance, at other times divided by racism and prejudice.15 Although this book describes some of the similarities and differences in women’s lives in relation to reproduction in the West, it focuses on Arizona. Primary sources used include approximately thirty oral histories, memoirs, newspaper accounts, government documents, letters, photos, and biographical collections. The oral histories provide an important primary source because the available written records do not adequately describe women’s experiences in relation to reproduction. The Arizona women who shared their stories concerning childbirth, birth control, and abortion provide a personal view into some of the most intense experiences of their lives. Likewise, those who described their involvement in providing reproductive health care or fighting against access to abortion illuminate attitudes and experiences that shaped the people behind the debates. They recounted difficult days, decisions, and outcomes while also celebrating new life and successes. These oral histories, which provide a unique historical view into women’s past in relation to reproduction, are used in combination with the other varied sources. When government documents and secondary sources make it possible, chapters also include analyses of conditions in New Mexico and Utah. Arizona’s late settlement patterns and multicultural population provide the background for this story. Nearby states, such as California and New Mexico, were settled earlier than Arizona because they were seen as more attractive economically and easier places to live. Many early travelers passed through Arizona quickly on their way to somewhere else. Arizona did not become a U.S. territory until 1863. From that time until 1886, it was “contested ground” as Native peoples struggled with newcomers to control the land and water.16 The numerous tribes who called this land home—including the Navajo, Hopi, Yavapai, Maricopa, Pima, Tohono O’odham, Apache, Mo-

6  •  Pregnancy, Motherhood, and Choice

have, Havasupai, Pascua Yaqui, Cocopah, Hualapai, and Quetchen—had varied creation stories, traditions, spiritual beliefs, and languages.17 As the nineteenth century progressed, they were often forced to abandon their cultures and ways of life as they coped with the influx of settlers from other parts of the United States and other nations. Most tribes made accommodations to the new settlers’ demands and moved onto reservations by the 1870s, but the Chiricahua band of the Apaches continued to fight until 1886, when Geronimo could no longer elude capture by General George Crook and the U.S. Army. By 1900, all of the tribes were struggling to adapt to their lesser status, brought about by loss of land and water, confinement on reservations, and some level of dependency on the federal government.18 The American Indian tribes living in Arizona, like those throughout the nation, possessed varied spiritual beliefs that influenced their medical practices. When illnesses or accidents occurred, American Indian healers used herbs, tree bark, leaves, roots, and shamanistic practices to care for and heal the sick. Their excellent knowledge of natural healing resources provided assistance to European settlers who adapted some of the same methods to cope with sickness and accidents.19 Likewise, Arizona tribes relied on similar remedies and healing practices during childbirth and for curing family members of sickness. Although Indian people had lived from the land for hundreds of years, their confinement on reservations limited their ability to hunt, move between growing areas, and gather wild plants, which were important components in healing. Prior to European contact, indigenous people possessed relatively good health. Although they suffered from illnesses such as dysentery, stomach ailments, rheumatism, consumption, and fevers, they were free of smallpox, cholera, and measles. As Europeans settled in America and moved across the continent, they spread these diseases among the Native people with disastrous results.20 Lacking immunity to the new illnesses, Natives suffered severe population losses. War, genocide, loss of land and resources, and forced relocation to less productive land also led to a tragic decimation of this population. The Native population declined from more than 5 million to fewer than 250,000 between 1492 and 1900.21 During the twentieth century, the population of tribes in Arizona and throughout the United States rebounded as birth rates soared. Even though American Indians suffered very high infant mortality rates relative to Anglos, their populations expanded substantially during the twentieth century.22 Over the decades of settlement, these varied Indian peoples coped with the arrival of newcomers from nearby Mexico and Europe. Different eth-

Introduction  •  7

nic groups sometimes shared traditions, food, and ideas, although more often they clashed and erected boundaries between each other.23 During the late nineteenth and early twentieth centuries, women crossed cultural boundaries, delivering babies for neighbors from other ethnic groups and sharing information about caring for infants and children. However, the federal Sheppard-Towner program of the 1920s provided more health resources to Euro-American women than to other ethnic groups. In 1900, still twelve years away from achieving statehood, Arizona Territory had a population of approximately 123,000.24 Residents of the sparsely settled territory coped with poor transportation in many sections, limited roads, and generally primitive conditions. Yet the territory began to experience significant growth; by 1910, when the population was more than 204,000, Arizonans enjoyed many of the benefits of developed communities, including schools in towns and rural areas, newspapers, libraries, churches, and fraternal organizations in the cities.25 Women were often the movers and shakers behind the organization of new libraries and churches. In 1912, after Arizona became a state, women gained the power of the vote through an initiative measure.26 By 1912, Arizona was a rural western state with 69 percent living in settlements of 2,500 people or fewer, compared to 31 percent in urban areas.27 Arizona had an extractive economy, like other Rocky Mountain states; the mainstays of the economy were ranching, mining, and farming. The majority engaged in subsistence farming, although very large ranches and farms also existed in several counties. The state’s natural resources created farming opportunities in desert valleys where the soil and climate allowed for productive farming when irrigation was possible. Roosevelt Dam’s completion on the Salt River in 1911 led to the development of Phoenix and the Salt River Valley. The dam stabilized the water supply, tempering the effects of floods and droughts. Mining—for copper and other minerals—provided a livelihood to those in several towns, including Ray-Hayden, Globe, Miami, Bisbee, Prescott, and Jerome.28 The natural resources created economic growth and led to physical difficulties in travel. Like other western states, there were enormous spaces in Arizona and a lack of infrastructure, which created adverse conditions extending far into the twentieth century. In Arizona’s landmass of nearly 114,000 square miles, there are three geographic areas, each with its own climate, flora, and fauna.29 In the northern section, which includes the vast Navajo Nation, high plateaus and canyons created beautiful vistas but little land for farming and difficult crossings of canyons and rivers. Lees Ferry, which carried travelers across the Colorado River, provided the only

8  •  Pregnancy, Motherhood, and Choice

crossing from southern Utah or northern Arizona to places further south, until a new bridge was constructed in Marble Canyon in 1928.30 In the north central and eastern regions of Arizona, huge mountains, with their winter snowfall, hampered movement during winter but fed the streams and rivers that irrigated land in lower elevations. The Sonoran Desert, covering most of Maricopa, Pima, and Pinal Counties, has limited rainfall and extremely high summer temperatures.31 During the early part of the twentieth century, Arizona’s climate and geographic features affected the procurement and delivery of all health care services. Later, transportation and public health improved, resulting in lower rates of maternal and infant death. Just as the natural environment influenced women’s health care, so did divisions between ethnic groups and intercultural relations. Historians have demonstrated that race is a social construction, which has been codified in laws relating to marriage, education, property ownership, and access to privileges reserved for those deemed “white.”32 Although racial categories may be fabricated and malleable, the divisions they create are substantial. In Arizona and throughout the nation, during the early twentieth century, white supremacy led to greater opportunities for EuroAmericans, while segregation and prejudice resulted in lack of hospitals and health education for minorities. In addition, limited economic op­ portunities resulted in lower incomes for people of color, which also adversely affected their ability to feed, clothe, and provide adequately for their families. In Arizona, segregation severely affected the African American population. The state’s schools, public facilities, and places of employment did not integrate until the 1950s and 1960s. While Native people were divided by space and reservation boundaries across the state, in towns, different ethnic and racial groups lived in separate neighborhoods and often worked in segregated jobs. These divisions, coupled with a lower level of education and fewer opportunities, were facts of life for many people of color.33 The segregation of African Americans was harsher and more extensive than that of Mexican Americans. Laws against interracial marriage did not affect Anglo–Mexican unions. In addition, Mexicans were legally classified as “white” and not bound by exclusionary laws designed for those of “Negro ancestry.” Despite this classification, those of Mexican descent still endured segregation, due to custom rather than law.34 The geographic area of Arizona was Mexican territory until the U.S.Mexican War, which ended with the Treaty of Guadalupe Hidalgo in

Introduction  •  9

1848. It resulted in Mexico ceding a large part of its northern frontier to the United States, including Arizona, north of the Gila River, New Mexico, Texas, and California. In 1853, the United States acquired southern Arizona through the Gadsden Purchase. Although U.S. leaders promised that Mexicans who were living in the region would be treated fairly and equitably, this promise, like many others, was not kept.35 People of Mexican descent were deeply involved in developing the territory’s economy. They worked in mines, on farms, on ranches, and in businesses and built the towns and cities. Many early Mexican residents were businesspeople or landowners, some of whom had large ranches dating back to the early nineteenth century. However, after the railroad reached Arizona Territory in the 1880s and the population expanded, Euro-American entrepreneurs acquired more wealth and began to exert economic dominance over Mexicans in Tucson and rural areas. At the ideological level, this dominance was supported by Euro-American stereotypes of Mexicans as lazy and inferior; Mexicans, in turn, viewed EuroAmericans as materialistic and crude. After the 1880s, intermarriage between the two groups declined in Tucson. Organizing for mutual support, Mexicans in Tucson and Florence formed lodges of the Alianza HispanoAmericana.36 During the early twentieth century, the demand for agricultural laborers in Arizona increased, and farmers welcomed Mexican immigrants, needing the labor. At the same time, many Mexicans, fleeing the 1910 revolution and poverty at home, saw Arizona as a desirable asylum. Arriving in Arizona to find work in the mines, on railroads, or on farms, Mexican immigrants usually worked in the lowest-paying job categories.37 Despite discriminatory policies in employment and education, Mexican immigrants continued to move to Arizona, finding jobs in mines or on farms. Between 1910 and 1920 the Mexican American population nearly tripled, growing from approximately 30,000 to an estimated 88,000.38 This expanding population experienced turmoil as companies alternately hired and fired Mexican laborers based on economic conditions. During the Great Depression, approximately 18,000 people of Mexican heritage left Arizona for Mexico, although there were no formal repatriation programs. Many found equally dismal economic conditions in Mexico and gradually moved back to the United States.39 Prior to World War II, children of Mexican descent usually attended segregated schools or studied in separate classrooms. This segregation, which also existed in other southwestern states, was an extension of divisions in the economy, neighborhoods, and churches. In mining and smelt-

10  •  Pregnancy, Motherhood, and Choice

ing towns, segregation played out in all of these arenas, as it did in the larger cities, such as Tucson and Phoenix. Despite discrimination and exclusion, Mexican Americans developed a vibrant cultural life in Arizona. In Tucson, Carmen Soto de Vasquez founded Teatro Carmen, a theater that showcased Spanish-language plays, musicals, and operas. Mexican people built churches, ran businesses, and created lively barrios. Placida Garcia Smith directed Friendly House, a settlement agency in Phoenix from the 1930s to 1962 that provided a place for new arrivals to learn English, find jobs, and gain citizenship.40 Those of Mexican descent played a vital role in Arizona’s history, but estimating their percentage of the state’s population is difficult. Over several decades, census enumerators included those of Hispanic descent in the racial category labeled “white.” In 1920 and 1930, those of Mexican descent were counted as a separate group, but from 1940 to 1960, they are lumped into the white category. To achieve a more accurate estimate of this population, one may examine school records, which state ethnicity of children during some decades. For example, in the 1940 report, the State Superintendent of Education in Arizona recorded that 29,165 children of Mexican descent attended Arizona elementary schools. At this time, children aged five to fourteen made up 20 percent of the population, so based on this number of school children, the total population of Mexican descent would have been 145,000 in 1940 or 28 percent of the entire population. This group’s percentage of the population may have decreased gradually during Arizona’s post–World War II population explosion, but surely it remained around 20 percent during the decades 1950 to 1970. In 1970, population estimates for those of Hispanic descent were based on surname and Spanish language criteria.41 In contrast to Mexican Americans, African Americans migrated to the state much later and in smaller numbers.42 From 1910 to 1940, the African American population in Arizona gradually expanded (see table 1), growing from 2,009 in 1910 to 14,993 in 1940.43 African Americans had moved to Arizona during the late nineteenth and early twentieth centuries to staff Fort Huachuca, a segregated fort. In 1930 when the African American population was 2.5 percent of the state’s entire population, Arizona had a higher percentage of African Americans than any other state in the Pacific and Rocky Mountain West.44 Many of these people left sharecropping arrangements in the rural South to find better economic positions, but in Arizona most worked as wage laborers on farms. Some farmed independently; only a few found new sharecropping arrangements.45 With limited capital to buy their own farms, many African Americans

Introduction  •  11

Table 1.  Arizona Population by Ethnic Group

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990

Total % African % American % Asian Population American Indian American

% EuroAmerican

% Mexican American

122,931 204,354 334,162 435,573 499,261 749,587 1,302,161 1,770,900 2,718,215 3,665,000

75.6 70 61 61 57.5 (est.) 87 (est.) 89 (est.) 74 74.5 71.3

n.a. 14.2 26 26 28 (est.) n.a. n.a. 17 16 18.7 (Hispanic)

1.5 1 2.4 2.5 3 3.5 3.3 3 2.8 3

21.5 14 10 10 11 8.8 6.4 5.4 5.6 5.5

1.4 0.8 0.5 0.6 0.5 0.4 0.4 0.5 0.8 1.5

Sources: Department of Commerce, Bureau of the Census, Thirteenth Census, Abstract with Supplement for Arizona (Washington, DC: Government Printing Office, 1911), 579; Fourteenth Census, vol. 3, Population (Washington: Government Printing Office, 1922), 74; Fifteenth Census 1930 Population, vol. 3, part 1 (Washington: Government Printing Office, 1933), 143; 1970 Census of the Population, vol. 1, Characteristics of the Population, Part 4, Arizona (Washington: Government Printing Office, 1973), 4-29, 4-93; 1990 Census of Population Social and Economic Characteristics, Arizona (Washington: Government Printing Office, 1993); Sixteenth Biennial Report of the State Superintendent of Public Instruction, 1940–1942 (Phoenix: State of Arizona, 1942), 27.

performed agricultural work in rural areas. Men also commonly served in the military, provided personal service, or labored in mills or on railroads from 1920 to 1950. Many African American women worked on farms and in domestic service.46 Caught up in a complicated web of social and economic inequality, African Americans labored long hours for low pay and contended with discriminatory legal policies. Educational segregation of blacks in Arizona dated back to the territorial days. A 1909 law allowed segregation of pupils of African descent from Euro-Americans. But in 1912, after Arizona became a state, the first legislature mandated grade school segregation, strengthening the state law.47 In areas of the state where African Americans lived, school officials instituted grade school segregation as the black population expanded. For example, when African Americans moved to Douglas in 1908, the school board set up a one-room “colored” school. Likewise, when the black agricultural population increased in Pinal County during the 1930s, school boards in Coolidge and Casa Grande moved to segregate. On the other hand, Mohave County had the smallest African American population of any, and segregation never existed there.48

12  •  Pregnancy, Motherhood, and Choice

The 1912 Arizona law mandated only grade school segregation. In 1921, the legislature changed the law to allow segregation in high schools. When twenty-five or more African American pupils matriculated to high school, 15 percent of district residents could call an election concerning segregation.49 This policy was unusual among western states; Texas was the only other western state that segregated in both grade and high schools. Wyoming and New Mexico allowed segregation of blacks in high schools but did not require it.50 In Arizona, high school segregation was much less common than that of grade schools. Some towns, such as Mesa and Tempe, had integrated high schools. Other communities, such as Casa Grande, Phoenix, and Douglas, segregated black and white high school students. There were other towns with restrictive admission policies based on race, and administrators often refused to admit African American students to their high schools. For those black youngsters living in a town with no “colored” high school, it was necessary to commute many miles a day, move to another town, or abandon their dream of extending their primary schooling.51 Segregation also affected African Americans’ participation in the labor force, and many became trapped in the lowest paying job occupations. However, there was also a black middle class. Most African American professionals served those of their own race. For example, Dr. Winston C. Hackett opened Booker T. Washington Hospital in Phoenix, when other hospitals were segregated. He operated the hospital until 1943, when his eyesight began to fail. Other black professionals were dentists, morticians, teachers, and business owners.52 African Americans also organized fraternal organizations and civil rights groups to improve their situation. By the 1940s, they were uniting with progressive Euro-Americans to challenge segregation and job discrimination.53 Asian Americans were much smaller in numbers than other ethnic groups. In the nineteenth century, they began arriving in the western United States to build railroads across the vast land and eventually settled in mining camps and towns where many worked in farming, mercantile stores, and laundries. Although Chinese laborers faced extreme prejudice in the West—and sometimes riots and violence—in Arizona they experienced segregation and discrimination but were not hampered by violence. Chinatowns grew up in Tucson and Phoenix during the last decades of the nineteenth century.54 In their own communities, Chinese people could resist the prejudice of the dominant culture and continue practicing their traditions. Still, they were not welcomed as citizens; the Chinese Exclusion Acts and legislation enacted during the late nineteenth and early twentieth centuries

Introduction  •  13

limited immigration and kept the Chinese population small in Arizona. In 1880, there were only 1,630 Chinese in the territory.55 People of Japanese descent who settled in Arizona were even fewer in number than the Chinese. In 1920, there were 550 Arizona residents of Japanese descent; by 1930, there were 879.56 Many of the Japanese people farmed, growing lettuce, cantaloupe, and strawberries. Like the Chinese, they contended with segregation in public facilities and antimiscegenation laws. In addition, the Arizona Alien Land Law of 1921 stopped Japanese aliens (who were ineligible for citizenship) from owning land. Despite these discriminatory laws, some Japanese families made lease contracts or owned land through their American-born children.57 During the 1930s, economic competition resulted in Euro-American anger and violence toward successful Japanese and Japanese American farmers in the Salt River Valley. Militant white farmers organized the Anti-Alien Association and called for strict enforcement of the Alien Land Law. Members of this organization protested against the success of nearby Japanese farmers, threatening some families with violence. Agents from the U.S. Department of Justice had to travel to the Phoenix area to stem the mistreatment.58 Japanese immigrants formed organizations to protect their own interests and for cultural and religious reasons. For example, the Japanese Association of Arizona was organized in 1920, the Japanese Language School opened in 1928, and the Arizona Buddhist Temple began in Glendale in 1932. These organizations unified the Japanese community and helped them withstand prejudice.59 Those born in Japan were not allowed to become U.S. citizens until 1952.60 During World War II, wartime hysteria and racism resulted in those of Japanese descent who lived in the southern half of Arizona being sent to internment camps. The line drawn by the military divided the Phoenix area, resulting in Japanese who lived on the southern side of the line being forced to relocate. Two of the ten “relocation centers” in the United States were in Arizona. Most from Arizona were sent to the Colorado River War Relocation Center, also known as Poston. Another large camp existed near Casa Grande, the Gila River War Relocation Camp, which contained many Japanese Americans from California. These two internment camps quickly became the third and fourth largest cities in Arizona. People’s lives were disrupted, careers were put on hold, and farms were often lost when they were interned. Following the war, Japanese Americans worked to reestablish their farms, including the flower gardens in south Phoenix, which became a popular attraction.61

14  •  Pregnancy, Motherhood, and Choice

At the end of World War II, people of color from all ethnic groups began to campaign for civil rights and equality in Arizona and throughout the nation. Many who served in the war took advantage of the GI Bill and earned an education. Thomas Tang, son of a prominent Chinese merchant from Phoenix, Tang Shing, earned an undergraduate degree and then a law degree. He married Pearl Tang, who went on to have a prominent career in public health in Maricopa County. Dr. Tang’s work was instrumental in lowering the county’s persistently high infant mortality rate, and Judge Thomas Tang was appointed to serve on the Ninth Circuit Court of Appeals.62 Individuals such as Pearl Tang functioned within their own cultures and in the much wider arena of Arizona’s laws and mores. Women’s roles in all cultures included childbearing, but they approached their fertility and motherhood with varying expectations and beliefs, based on their own culture and worldview. During the first part of the twentieth century, most women viewed motherhood as their most important role in life, but certain groups accented fertility and childbearing more than others. For those who were Mexican American, Catholic, Mormon, and Native American, limiting fertility was taboo during this time. Their experiences during childbirth also varied culturally, with many women finding comfort in their own traditions and informal female networks. American Indian women relied on age-old practices to control pain in childbirth, and Mexican American women called on parteras (midwives). African American women also used midwives in childbirth and contended with segregated medical facilities. Privileges related to race and ethnicity affected women’s reproductive lives. Euro-Americans gained greater access to health education and information that could potentially save lives. The federally sponsored SheppardTowner Program attempted to lower high maternal and infant mortality rates, but administrators of the program in Arizona did little to help ethnic and racial minorities who suffered the most from high death rates. Program administrator Maude Howe hailed from Cochise County and reflected common prejudices toward Mexican Americans.63 Public health programs brought some improvement during the 1930s and 1940s, but infant mortality in the state remained nearly twice the national average. Economic class and access to wealth also played a part in reproduction and health care. Generally, those with middle or high incomes were better able to provide for their families and find doctors who would prescribe birth control (even when it was illegal) or perform safe abortions before the Roe v. Wade decision legalized the procedure.

Introduction  •  15

The advent of the birth control movement in the 1930s brought new options to Arizona women of all classes and races. As Margaret Sanger pushed for acceptance of the Mothers’ Health Clinics, she justified contraceptives using a variety of arguments, including eugenics philosophy. Sanger talked of improving the “race” and creating a race of thoroughbreds in language that carries racist undertones in twenty-first-century America. At the time, Sanger promoted birth control to improve the entire human race and to give women the ability to control their own reproduction. She rejected the eugenicists’ call for Euro-American middle- and upper-class women to have more babies during the 1920s, at a time when they were bearing fewer children than immigrants and women of color. Even though she campaigned for birth control to provide all women with the choice to limit fertility, she used a type of “racial maternalism” that assumed that she and other birth control advocates knew best how diverse women should control the size of their families.64 Despite the cultural imperialism inherent in some of Sanger’s actions and statements, the birth control movement that she fostered provided services to women from all ethnic groups at a time when Arizona was highly segregated. Women of color became patients at the first Mothers’ Health Clinics and were paid employees and administrators of the newly named Planned Parenthood clinics in the 1940s. This book explores intercultural relations within the birth control movement, its rhetoric, and the involvement of women from different ethnic groups, demonstrating that even though Euro-American middle- and ­upper-class women volunteered as leaders within the movement and funded it, many women of color became involved in different capacities—as patients, volunteers, employees, and backers—because they believed family planning could improve their lives and those of other women. Women of Mexican and African American descent worked in the clinics, advocating “planned parenthood” so women could determine the size of their families and adequately provide for all. Through their actions, these clinic employees demonstrated that for them, motherhood involved planned pregnancies and the ability to enjoy sex without the fear of pregnancy. From the beginning of the birth control movement in Arizona, Catholic leaders campaigned against it, arguing that contraceptives were immoral. Therefore, it is surprising that a Catholic priest, Father Emmett McLoughlin, provided birth control in south Phoenix through St. Monica’s Clinic in the late 1940s.65 McLoughlin’s work, along with that of many volunteers and public health nurses, illustrates the strength of the network of people who expanded access to fertility control during this time.

16  •  Pregnancy, Motherhood, and Choice

From 1950 to the 1960s, Arizona continued to have a very high birth rate.66 In fact, in 1950, the state had the third highest rate in the nation (following Utah and New Mexico). Many of these growing families remained in poverty, living in unhealthy conditions in migrant camps, in urban enclaves, and on Indian reservations. Physicians such as Dr. Pearl Tang and tribal leaders like Annie Wauneka struggled to improve maternal health care and lower infant mortality. To have an impact on the persistently high level of infant mortality, the programs of these innovative leaders relied on expanded cross-cultural communication among Arizona’s diverse population. At the same time, the state’s gradual urbanization improved transportation and health care access. Reflecting trends across the nation, Planned Parenthood operations and public health programs expanded greatly by the late 1960s. Clinics and health care providers generated new options in fertility control for Arizona women and those throughout the Southwest in rural and urban areas. Despite religious conflicts and varying ideals related to pregnancy and family, increasing numbers of young women from all ethnic groups used birth control, illustrating a generational shift. Contraceptives became available to unmarried women by the late 1960s. During these years, volunteers remained vital in delivering contraceptives, but there were also larger numbers of professionals involved, including public health nurses and doctors. The fears of a population explosion generated greater public support for family planning, while racism and coercion resulted in the sterilization of American Indian women without informed consent. During the late 1960s, some in Arizona began to question the state’s abortion laws, which allowed the procedure only to save the mother’s life. Activists, lawyers, and physicians, along with Planned Parenthood employees and volunteers, repeatedly attempted to reform these laws through legislation and the courts but were unsuccessful. Arizona’s abortion laws did not change until the Supreme Court decision in Roe v. Wade made abortion legal across the nation. Following this decision, maternal deaths associated with abortion declined. At the same time, the right-to-life movement gained steam, and as the 1970s ended, conflict related to access to abortion continued in Arizona and throughout the nation. Arizona women became movers and shakers on both sides of the issue, and women from the diverse ethnic and religious groups of the state had varying and often conflicting views on abortion. The fight related to abortion continued into the 1990s, sometimes affecting access to all forms of reproductive health care.

Introduction  •  17

The story of women and reproduction in Arizona reveals women’s struggle to function within their own cultures and within the legal structure and health care systems of this southwestern state. At the same time, it illustrates varying ideals concerning motherhood and family, which shifted during the course of the twentieth century, as changes in reproductive health provided the means to rethink visions of womanhood, motherhood, and sexuality. Even before the second wave of the feminist movement challenged the primacy of the maternal role, some Arizona women chose birth control to improve their own health and that of their families, while others rejected reproductive control measures they viewed as immoral. Women’s private decisions about pregnancy and childbirth continued to create discord in Arizona and throughout the nation as the century ended, illustrating once again how cultural, religious, and societal views of women and motherhood affected and even defined this debate.

cha p te r o n e

“You’re My Miracle” Babies, Birth Rates, and Health Care, 1910–1940

During the early twentieth century, Arizona women lived in a beautiful but harsh land. The Sonoran Desert in the southern half of the state is made up of a great variety of cacti, plants, and wildlife with terrain including several mountain ranges and very little water. From the desert, travelers going north climb into canyons and mountains where temperatures drop, snow falls, and Ponderosa pines stand tall. In this rural and sparsely populated state, the geography; long distances between farms, ranches, and towns; and lack of professional medical care created challenges for women in relation to their reproductive health. New Mexico, Utah, and other Rocky Mountain states also contained vast expanses of mountains and deserts. This beautiful western region was isolated and rural for the first part of the twentieth century. Even in 1940, these factors led to difficulties for Valentina Morales, who was alone at the end of her pregnancy, herding goats outside of Wickenburg when early labor began. She eventually gave birth to Angel Morales, who described his mother’s experience in an oral history interview: My mother was herding goats at Senasky mine, and Daddy had another band of goats down at the Perdido down at Vulture Peak. . . . My sisters had a bunch of goats at this ranch. . . . My mother was getting real heavy with me. She told me, “I knew it was time, but in them days, you don’t know when you’re due.” She was gonna have a baby. She thought it was one, but there was two of us. . . . She said, “I penned the goats up early that day. I didn’t even have a horse. I 18

Babies, Birth Rates, and Health Care, 1910–1940  •  19

was herding them a foot. . . . I walked from that ranch to that ranch to that ranch. There was trail that goes up there.” They had an old Model T Ford. They said they better take her to town. . . . They took her to Dr. Broiler’s. They sent word the next day that mom was in town and very ill. . . . A week later I was born. My brother had been dead for three days. She [mother] said, “You’re a miracle, you lived. You’re my miracle.” During her lifetime, Valentina gave birth to twelve children, but only seven lived to adulthood. She raised goats with her husband and children on a successful ranch outside of Wickenburg.1 The physical and emotional challenges faced by Valentina and other women in the region combined with cultural expectations based on gender. Women from all ethnic groups were influenced by conceptions of womanhood as defined by their particular culture, tribe, religion, and class. Restrictions related to race and ethnicity also defined these gendered roles. Mothers and the role of motherhood were highly valued in all groups, but some, including Mexican Americans, Mormons, and American Indians, stressed fertility more than others. The family economy in urban and rural areas also influenced women’s roles and the size of families, with ranch and farm people from all ethnic and religious groups having more children than urban women did.2 Among African Americans, urban women had the lowest birth rate of all groups, while those in rural areas had a very high rate of fertility.3 This chapter examines measures to control fertility in the early twentieth century, birth rates, and childbirth practices, demonstrating that a woman’s choices and health care were affected not only by the region’s environment and rural nature but also by the expectations, rituals, and traditions of her culture. At this time, most women expected to marry and raise families. Commonly, they viewed their roles as wives and mothers as their primary function in life. Some groups, such as Mexican Americans, Catholics, American Indians, and Mormons, opposed the use of contraceptives, whereas others tried varied means to limit fertility.

Controlling Fertility Women who wanted to control their fertility with contraceptives faced legal obstacles in Arizona and throughout the nation from 1900 to the late 1930s. Arizona territorial law restricted access to abortion and forbade any

20  •  Pregnancy, Motherhood, and Choice

notice or advertisement of contraceptives. It read as follows: “Arizona Criminal Code, Tit. 13, 1901 (rev. 1913, 1928, 1939) (13–212) A woman who solicits from any person any medicine, drug or substance whatever, and takes it, or who submits to an operation, or the use of any means whatever, with intent thereby to procure a miscarriage, unless it is necessary to preserve her life, shall be punished by imprisonment in the state prison for not less than one nor more than five years.” Another Arizona law mimicked the federal Comstock Law 1873), which outlawed birth control throughout the nation: “(13–213) A person who willfully writes, composes or publishes a notice or advertisement of any medicine or means for producing or facilitating a miscarriage or abortion, or for prevention of conception, or who offers his services by a notice, advertisement or otherwise, to assist in the accomplishment of any such purposes, is guilty of a misdemeanor.” The state legislature approved these laws in 1913, and they were in effect even after a judicial decision reversed the Comstock Law in 1936.4 In addition to the questionable legal status of birth control, strong social sanctions curtailed its use in some quarters. Roman Catholics considered birth control sinful, and many Mexican Americans in Arizona opposed its use. Farm wife Catalina Padilla, living outside of Florence, bore eleven children and never complained about her pregnancies. “It was her fate,” said Catalina’s daughter, Amelia. “You’re supposed to have all the children that are coming to you.” Women commonly believed that only God should determine the size of their families. However, some Mexican American women nursed babies for two or more years in an effort to prevent pregnancy.5 Navajos living in the Four Corners region also stressed the importance of motherhood in their culture, which traces matrilineal descent. In the Navajo tradition, when a girl begins to menstruate, she is publicly honored with the Kinaaldá ceremony, which recognizes her new status as a woman who can give birth. Through giving birth, the Navajo mother transmits her clan membership to her child. Women’s role as bearers of children and caretakers is vitally important, according to anthropologist Joanne McCloskey, author of Living through the Generations: Continuity and Change in Navajo Women’s Lives. Traditional Navajo women measure wealth by the number of children they have and frown on birth control measures.6 A study by Anne Wright also demonstrated the importance placed on motherhood. One woman Wright interviewed stated, “I was born to be a mother because I was born a girl.” Clearly, the female role is tied up with motherhood among traditional Navajo women.7

Babies, Birth Rates, and Health Care, 1910–1940  •  21

Mormon leaders also frowned on the idea of limiting family size; Mormon women received instructions from church leaders to “multiply and replenish” the earth. Women were to fulfill their role by having babies who would provide homes for waiting spirits. Voicing an opinion similar to that of Mexican Americans that bearing children was a woman’s fate, some Mormon leaders such as J. Reuben Clark called motherhood “a duty, a mission . . . a destiny.” Clark and other Mormon leaders viewed raising and caring for families as women’s most important work. Even while the Mormon church celebrated large families, some women prolonged nursing babies in an effort to avoid pregnancy. In the Eden area of Graham County, some Mormon mothers nursed their children for four years.8 For many women during the early twentieth century, babies were a natural outcome of marriage. In many oral histories, Mexican American women discuss numerous pregnancies and large families as the norm.9 In addition, the idea that sexuality and motherhood went hand in hand was espoused by many in positions of authority, including physicians, priests, church elders, and government leaders. According to this view, those who wanted to limit their families were selfish and immoral, as stated by Bishop Daniel Gercke of the Catholic diocese in Tucson.10 Of course, as is often the case, reality was sometimes different from the suggested ideals. Among the Mexican American population, it appears that some Spanish-speaking women in Prescott were interested in contraception because pharmacies distributed medical almanacs containing contraceptive remedies in both Spanish and English. Pharmacist W. W. Ross provided patent medicine almanacs such as El Almanaque de los Cumpleanos para las Senoras (The Ladies Birthday Almanac, 1914), according to historian Ann Hibner Koblitz. The almanac advertised many preparations, including Thedford’s Black-draught, Wine of Cardui (the women’s tonic), and vaginal washes with Spanish-language testimonials from women in the Southwest. Advertisements touted that these products would regularize menstrual periods and stop conception. Hibner notes that the information provided in the Spanish almanac was more explicit than that in the English almanac, perhaps because publishers assumed the Comstock law enforcers would not bother to translate Spanish.11 Although it is impossible to know how many women bought the contraceptive douches and draughts, the fact that pharmacists distributed the almanacs, both in Spanish and English, indicates that some Hispanic women may have used the remedies. Several historians and sociologists have studied black women’s use of

22  •  Pregnancy, Motherhood, and Choice

contraceptives. Jessie Rodriquez demonstrates that African American women were interested in controlling their fertility and participated in organizing urban birth control clinics. To improve the family and economic lives of the black population, many urban women used birth control. Other studies also argue that 40 to 60 percent of this population was using birth control in urban centers such as Boston and New York. Studies among rural African Americans also suggested some contraceptive use. “The Black population has always contained in its culture knowledge of birth control, whether it be in the form of douching, withdrawal, induced abortion or some other method,” state Joseph McFalls and George S. Masnick. These common methods were also available to other ethnic groups.12 In the 1920s, W. E. B. du Bois argued that access to birth control would help the black community progress. Along with other African American leaders, du Bois urged increased availability of contraceptives to improve health among African Americans mothers and babies who faced high maternal and infant mortality rates. Although sources are unavailable to confirm this, most likely birth control use resulted in the low fertility of African American women in the urban West.13 (See table 2.) American Indian women across the continent traditionally had access to herbs and other natural methods that controlled fertility. In fact, scientific research concerning remedies used by Natives to suppress fertility aided in the discovery of the birth control pill. Native women in Arizona drew on tribal knowledge, using a variety of means to suppress ovulation and limit conception. Navajos drank an infusion of the milkweed plant after childbirth to bring about temporary sterility. Hopis made a concoction of the Indian paintbrush plant to limit “the menstrual flow.”14 American Indian women also attempted to control fertility through prolonged nursing.

Table 2.  Children under Age of 5 per 1,000 Women (Age 15–45)

Mexican descent Euro-American African American American Indian

United States

Rural West

Urban West

702 386 393 680

n.a. 482 546 n.a.

n.a. 259 216 n.a.

Source: Charles E. Hall, Negroes in the United States 1920–1932 (Washington: Government Printing Office, 1935), 202. n.a. = not available.

Babies, Birth Rates, and Health Care, 1910–1940  •  23

Although Native women had varied knowledge about limiting fertility, their population dropped drastically during the nineteenth century—not through use of natural contraceptives but due to dislocation, violence, and loss of land and resources.15 For example, after the 1860s, the Pimas in central Arizona lost much of their water supply due to diversion of the Gila River by Mexican and Euro-Americans who farmed upstream. Lack of water limited farming and led to poverty and dependence on the federal government by the turn of the twentieth century.16 Culture, ethnicity, and religion affected access to and use of contraceptives. During the first few decades of the twentieth century, the majority of Arizona women did little to limit their fertility. Groups such as Mexican Americans, Mormons, Catholics, and Navajos frowned on limiting conception, but some women prolonged nursing in an attempt to avoid pregnancy. American Indian women traditionally knew of herbal remedies to decrease fertility, but it appears that they rarely used them during this period because they welcomed large families, and their birth rate was high. African American and Euro-American women sometimes used contraceptives such as condoms, sponges, and douches.17 Cultural conceptions of motherhood and legal restrictions determined options for all women in relation to fertility control. Access to transportation, traditional knowledge, and legal restrictions also affected contraceptive use.

Birth Rates Among Arizona women, those of American Indian descent had one of the highest birth rates, which was also reflected in population growth across the United States. From 1900 to 1980, the nationwide American Indian population grew from fewer than 250,000 to 1.37 million by 1980. Navajos contributed to this expansion; their tribe grew from 20,000 in 1900 to more than 158,000 by 1980.18 As measured among all tribes, American Indian women’s fertility was well above that of the total U.S. population even though it decreased beginning in the 1960s.19 While American Indian women had a high fertility rate during the first half of the twentieth century, so did women throughout Arizona. In fact, Arizona had a higher birth rate than most other Rocky Mountain states. Only Utah, with its predominantly Mormon population, and New Mexico, with its Hispanic population, had higher birth rates. Following the common pattern throughout the United States, Arizona’s birth rate dropped during the early years of the Depression and then began to climb

24  •  Pregnancy, Motherhood, and Choice

after 1935. In 1938, Arizona had one of the highest birth rates in the nation; only women from Mississippi, West Virginia, New Mexico, and Utah had higher rates of fertility, as measured through birth registration.20 Before the post–World War II boom, Arizona was still a rural state, with high percentages of Mormon and Mexican American populations, which contributed to the high birth rate. Mexican American culture celebrated large families, along with the role of motherhood.21 Mexican American women had higher fertility rates than those of Euro-American women in Arizona and throughout the nation. In Tucson, in 1900, Mexican women had an average of 5.7 childbirths, whereas Anglo women had 3.2, according to Thomas Sheridan. Mexican American women bore children for a longer period, having babies later in life than the average Euro-American woman. Additionally, more babies were born to Mexican American women in rural areas than in urban areas.22 Sheridan used city census documents to analyze the fertility of Tucson’s Mexican women; the use of U.S. Census documents regarding the Mexican American population is problematic. During some decades, Mexican American women are grouped with whites in the U.S. Census, whereas in other decades all women of color are lumped together in the category “nonwhite.” To deal with the lack of historical census figures specific to Hispanics, demographers Michael R. Haines and Myron P. Gutmann studied 1910 census manuscripts from the six states containing the majority of the U.S. Hispanic population (California, Arizona, New Mexico, Texas, Kansas, and Florida). These scholars used the criteria of mother tongue, Spanish surname, place of birth, and parents’ place of birth to identify Hispanic origin. They found that the Mexican-origin population had a higher rate of fertility than did blacks or whites. The Hispanic childwoman ratio was 43 percent higher than the national white population and 36 percent higher than that of blacks.23 Another study completed by Charles Hall in 1930 compares the birth rate of Mexican women to that of other groups with similar results (see table 2). Based on Hall’s work, Mexican women had the highest rate of fertility, followed by American Indians, then African Americans, and Euro-Americans.24 Among African American women, those in the rural West bore considerably more children than those in the urban areas. Euro-American women in the urban West also had fewer children than rural women, but in 1930, western urban blacks had the lowest rate of fertility.25

Babies, Birth Rates, and Health Care, 1910–1940  •  25

Cultural Choices and Childbirth Culture, tradition, location, and expediency influenced women’s choice of caregivers in childbirth. In the rural West, there was a long transition between social childbirth, when women cared for each other, and medically managed birth. Although some middle- and upper-class urban women in the northeastern United States had shifted from midwives to doctors in the late eighteenth and early nineteenth centuries, the long distances between ranches and towns, a lack of competent physicians in rural areas, along with personal preferences and traditions meant that many western women, especially minority women, relied on midwives up until the 1940s.26 Some midwives were highly skilled, like Martha Ballard, the Maine midwife, whose diary and story is revealed in A Midwife’s Tale by Laurel Thatcher Ulrich. Others were untrained. Although Martha Ballard acted as midwife in the late eighteenth and early nineteenth centuries, these twentieth-century childbirth attendants had some of the same problems as she did—lack of transportation, difficulties due to weather, and complicated deliveries.27 For American Indian women, tribal customs and spiritual beliefs directed health care and childbirth practices. Traditionally, medicine men and women performed rituals and used natural remedies to heal the sick and create balance and harmony. Maintaining balance also involved adhering to appropriate times for certain rituals and following restrictions.28 For example, the Tohono O’odham believe that humans are part of the natural world and must maintain balance with their surroundings through adhering to traditional practices in hunting and general behavior. When a woman is pregnant, her husband must follow certain practices as he hunts and kills animals to prevent birth deformities.29 Among the western Apaches, pregnant women were advised never to eat intestines for fear that the baby’s cord would become too long and cause problems during delivery.30 In her account of White Mountain Apache family life, Eva Basso tells the birthing story of a mother who ate beef intestines during her pregnancy, disregarding the taboo concerning intestines. Eva’s mother, Ann Beatty, received a call to assist with the birth near Oak Creek on the Fort Apache Indian Reservation. It was a very difficult birth because the cord was wrapped around the baby’s leg and neck, impeding his delivery. Ann Beatty manipulated the baby’s leg and freed the cord and turned him around for delivery. Finally the baby emerged with still more cord wrapped

26  •  Pregnancy, Motherhood, and Choice

around him. They freed him from the cord, delivered the afterbirth, and then cut the cord. The new mother fainted, but both baby and mother lived.31 Among American Indians, many women, like Ann Beatty, were called to assist relatives and neighbors during childbirth. During the first forty years of the twentieth century, most native women gave birth at home with lay assistants, following age-old traditions that were usually successful in bringing about safe deliveries. Euro-American medical observers in the late nineteenth century were impressed by Indian obstetrical methods, including massage and manipulation techniques used for the expulsion of the fetus and the placenta. They found a low death rate for both mothers and infants.32 Navajos, who looked on pregnancy and childbirth as natural processes, advised women to exercise, work hard, and refrain from daytime naps. Drawing on the logic that “like produces like,” Navajos advised pregnant women to suck nectar from penstemon or eat a hummingbird’s egg. They hoped that this would result in the women producing small, strong babies to make deliveries easier.33 Apaches also advised pregnant women to stay busy, related Eva Tulane Watts: “Don’t let the sun step over you. Get up early and walk around outside. And during the day, don’t lay down too much, don’t sit too much. If you sit all day, the baby’s head gets bigger and flat on top. . . . Keep walking. You don’t have to run or go someplace fast, just keep walking. That way, when the baby is born, it will be small.”34 When a Navajo woman went into labor, she commonly drank herbal tea and sent for a female relative to assist her. Sometimes male midwives, like Bahe A. Begay, also assisted in childbirth. Female helpers spread an old cloth or sheepskin on the floor, where the expectant mother knelt during the birthing process, supporting herself with a woven red sash that was suspended from the roof above her head. Bahe Begay explained that sometimes Navajos cut a V-shaped pole “long enough to lean against the Hogan wall at a 45 degree angle to the floor.” The laboring woman pulled on the rope, which was attached to the pole. The woman knelt and squatted, leaving enough space for the baby to emerge. Bahe acted as midwife in several births and sometimes put his arms around the woman to help her hold the rope if she became weak.35 During a protracted labor, the midwife kneaded the mother’s abdomen and attempted to turn the baby. Sometimes the midwife and her assistants held the mother upside down and shook her. In the background, a singer chanted the Navajo creation story while the midwife rubbed pollen on the mother’s belly. Navajos also sang unraveling songs during labor. As the

Babies, Birth Rates, and Health Care, 1910–1940  •  27

baby emerged, the midwife applied pressure from behind while an assistant knelt in front to catch the infant. Navajo women usually rested for two or three days after childbirth, with first-time mothers reclining for four days or more.36 Apache women also traditionally knelt during childbirth, holding on to a door post while female midwives stood by. In their book Apache Mothers and Daughters, anthropologist Ruth McDonald Boyer and registered nurse Narcissus Duffy Gayton, a Mescalero Apache and former director of the reservation’s Community Health Representative Program, describe how Narcissus’s grandmother, Beshád-e, gave birth in 1898. Beshád-e silently held onto a door post while her mother, Dilth-cleyhen, massaged her stomach downward and caught the baby girl when she emerged. After bathing the infant in warm water, Dilth-cleyhen strapped a buckskin band around the mother’s waist to keep her stomach from sagging. Later, she made a cradleboard for her new granddaughter.37 Over thirty years later, Beshád-e was called into service as midwife for her sister, Lillian, in 1935. She hurried on foot, “six long miles” to her sister’s home. The labor was protracted, but Lillian refused to go to the hospital, believing it was “just for those who are going to die!” Finally a baby girl arrived, and Besháde returned home. A few weeks later, Lillian became ill and once again refused to see a physician. Finally Besháde convinced a doctor to visit her and found that Lillian suffered from an infection because she had not delivered all of the afterbirth. Even though the doctor prescribed medicine, Lillian died within four months.38 In uncomplicated deliveries, untrained midwives were usually successful in caring for the mother and baby. Memoirs written by Anna Moore Shaw, a Pima, and Helen Sekaquaptewa, a Hopi, describe successful deliveries by relatives and lay midwives.39 However, complications, such as breech births or retained placenta, led to deaths. In Desert Indian Woman, Frances Manuel, a Tohono O’odham, describes losing a baby who was born breech. They had tried to summon a doctor, and even though one eventually came, the baby died.40 Prior to 1940, most Indian women went to the hospital only if they needed emergency assistance. Frequently, these visits involved complications caused by retention of the placenta following childbirth. Unfortunately, by this time the women usually were seriously ill. The majority of Navajo deaths related to childbirth were caused by retained placenta, which reinforced the Navajos’ traditional association of hospitals with death. This attitude began to change with the introduction of antibiotics after World War II. At the same time, the medical community became

28  •  Pregnancy, Motherhood, and Choice

more knowledgeable about Indian cultures and accepting of traditional healing practices. Consequently, visits by Navajos and other American Indians to hospitals increased after 1945.41 Like American Indians, rural Mexican American women throughout the West traditionally relied on midwives, or parteras, to assist in childbirth. Parteras commonly were taught by older female friends and became the health advisers for Mexican American communities. For example, two parteras delivered babies and cured illnesses among Mexican American families in Arizona’s Aravaipa Canyon. Livia León Montiel describes how her great-grandmother, who had been a midwife in both Sonora and Arizona, assisted her granddaughter—Livia’s mother—give birth to nine children at the family’s homestead on the Rillito River near Tucson.42 In Flagstaff, Blasa Rodriguez was both a curandera (healer) and partera for the Mexican American community. She gathered herbs in the nearby woods and delivered many babies, often taking her grandson, ­David Estrella, with her at night when she went to assist a woman. In an oral history interview, Estrella described these experiences: “I remember when I was small, she’d get me up, three or four in the morning. Somebody’s having a baby, and I had to go with her, because of the snow, and she wasn’t a young woman—she was quite old by then . . . Sometimes I had to hold the woman’s hands when she was there. But I was a kid. Hardly any man would be in there, but I was a kid, so I could.”43 Mexican American women and American Indian women usually relied on female attendants and also shared some other childbirth practices. Like the Navajo, some Mexican American women knelt to give birth while holding onto a rope suspended from a ceiling beam. They also drank chamomile tea at the end of pregnancy and during labor. Like Apache women, some newly delivered Mexican American mothers strapped a faja, or heavy cotton band, around their stomachs to keep the stretched muscles from sagging.44 Many Mexican American women gave birth at home, assisted by parteras, until approximately 1950, according to Margarita A. Kay. Parteras usually examined pregnant women to determine the position of the baby and progress of the pregnancy. The midwife also advised the mother-to-be to prepare her bed and other supplies for the delivery. When she went into labor, she drank chamomile tea, which could soothe false labor or strengthen contractions in true labor. Family members called parteras when the labor pains were five minutes apart.45 During labor, parteras first massaged the mother’s abdomen to determine fetal position and possibly adjust it. Mothers commonly walked

Babies, Birth Rates, and Health Care, 1910–1940  •  29

around until the baby arrived. Like other midwives, the parteras allowed nature to take its course and did not rush the process. After the baby arrived, the partera cut the cord with scissors that had been boiled and then “sterilized” with alcohol. They used drops of silver nitrate or lemon juice in the baby’s eyes. After caring for the baby, the midwife delivered the placenta. Retained placenta and possible hemorrhage were the most feared complications. To aid in expulsion of the placenta, some midwives gave the mother a bottle to blow into or she was urged to try to vomit.46 Some Mexican Americans, such as the Feliz family of Florence, relied on parteras or doctors, as the circumstances permitted. A midwife helped deliver Ramona Feliz’s first baby, but then moved away. Thereafter an elderly neighbor woman examined Ramona at the end of each pregnancy to determine when the baby would arrive. Then Ramona summoned the doctor to assist in the delivery.47 Occasionally, unforeseen circumstances frustrated the best efforts to summon a physician. Rachel Mix Herrera’s doctor was off gambling in Nogales when she went into labor. Luckily, her husband had witnessed the births of two of the couple’s other children and was able to assist her. When the tardy doctor finally arrived, the Herreras dismissed him. The happy father cut the umbilical cord with sterilized silk thread.48 In the rural areas of Arizona, African American women also used midwives in childbirth prior to World War II. Those in small towns often sent for African American midwives from larger cities, such as Tucson or Phoenix. If midwives did not arrive on time, family members did their best to assist the laboring mother. As described earlier, thirteen-year-old Christina Ellington assisted her mother, Anna Mae, when she gave birth. After the tardy midwife arrived, Christina cut the cord.49 Throughout the rural West, the challenge faced by Christina Ellington was not unusual during the first half of the twentieth century. Often, the person who performed a delivery was less a matter of choice than a con­ venient solution in an emergency. In Graham County, Zola Claridge stepped in to deliver a Mexican American neighbor’s baby because the mother had miscalculated the due date, and no one else was available. Sonoita ranch woman Olive Stoddard also delivered her neighbors’ babies. “It was a wonderful experience as long as you know the baby is coming okay,” she recalled. “If it isn’t, you’ve got to either load them up or call the doctor.” In much the same way that people helped one another dig irrigation ditches or wells, friends and neighbors rallied to help women give birth. Here, as elsewhere, women’s informal communities provided emotional and physical support during times of crisis and joy.50

30  •  Pregnancy, Motherhood, and Choice

Minnie Guenther, a missionary on the White Mountain Apache Reservation, had nine children, all born without a doctor’s assistance. In a hand-written memoir, she described the day that one son was born in 1916. She and her husband, Edgar, taught school for Apache children, and she had requested that he take the classes so she could rest. She finally convinced him to close the school when she realized that it was more than a case of fatigue. “Suddenly I knew it was too late, too late to teach school, too late to build a bridge, too late for a doctor again. But thank the Lord all went well. The next day the Army doctor came out to see our fine baby boy and check on his mother,” wrote Guenther.51 Like many women writing in the early twentieth century, Guenther did not elaborate on her personal, physical experiences, but it is clear that her difficulties related to childbirth. She had another hard time during World War I, when her husband was arrested because he had a German name, and Minnie gave birth to her fourth child all alone.52 Minnie and Edgar Guenther taught children and nursed the sick all over the White Mountain Reservation, making strong friendships with the Apache people. Minnie’s Apache friends made her baby girl a cradleboard, and an Apache woman named Shima helped raise the Guenther children.53 In isolated areas of the West, cultural exchange occurred between different groups, as they shared customs and assistance in the crucial work of bearing and raising children. Like Minnie Guenther, other women throughout the West also called for their husbands’ assistance during childbirth. A federal Children’s Bureau study in a rural Montana county found that one in eight women were delivered by their husbands because no one else was available in 1915 and 1916.54 Olive Stoddard, a Sonoita ranch woman, also described how her husband used practical knowledge gained by helping cows give birth to see her through one complicated delivery. “My first daughter was born with a cord around her neck,” Olive remembered. “As soon as the head was showing he [her husband] felt, he knew that much from the calves to feel when the head was showing. It [the cord] was around her neck, so he hurried her out and got it off.” Because the nearest doctors were in Nogales, “and they weren’t too good at that time, that is the baby doctors,” Olive relied on her aunt, sister, husband, and midwife for the births of her seven children. Her mother “had always used a chair to pull” when giving birth, and Olive saw no need to call on a physician.55 Among the Mormon community, women supported each other during childbirth. During the nineteenth century, members of the Church of ­ Jesus Christ of Latter-day Saints, like many Euro-American women,

Babies, Birth Rates, and Health Care, 1910–1940  •  31

learned of a variety of childbirth options but preferred the assistance of qualified female attendants.56 Because church leaders frowned on the presence of male doctors at childbirth and yet wanted to ensure excellent obstetric care in early Mormon communities, church leaders encouraged several women to attend medical schools in the East. These female physicians eventually returned to train other women in Utah and surrounding states as midwives. Ellis Shipp, a Mormon mother from Salt Lake City, traveled to attend the Woman’s Medical College of Pennsylvania in 1875. At that time, Shipp was the first wife in a polygamous family and had already given birth to five children, two of whom died in infancy. While she studied medicine, her sister and sister-wife cared for her children. Despite this assistance, earning her medical license and living away from her family was a hardship for Shipp, but she persevered, graduating in 1878. When Dr. Shipp returned to Salt Lake City, she had five more children, cared for her family, and taught women “the art of nursing and obstetrics.”57 She had resolved early on in her career to improve women’s care in childbirth, and she offered classes in Salt Lake City and the surrounding vicinity. In 1899, after her own children were grown, she began traveling to teach women from Canada, Arizona, Colorado, and Mexico about childbirth practices. Shipp’s influence, and that of other Mormon physicians, reached women in Arizona. Sarah Vance, of Mesa, Arizona, studied obstetrics under Dr. Shipp in Utah and then returned home and served as a midwife for many years during the last quarter of the nineteenth century. Nancy Boren, who homesteaded in Matthewsville (present-day Pima), took a midwifery course from one of the newly trained doctors and served for many years as a midwife in Graham County.58 Elizabeth Hanks Curtis was another Mormon midwife who practiced in Graham County from the late 1890s to the 1920s. Unlike Nancy Boren and Sarah Vance, Elizabeth did not attend church-sponsored midwifery school. She had acquired some informal training from a doctor in her native England. Elizabeth was the second wife of Moses Curtis, whom she married when she was eighteen in 1870. At that time, Curtis was fifty-four and had a family of seven children with his first wife. Elizabeth gave birth to eight children. When her husband died in 1907, she continued to act as midwife and practical nurse in the community. Her patients considered her a very competent practitioner who delivered nearly 1,000 babies and lost very few to death. She charged $5 to care for mother and infant for two weeks, frequently fording the Gila River to attend the sick or deliver a

32  •  Pregnancy, Motherhood, and Choice

Elizabeth Hanks Curtis, Mormon midwife from Eden, Arizona, delivered over 1,000 babies, seldom losing a baby or a mother. Courtesy of the Eastern Arizona Museum and Historical Society.

baby. The pharmacist in Eden so respected Elizabeth’s work that he allowed her to purchase medicine without a doctor’s prescription.59 Even though they lacked extensive formal training, early twentieth century midwives compiled a credible record in assisting women through uncomplicated births. In fact, they had lower maternal and infant mortality

Babies, Birth Rates, and Health Care, 1910–1940  •  33

rates than those of physicians. In general, midwives had more practical experience than most male physicians and rarely employed interventionist methods, such as forceps and drugs, which frequently caused complications. In addition, midwives were affordable. Because they usually limited their practice to friends and relatives, midwives often collected less than half the fees charged by general practitioners. Moreover, midwives performed a variety of household chores that were beyond the scope of services expected of physicians, including help with the housework and child care while the mother tended to her new infant.60 Occasionally, women suffered serious complications from childbirth that were too difficult for midwives to handle. For example, Francisca Gastelum Rosales, who had migrated to Arizona during the Mexican revolution, lost four midwife-delivered babies between 1899 and 1918. Francisca’s situation was complicated by an unexplained medical condition that often induced a coma in her after childbirth. Following the birth of an infant in 1919, Francisca, who was tired and worn out from numerous pregnancies and hard work, slipped into a coma and died. Her baby also died, leaving her husband to care for four young boys and a girl.61 Women throughout the United States feared this turn of events. According to historian Judith Leavitt, their concerns were justified. Deaths in childbirth at the turn of the century were sixty-five times more likely than in the 1980s. Approximately 1 mother died for every 154 living births. Leavitt calculates that if women delivered an average of five live babies during their childbearing years, one out of every thirty women might be expected to die in childbirth. Others could expect to suffer birth complications—such as lacerations and tears in the vaginal wall, cervix, and perineal tissues—that sometimes went unrepaired. These were fairly common injuries, regardless of whether the patient was attended by a doctor or midwife. As a result, some women endured years of ill health.62 In an effort to regulate midwifery, the Arizona State Board of Health set down specific rules and regulations that became state law in 1920. Midwives who received financial compensation for their services were required to register with the county and abide by the state-mandated Midwife Safety Rules. In addition to outlining proper sanitary practices, the regulations forbade midwives from examining a patient by inserting fingers or an instrument into the birth canal, administering drugs, or giving injections into the birth canal. If a woman went into labor and failed to give birth within twenty-four hours, the midwife was required to call for a physician’s assistance. Similarly, midwives were instructed to send quickly for a physician in the event the mother was bleeding heavily or was weak or feverish. If a baby should emerge from the birth canal feet or buttocks

34  •  Pregnancy, Motherhood, and Choice

first, midwives should pull the infant out to hasten delivery of the head. Finally, health officials instructed midwives to administer a solution of 1 percent nitrate of silver to the newborn’s eyes to prevent soreness or blindness. Every practicing midwife was required to report births within five days of delivery.63 Midwives who registered and signed a pledge to observe these regulations received a permit that allowed them to deliver babies for pay. In 1923, the State Board of Health attempted to bolster compliance by enacting fines for anyone without a permit who accepted money for de­ livering babies. The effectiveness of the regulations was limited. Even though they were published in Spanish and English, many practicing midwives probably never heard of the rules due to the isolation of Arizona’s rural areas. Numerous primary and secondary accounts of childbirth demonstrate that midwives, neighbors, friends, and relatives continued delivering babies to meet new mothers’ needs, no matter what rules were established by the state. Because midwives who failed to register with the state usually did not receive birth certificate forms, many births went unrecorded.64 Due to long distances between ranches and towns, lack of competent physicians, and cultural preferences, many women in rural areas used informal childbirth methods. This was especially true of women of color, and reliance on midwives lasted into the 1940s. Euro-American women were more likely to turn to physicians beginning in the 1920s. Some rural women traveled into town as their due date approached to be near a doctor. For example, Marie Christensen Glenn stayed in a Douglas hotel during all four of her pregnancies so that Dr. Adamson could deliver her babies. In mining towns, Euro-American and Mexican American women often gave birth assisted by company doctors. In towns, women often found reliable physicians, and many turned to them for assistance in childbirth. Their experience was quite different than those attended by midwives at home. During the early twentieth century, women were required to stay in bed for at least ten days after giving birth in the hospital, and many said that they became very weak after the lengthy bed rest.65 In 1914, Dr. Rosa Boido and her husband, Dr. Lorenzo Boido, began offering Phoenix women a new birthing option. They opened a Twilight Sleep Hospital where women received anesthesia (scopolamine and morphine) during labor and delivery. The Boidos secured this anesthesia from doctors in Germany, who developed “twilight sleep,” so named because women went through labor without feeling any pain, almost as if asleep. Women’s desire to avoid the tumultuous misery associated with childbirth

Babies, Birth Rates, and Health Care, 1910–1940  •  35

made the use of this anesthesia popular in urban centers in the United States and Europe during the 1910s.66 The twilight sleep method employed a combination of drugs that resulted in women not remembering their deliveries. These drugs differed from those used by other physicians, who relied on opium, chloroform, ergot, quinine, cocaine, or ether to ease pain and speed deliveries. However, women still endured pain because the medicines hampered muscle function and could not be used throughout labor and delivery.67 Some women embraced the twilight sleep method because it seemed to erase all discomfort connected to childbirth. Although this method eased discomfort, it did not last long because the drugs depressed babies’ nervous systems and caused breathing problems among infants. In Phoenix, Dr. Rosa Boido also ran into difficulties when she was arrested for performing an abortion in 1918. The Twilight Sleep Hospital closed during her imprisonment.68 Although twilight sleep provided only a fleeting option for Phoenix women, there were a few maternity homes in the state that operated for many years. In Tucson, the Stork’s Nest provided a place for women to give birth from the 1920s to the 1940s. Helen Jacobs opened the maternity home in 1922 after her daughter died in childbirth in Bisbee, Arizona, because she felt that women needed additional assistance in childbirth. Nurses staffed the birthing center with two at a time covering eight-hour shifts throughout the day to attend women until birth was imminent— then they called a doctor. Foreshadowing changes to come in most hospital births, husbands were allowed in the delivery room when the baby arrived. During the time the Stork’s Nest operated, St. Mary’s was the only hospital in Tucson.69 Women often remained in the Stork’s Nest for ten days following delivery, but paid only $25 to $35 for their stay, including meals. The facility contained eighteen beds, but at times, twenty women could be squeezed into the available rooms. Helen Dana, a Mormon practical nurse and midwife, also opened a maternity home in 1924 to make ends meet after her husband became an invalid. She had assisted Dr. Benjamin Moeur in childbirth cases for several years prior to working as a midwife. Operating the maternity home in part of her own house, Helen delivered more than 1,200 babies for Euro-American, Mexican American, and African American women. She is credited with never losing a mother or baby while acting as midwife from 1924 to 1959. Helen allowed her midwife license to expire in 1959 but worried about turning away expecting mothers: “I just don’t know what I’m going to do when some of these poor men bring me their wives

36  •  Pregnancy, Motherhood, and Choice

who are just ready to have their babies. Many times there just isn’t time to get them to the hospital even by ambulance.” Despite these concerns, she retired at the age of seventy-four in 1959.70 Helen Dana’s maternity home served women from all ethnic groups, but some medical facilities were segregated in Phoenix prior to World War II. There was no hospital serving African Americans until physician Winston Hackett founded the Booker T. Washington Hospital in 1921 for Phoenix blacks. Dr. Hackett, an African American, treated illnesses of all kinds and delivered thousands of babies, according to Winstona Hackett Aldridge, his daughter. As Dr. Hackett aged, his eyesight weakened, so Winstona drove him to attend women in childbirth. She recalled in an oral history interview: “I can remember going up and down the canals, with him to deliver the babies. . . . I’d just go right in there and help. . . . I’d stay with him. . . . He delivered babies all over.” Dr. Hackett assisted women from all ethnic groups, although the majority of his clientele were African American.71 He accepted in-kind payment for his services, sometimes receiving chickens and farm produce instead of cash, operating the hospital until 1943. From 1900 to the 1940s, Arizona women’s birth rates, views of pregnancy, and childbirth experiences varied due to differences in culture, religion, race, socioeconomic status, and location. Many American Indian, Mexican American, Catholic, and Mormon women celebrated large families and did little to limit fertility. At this time, many believed that marriage, sexuality, and babies were all linked. Others attempted to limit their family’s size but were constrained by both legal and social sanctions. During the early decades of the twentieth century, the dynamics of motherhood involved expanding families and high fertility. In giving birth, many women found comfort in their traditions and informal female networks. American Indian women used traditional practices to ease the pain of childbirth, as did many Mexican American women who relied on parteras. African American women also called on midwives in childbirth and contended with segregated medical facilities. While women of color commonly chose lay attendants to deliver their babies, urban Euro-American women were more likely to rely on physicians by the 1920s and 1930s. Arizona’s isolation; long distances between ranches, farms, and towns; and lack of qualified medical personnel resulted in a long transition between social childbirth and medically managed birth, which also occurred in other western, rural states. Arizona’s rough canyon country and sparse deserts, along with tradition and the family’s economic

Babies, Birth Rates, and Health Care, 1910–1940  •  37

means of support, influenced the birth rates and reproductive experiences of these diverse women. Similar factors played a role in Arizona’s infant mortality rate during the early twentieth century. Some new mothers faced great difficulties in caring for their babies due to lack of public health information, poverty, and poor sanitation. The next chapter explores Arizona’s high infant ­mortality rate and women’s varied experiences due to race, class, and ­ethnicity.

cha p te r two

Saving the Babies Lowering Infant Mortality in the Southwest

In 1937, when Phoenix resident Rita Cruz Ruiz was a child, her mother, Maria Barbo Cruz, died. The afternoon of her burial, Rita’s baby cousin also died. Although the child had been healthy, she became ill and passed very quickly. “The babies were here today, and tomorrow they were gone,” said Ruiz, who recalled many infant deaths. The family buried the baby with Rita’s mother. “They hurried up and dressed her in white and made a little coffin for her,” said Ruiz. Maria Cruz and the small child were buried in Cementerio Lindo in south Phoenix where three of­ Maria’s own infants were already interned. Maria had given birth to nine children by the time of her death in 1937; six were still living.1 In the Cementerio Lindo there is a row of graves with markers denoting the short lives of infants in 1930. Throughout this county cemetery that served a predominantly Hispanic population, there are hundreds of markers on babies’ tombs, sadly illustrating the high number of infant deaths. These graves, along with public health documents, vital statistics, and other sources, illustrate the great difficulties faced by Arizona families when caring for their infants. Arizona’s infant mortality rate was one of the highest in the nation during the first half of the twentieth century. New Mexico’s rate was even higher—this state led the nation in infant deaths during the late 1920s and 1930s. In nearby Utah, the infant mortality rate was less than half that of the other two states.2 Poverty, lack of sanitation, and inadequate prenatal care hampered in38

Lowering Infant Mortality in the Southwest  •  39

fants’ health in Arizona and New Mexico.3 The federal Children’s Bureau found that environmental factors and poorly informed caretakers contributed to high infant mortality rates across the United States. The nation’s first federally sponsored health care program, the Sheppard-Towner Program, attempted to lower maternal and infant mortality rates through improvements in health education, expanded prenatal care, and midwife education.4 However, program administrators did little in Arizona to help ethnic and racial minorities who suffered the most from high infant death rates. Access to public health measures could potentially improve the health of women and babies, but due to discrimination and prejudice, this care was not available to all women.5 After the Sheppard-Towner Program ended, public health professionals continued to provide assistance to pregnant women, new mothers, and babies. Yet by the 1940s, infant mortality in Arizona remained nearly twice the national average, and it was still higher in New Mexico.6 By contrast, in Utah, the infant mortality rate was one of the lowest in the nation. In close-knit Mormon communities, the National Woman’s Relief Society of the Church of Jesus Christ of Latter-day Saints worked with Sheppard-Towner nurses throughout the state to improve health care for mothers and babies.7 This chapter examines conditions affecting infant mortality and efforts to improve health care in these southwestern states. It demonstrates that race, ethnicity, religion, class, and geographic location all affected women’s access to public health information, their health, and that of their families. In addition, prejudice and discrimination undercut the success of Progressive initiatives that were designed to improve health care and lower mortality rates.

The Beginnings of Public Health Public health developed slowly in Arizona due to the state’s rural nature and sparse settlement. In 1902, the Arizona Territorial legislature established the Board of Health, with Dr. R. M. Dodsworth at its head. He began working to improve citizens’ health by tracking diseases and documenting vital statistics. By 1905, half of Arizona’s counties were reporting births and deaths.8 In 1910, the Report of the Territorial Board of Health to the Governor of Arizona announced a high infant mortality rate. Although only 2.56 percent of the territory’s population was under the age of one, 23 percent

40  •  Pregnancy, Motherhood, and Choice

of all deaths occurred among this group. The rate of infant mortality was especially high among Mexican Americans, and the majority of deaths were caused by diarrhea.9 To achieve an accurate reading of infant mortality at this time, complete birth registration statistics were needed; the infant mortality rate was based on the number of deaths in relation to that of births. During these early years and for some time, Arizona’s record of births and mortality was incomplete because many midwives and relatives who delivered babies did not register births. Likewise, deaths were not always registered with the county or state. This was also a problem in many other states, and the federal Children’s Bureau waged a nationwide campaign to improve documentation of births and deaths.10 After Arizona achieved statehood in 1912, the state Board of Health and county superintendents pushed toward this goal through articles in the state public health bulletin. Birth certificates were necessary to establish parenthood of children and to provide individuals with proof of age and identity for inheritance purposes. Keeping an official record of deaths would allow public health officials to understand age at time of death, along with the cause of death, so they could begin the work of improving health to lower mortality.11 In New Mexico, the commitment to improving public health also developed slowly. In 1919, the state established a public health program after the influenza epidemic resulted in the deaths of 1,055 New Mexicans. This new program focused on collecting vital statistics, preventing disease, and improving sanitation and public health education. County public health offices also became involved, but the state and county programs were funded inadequately.12 The New Mexico public health program, like that in other states, worked to document births and deaths. Through the leadership of the Children’s Bureau, this became a national issue during the Progressive era. Julia Lathrop promoted a birth registration campaign that she con­ sidered “a precondition for all other child welfare work.”13 With the hope of collaborating with existing organizations, Children’s Bureau staffers worked with the General Federation of Women’s Clubs to secure state compliance with birth registration goals. Founded in 1890, the General Federation of Women’s Clubs united a great variety of women’s organizations across the nation. Women joined these clubs to study topics of interest, improve their communities, and socialize. These clubs also provided volunteer labor to improve child welfare, establish libraries, and beautify towns.14 Health professionals discussed the topic of birth registration in the Ari-

Lowering Infant Mortality in the Southwest  •  41

zona State Board of Health monthly publication, the Bulletin. Following gender norms of the time, a 1915 article stated that birth registration documentation would allow girls to legally marry in Arizona. Birth registration would allow boys the right to vote, serve on juries, or join the military.15 This proof of birth could also aid females in voting because by this time, women in Arizona had won the franchise (but they were not allowed to serve on juries until 1945).16 States were required to register 90 percent of births to meet the requirement for inclusion in the Census Bureau’s birth registration area. In 1926, Arizona complied with federal directives, thereby qualifying as a birth registration state. New Mexico reached this threshold in 1929, whereas Utah had qualified much earlier, in 1917.17

Lowering the Infant Mortality Rate Before Arizona registered the majority of state births, accurately determining the infant mortality rate was impossible. However, in the 1910s, phy­ sicians, public health officials, and club women discussed the need to ­decrease infant deaths through the “better baby” movement, which was founded by the Children’s Bureau. Based on the idea that medical science could improve health, reformers advocated sharing knowledge with mothers about proper health and the care and feeding of infants.18 Throughout the United States, many in public health promoted Better Babies weeks to encourage mothers to weigh and measure their children to determine if they fell within the “normal” ranges for children of their age group. They also encouraged baby contests, where babies were examined and tested for mental and physical health. These contests were tied to the positive eugenics movement in that they promoted the improvement of the human race by encouraging parents to keep their children healthy and fit.19 In an article in the Arizona State Board of Health Bulletin in October 1916, Dr. Mary Lawson Neff of Phoenix discussed baby health contests, designed to help mothers learn what to expect in terms of their babies’ size and health. Babies that participated would receive an examination by physicians who could identify possible health problems. The article promoted the baby health contests, but it was a few years before one was held in Phoenix.20 The following year, Dr. C. W. Sult spoke to the Flagstaff Woman’s Club during Better Babies week. Dr. Sult did not bring up contests but instead pointed to the need to end poverty to lower the high infant death

42  •  Pregnancy, Motherhood, and Choice

rate. He stated that rather than informing women about the proper schedule and number of infant feedings, it was more important to discuss the difficulties mothers faced in caring for large families on low incomes. “When the time comes that every man in the land receives a living wage for his labors and every person can receive nourishing food in sufficient amount, then will the problem of the conservation of our babies be solved,” he stated.21 He called on women to assist their neighbors and the government to provide more help to the needy. In this way, Dr. Sult accented the effect of poverty on infant mortality rather than publicizing the common platitudes of the Better Babies movement, such as the importance of science in improving infant health. He appealed to club women to use legislative means to lower the infant mortality rate. Between 1918 and 1921, there were Better Babies clinics and contests at the Arizona State Fair, which was held every fall in Phoenix. Following common patterns throughout the nation, the contests were based on emerging ideas about race betterment.22 In 1918, the Congress of Mothers of Arizona, under the auspices of the Children’s Bureau, supervised the clinic. At this time, as World War I raged, the fair program stated, “The Better Babies Clinic is a national movement as a war measure to insure better babies and a healthier race.” The clinics stressed examination of babies for mental and physical health and education of parents regarding care of their young.23 These types of clinics and contests were occurring all over the nation and were often publicized in Woman’s Home Companion.24 During the next few years, Better Babies contests were held at each state fair. In 1920, babies who entered could receive a “regular $25 examination free of charge” from a physician.25 In 1920, the Arizona Republican reported that “Little Miss Virginia Marie Drey” won the contest in Maricopa County, winning a gold medal and $100 from the County Board of Supervisors. The article listed a few dozen children who won in different categories, but there were no babies with Hispanic surnames.26 To register for the contest, parents had to submit entries to the state Child Welfare Department nearly two weeks before the contest, and only 200 entries were accepted.27 It is likely that Mexican American parents did not participate because they did not learn of the contest or receive advance publicity or encouragement to participate. At this time, segregation and divisions between ethnic groups existed in Arizona, and those of Mexican descent may have felt excluded. Later, as Maude Howe and the Arizona Child Welfare Bureau continued their educational work, their messages related to health practices often reached Euro-Americans and not those of Mexican descent.28

Lowering Infant Mortality in the Southwest  •  43

Children’s Bureau director Grace Abbott pushed the Better Babies movement nationally, and she was in agreement with Dr. Sult regarding the economic causes of infant mortality. Abbott believed that infant mortality was an “index of social and economic and sanitary conditions.” Certainly, that seems to have been the case in Arizona, where poverty and poor sanitation were widespread in both rural and urban areas. Mexican immigrants, in particular, worked and lived in conditions that placed their most vulnerable family members in great peril.29 Although many Mexican residents of the Arizona Territory had been property or business owners, the majority migrating after the turn of the century were laborers. Often the new immigrants became trapped in the lowest paying job categories on railroads, on farms, or in mines, where they lacked economic mobility and contended with Anglo-dominated unions that excluded them. Living conditions for many working-class Mexicans were abysmal. By 1911, south Phoenix contained a barrio with a shack town that public health officials considered a health menace. Public Health director T. Cuvellier claimed the housing conditions there were as bad as any in New York City. People struggled with high rent, serious overcrowding, and a lack of sanitary facilities and clean water. During the influenza epidemic of 1918–19, Mexicans suffered from many of the worst cases because crowded conditions and “improper nourishment” made them more susceptible to disease, according to Dr. Frederick T. Fahlen.30 Euro-Americans in Phoenix pointed to the Mexicans’ supposed reliance on traditional folk remedies to explain their higher rates of illness and called for the study of hygiene in Grant School, whose population was largely Mexican American. But the potential of hygiene study to improve the lot of Mexican agricultural workers was dim in the 1920s. Early in the decade, the Arizona Cotton Growers Association (ACGA) lured thousands of Mexican laborers to Arizona with the promise of high wages, but paid them poorly and then routinely fired them if they attempted to organize unions. When the cotton market lost steam following the post– World War I boom, growers laid entire families off, leaving them penniless and stranded in Maricopa County. Homeless and hungry, these Mexican families received little help from the ACGA. Finally the Mexican government repatriated the stranded workers. The desperate situation of the braceros in Maricopa County in 1921 illustrates common economic use of Mexican labor in Arizona. Pulled north during economic booms, they were routinely laid off and sent home when the boom went bust. In the meantime, migrant workers often lived in tents, shacks, or abandoned railroad cars; used irrigation canals for water; and used the outdoors as a toilet.31

44  •  Pregnancy, Motherhood, and Choice

According to federal Children’s Bureau researchers, poor living conditions in rural areas and overcrowding in cities contributed to the high infant mortality in Arizona and other disadvantaged areas throughout the United States. The infants of fathers who earned less than $550 a year were more than twice as likely to die as those whose fathers earned over $1,250 annually. Mexican laborers in Arizona commonly fell into the former category, with farm laborers earning less than $550 annually and miners earning slightly more.32 Women in impoverished urban areas, along with rural women in farm camps lacking clean water or decent sanitation, faced difficulties in ensuring the health of their newborn babies. While Dr. Sult pushed for an end to poverty to save the babies, others focused on what they called the carelessness of mothers. Some public health officials claimed that women’s poor mothering led to infants’ deaths due to artificial feeding, flies, and filth. In an article titled “Killing the Babies,” public health officials decried artificial feeding of infants, which they claimed led to two and a half times more diarrhea than that experienced by breastfed babies.33 Nursing babies was the traditional method of choice for health professionals, but this was not possible for mothers who worked long hours or were malnourished themselves. Likewise, maintaining proper sanitation was nearly impossible in some impoverished homes, so the “blame the victim” tone of this article accomplished little. In 1919, the State Board of Health established a Child Welfare Program, demonstrating a commitment to improving young people’s health. Maude H. Howe, director of the new program, had worked as special agent for the Children’s Bureau and as state chair of the Child Conservation Section of the Field Division of the National Council of Defense. Howe, an active member of the Arizona Federation of Women’s Clubs (AFWC), quickly began working to improve the health of infants by encouraging women throughout the state to organize for public health. Following the lead of federal Children’s Bureau staffers, Howe hoped to use women’s clubs to push for birth registration, vital statistics, and community public health nurses. The AFWC supported these efforts and lobbied for state appropriations for the nurses.34 In 1921, Howe organized programs to promote birth registration and teach women about prenatal care and the health of infants and children. She distributed pamphlets about these topics in both English and Spanish. This work was greatly needed to lower Arizona’s infant mortality rate, which was 155 per 1,000 births (15.5 percent) in 1920. For those of Mexican descent, 28.2 percent died in the first twelve months of life, and 45

Lowering Infant Mortality in the Southwest  •  45

percent of American Indian babies died. According to Howe’s records, only 6.8 percent of the Euro-American babies died in the first year. In July 1921, Howe attributed Arizona’s high infant mortality rate to the presence of Mexican families in the state in 1920: “Such a large proportion of the deaths of Mexican babies is due to ignorance of the mothers that the possibilities of educational work among them are surely worth demonstrating.” She also stated the following regarding the impoverished families who had worked in the cotton fields and then been laid off: “With the present exodus of the Mexican population from our cotton fields and mining camps and a persistent educational campaign among those who remain, the infant mortality rate should more closely approximate that of most other states.”35 Howe’s remarks display harsh disregard for the hard-pressed laborers and their families who had assisted farmers during the cotton boom. Although she planned to implement a new campaign to help the Mexicans who continued to live and work in Arizona, the infant mortality rate for those of Mexican descent remained high throughout the 1920s. In 1922, Arizona’s infant mortality rate was nearly double the national rate with 142 deaths per 1,000 infants under one year of age, compared to 76 infant deaths per 1,000 births in the nation as a whole. Other western states had lower rates than Arizona. For example, Montana’s infant mortality rate in 1925 was 71 per 1,000, and in Utah only 56 babies died for every 1,000 births. In the West, only New Mexico, with an estimated infant mortality rate of 145 per 1,000, fared worse than Arizona.36 When compared with infant mortality rates worldwide, Arizona’s and New Mexico’s statistics are even more dismal. During and immediately after World War I, the United States ranked seventeenth out of twenty industrialized nations in maternal mortality and eleventh in infant mortality, both shocking figures. In 1916, 16,000 Americans died during childbirth, and the number rose to 23,000 in 1918. During both years, 250,000 babies died nationwide.37

The Sheppard-Towner Program To reduce the country’s high infant and maternal mortality rates, a powerful women’s lobby persuaded the U.S. Congress to pass the SheppardTowner Maternity and Infancy Protection Act, the nation’s first public health law. Based on the ideal that health and survival was the right of every child, the bill appropriated $1,480,000 the first year and $1,240,000 in

46  •  Pregnancy, Motherhood, and Choice

five subsequent years in matching grants to the states. Progressive leaders such as Florence Kelley, Grace Abbott, and Jeanette Rankin had been occupied with this issue for years. The legislation finally passed in 1921 after women won the vote in 1920, and congressional members feared the voting potential of this newly enfranchised group.38 Arizona club women lobbied powerfully for implementation of the Sheppard-Towner Act in their home state. As chair of the AFWC Legislative Committee, C. Louise Boehringer urged members to become familiar with the reform measure and lobby their lawmakers to support it. Boehringer served in the state legislature herself at this time, and she sponsored and secured passage of a related Child Welfare Bill.39 The Arizona legislature pledged funds for the Sheppard-Towner Program and accepted the federal block grants. However, poor administrative decisions and ethnic prejudices affected the program’s implementation, while at the same time, poverty and unhealthy living conditions among the most disadvantaged residents limited its effectiveness. In the Mexican community, more than 1 in 5 infants (230 of each 1,000) died in the first twelve months of life in 1924. This was the highest infant mortality rate for any ethnic group in Arizona. For American Indians, the infant mortality rate was 184 per 1,000 in 1924 (see table 3). Among both groups, the infant mortality rate greatly exceeded the 112 per 1,000 rates for babies of color in the United States in 1924.40 What conditions created such a disastrous situation for Arizona’s infants? As elsewhere in the United States, infant mortality in Arizona was strongly linked to improper feeding and gastrointestinal diseases, which resulted in approximately one-third of infant deaths nationwide. Although traditional practice and modern science encouraged mothers to breastfeed infants, poor nutrition and overwork limited mothers’ breast milk. Mothers who were unable to breastfeed turned to bottle feeding—a complicated process that cost money to buy pure milk, bottles, nipples, and formula, while also requiring the time to prepare the formula and sterilize Table 3.  Arizona Infant Mortality Rates, 1924

Births Deaths

White

Mexican

Indian

4,126 255

3,184 734

493 91

Source: Arizona Department of Health, Report to the Children’s Bureau by Mrs. Charles Howe, January 1, 1925–June 30, 1925. RG 102, National Archives.

Lowering Infant Mortality in the Southwest  •  47

the bottles. Because of these difficulties, bottle-fed babies were three times as likely to die in the first month as were breastfed babies. Feeding infants with sanitary bottles was nearly impossible for those migrant workers who lacked clean water and adequate kitchen equipment.41 Although reservation Indians led a more settled existence than migrant workers, they also suffered from a high infant mortality rate. Health researchers pointed to poor sanitation as the root cause of infant diarrhea among the Navajos. Water often had to be hauled many miles to oneroom dwellings, where livestock and discarded garbage attracted flies. Due to transportation difficulties, lack of medical facilities, and distrust of physicians, many ill infants did not receive medical care through EuroAmerican health facilities. If they were examined by physicians, the situation was usually very serious, and if they died in the hospital, it perpetuated a fear of hospitals.42 In addition to these problems, the Bureau of Indian Affairs (BIA) provided inadequate health services on the Navajo Reservation and other reservations throughout the nation. The Merriam Report in 1928 was a scathing indictment of the federal government’s commitment to Indian health. Lewis Merriam surveyed BIA-administered health care and found that poor staff training, overemphasis on clinical care, lack of funds, and cultural arrogance hampered the delivery of health services to American Indians. These inadequacies had a debilitating effect on American Indians’ babies and their families.43 Recognizing that diet and sanitation affected the health of babies of every ethnicity throughout the nation, Children’s Bureau staffers designed the Sheppard-Towner educational program that stressed healthy pregnancies, safe childbirth, and adequate feeding of infants and children. Director Grace Abbott encouraged state personnel to do “intensive work in rural communities where adequate medical and nursing facilities are lacking.” Arizona, with 65 percent of its population in rural areas, benefited from the program’s local focus, but the program did not help American Indians on reservations who received health care at this time through the BIA.44 Beginning in 1922, the State Board of Health’s Child Hygiene Division administered Sheppard-Towner work in Arizona. Except for fiscal year 1923 to 1924 and from January to June 1927, when the program relied only on federal funds, the state legislature appropriated money annually to provide a budget of approximately $19,000 from state and federal sources. With these funds, Arizona program director Maude Howe hired three field nurses to instruct women about healthy pregnancy, childbirth, and

48  •  Pregnancy, Motherhood, and Choice

child care. Their duties also involved investigating and compiling statistics on prenatal and postnatal cases, infants, and preschool children in their areas; enlisting the help of local physicians to set up clinics; surveying sanitary conditions; noting epidemics or diseases; reporting on the number of registered and practicing midwives; and conducting follow-up work.45 State health officials encouraged Sheppard-Towner field nurses to organize clinics for mothers and infants and make home visits whenever possible. Arizona health professionals confronted a daunting task in covering the state’s 113,956 square miles. To better implement the program, Howe divided the state into four districts and assigned one nurse to a district, each of which included several counties. Then she hired Alice Carolina Valenzuela, a Spanish-speaking nurse, to work “with the Mexican population” in twelve of the fourteen Arizona counties. A recent graduate of the nursing program at St. Joseph’s Hospital in Phoenix and eager to serve her own people, Valenzuela logged many miles across the state in her trusty Chevrolet. In addition to caring for mothers and babies, Valenzuela learned to fix flat tires, make car repairs, and drive on washed-out roads. According to Howe, Valenzuela’s workload was both heavy and difficult. Valenzuela faced the nearly impossible task of caring for the health needs of mothers and infants of Mexican descent in a population that grew from 88,464 to 114,173 between 1920 and 1930. She was also charged with locating Mexican midwives, many of whom could neither speak nor write in English. Apparently, Valenzuela performed her duties well, earning compliments from Howe and staying with the program for five years until her marriage in 1927.46 Reports from health officials note that Valenzuela worked with the Mexican American population, but they fail to mention other people of color, such as African American nurses, performing the same service. Sheppard-Towner personnel did not target the African American population for special attention, even though in some years this group had high infant mortality rates. Perhaps they did not focus on African Americans in Arizona because they were a small section of the population. EuroAmericans and the segment of the Mexican American population that Valenzuela contacted in her travels were the main beneficiaries of the program.47 To improve the health of mothers and babies, Valenzuela and other Sheppard-Towner field nurses visited women and children in their homes, organized hundreds of health meetings throughout the state, and distributed thousands of pamphlets describing proper prenatal, postnatal, and

Lowering Infant Mortality in the Southwest  •  49

infant care. They also organized classes for mothers and “Little Mothers” (older female siblings) concerning the care of infants and preschool children. In addition, they provided individual instruction to mothers of malnourished children while also giving group demonstrations about preparing formulas and sanitizing baby bottles.48 Members of the AFWC not only lobbied to fund the Sheppard-Towner Program but also supported its implementation in a variety of ways. They organized discussion groups, attended meetings with field nurses, and organized conferences related to hygiene, aiding the overworked public health nurses.49 Sheppard-Towner nurses also surveyed and reported on the skills and abilities of midwives as one way of improving childbirth practices and lowering infant mortality. By 1923, 123 women had complied with the 1920 Arizona law that required midwives to register. Most who registered lived in Apache, Navajo, and Santa Cruz Counties. Unlike their counterparts in seventeen other states, including neighboring New Mexico, Arizona’s Sheppard-Towner nurses did not conduct organized classes for midwives, whom the state’s health administrators believed were “too scattered to justify the time and expense such classes would involve.” Instead, they focused on individual instruction and providing “as much supervision as is possible without the backing of legal authority.” The comment about legal authority most likely pertained to nurses’ inability to force midwives to either get training or stop delivering babies.50 Nurses’ discomfort concerning midwives is evident in a letter written by Nellie Willcox when she left her position as Sheppard-Towner field nurse. Willcox reported that she had inspected fifty midwives, “not one of whom has ever had a single day of training, and not one of whom used a preventative for blindness.” Also citing huge counties, covering 11,000 square miles, where few doctors or graduate nurses practiced, Willcox said these conditions contributed to the high infant mortality rate in 1922.51 During the six-month period of July to December 1924, SheppardTowner field nurses instructed seventy-three midwives individually and visited prenatal and postnatal cases with them. Although many midwives appreciated their instructions, some were resentful, according to the Shepphard-Towner nurses. The greatest difficulty stemmed from the large number of midwives who could neither read nor write. Director Howe pointed to only one success in relation to midwives—weeding out “objectionable” ones and making others more aware of state regulations.52 From January to June 30, 1925, Sheppard-Towner nurses visited 100 midwives, but in later months and years, they paid less attention to the

50  •  Pregnancy, Motherhood, and Choice

unprofessional birthing attendants and seemed discouraged with the results of their efforts with midwives. Frustrated because state law did not demand that midwives possess specific qualifications, Sheppard-Towner personnel concentrated on registering more midwives, and as of 1925 midwives of the following ethnicities were registered: white—54; Mexican—73; Negro—6; Indian—1; Japanese—1. By this time, nurses reported eliminating a number of Mexican midwives because of old age or unfitness. From the sources available it is impossible to know whether the Mexican midwives were actually less fit than others or if ethnic prejudice influenced the nurses’ decisions. Throughout the United States, Euro-American middle-class health professionals frowned on the traditional methods and practical training of immigrant midwives, even though midwives had lower mortality rates than physicians did.53 The health administrators’ decision to forgo midwives’ classes in Arizona contrasted with the programmatic decisions in New Mexico, where numerous midwives also worked. Like Arizona, New Mexico had a very high infant mortality rate of 145 infants per 1,000 in 1925. To decrease the number of infant deaths, officials instituted midwife education through the Sheppard-Towner Program. Sheppard-Towner nurses in New Mexico first had to locate midwives, which in itself was a difficult task. They met resistance from people suspicious of their program, but with great effort they overcame fear, wariness, and language barriers to find and educate midwives throughout the state.54 Most Sheppard-Towner nurses in New Mexico spoke Spanish or learned it quickly to communicate with a population that was 60 percent Hispanic. Sheppard-Towner personnel created a successful program in the state where, due to cultural preferences, poverty, and lack of medical personnel, midwives delivered the majority of the babies. Historian Sandra Schackel credits the midwife education program with great importance in health professionals’ success in lowering the New Mexico infant mortality rate from 145 in the mid-1920s to 100 in 1940.55 In Arizona, Sheppard-Towner personnel claimed midwives were “too scattered” to bring together for classes and nearly discontinued instructing them individually by 1925. Additionally, language remained a barrier in Arizona, where only one Spanish-speaking nurse served the entire state. Although various pamphlets and the regulations covering midwifery were issued in Spanish, these materials provided little practical education and were of no use to midwives who could not read or write.56 In 1929 when Arizona health personnel submitted their final report to the Children’s Bureau, they were able to demonstrate little success in

Lowering Infant Mortality in the Southwest  •  51

curbing infant mortality (see table 4). The rate had been 142 in 1922 and was 143.7 in 1928. Broken down by ethnic group, Arizona’s infant mortality rate was 77.8 deaths in the first year of life for Euro-Americans and 205 among Mexican infants per 1,000. Howe explained the state’s overall infant death rate by focusing on the high rate for those of Mexican descent: “As long as Arizona has its constantly changing and shifting Mexican population I am convinced that we shall be able to show little if any improvement in the infant mortality rate as a whole,” she wrote. She attributed the high infant mortality rate to “large numbers of ignorant and constantly changing groups of Mexican laborers.”57 Howe attempted to blame the program’s poor record on the Mexican population. Although she and other Sheppard-Towner personnel were aware as early as 1921 of the high mortality rate among Mexican American infants, their attempts to reach this community were feeble and ineffective. They distributed no educational literature to “Mexicans of the migratory class” because they did not believe they would receive it. Unfortunately, they abandoned some of those with the greatest need for their services. The Sheppard-Towner Program commonly worked with community organizations to increase visibility and contacts, but there is no record of anyone from the Arizona program contacting a Mexican mutual aid society, such as Liga Protectora Latina. Although infant mortality among the Mexican population decreased from 230.5 to 205 during the Sheppard-Towner Program, it was still nearly double that of babies of color in the nation at large. The ineffective work of the Sheppard-Towner Program with Arizona’s largest minority group greatly hampered its overall success.58 In Utah, the population was much more homogeneous than in Arizona, so fewer challenges related to ethnic division and prejudice affected implementation of the Sheppard-Towner Program. People of color made up approximately one-third of Arizona’s population, whereas in Utah, less than 3 percent were from minority groups.59 In addition, the vast majority practiced the Mormon faith, leading to strong community and church

Table 4.  Arizona Infant Mortality in the 1920s 1922

1923

1924

1925

1926

1927

1928

142.1

125.4

130.8

132.9

116.4

126.8

143.7

Source: Arizona State Board of Health, Sheppard-Towner Report, July 1, 1928–June 30, 1929, submitted by Mrs. Charles Howe, RG 102, State of Arizona, National Archives.

52  •  Pregnancy, Motherhood, and Choice

networks, exemplified by the remarkable commitment and involvement of the women’s Relief Society in the Sheppard-Towner Program. After the federal Sheppard-Towner Act passed, the leaders of the Relief Society secured support from the president of their church.60 Even though some in Washington, D.C., called this public health program a communist plot to gain control of the nation’s children, the Relief Society joined Progressive women leaders to support it. Amy Brown Lyman, a Mormon woman who had volunteered at Hull House in Chicago, served in the Utah legislature in 1922, where she successfully advocated for Utah’s acceptance of the Sheppard-Towner block grant.61 Mormon women had a strong organizational structure already established when they began their Sheppard-Towner work. Founded in 1842 by Joseph Smith, the president of the Church of Jesus Christ of the Latterday Saints, the Relief Society provided a means for Mormon women to promote education and study health, hygiene, and midwifery, while also aiding the sick and the poor. Women participated in the Relief Society working on a local level within their church wards, but directions to local wards also came from the Relief Society president.62 In 1923, the Relief Society executive committee encouraged stake and ward presidents to work with Sheppard-Towner nurses and other medical personnel. Mormon women throughout Utah and those in neighboring states became involved in distributing literature on proper prenatal care, organizing conferences to instruct women about nutrition, hygiene, and child care, and helping with examinations of children and infants. Local leaders designed their own programs to meet community needs. From 1925 to 1929, more than 52,925 infants and children were examined in Utah alone, 133 health care centers were established, and over 3,700 women attended mothers’ classes. Displaying the depth of their commitment, over 4,000 trained volunteers assisted public health officials in this work.63 The Relief Society also assisted women by providing sanitary articles for delivery to new mothers and babies. Each ward and stake provided baby layettes, maternity clothing, and a convenient supply of necessary instruments for physicians and midwives, including bandages.64 In yet another aspect of their Sheppard-Towner work, Relief Society organizations established maternity health centers in seventeen different Utah communities. Some provided a few sanitary beds and assistance from volunteers, whereas others were fully equipped maternity homes with trained staff. For example, the Cottonwood Stake secured funding to ac-

Lowering Infant Mortality in the Southwest  •  53

quire a building which they equipped with the necessary supplies and personnel, including a trained nurse.65 Mormon women from Arizona also participated nominally in the Sheppard-Towner Program, hosting nurses who discussed the care and feeding of infants and young children. The Mesa Relief Society from Ward 2 publicized a talk by Miss Jensen, a Sheppard-Towner nurse, in April 1924.66 In January 1929, Sheppard-Towner nurses visited a Relief Society meeting in Chandler and examined the “little children from six years down.”67 In addition, members of the Relief Society in all communities cared for the ill, taught mothers about infant care, helped families devastated by the loss of a parent, and sewed clothing and quilts for the needy. These activities surely benefited the health of infants and families among this group, but they assisted members from their own congregations, not those from other religious or ethnic groups.68 In Utah, where the majority population was Mormon, the Relief Society activities had a great impact. Between 1921 and 1928, the Utah infant mortality rate fell from 73 per 1,000 births to 59. Utah’s success in lowering the infant mortality rate attracted the attention of the Children’s Bureau. Grace Abbott met with employees of the Utah State Board of Health, as well as Amy Brown Lyman and members of the Relief Society General Board, to congratulate them on their work.69 In the nation as a whole, the infant mortality rate decreased from 76 per 1,000 in 1921 to 67 per 1,000 in 1928. Maternal mortality also decreased. Despite these gains, the American Medical Association (AMA) lobbied powerfully against reenactment of the Sheppard-Towner Act and defeated it in 1929. By this time the women’s lobby had dissipated and the AMA campaigned against government intrusion in private life, claiming the bill had wasted tax money, failed to reduce mortality, and had not fostered a “single new idea.”70 Reducing maternal mortality throughout the United States was another goal of the Sheppard-Towner Program. In Arizona, the maternal mortality rate showed a gradual decrease during the life of the program, but it had never been a significant problem in comparison to the rest of the United States. From 1922–1925 and 1927–1928, maternal mortality was lower in Arizona than the national rate; the rate was higher in Arizona during 1921 and 1926. In Arizona the overall maternal mortality ranged from 5 to 7.5 deaths per 1,000, although it was higher among American Indian women.71 Perhaps Arizona mothers received adequate care in childbirth but their children died in high rates because unhealthy living conditions affected

54  •  Pregnancy, Motherhood, and Choice

infants more than mothers or possibly births and deaths were underreported, skewing the statistics. Based on the available vital statistics, Arizona had a lower rate of maternal mortality than did Utah and New Mexico. The maternal mortality rate dropped in Utah during the life of the Sheppard-Towner Program from 10.4 per 1,000 in 1921 to 9.6 in 1928, which was approximately an 8 percent drop. In New Mexico the maternal mortality rate was 9 per 1,000 live births in 1929. The national average was 6.9 per 1,000 in 1929.72

Improving Health during the 1930s When the Sheppard-Towner Program ended, Arizona health administrators cast about for new sources of public health funds. With the cooperation of the U.S. Public Health Service and funding from a Rockefeller Foundation grant in 1930 and 1931, the State Board of Health established public health units in Pima, Maricopa, Gila, Cochise, and Yuma Counties. Nurses at these centers provided immunizations against diphtheria, typhoid, and smallpox, and Child Hygiene Division nurses continued work done under the Sheppard-Towner Program by examining pregnant women, babies, and children.73 It is evident that this public health work did not reach some sections of the population. The infant graves in the Cementerio Lindo of south Phoenix, which were especially numerous in 1930, represent the great sadness and loss endured by the city’s Mexican American population. In the state as a whole, babies of Mexican descent comprised over half of all infant deaths—664 deaths of a total of 1,185 in 1930. At this time, Mexican Americans made up approximately one-quarter of the population. As the economy crashed at the beginning of the Depression, unemployment, hunger, and malnutrition may have led to these high rates of sickness and death. Diarrhea and premature births caused the majority of infant deaths among all ethnic groups.74 The African American population in Phoenix also suffered during the Great Depression. Although many black women used the services of Dr. Hackett, some were too poor to secure medical assistance. Serving an African American parish in the 1930s, Father Emmet McLoughlin, a Catholic priest, found abysmal living conditions in south Phoenix. In a slum of shacks, “babies were born without medical care; they often died because of the extreme temperatures,” he wrote. Untrained midwives and neighbors delivered babies in these conditions, until McLoughlin and others

Lowering Infant Mortality in the Southwest  •  55

began a maternity clinic. Placida Garcia Smith, the director of Friendly House, a settlement agency for immigrants, worked with Father McLoughlin to open a clinic for the minority women of south Phoenix. These two community leaders found volunteer staff from St. Joseph’s Hospital to work in the clinic to provide free prenatal and maternity care.75 The establishment of this clinic indicates that impoverished people in south Phoenix received little assistance from county and state public health officials. However, during the 1930s, county public health workers attempted to expand programs for infants and children. Although funds were limited, nurses examined children and babies and taught classes about prenatal care. One can only surmise that these services reached Euro-Americans more than minority groups because the disparity in infant mortality rates persisted throughout the decade. Impoverished conditions in cities and rural areas hampered these and other efforts to lower the infant mortality rate. Although public health nurses could not raise poor families’ income, they could provide them with educational services, and for people of color, these services were lacking.76 Nevertheless, by providing a minimal level of care for mothers and babies, and immunizing families against common childhood diseases, the county and state health units helped lower infant mortality during the 1930s. The infant death rate was 143.7 per 1,000 in 1930; it dropped to 112 deaths by 1935 and to 84.3 in 1940. Infant mortality for Mexican Americans decreased although it remained higher than that of EuroAmericans due to continued overcrowding, a lack of sanitary facilities, and poor housing. For example, in 1938, Mexican Americans in Pima County had an infant mortality rate of 144 per 1,000, while the Euro-American rate was reportedly 29. Dr. Lewis Howard, head of the county health department, believed malnutrition due to poverty, ignorance of proper prenatal care and infant care, and lack of hospital facilities caused the high mortality rate.77 In New Mexico, the public health department continued work begun through the Sheppard-Towner Program by training and regulating midwives. Physicians, public health employees, and volunteers also set up clinics to provide prenatal and infant care. By 1939, the infant mortality rate had dropped to 104, and it was 65 per 1,000 by 1949.78 People in Utah also continued maternity and infant care work during the 1930s. The Relief Society Magazine advocated social reform and public health programs, and the organization used money earned from its wheat fund to finance programs and maternity hospitals. The Cottonwood Stake Relief Society continued operating the Cottonwood Maternity Hos-

56  •  Pregnancy, Motherhood, and Choice

pital until 1963. The infant mortality rate in Utah remained lower than many other states—in 1935, it was 49 per 1,000; five years later, it had dropped to 40.6.79 During the Great Depression, American Indians in Arizona continued to suffer extreme losses due to infant mortality. Through the New Deal, health care programs on reservations improved, but great distances, isolation, poor sanitation, and distrust of Euro-American health care practitioners hampered efforts to lower the infant mortality rate.80 In 1942, the rate was still shockingly high in Arizona at 189 deaths per 1,000 American Indian infants.81 In these southwestern states, ethnicity, race, religion, and class all affected access to health care and infant mortality. Middle-class people of color with stable living conditions and decent incomes suffered much less from poor health than those living in poverty. Numerous oral histories of middle-class people of color make little mention of infant mortality. Those with farms and ranches, or in towns, with adequate incomes and communities able to provide assistance as needed, secured care for their children.82 In Arizona and nearby states, factors such as lack of sanitation and prenatal care, along with poverty, led to family tragedies and a high infant mortality rate between 1900 and 1940. Infant deaths were strongly tied to socioeconomic class, and typically minority people had lower incomes than Euro-Americans. In addition, minority people from every class enjoyed less access to public health education provided by programs such as Sheppard-Towner, while the Euro-American families enjoyed greater privileges and public health information. The advances of science and education touted by Progressive leaders had the potential to ease human suffering, but these benefits were not available to all sections of the population. Women’s biological roles as mothers united these diverse women, but huge differences stemming from privileges of class and color created a variety of experiences and devastating hardships for impoverished women and their children. When Margaret Sanger began working with volunteers to organize the birth control movement in Arizona, she cited the state’s high infant mortality rate as an indication that women needed contraceptives. Sanger and others claimed that birth control could potentially improve women’s health and that of their infants. The following chapter discusses Sanger, the Arizona women with whom she worked, and the clients of the state’s first birth control clinics.

c h ap te r thre e

Margaret Sanger and the Arizona Birth Control Movement

Margaret Sanger, the notorious and pioneering president of the American Birth Control League, came to Arizona from New York during the early 1930s for the same reason many others arrived during this time—to improve a relative’s health. Her grown son suffered from respiratory illnesses, and doctors recommended Arizona’s dry, warm climate. Sanger brought her ambitions, history, and philosophy to the rural western state and quickly began working with local volunteers to establish birth control clinics in Tucson and Phoenix. By the end of the third decade of the twentieth century, Sanger had helped establish a strong birth control movement in Arizona, providing women with expanded options in fertility control. Since the beginning of the birth control movement in the United States in the early 1910s, organizers had attempted to give women the means to limit their fertility. The movement faced fierce opposition by forces and institutions—especially religious ones—against reproductive freedom for women. In Arizona and throughout the world, the Catholic Church strongly opposed use of contraceptives and pressured female parishioners to lead a moral revolt against contraceptive access. Others followed eugenics principles and attempted to stop certain women from reproducing through laws limiting marriage and even forced sterilization of patients in state institutions. Controversy also existed in relation to abortion, which was illegal in Arizona and throughout the United States.1 Religious opposition to fertility control was much stronger in Utah and New Mexico, where clinics that focused on fertility control were not successful until many years later.2 57

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This chapter explores the people and ideologies behind the Arizona birth control movement, those who challenged them, and Arizona women’s desires for fertility control. Even though some religious, institutional, and legal structures attempted to curtail contraceptive use and women’s choice of when to bear children, during the 1930s, women of diverse class and racial backgrounds came together to secure the means to control their own reproduction. To do so, they had to redefine their roles as mothers, by claiming the right to determine how many children to have rather than allowing nature to take its course. They also separated sex from reproduction, rejecting the idea that intercourse naturally led to pregnancy. Certain groups contested this change because controlling one’s fertility violated traditional notions of womanhood and motherhood. Despite these conflicts, the new mothers’ health clinics remained open in Tucson and Phoenix, allowing their clients to limit their families, if they so desired. Among many sections of the U.S. population, attitudes concerning birth control changed during this time. Contraceptive use was limited during the 1920s, but by the 1930s, various methods of fertility control were more easily accessible and viewed more favorably by the medical profession and general public. At the same time, a lively market for overthe-counter contraceptive remedies existed, frequently billed as feminine hygiene products. One of the most commonly purchased items was Lysol, which was used as a disinfectant douche. A nationwide survey of attitudes toward contraceptives in 1936 found that 70 percent of the 100,000 people surveyed favored access to birth control. In 1937, the American Medical Association endorsed birth control. Federal laws denying the right to use contraceptives were reversed in 1936, but many state laws still decreed it illegal.3

Sanger and Her Work in Arizona In Arizona, Sanger played an important role in fostering the birth control movement by working with female volunteers who opened clinics in Tucson and Phoenix. Her national campaign for birth control began in New York in 1914, with the then-radical goal of liberating women from unwanted pregnancies. In the following decades, her rationale regarding the need for birth control changed with the times, partially reflecting changes in politics among her followers and supporters. In 1914 Sanger held socialist views, which led her to advocate birth control as a means to challenge the U.S. class system. She argued that the capitalist system required

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numerous children from the working class who were destined to become poorly paid workers. She also believed that access to contraception was essential for women’s health and liberation. Defying the 1873 Comstock Law, which outlawed birth control, she used her magazine, The Woman Rebel, to begin a discussion of contraceptives. After Comstock Law enforcers stopped the mailing of this publication, Sanger wrote “Family Limitations,” a pamphlet detailing contraceptive methods, including douches, condoms, pessaries, sponges, and suppositories. Sanger secured the assistance of members of the International Workers of the World to distribute 100,000 copies of this pamphlet as she fled to Europe to avoid prosecution under the Comstock Law.4 During this early period of her advocacy of birth control, from 1914 to 1917, Sanger was not alone. Other activists, including socialists and anarchists, also distributed birth control and faced jail time for their activities. However, most suffragists who belonged to the National American Woman Suffrage Association were lukewarm in relation to this cause. They tended to focus solely on winning the vote and often glorified women’s role as mothers to push for suffrage.5 Events during the late 1910s changed the political landscape of the United States; the Red Scare of 1917–1919 greatly diminished the presence of the Left as many socialists and anarchists were jailed or deported. Among leftists remaining in the country, few supported the birth control movement. The women’s rights movement was also in decline; after women won the vote in 1920, many former suffragists abandoned organized activities for women’s rights. One of the few existing feminist organizations, the National Women’s Party, focused solely on securing an Equal Rights Amendment and refused to back birth control access, believing it was too controversial.6 Although Sanger counted on little support from the Left or from feminist organizations, she and others organized the American Birth Control League (ABCL) in 1921. It attracted a membership of over 37,000 by 1926, with the typical member being an upper-class Protestant. Many of these women had supported women’s suffrage. The ABCL suffered from financial difficulties and internal strife. In 1928, Sanger quit the organization and focused her energies on the Clinical Research Department, a birth control clinic in New York.7 Sanger found new assistance through the growing eugenics movement in the early 1920s, which was receiving widespread support in the United States. She and other social radicals, such as Charlotte Perkins Gilman, a feminist intellectual leader, supported eugenics as a “civilizing force that

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would further the rights of women, as well as improve the race,” states Wendy Kline in Building a Better Race. Many religious leaders also supported eugenics, believing that the social ills of pauperism, crime, disease, alcoholism, and prostitution could be solved scientifically through the eugenics movement.8 Sanger’s understanding of eugenics differed from that of many eugenicists. She believed that lack of control over fertility led to demoralizing conditions for impoverished families who could not provide for their children. She argued that impoverished environments produced feebleminded children, not that the poor were naturally feeble-minded. In 1919, Sanger wrote that society needed “more children from the fit, less from the unfit—that is the chief issue of birth control.” She also discussed “over breeding” that could be harmful to “our way of life.” Although these statements may seem inflammatory and racist in the twenty-first century, they must be considered in context of the time period of the early 1920s. When the ABCL spoke out in favor of birth control as a means to improve “the race,” they defined the race as humankind in general, not as any particular race.9 Sanger emphasized that individual women must have the right to determine the size of their families and that women’s ability to control fertility would improve the “race.”10 In speeches throughout the 1920s and 1930s, Sanger argued that those who were feebleminded, morons, insane, syphilitic, or criminal should not have children. She advocated greater access to birth control both to reduce reproduction of those with negative traits and to improve women’s health. Sanger did not back those who decried race suicide, claiming that educated middle-class women were bearing fewer children while immigrants and people of color had high birth rates. In 1905, President Theodore Roosevelt attacked women who avoided motherhood in favor of education and careers. Antifeminists claimed that college education and work outside the home hurt women’s health and therefore their fertility.11 Historian Rickie Solinger states that Sanger joined with eugenicists when they “championed birth control even for healthy women.” The decline in the birth rate for the middle and upper classes during the early twentieth century most likely occurred because these women could find sympathetic physicians willing to provide contraceptives and abortions, while many of the poor, with no access to private doctors, could not.12 In 1934, Sanger clarified her use of the term “unfit,” saying that she “deplored” the term’s use in relation to specific races or religions. Nevertheless, her alliance with those in the eugenics movement gave support to

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others who believed that birth control should be used to limit the reproduction of those who were not Euro-American and of the middle class.13 By the 1920s, Sanger’s allies included some eugenicists and others from the middle and wealthy classes of the population. She also gained support from the middle-class members of the ABCL. The once-fledgling birth control movement, which had been assisted by radicals and the International Workers of the World, turned into a professional campaign, directed by Sanger’s ABCL and Mary Ware Dennett’s Voluntary Parenthood League. As they struggled to open clinics and lobby for changes in legislation, these organizations searched for donations from the wealthy. Sanger’s focus changed from securing assistance from leftist activists to finding wealthy donors to support her cause. By 1930, fifty-five clinics existed in twenty-three cities in the United States, and many were run by professional and well-to-do groups for the poor. Some ABCL affiliates were similar to upper-class women’s clubs whose members had the ability to raise funds.14 In the mid-1930s, Sanger again challenged the Comstock Law by arranging to have birth control devices sent from Japan to ABCL physician Hannah Stone. Since her flight to Europe in 1914, Sanger had developed international ties, which provided access to education regarding contraceptives and political influence. In this situation, her contacts in Japan provided a means to ship diaphragms and challenge the Comstock Law.15 As expected, the Customs Service intercepted the package, resulting in a court battle concerning the rights of physicians to receive birth control devices through the mail. Judge Augustus Hand of the U.S. Court of Appeals heard the case and ruled against the government on appeal, maintaining that when the Comstock Law passed in 1873, knowledge about contraception was poor. In his 1936 ruling (United States v. One Package of Japanese Pessaries), Hand stated that Congress would not have considered birth control as obscene if lawmakers had possessed present-day facts related to contraception and pregnancy’s dangers. Hand’s decision removed all federal bans on birth control, but in practice, it was restricted to married women who consulted doctors. In addition, many states continued to outlaw birth control.16 During the year of Hand’s ruling, Esther Louis Struckmeyer, known as Fritzi, was elected to the Arizona state legislature. A young, single woman from Phoenix, she introduced a bill in the House in 1937 to eliminate the ban on birth control information. During committee consideration of the bill, it was changed to allow only doctors to distribute birth control infor-

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mation. Sanger called Struckmeyer a courageous young woman who was the “first woman in any state legislature or in congress to have the courage to introduce legislation which would remove obstacles to the movement which means so much to their own sex.”17 Hand’s decision and similar state measures, like that in Arizona, provided more reproductive freedom, but some eugenicists tried to deny women’s ability to control their own reproduction by forcing the sterilization of so-called mentally defective women during the 1920s and 1930s. Many of these women were working-class Euro-Americans. Whereas positive eugenics promoted the need for upper- and middle-class Euro-Americans to have more babies, negative eugenics targeted those considered unfit and often stereotyped the working and poor classes as the group whose breeding should be restricted. For the most part, male scientists were behind this campaign to restrict the reproduction of the “unfit,” but some female Progressive reformers also became involved. Concerned about workingclass women who were perceived as decadent, these eugenics advocates believed these so-called rebellious women should be controlled through sterilization.18 Many eugenicists believed feeble-mindedness was a direct result of sexual promiscuity. In her book, Choice and Coercion, Johanna Schoen demonstrates that the Eugenics Board in North Carolina sterilized women from impoverished families who were seen as sexually promiscuous or ­unsupervised. “Sexual behavior, race, and class background constituted major factors in the identification of the so-called feebleminded,” states Schoen. Wendy Kline examined the California eugenics program at the Sonoma State Home and found that decisions “focused more on female sexuality and reproduction than on specific racial categories.” Yet race was very important, because eugenicists attempt to circumscribe the behavior of white women that they believed would result in racial degeneration. By sterilizing those Euro-Americans deemed “defective,” the eugenicists believed they could improve the white race.19

The Eugenics Debate in Arizona In Arizona, the state legislature became involved in the eugenics debate in 1915 when the Senate passed Bill 82, which limited the ability of the “unfit” to marry, to decrease their fertility. The Senate also passed Senate Bill 100, creating the State Board of Health to monitor state patients’ “fitness” based on eugenic principles. Although the Senate passed these bills,

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they failed in the Public Health and Statistics Committee of the House of Representatives.20 The Arizona legislature did not consider another eugenics bill until after the Supreme Court decision in May 1927 that upheld the Virginia involuntary sterilization law. In the Buck v. Bell decision, the highest court allowed the state of Virginia to sterilize an unmarried eighteen-year-old woman named Carrie Buck who had given birth to a baby. Buck’s mother was reportedly a prostitute who had been declared feeble-minded and sent to Virginia’s Colony for Epileptics and Feebleminded. This Supreme Court decision demonstrates that the court believed the state had the right to interfere with the reproduction of “socially inadequate persons.” This decision and the enactment of state laws allowing forced sterilization illustrated acceptance of eugenics principles and willingness to restrict the reproductive freedom of those considered unfit for parenthood.21 After the Buck v. Bell decision, many states, including Arizona, reentered the eugenics debate.22 In 1929, the Arizona state legislature passed a bill allowing the sterilization of state institution inmates, the first eugenics law passed in the state. Twenty-three other states had already passed laws allowing mandatory sterilization. California passed a law allowing forced sterilization as early as 1909, and the majority of the nation’s sterilizations occurred in California.23 Arizona’s 1929 eugenics law allowed the “sexual sterilization of inmates of certain state institutions in specific cases.”24 It permitted the superintendent of the State Hospital for the Insane to order a patient’s sterilization if it was deemed “in the best interests of the patients and of society.” Certain conditions might lead to sterilization, including idiocy, imbecility, feeblemindedness, or epilepsy. The law required the superintendent to present the recommendation for sterilization to the Medical Board of Examiners, which was charged with making the final decision. Guardians or parents of the patient were to be notified about the possible sterilization, and they were allowed to petition in support of or against it.25 In the year following the law’s passage, the director of the State Hospital for the Insane requested that the Board of Medical Examiners consider his request to sterilize two women at the hospital. After a hearing, the board approved the request, allowing Carrie Davis and Verne Mae Hillman to be sterilized in July 1930. Davis had been committed to the insane asylum by her husband in 1928, and Hillman had been committed by her father in 1930. Records indicate that Davis had had a mental breakdown leading to her husband’s petition for her commitment. She remained in the insane asylum until her death in 1966. Hillman’s order of commit-

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ment was backed up by a physician’s ruling that she was insane. However, she was released from the hospital in 1934, four years after her sterilization.26 The following year, the director requested that fourteen women be sterilized. The Board of Medical Examiners agreed to hold a hearing regarding this request, but to date, no records of the hearing have been found. In the minutes of the board, there is no further mention of these women.27 From 1931 to 1937, Board of Medical Examiners meeting minutes do not mention requests relating to sterilization of state mental institution patients. Then in January 1938, there was a petition requesting that Beatrice Delci be sterilized. The board decided “not to take any action on the case until the next meeting at which time the patient and her parents would be present for examination and consultation at which time an intelligent decision could be arrived at.”28 Unfortunately, the notes from the next recorded meeting do not mention Delci or the petition requesting her sterilization. No record of this hearing can be found in the board records or at the Arizona State Archives. Archival sources documenting the Board of Medical Examiners’ meetings are sparse. During the nine years following the request regarding Delci’s sterilization, there is no discussion of this topic in available meeting notes, most likely because the director of the State Insane Asylum did not push for sterilizations. In 1947, a newly appointed head of the hospital, Dr. John A. Larson, revived the issue of sterilizing patients. An article in the Phoenix Gazette discussed Larson’s desire to sterilize hospital inmates “who have hereditary insanity, imbecility, idiocy, feeble-mindedness or epilepsy.” The Gazette reporter, Dan Madden, stated that by 1946 only 20 sterilizations had been performed in Arizona since the sterilization law passed in 1929, whereas California reported 17,835 sterilizations by this time. Larson contended that sterilizations had been limited in Arizona due to a rapid turnover of insane asylum directors.29 Larson, praised as a “nationally-famed psychiatrist,” planned to begin sterilizing “mental defectives” because they “are by nature sexually promiscuous, and thereby more certainly would have children. Their children would probably be as mentally unfit as they,” he contended. Therefore, Lawson pledged not to parole a single feeble-minded person. He warned that due to the oversight of the Board of Medical Examiners and possible appeal of the board decision by the superior court and then state Supreme Court, it could be months before the first “test case” passed the legal hurdles.30 Two years later, in 1949, the Board of Medical Examiners considered a

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petition for sterilization. Hearing notes document consideration of the sterilization of Vivian Day Morris. Attending the hearing were Assistant Attorney General Joseph P. Ralston, Dr. Larson, Dr. Erickson, Vivian Day Morris, and her father. The board heard the evidence and examined the “girl herself” before deciding that “She was a good subject for sterilization, and it was so ordered.”31 These notes do not describe the nature of Morris’s problem or reason for the procedure. Within weeks of Morris’s sterilization, Dr. Larson was in trouble with the board of the insane asylum, which was now called the Arizona State Hospital for the Insane. Several board members wanted to fire Larson because he was reportedly a poor administrator.32 By April 1949, Larson was no longer director of the hospital.33 These sources indicate that approximately twenty forced sterilizations had occurred in Arizona by 1947. If these are the only incidences of sterilization, Arizona was quite different from states such as California, where thousands of sterilizations were performed, and Minnesota, where nearly 1,300 took place between 1926 and 1938.34 Despite the lack of evidence of numerous forced sterilizations, the passage of the law allowing this procedure demonstrates the acceptance of eugenics ideals among those in state government.

Birth Control Clinics in Tucson and Phoenix Sanger arrived in Tucson in 1934, hoping the dry climate would improve her son’s health. In the Old Pueblo, she quickly began promoting a birth control clinic, working with Tucsonan Barbara Dittman to organize a meeting of prominent women who were “friends” of the birth control movement. At that time, Tucson’s population was approximately 33,000.35 Sanger looked for women with social standing, political connections, and the ability to provide economic support for the new clinic. In this way, she used the same organizational tactics she had employed in the 1920s in New York and around the country. After an organizational meeting attended by “60 of the best women in Tucson,” the clinic began to take shape. The women leased a small house in a Tucson barrio for $25 a month and hired a practical nurse to staff Clinica para Madres (Mothers’ Clinic). Fees charged were never greater than $1, and many women paid nothing for services. The number of clients grew slowly. For the first three weeks, no one arrived. The clinic operated illegally until the 1936 Hand decision that struck down the Comstock Law. The number of patients

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grew gradually, and by the end of 1937, the little clinic provided services for seventy patients during the winter months.36 Many of the clients at the Mothers’ Clinic were Mexican American, as illustrated by photos taken of Sanger and a group of women on the clinic’s front steps. Although the available written sources do not discuss the ethnicity of clients, the photos and the clinic’s location in Tucson’s oldest barrio demonstrate that it served minority women. At this time in Arizona, those of Mexican descent made up approximately 25 percent of the population,37 and this ethnic group was composed of people with varied class standing. Tucson contained a Hispanic elite with families possessing longstanding businesses and political power, while others made their living as railroad workers or unskilled laborers.38 Virginia (Ginger) Yrun, executive director of Planned Parenthood of Southern Arizona in the 1980s, recounted in an oral history interview how she learned that her grandmother was a client at the first Mothers’ Clinic. After she found a photo of her grandmother at the clinic in old Planned Parenthood files, Yrun’s mother confirmed that she had visited the clinic.

Margaret Sanger, front row center, with volunteers and clients in front of the Mothers’ Health Clinic in Tucson, 1936. Courtesy of the Sophia Smith Collection, Smith College.

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“My grandmother’s life was saved by being able to access birth control, a diaphragm,” she said. Yrun’s grandmother, Emilia Lemas, a Mexican American, had been advised by her physician to visit the clinic after she had had several miscarriages. Becoming pregnant again would have severely threatened her health. Although the women of this Catholic family were aware of the church’s dictates against contraceptives, they had the fundamental belief that women’s health and independence were vitally important.39 Emilia Lemas’s story is especially significant because women who used the first Mothers’ Clinic did not leave many records related to their concerns and beliefs. By taking the initiative to secure contraceptives, Lemas rejected Catholic religious tradition, which claimed that birth control was immoral. She defined her own course as a mother and as a woman, limiting her fertility to save her health. Perhaps realizing that contraceptives might be attractive to Catholic women, the Church aggressively attacked the clinic. Soon after the Tucson clinic opened, the Catholic Church urged the faithful in Tucson “to halt the birth control movement.” A Church paper strongly condemned the practice, claiming that the “immorality of the modern parent who is eaten up with selfishness and the love of pleasure” led to birth control use. The paper further quoted physicians who claimed that contraceptive use would harm a woman’s nervous system and damage her health.40 The Church’s campaign against birth control continued into 1935 when Bishop Daniel J. Gercke wrote a letter to the “priests and faithful of the diocese of Tucson” stating that no Catholic woman was allowed to remain part of any organization that endorsed birth control. This letter was the bishop’s response to the General Federation of Women’s Clubs’ approval of contraceptive access. His diocese comprised the state of Arizona and included many Catholic women who belonged to women’s clubs. Claiming that the purpose of sex was reproduction, he wrote that those who attempted to control their fertility were guilty of a “sin against nature and commit a deed which is shameful and intrinsically vicious.” He further stated, “Many women are pagan at heart for want of proper education and culture.” He urged Catholic women to accept their duty to uphold the “sanctity of marriage and the normal, binding obligations of motherhood.”41 In these strong statements, Bishop Gercke reflected the views of Pope Pius XI, who in 1930 condemned any interference with fertility. Throughout the decade of the Depression, the Catholic Church used its power to characterize birth control use as an immoral act that undermined traditional mothers in their sacred role.42 The Church also opposed the eugen-

68

Clinic celebration at Margaret Sanger’s home in Tucson. Sanger is sitting in the front row, fifth from the left, wearing a white hat. Emilia Lemas, Virginia Yrun’s grandmother, is standing, two rows directly behind Sanger, wearing a hat with the black band. Virginia Yrun, executive director of Planned Parenthood of Tucson in the late 1980s and 1990s, did not know that her grandmother was one of the first clients at the Mothers’ Health Clinic until she found this photo at the Planned Parenthood office. Courtesy of Planned Parenthood of Arizona.

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ics movement, but made a small offering to women by explaining the “rhythm method,” which allowed couples to limit their families by having sex only during women’s infertile periods. In Santa Fe, New Mexico, the Catholic Church’s opposition and power made it difficult to distribute contraceptives at the Maternal Health Center. Founded in 1937 with a grant from Sanger’s Clinical Research Bureau of New York, this center began with the goal of providing general health services for women and children, including contraceptives. Due to strong opposition from Archbishop Rudolph A. Gerken, maternal and infant health care, rather than birth control, took priority, and the Sanger foundation withdrew its support. However, the clinic continued to quietly dispense birth control while making general health care for women and children their main priority.43 Although clinic organizers also faced opposition from church leaders, the Tucson Mothers’ Clinic remained open. In 1939, organizers printed a brochure outlining the aims of what they called planned parenthood for the family, child, mother, and community. Through use of the phrase “planned parenthood,” organizers attempted to turn the focus to responsible family choices regarding number of children rather than centering on the connection of the sex act with conception and the birth of a child.44 Benefits for the family included “removal of fear from the marriage relation,” and the opportunity to care for and educate every child. Here this reference to the “marriage relation” reflected the idea that sexuality could be freer without the fear of pregnancy. For the child, benefits involved assurance of being wanted and an increased chance for a healthy mind and body. Birth control could assist the mother by providing a means to preserve her health through spacing of children and by ending abortions, which caused many maternal deaths. The staff at the clinic further stated that birth control could help the community by reducing the spread of tuberculosis in crowded homes, reducing taxes necessary for governmental relief, and lessening delinquency, crime, and the occurrence of syphilis and insanity.45 When speaking to raise support for the clinic, Sanger used similar arguments, perhaps attempting to appeal to everyone with a variety of ideas that were common throughout the United States. The clinic board combined humanitarian, eugenic, and economic arguments to advocate for birth control. Through the use of these arguments, contraception became less a means to achieve women’s sexual and reproductive self-determination than it was a tool for family stability and community health.46

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This birth control rhetoric provided another definition of motherhood that involved planning when to give birth to better care for one’s family. Sanger and clinic volunteers did not challenge the importance of motherhood for women; instead, they stated that women could be healthier, more able mothers if they could space and plan their families. In a talk to benefit the Mothers’ Clinic of Tucson, Sanger used a variety of arguments, including one reflecting the eugenics philosophy. She stated that the “physically unfit usually beget the unfit,” and that “mental defectives, morons, idiots, imbeciles, are begotten by parents or progenitors whose bloodstream carries the taint which affected them.” In the same speech, she discussed the high rate of infant mortality and stated that birth control would eradicate abortion and improve women’s health. She combined a variety of arguments, perhaps to attract as many followers as possible.47 What impact did the eugenic arguments have in the community, and to whom was Sanger appealing? In particular, how did women of color respond to this rhetoric? Assessing the effect of these arguments is difficult. Tucson, like Phoenix, was divided by race and ethnicity. Schools were segregated and divided by ethnicity, as were jobs. The segregation experienced by African Americans was more harsh and restrictive than that known by Mexican Americans. Blacks faced segregation in public facilities, schools, neighborhoods, and jobs, in both Tucson and Phoenix.48 Despite these racial and ethnic divisions, Arizona clinics served women from all ethnic groups, and therefore, the birth control movement was progressive during this time of segregation. The rhetoric of the birth control movement here sometimes cast the impoverished in a negative light, but at the same time, the clinics provided contraceptives to all.49 During the late 1930s, Sanger helped organize a clinic in Phoenix. Through Arizona Republic newspaper articles, Sanger continued to publicize her views regarding birth control’s benefits. In 1937, she told an Arizona Republic reporter that limiting families to the number for which parents could provide would improve the human race. Reducing the number of indigents in the society would also lessen the tax burden. In addition, Arizona’s high infant mortality rate could be lowered if women had more access to birth control. “Science has given us the means of knowledge which when applied to our problems, could reduce maternal deaths, lessen poverty, wipe out unemployment, and create a race of human thoroughbreds,” Sanger said in a statement reflecting all of these views.50 In discussing the high rate of infant mortality, Sanger did not exaggerate; from the 1920s to the 1950s, Arizona had an infant mortality rate

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much higher than the national average, as discussed in the previous chapter. The rate remained especially high for Mexican American and American Indian infants, so this argument may have appealed to these groups, as well as those in the medical profession who attempted to help parents and their babies.51 The Arizona Federation of Women’s Clubs (AFWC) supported the new birth control clinics, passing a resolution in 1935 endorsing distri­ bution of contraceptives by physicians. N. Bess Prather, president of the AFWC, spearheaded the drive for this measure. Prather hailed from the small town of Casa Grande and became an ally of Sanger, helping organize clinics in the Southwest from 1935 to 1937. Prather also organized a talk by Sanger in the ranch town of Willcox, southern Arizona, in 1935.52

Abortion Unwanted pregnancies that ended with abortion were another health concern affecting women. In Arizona, and throughout the nation, abortion was illegal but underground and seldom prosecuted unless it resulted in a woman’s death. In the 1930s, there were rumors that an “abortion ring” existed in the state.53 Sanger’s desire to end the need for abortion by providing access to birth control probably appealed to many Arizonans. Arizona court records demonstrate that both lay practitioners and physicians performed abortions during the first half of the twentieth century. In 1918, Rosa Boido, a physician, was convicted of performing an abortion and sent to state prison. Boido was a well-respected physician who practiced medicine with her husband, also a physician. This case received newspaper attention and resulted in the closure of the Boidos’ twilight sleep clinic. Court documents tell the story of an unmarried woman, Dora Juhl, visiting the Boidos’ hospital to secure an abortion. Juhl stated that Rosa Boido agreed to perform the procedure for the sum of $50 but later raised it to $100 after her pregnancy progressed. Juhl secured the $100 from her boyfriend and returned for the abortion. Meanwhile, the boyfriend’s brother, a police officer, learned of the operation and arrested Dr. Boido. In court, the county attorney stated that evidence indicated Dr. Boido had performed a number of other abortions. A jury of twelve men convicted Boido, who was forty-six years old. Boido was not tried by a jury of her peers because women were not allowed to serve on Arizona juries until 1945.54 The jury proposed that she receive clemency for her crime, but the judge ruled against this recommendation.55

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Was the prosecution of Rosa Boido at this time a result of poor luck on her part, after she agreed to help Juhl, who knew a police officer, or did it occur because the police officers and the judge wanted to prosecute and convict a female physician? Historian Leslie Reagan found that during the late nineteenth century, as male physicians campaigned to keep women out of the medical profession, they “degraded female physicians by accusing them, along with midwives, of performing abortions.”56 In the early twentieth century, there was another campaign by physicians to discredit midwives by stating that many of them performed abortions. Reagan found in her study of the Chicago area that both physicians and midwives performed abortions; however, the medical profession attempted to cast women who did so in a negative light.57 This may have influenced Boido’s prosecution at a time when very few female physicians practiced in the state. Records from another case reveal the experiences of a young woman named Odessa Ball in April 1936. Ball, then twenty-one years old, traveled from her central Arizona home in Coolidge to visit a friend in Buckeye, west of Phoenix. She stayed with her friend for several days and then went to Billie Kinsey’s home, reportedly to have an abortion. At Kinsey’s home, she became very ill and was later transported to the hospital by Kinsey’s husband. Odessa Ball died at the hospital on April 28. Billie Kinsey was tried and found guilty of murder in the second degree.58 Kinsey appealed the verdict of April 1937, with her attorney arguing that Ball had tried to do the abortion herself and Kinsey had “merely attempted to alleviate her condition after deceased had already committed abortion.” However, following Ball’s death, officers found evidence of Kinsey’s abortion practice, including a bread box containing a number of surgical instruments, several with stains of fresh blood, and a number of towels and sheets that had been freshly laundered. They also found a curette and speculums in Kinsey’s possession, along with a pad and some cotton with fresh blood stains. An autopsy revealed that the medical ex­ aminer saw evidence of cuts, abrasions, and lacerations on Ball’s uterus, which were possibly inflicted by a curette. Judge Arthur T. La Prade, writing for the Arizona Supreme Court, affirmed the verdict, stating that the jury properly found the defendant guilty of murder in the second degree.59 As in Boido’s case, only men heard the case against Kinsey. These cases resulted in public shaming for the single women who had abortions and the women accused of performing them. Like similar cases around the country, they were, in themselves, a form of social control.60 Later, in 1945, a male physician, Dr. Nathaniel D. Hightower, ap-

Margaret Sanger and the Arizona Birth Control Movement  •  73

pealed his conviction of performing an abortion of Viola Pickens Stiles, a married woman. Viola Stiles died, and Hightower was prosecuted for both murder and conducting an abortion but only convicted of the latter. Hightower had also been treating Stiles for gonorrhea, and her gonorrhea raised “a reasonable doubt as to the cause of death,” leading to only one conviction. Hightower appealed his conviction, but failed in his appeal.61 According to historian Leslie Reagan, abortions were commonly performed by both physicians and midwives, and the majority of the procedures were safe. Many physicians did the procedure in the privacy of their offices or sent their patients to other physicians who performed abortions. Many patients were married, like Viola Stiles; usually their safe abortions remained private. However, Stiles’s death and gonorrhea led to a loss of privacy and a public shaming for her family through this trial. Unfortunately, poor women with no access to physicians often self-aborted with disastrous health consequences. Sanger’s claim that contraception was needed to reduce the number of abortions probably appealed to many, including those in the health profession.62 Throughout the nation, the incidence of abortion increased during the hard times of the Great Depression.63 It is noteworthy that Sanger and volunteers established clinics in Tucson and Phoenix at this time, when Arizona, like the rest of the nation, reeled under economic pressures caused by falling commodities prices, soaring unemployment, and loss of tax revenue for state and local governments. The involvement of prominent women with fund-raising skills who had time to volunteer was absolutely essential to the clinics’ establishment.64 It appears that many of these volunteers were genuinely committed to aiding women who did not have private physicians. Even after the legalization of birth control, contraceptive access was usually limited to those with the means to visit physicians. Therefore, birth control clinics that provided information to the poor were vitally important, and their numbers increased during this decade. By 1937, there were 357 birth control clinics in the nation, used by women of every class and race, although middle- and upper-class women were more likely to receive contraceptives from private physicians.65

Phoenix’s Birth Control Clinic To organize the Phoenix birth control clinic, Sanger met with wellconnected women from prominent Phoenix families who became committed to the cause. Mrs. Walter Bimson (wife of the Valley National Bank

74  •  Pregnancy, Motherhood, and Choice

president), Margaret Johnson (Peggy) Goldwater (young wife of Barry Goldwater from the prominent merchant family and future senator), and Maie Heard (wife of landholder, newspaper publisher, and investor Dwight Heard) were all involved. Sanger had met Maie Heard sometime prior to the clinic’s establishment, and the two had formed a strong friendship. The Heards owned the Arizona Republic, which reported on Sanger’s work in a very positive manner. Maie Heard encouraged other women to become active in the cause and offered moral support to the clinic’s first president, Mrs. Lucy Cuthbert. The Phoenix Business and Professional Women’s Club supported the new clinic, hosting a large event with 300 business women, the governor, mayor of Phoenix, chief justice of the Arizona Supreme Court, and other public officials.66 The first birth control clinic in Phoenix opened at 711 E. Adams Street, near the county welfare building. From 10 a.m. to noon, Monday through Saturday, the Mothers’ Health Clinic, with the assistance of Dr. Clyde Barker, provided information about contraceptive methods, along with prenatal care. Patients paid a nominal fee or nothing for contraceptives, based on what they could afford, according to an Arizona Republic article. Volunteers received the patients and kept the files. Dr. Barker, also a volunteer, met the patients, and a paid nurse worked with him. Barker fitted women for diaphragms and distributed contraceptive spermicide. In this way, the clinics in Phoenix and Tucson fit the pattern common in the United States of relying on volunteers and a paid nurse during the 1930s.67 Peggy Goldwater became one of the first and most committed of vol­ unteers during this time, and her involvement in family planning continued throughout her life. In October 1982, Planned Parenthood of Central and Northern Arizona honored her service of nearly half of a century. Peggy discussed her motivation in relation to birth control, saying that she became interested after a volunteer stint at the New York Infirmary for Women and Children when she was a young art student. Witnessing babies born to overwhelmed and impoverished women, she came to believe that it was “an injustice and a terrible tragedy for a little baby to come into the world unloved, unwanted and with no chance for health, dignity and self-fulfillment,” she said.68 She later taught her children that “families should be planned and if you couldn’t take care of them, you don’t have children,” said Joanne Goldwater, Peggy’s daughter.69 Sanger advised Peggy to space her children, and she did so, having her babies approximately two years apart. For Peggy Goldwater, birth control and family planning were important personal decisions that were central to a woman’s life.70

Margaret Sanger and the Arizona Birth Control Movement  •  75

Other volunteers at the Phoenix clinic also had experience in hospitals and sanatoriums serving impoverished people. Several women, including Goldwater, Heard, and Lucy Cuthbert, volunteered to help patients at Saint Luke’s Home, a sanatorium for those suffering from tuberculosis.71 “All were aware of the need for direct birth control assistance and information among those who had the most children and could least afford it. We knew family planning could relieve a great deal of human suffering,” Goldwater later said in an interview. At the same time, they felt “somewhat bold and daring” but refused to be embarrassed about their activities. Newspapers reported the establishment of the clinic and the names of volunteers during this time when people seldom discussed birth control openly.72 Most likely, the middle- and upper-class women who volunteered in the birth control clinics had access to contraceptives themselves and believed other women should have the same options. Sources such as photos and newspaper articles indicate that despite the eugenics rhetoric and implied condescension of some middle-class volunteers, a great variety of women, including those of the working class, whites, blacks, and Mexican Americans, responded positively to these clinics.73 In the 1940s and 1950s, several minority women went on to work as nurses and administrators in the clinics in both Tucson and Phoenix. At the same time, there were women from different cultural and religious groups who avoided the clinics because they believed birth control defied traditional notions of female behavior. These women continued to allow God and fate to determine their family’s size. Other women lost the ability to make their own choices when they were sterilized forcibly in the state insane asylum. Arizona legislation, passed in 1929, allowed this practice. The number of sterilizations in Arizona was limited, in contrast to several other states where forced sterilization was much more common. For those who wanted to control their fertility, the new Mothers’ Health Clinics provided greater self-determination and new options for women in Tucson and Phoenix. Sanger’s multifaceted appeal for family planning involved several arguments that appealed to Arizona women. Her discussion of problems related to high fertility and infant mortality, abortion, and poverty captured the attention of many and encouraged a committed group of middle-class volunteers. Her public discussion of abortion may have resulted in increased support for the birth control clinics because abortions resulting in patients’ deaths were publicized in the state. Sanger’s arguments also supported positive eugenics, reflecting common attitudes during this time period.

76  •  Pregnancy, Motherhood, and Choice

No matter what the philosophy or arguments Sanger and volunteers relied on to build the birth control movement, women from all ethnic groups used the clinics for a very fundamental reason—to control their own reproduction. During an era when jobs, neighborhoods, and schools were segregated, the clinics served a diverse group of women who desired access to contraceptives, even as the Catholic Church campaigned against birth control. Although sources explaining these women’s motivation are limited, one can surmise that they chose birth control for a variety of reasons, including their own health, to better care for their families, to enjoy sex without fear of pregnancy, and for economic reasons. For some women, the notion of motherhood was changing to involve limiting their family size so they could better care for their children. For others, traditional ideals about pregnancy and motherhood continued to define their reproductive lives. At the end of the Great Depression, the Arizona birth control movement expanded into the state’s cotton camps. The following chapter discusses the work of an energetic Farm Security Administration nurse and a Catholic priest who were determined to educate women about birth control options.

c ha p te r fo ur

“Tis a Sobering Experience” Providing Contraceptives for the Rural and Urban Poor

During difficult years of economic depression and war, new people brought energy and drive to Arizona’s birth control movement. Mildred Delp, a Farm Security Administration nurse, traveled throughout the state, speaking with migrant mothers about birth control. Father Emmett McLoughlin, a Catholic priest, provided contraceptives through St. Monica’s Clinic in south Phoenix, putting his priesthood in jeopardy. These individuals, along with volunteers, nurses, and doctors, expanded the birth control movement, providing new options to women from all ethnic groups in rural and urban impoverished areas across Arizona. Mildred Delp, a registered nurse, drove thousands of miles and talked to hundreds of migrant women between 1939 and 1942 to teach them the benefits of controlling their fertility with contraceptive foam spermicide. Working with nurses, volunteers, and physicians from throughout the state, Delp built on the foundation created by clinic volunteers in Tucson and Phoenix. Her detailed reports describe the struggles of migrant women at the end of the Great Depression and document women’s desire for birth control. These migrant mothers had high rates of fertility and extreme difficulties caring for their children as they followed the crops to make a living. Those who began using contraceptives provided by Delp were not rejecting the role of motherhood; rather, they were attempting to better care for and feed the children they already had. Following repeal of the Comstock Act in 1937, the Farm Security Administration (FSA) began this program quietly, supplying contraceptives to women in migrant camps throughout the nation. Although the federal 77

78  •  Pregnancy, Motherhood, and Choice

government did not officially endorse distribution of birth control, doctors and nurses operating the migrant health program viewed contraceptives as part of a larger preventative and educational program for their clients that could improve the family and economic lives of the migrants.1 Charged to serve the “bottom third” of America, the FSA hoped to rehabilitate the 1.7 million farm families throughout the nation who were experiencing economic devastation and often dislocation during the Great Depression. Providing medical care and preventive health education became important components of this rehabilitation, according to Michael Grey, author of New Deal Medicine: The Rural Health Programs of the Farm Security Administration.2

Migrants in Arizona Uprooted by drought and poverty, many migrants crowded into unsanitary labor camps located near cotton fields. Having abandoned their failing farms in Oklahoma, Arkansas, and Texas, they were attracted to Arizona by an advertising campaign waged by state farming associations. The majority of the laborers were Euro-American, but there were also Hispanics and African Americans. During the harvest of 1938, approximately 40,000 migrants, many living in dilapidated and unsanitary camps, picked cotton. Entire families worked for an average of $10.14 a week. Women struggled to hold their families together during these difficult times.3 Ann Stephens traveled to Arizona from Texas with her husband to find work. Arriving with only thirty-five cents in her pocket, she discovered despicable living conditions in migrant camps, as she related in an oral history interview: I’d never seen people live in tents, and live like they were living, cooking outside on a campfire, and sleeping in a tent, and getting up early in the morning and going out and picking cotton, and come in and, you know, just never have half enough of anything. . . . We had always lived above that . . . I never lived in a tent, and I just didn’t like the looks of tent city. . . . I thought it was the jumping-off place, the end of the world. They were dirty! You know, they lived on dirt ground, and they didn’t have no inside toilets. They didn’t have no showers. They didn’t have anything. To me, it was terrible.4 Ann worked with those who lived in tents, but she was fortunate in that her father rented a house for her and her husband. Still, the living condi-

Providing Contraceptives for the Rural and Urban Poor  •  79

Migrant family, living on Highway 89, near Chandler, 1940. Mildred Delp helped women and families like this one as she traveled around the state. Photo by Dorothea Lange. Courtesy of the National Archives.

tions in the camps distressed her. “Little kids running around with no shoes on, half enough clothes, half enough to eat . . . to me it was sickening,” she said.5 Studies of health conditions in migrant camps found that unsanitary conditions increased disease among children and adults. In addition, infant mortality rates grew substantially during picking seasons. The health of all migrants suffered, but people of color experienced the most devastat-

80  •  Pregnancy, Motherhood, and Choice

ing conditions with higher rates of infant mortality and infectious diseases.6 Through the FSA, the federal government organized medical cooperatives in rural America staffed by local physicians who provided health care for the poor. The migrant health programs involved a multifaceted approach by focusing on nutrition, health education, and sanitation. The program provided immunizations, prenatal and postnatal care, and obstetric care for women and children. Nurses were responsible for most of the educational work and routine medical care, but they also relied on local physicians. Both economic and philanthropic motivations fueled the participation of physicians in the FSA program. During the difficult decade of the 1930s, physicians also suffered economically as many of their patients could not pay for their services. They commonly accepted payment in kind, such as chickens, vegetables, and other food goods.7 Historian Marsha Weisiger conducted oral histories with approximately twenty Oklahomans who landed in Arizona during the Depression. She wrote about their experiences in Land of Plenty: Oklahomans in the ­Cotton Fields of Arizona, 1933–1942. According to Weisiger, many of the migrants lived in camps that lacked clean drinking water and sanitary facilities. Public health officials were concerned with dysentery, measles, smallpox, typhoid, pneumonia, and scarlet fever. Poor housing led to illnesses for migrants who suffered in bad weather. Increasing the misery, they could not work when it rained; therefore, they earned no pay during rainy weather.8 The FSA tried to aid the migrants by creating farm labor camps with clean water and sanitary facilities. The first Arizona FSA farm labor camp, the Agua Fria Farm Workers Community, was located west of Phoenix. It contained a few cottages and dozens of small cabins made of sheet metal with wood or concrete floors. The second camp, at Eleven-Mile Corner in Pinal County, served 1,800 people. Located at a central point, eleven miles from Casa Grande, Coolidge, and Eloy, it opened in 1940. These camps provided improved living conditions for some of the migrant families, but the great majority lived in makeshift camps near the fields and on farmers’ lands.9

Mildred Delp’s New Deal Migrants living in these camps had many and varied needs during these years, and some were interested in controlling their fertility. From 1939 to

Providing Contraceptives for the Rural and Urban Poor  •  81

1942, Mildred Delp organized family planning clinics in migrant labor camps in Arizona and California. Traveling throughout both states, Delp logged an average of 1,812 miles per month, instructing women in contraceptive methods, meeting with nurses and doctors, and sharing information about birth control. Her work and detailed reports provide a measure of women’s attitudes toward and use of contraceptives.10 Delp’s 1940 report, titled “Baby Spacing,” describes contraceptive use among the migrant women in California and Arizona, demonstrating that the older the women were, the more likely they were to have used birth control. Yet as table 5 indicates, it appears that the women used contraceptives sporadically, especially among the younger cohort, whose average number of pregnancies was nearly the same, whether or not they reported using contraceptives.11 Delp based the report on interviews with 858 women in Arizona and California from March through August 1940. Her work experiences led her to focus on the proper use of contraception and health education, so women would have the opportunity to determine when they wanted to bear children. In this report, Delp described her “contraceptive work in the rural areas of California and Arizona, designed exclusively to teach Baby-Spacing to migrant mothers and those whose incomes are far below the subsistence level.” She established clinics that were held every six to eight weeks to reach new mothers and provide refills of contraceptive supplies for those already using birth control. In 1940, she met with an average of 135 new mothers every month. Delp believed this service was of primary importance to migrant mothers, and she included women’s responses and notes in her report: “Dear nurse, could you please send me one o [sic] them cans of preventing powders having children?” Or, “Dear Mildred: I’m in a Table 5.  Migrant Women and Baby Spacing Age Have used birth control Average number of pregnancies for   those who used contraceptives Average number of pregnancies for   those not using contraceptives

Under 20

20–24

25–34

35–44

45 and older

37.4% 1.19

43% 2.15

49.1% 4.25

47.2% 6.52

62.5% 6.90

1.11

2.23

4.35

7.34

8.83

Source: Mildred Delp, “Baby Spacing Report on California and Arizona.” Planned Parenthood Federation of America, Sophia Smith Collection.

82  •  Pregnancy, Motherhood, and Choice

fix. My little boy pried the bottom out of my can of powder. There’s only enough left for one more use. I think it is wonderful. My last period was July 30th, and my next one depends on you. Urgent.”12 In another series of descriptive reports titled “My Day,” Delp documented her daily activities, describing her visits and meetings with migrant women, as well as with the nurses, doctors, and volunteers with whom she worked. She was careful to coordinate with those already working in the birth control field, including Margaret Sanger, Dr. Clyde C. Barker, Peggy Goldwater, and several nurses working at FSA clinics. Visiting and organizing clinics in Maricopa, Pinal, and Yuma Counties, she traveled around the state. In the Phoenix area, there were several clinics, spread out “more or less like a fan, covering an agricultural area of about sixty-five miles,” she wrote on April 11, 1939. She met Dr. Clyde Barker, whom she described as a young Oklahoman “who has been most courageous (against Catholic opposition) in conducting the B.C. clinic for the ‘League’ here.” According to Delp, Barker supported the FSA birth control program because many rural women lacked the means to travel to Phoenix for contraceptives, where they were distributed free of charge to those unable to pay. Delp also met Mrs. H. T. Cuthbert, president of the Birth Control League in Phoenix, along with the organization’s board. By meeting with these volunteers, Delp gained a great deal of support while she established new clinics in rural areas.13 Delp and other FSA nurses provided women with spermicidal foam powder. Although she did not fit women for diaphragms, she referred those who wanted them to the clinics in Tucson and Phoenix. In 1940, Delp reported that migrant women in general did not prefer diaphragms for two reasons: many were unable to buy jelly, or they found the diaphragms uncomfortable. Delp wondered if the women had been properly fit by a physician for this method of birth control. Throughout the nation, the lack of a proper fit limited use of diaphragms, according to historian Linda Gordon.14 As she worked to distribute contraceptives to migrant women, Delp looked for supportive physicians in Phoenix and surrounding towns. In Arizona’s capital city, Delp found several physicians who agreed to sponsor the contraceptive program, including Drs. James M. Mason, C. L. Pohle, and Kenneth Peterson. Dr. Peterson, however, worried about publicity because Phoenix was a “Catholic town,” reported Delp, who was always conscious of opposition from the Catholic Church. These doctors all belonged to the Agricultural Workers Health and Medical Association (AWHMA), which developed a migrant health plan for California and

Providing Contraceptives for the Rural and Urban Poor  •  83

Arizona before it expanded nationally.15 Physicians with the AWHMA program staffed clinics in Phoenix, Chandler, Tolleson, and Buckeye, caring for migrants who suffered from injury or illness, as well as malnutrition. They also educated patients about contraceptive options.16 At the Buckeye clinic, Delp met with Mrs. Phoebe C. Eittreim, RN, and Dr. V. J. Jeffery. Nurse Eittreim planned to make home visits with the foam powder contraceptive, and Dr. Jeffery expressed enthusiasm for the program, even wondering if “this stuff will work at our house!”17 Indeed, all the physicians with whom Delp visited expressed interest in the program, leading one to wonder if Delp only visited physicians whom she guessed would be supportive. At the end of April 1939, she felt satisfied with her progress and assistance from nurses in five clinics who were committed to reaching needy mothers in migrant camps.18 After launching the birth control program in Arizona, Delp traveled to

Migrant mother and baby, living near Buckeye, 1940. Photo by Dorothea Lange. Courtesy of the National Archives.

84  •  Pregnancy, Motherhood, and Choice

California. She returned to Arizona in early 1940 and began revisiting clinics. Many of the same physicians and nurses were still involved in the program, such as Dr. Clyde Barker. In January 1940, Delp attended a clinic in Peoria with Barker and a public health nurse. Barker fit some women with diaphragms, and Delp provided others with foam powder. Delp recorded that some new women also became involved, such as Mrs. Alex Moldanado, who organized meetings for Mexican mothers on January 11 and 18. Fifteen women, many with babes in arms, received foam powder, and others accepted refills, having already been supplied with contraceptives. Delp reported that someone interpreted English for the “adorable” group, all “spotlessly clean.” It appears that the clean appearance and pleasant manner of these women of Mexican descent may have surprised Delp, who made note of it in her report. She also noted that the women had had an average of one pregnancy every eighteen months.19 Though many of her “My Day” reports were upbeat, Delp became discouraged when her patients used the spermicide carelessly and became pregnant. In her travels, she met many women with numerous children, including one thirty-one-year-old mother who was pregnant for the sixth time in sixteen years and very unhappy due to the family’s economic uncertainty. Delp encouraged her to visit Dr. Barker’s Phoenix clinic following her delivery, and she agreed.20 In May 1940, Delp noted that Margaret Sanger had recently spoken to a group of women at the Agua Fria camp on the west side of Phoenix, but her talk was poorly attended. Sanger also spoke at the Eleven-Mile Corner Camp in Pinal County, Delp noted, on May 9, 1940.21 Delp became friendly with Sanger and maintained an active correspondence with her concerning the doctors who supported the birth control movement and others who opposed use of contraceptives.22 On May 10, 1940, in Buckeye at an AWHMA clinic, Delp spoke with thirty-five women of mixed ethnicity, including women of European, African, and Mexican descent, “all most congenial” and “28 new mothers receiving instructions, and F.P.” (foam powder). During the week ending May 11, she reported fifty-nine new patients, eighteen “re-checks,” and eight refills.23 In July, in western Arizona, Delp met with women from a new camp of fifty families. She described a very successful meeting, attended by twenty women, including “Negro women. . . All so clean and nice, despite the soaring temperature.” According to the report, twelve grateful mothers took foam powder.24 Again, Delp notes the cleanliness of the women of color, displaying a condescending attitude. Such sympathetic views mixed with condescension were similar to those of other case-

Providing Contraceptives for the Rural and Urban Poor  •  85

The Farm Security Administration improved conditions for migrant families by building camps with clean water and sanitary facilities. This camp was located near Eloy. Margaret Sanger spoke here in May 1940. Courtesy of the National Archives.

workers around the country, according to historian Linda Gordon, who noted that many early birth control workers were educated women who had had little contact with the very poor.25 Like Sanger and volunteers in Arizona cities, Delp displayed a maternalistic attitude toward her patients, especially women of color. Delp’s ethnocentric attitudes received a greater test when she visited Guadalupe, located near Tempe. The town site of Guadalupe, established in 1914, was inhabited by Pascua Yaqui Indians who were immigrants from Mexico. In the early twentieth century, they had fled Mexico for the United States, seeking a safe environment and employment, which they found in the Phoenix area. Yaqui men provided valuable labor for both the Salt River Valley Water Users’ Association and local farmers, and women did service work and laundry. Although they lived in impoverished conditions in Guadalupe, they enjoyed their own traditions and an active community life. People of Mexican descent, who also provided farm labor, began settling in Guadalupe by the 1930s.26 When Delp visited Guadalupe, the population was approximately 300. Delp had been to migrant labor camps and assisted many impoverished

86  •  Pregnancy, Motherhood, and Choice

people, but the conditions in Guadalupe still surprised her. She described the little settlement: occupied by about 100 Yaqui Indian families, who lived in forlornlooking adobe houses—to me, a typical Mexican village, infested with pathetically dirty children, some of whom have advanced trachoma, pointed out by one of the teachers from the school held within the tract. There is a laundry cooperative carried on also, under the supervision of Mrs. Ruby Wood who speaks the Yaqui language fluently and directs this work. . . . The Indian women do their own laundry, also take in outside work for their partial support, while the men mostly work on the nearby ranches. . . . Mrs. Wood urged us to plan a BC meeting, as so many of the mothers ask her for such advice. Accordingly, a clinic was set for a week hence, same to be held among the washers and mangles! And to be “delivered” through an interpreter! Heaven help us all.27 The next week, despite her prejudice and concerns, Delp met with twenty-five Pascua Yaqui women in the laundry cooperative, with an ironing board serving as her demonstration table. She noted that all of the women draped their heads artistically with scarves. As she spoke, an interpreter busily translated while the women talked among themselves. Twenty-three of them left the meeting with spermicidal foam powder, demonstrating their interest in contraceptives, no matter how they may have perceived Delp. Ranging in age from nineteen to thirty-six, they all had large families. Delp also recorded that there was a high percentage of infant deaths in the area.28 Delp’s reports in November 1941 display the interest of minority women in contraception. On November 11, she wrote, “We had one Mexican mother, 3 Negroes, and 13 white women—all interested and articulate. Everyone is picking cotton.” Minority and impoverished women had their own reasons for using birth control, regardless of the desires and perceptions of those who provided it. They most likely ignored the condescension of women like Mildred Delp because she provided a valuable service.29 The migrant mothers needed all kinds of assistance, Delp found. She described a home visit on a very rainy day in January 1941: “Tis a sobering experience to find a youngish mother in bed in a 16×14 metal cabin, with two babies cuddled close to her, one 10 days old, the next 15 months, with three other small kiddies hovering over a little tin stove to dry out from the downpour.” The high fertility and impoverished living conditions of these

Providing Contraceptives for the Rural and Urban Poor  •  87

women affected Delp, who was gratified when she could help them limit their fertility.30 While Delp’s detailed reports demonstrate her ideas and feelings in relation to her clients, ascertaining the response of the migrant women is difficult. The records document their attendance at meetings and acceptance of contraceptives. Delp also includes notes that they wrote to her, asking for assistance. Despite the lack of actual interviews with the migrant women and limited written sources by them, these reports illustrate their interest in contraceptives and their desire to limit their fertility. During her time in Arizona, Delp continued to maintain contact with those providing contraceptives in Phoenix. She and another nurse had tea with Peggy Goldwater, Margaret Sanger, and members of the Phoenix birth control board on February 4, 1941. Delp made plans to take this group to visit the FSA migrant camp clinics. In October 1941, she met with Dr. Clyde Barker, who informed her of new Catholic appointments on the state health board. Delp also found that some of her patients were using the Tucson Birth Control Clinic, and she provided spermicidal jelly to those who had diaphragms. Her reports illustrate that there were strong connections between professionals and volunteers throughout the state who supported the active birth control movement.31 In December 1941, Delp began to feel the effects of the war, as Dr. Neff, who had participated in a Mesa family planning clinic, became involved in caring for soldiers stationed at Falcon Field. Nurses also left to serve in the armed services, causing staff changes and program disruption.32 Despite these changes associated with the war, Delp continued organizing clinics. She described meeting with mothers in April 1942: “A grand group of women, many carrying very young babies, but all interested and responsive. Diaphragm technique was also explained, with mention of Phoenix and Tucson services, in case any preferred to go there. 12 new patients for foam jelly were filled, and 2 refills—age group 22 to 36, all white women–with high fertility—nearly all having attempted to use some form of B.C. at one time or another-withdrawal, usually or condoms intermittently, as funds were available. The fallibility of douching alone or nursing a baby is stressed as unsound contraceptive practice.”33 Although Delp documented successful work in Arizona, her time there soon ended. She received a letter requesting her presence in Portland, Oregon, in May 1942 to direct the FSA nursing staff in distributing contraceptives.34 Her “My Day” reports concerning Arizona stopped at this time as she left her southwestern post. During her time in the state, she logged

88  •  Pregnancy, Motherhood, and Choice

tens of thousands of miles traveling to meet with migrant women. Her dedication to sharing contraceptives provided an important option to migrant women of all ethnic groups. As the nation jumped wholeheartedly into the war effort, the New Deal’s popularity waned, and the FSA lost momentum and funding. Many rural physicians and nurses became involved in the war effort, and as jobs became more plentiful, farm workers flocked to urban areas to find more lucrative positions. Yet the food production program demanded by the war required many laborers, and the FSA health programs remained in limited form during the war because they improved worker productivity.35 During World War II, the birth control movement in Arizona slowed down. Many of the men were away, and women volunteers became involved in activities supporting soldiers on the home front. Sanger remained in the state during the winters, advising leaders of the Tucson Birth Control Clinic and volunteering on the board of the Desert Sana­ torium, which became the Tucson Medical Clinic.36 The national orga­ nization of Planned Parenthood continued operating and distributed pamphlets equating birth control with patriotism, national strength, and military victory.37

Birth Control in Post–World War II Arizona Following the war, the population in Arizona began to grow as many soldiers returned, married, and started families. The post–World War II economic boom in Arizona generated new companies and the expansion of old ones.38 As the birth rate climbed following the war, women refocused their efforts to provide family planning services. Whereas the clinics in the 1930s were called Mothers’ Health Clinics, by the 1940s, they were part of the Planned Parenthood Federation of America (PPFA), organized in 1942. The PPFA focused on family planning to strengthen the family unit, yet by making contraception more accessible to women, the organization freed females from unintended pregnancies, creating more opportunities and expanded choices when they were able to control their reproduction.39 “The Planned Parenthood Clinic of Phoenix will open new offices tomorrow in the Episcopal Mission parish house, 519 W. Pima Street,” read an Arizona Republic article on March 31, 1947. Mrs. A. B. Kinsolving, chair of the clinic, was the wife of Episcopal Bishop Kinsolving. Mrs. Kinsolving stated that the clinic would provide contraceptive services, along

Providing Contraceptives for the Rural and Urban Poor  •  89

with information related to sterility and infertility. Although the clinic was open every day at 10 a.m., consultations with physicians occurred only on Tuesday mornings.40 It is noteworthy that the Episcopal Church provided active volunteers and space for the birth control clinic at this time. Bishop Kinsolving managed St. Luke’s Sanitarium, caring for many with limited means who suffered from tuberculosis. The Episcopal Church, along with official bodies of Unitarian Universalists, Reform Jews, and numerous other Protestant churches, supported access to birth control by the early 1930s.41 During these years, birth control activities also continued in Tucson. The clinic, still located at 28 E. Corral Street, had a long list of sponsors, including many physicians. Sanger was the clinic’s honorary chair.42 She and birth control activists continued to quarrel with Catholic Bishop Daniel Gercke, a staunch opponent of access to contraceptives. In 1945, the newly renamed Tucson Planned Parenthood Clinic applied to become a member of the Tucson Council of Social Agencies. Although the council agreed to this request, the Planned Parenthood clinic was not formally ­accepted.43 After learning about the clinic’s potential admission to the Council of Social Agencies in January 1946, Bishop Gercke protested the clinic’s membership. He claimed that the principles of the Planned Parenthood Association were “immoral, that they violate God’s laws, and that God’s laws cannot be changed by man.”44 The bishop threatened the withdrawal of Catholic Social Services if Planned Parenthood gained acceptance in the Council of Social Agencies.45 Despite the bishop’s threats, a few months later, the leadership of the council accepted Planned Parenthood as a member. Mrs. Benson Bloom, an active sponsor of the Planned Parenthood clinic, speculated that the “little people and the small agencies” provided this victory.46 The following year, Sanger and Bishop Gercke again represented opposing views, this time in talks before the American Legion Luncheon Club in Tucson. Sanger spoke on March 25, 1947, stressing the need to inform women about contraceptives so they could space their children. She criticized those who would deny family planning information to the needy and supported offering birth control to those women with a temporary disease, such as tuberculosis, so they could delay childbearing until they were healthy. She also stated that overpopulation caused world wars and criticized the Russian government for paying women to bear children.47 When Bishop Gercke took the podium at the American Legion the following week, he opposed birth control for several reasons. Use of contra-

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Bishop Daniel J. Gercke, the Roman Catholic leader of the diocese of Tucson, waged a running battle with Margaret Sanger about the issue of birth control. Courtesy of Diocese of Tucson Archives.

ceptives was an “insidious influence that has been lulling her [America] to sleep,” he said. Furthermore, the practice threatened marriage because it undermined the reason for this union, he stated. Herein, Gercke directly linked marriage and sexuality with reproduction. In addition, he claimed that lowering the birth rate would result in America’s inability to fight another war, and he used the Soviet policy of promoting large families as a model for the United States.48 Gercke challenged Sanger’s views as if they were debating the effect of the birth control movement on national security and the Soviet Union’s policy related to childbearing. Sanger maintained that overpopulation caused world wars, whereas Gercke argued that large families would help win them.

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Father Emmett McLoughlin, a Catholic priest and founder of St. Monica’s Clinic in south Phoenix, also quarreled with the powerful Bishop Gercke. Serving many minority people who had limited access to health care, Father McLouglin had founded St. Monica’s Maternity Clinic in 1937. The clinic relied on nurses and hospital interns who donated their services to women in the neighborhood. By 1944, the maternity clinic had evolved into a hospital, located on Buckeye Road and east of Seventh Avenue. The Booker T. Washington Hospital, which had served African Americans, had closed a year earlier, and St. Monica’s received medical supplies and technical equipment from this hospital.49 By organizing the clinic and hospital, Father Emmett McLoughlin provided an extremely valuable service to the poor of south Phoenix who lacked medical care. He also pioneered by offering the area’s first integrated nurses’ training program at St. Monica’s Clinic, which was the first integrated program west of the Mississippi River.50 In August 1947, Bishop Gercke contacted Father McLoughlin by letter about a vacancy on the Arizona State Welfare Board, which was part of the same bureaucracy as the Arizona State Board of Health. In the letter, Gercke mentioned that Margaret Sanger “was reported to have said that no ‘fish eater’ would ever occupy this position.” Gercke worried that if a Catholic were not on the board, Sanger would be able to “pass a law legalizing all the clinics which her group is opening throughout the State.” This is a curious statement because by this time, birth control was already legal. Nevertheless, Gercke urged McLoughlin to support Dr. Clarence R. Kroeger, a Catholic, for this position.51 Unfortunately for Bishop Gercke, McLoughlin opposed this particular candidate because McLoughlin believed he did not meet the requirements of state law. In addition, McLoughlin possessed radically different ideas about birth control than did Bishop Gercke. An Irish Catholic and a Franciscan, Father McLoughlin nonetheless believed that the Catholic Church’s dictates regarding birth control were catastrophic. In his autobiography, The People’s Padre, he wrote the following: “The Roman Catholic prohibition of birth control has exploited women, bankrupted and disrupted families, and burdened the Catholic population with thousands of unwanted and uncared for children. . . . By orders of the hierarchy, priests must preach against birth control as mortally sinful. But they are closer to the people than the bishops are. They know, on the one hand, that it is practiced by a very large percentage of their parishioners.”52 Father McLoughlin’s work through St. Monica’s Clinic led to his expanded understanding of the health needs of those living in the area. He

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had struggled for years to meet this community’s basic needs and was involved in providing prenatal care to mothers. In the 1940s, doctors at St. Monica’s Clinic branched out in a new direction, instructing patients about contraceptives. Father McLoughlin wrote, “My beliefs regarding birth control, of course, were heretical. I believed in it and instructed our medical interns to give all contraceptive advice necessary to the numerous mothers who crowded our clinics.” McLoughlin violated Church policy and waged a running battle with the Church on this issue. He had additional arguments with Franciscan Order leadership, who asked him to leave his position as superintendent of St. Monica’s Hospital. Eventually, McLoughlin left the priesthood after refusing to accept Church orders to leave his hospital post. He went on to marry and live in Phoenix, working as superintendent of the hospital he had founded.53 McLoughlin was well respected among Phoenix’s African American and Mexican American communities. In addition to providing health care for the poor, he opened gyms and recreation centers for young people and gained the trust of all. He also successfully lobbied the state and federal governments to provide new public housing in Phoenix.54 After World War II, St. Monica’s Hospital was renamed Memorial Hospital in honor of veterans; this facility continued distributing contraceptives and eventually hosted a Planned Parenthood clinic.55 Support for access to birth control also came from an African American newspaper called the Arizona Sun during these years. In 1947, the Sun, located in Phoenix, ran an article datelined New York concerning the second nationwide Planned Parenthood campaign. The article stressed that planned parenthood could help lower maternal and infant mortality which were higher among African Americans than among Euro-Americans. At this time, a clinic at 521 W. Pima Street operated in a black neighborhood with staff assistance from Mrs. Hallie Richardson, an African American nurse. Richardson was described in another article in the Phoenix Gazette as a registered nurse who is able to give helpful and individual service to every woman.56 This advocacy for the birth control movement by African American newspapers was common throughout the United States, according to historians McCann and Solinger. Black newspapers shared information about clinics, contraceptives, and the Planned Parenthood organization. As early as the 1920s, some in the black community, including W. E. B. du Bois, urged women to use birth control to lift up the race and facilitate economic advancement. They based their rationale on the need for every-

Providing Contraceptives for the Rural and Urban Poor  •  93

one in the African American community to have health care, education, and economic well-being.57 People in the medical community also began to publicly support contraception at this time. In 1948, the Arizona State Medical Association and the Maricopa and Pinal County Medical Associations announced their endorsement of the Planned Parenthood Committee. This wellpublicized approval by medical associations strengthened the standing of the family planning organization.58 In February of the following year, the Planned Parenthood Committee of Phoenix initiated a fund-raising campaign to finance a second clinic to meet the needs of an expanding client base. The drive was successful—a few months later, a newspaper article noted that the second Planned Parenthood clinic opened at 1005 E. Washington Street. In a well-posed newspaper photo that publicized the clinic’s opening, a young Mexican American woman, Mrs. John Perez, sits with her daughters, as her husband stands behind her. Mrs. Perez is being interviewed by a EuroAmerican woman, Mrs. Wilbert Bond, secretary for Planned Parenthood. In the background, behind the Perez family and Mrs. Bond, is a poster of a Euro-American couple with three healthy-looking children. The image presented both by the photo of the Mexican American clients and the poster is that use of contraceptives would enable all families to be strong and healthy.59 Planned Parenthood rhetoric and publicity did not challenge the notion of motherhood’s importance; instead, organizers stressed that planned families were better for the mother and the entire family. The clinic on Washington Street did not remain open for long. In March 1950, the two smaller clinics closed, and a new one opened at 102 E. Pierce Street. Clinic chair Mrs. Dennison Ketchel stated that this new clinic would meet the increasing demand for services. The clinic cared for 285 patients in 1948, 566 in 1949, and expected an increase in numbers in 1950. The new location boasted a three-room suite and a private entrance.60 By the end of the 1940s, a great variety of people were providing birth control in Arizona: Margaret Sanger; numerous physicians; Lucy Cuthbert, Peggy Goldwater, and many other volunteers; FSA nurses, and a Catholic priest. The activities of volunteers and medical professionals during the 1930s and 1940s extended contraceptive access to impoverished rural and urban women from all ethnic groups. While middle-class women acquired birth control from their private physicians, the poor were unlikely to see physicians regularly and often went without the services that the middle class enjoyed.61 Arizona women who desired contracep-

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tives received assistance from both professionals and volunteers who withstood the opposition of the powerful Catholic Church. Those in the birth control movement served a receptive clientele made up of many women who persevered in seeking out clinics, physicians, and nurses, even when large obstacles stood in their way. Their self-determination is a vital component of the state’s birth control story. It illustrates that during the 1930s and 1940s, some Arizona women were redefining notions of family and motherhood by attempting to control their own reproduction to improve their health, improve the family economy, and better care for their children. By the 1940s, women gained new options in fertility control, but they faced other challenges related to reproductive health, especially in rural areas. The following chapter discusses attempts to decrease maternal and infant mortality in impoverished and remote areas of the state, as well as the leaders who expanded public health to improve the lives of women and their families.

cha p te r fi ve

Battling Poverty and Isolation to Improve Mothers’ and Infants’ Health

In 1963, Dr. Pearl Mao Tang became chief of the Maricopa County Bureau of Maternal and Child Health. A Chinese American who had fought to obtain a medical license in Arizona, Tang was instrumental in lowering the infant mortality rate in the state’s most populous county. Her work and that of American Indian leaders and public health nurses aided families in migrant farm camps, impoverished urban areas, and on Indian reservations. Although mothers’ and infants’ health care improved, even in 1970, the infant mortality rate on some American Indian reservations remained as high as that of developing countries.1 Oral history interviews of Dr. Tang, along with memoirs and reports related to American Indians, illustrate the varying quality of health care for women and families during the decades following World War II. While upper- and middle-class women in urban areas had many options in reproductive healthcare, others struggled to secure basic assistance, which was often determined by their locale, race, ethnicity, and income level. Tang and others worked through the public healthcare system to meet the needs of the poor in cities and migrant labor camps. Many American Indians, living on isolated reservations with poor roads, often lacked basic care, which resulted in a rate of infant mortality that was three to four times higher than the national average.2 Even during the 1950s in the rural West, a lack of infrastructure affected reproductive health care. This chapter illustrates that ethnicity, geographic location, and income level continued to have a vital impact on women’s health from the 1950s to 1970. 95

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Despite these difficulties, through the dedication and persistence of two public health leaders—Pearl Tang and Annie Wauneka, a Navajo— cross-cultural communication improved, leading to better delivery of health services and lower rates of maternal and infant mortality. These women made it safer and healthier to give birth and raise families, improving the health of mothers, babies, and entire communities.

Childbirth: Still Precarious for Some In 1953, Mary Zillatus, a public health nurse, began working on the Navajo reservation, which covers nearly 27,000 square miles. This reservation is the largest in the United States and occupies northeastern Arizona, the southeastern portion of Utah, and northwestern New Mexico.3 In a memoir describing her work, titled “Transfer to Nowhere—1953 Pinon,” Zillatus illustrated the remoteness of reservation life and the effects of isolation on healthcare. She lived and worked in the little settlement called Pinon, located in the middle of the “vast Navajo Reservation 106 miles from the nearest shopping center Winslow.” In addition, the nearest doctor was in Keams, sixty miles away.4 Zillatus, charged with providing health care for those in the surrounding area, soon found that some of her most challenging cases involved women giving birth. One delivery went well with the birth of a healthy baby boy; however, the mother, Juana, hemorrhaged following his birth. Zillatus treated the woman as best she could and then drove her patient over rough dirt roads to Keams, where a doctor waited, ready to give Juana a transfusion, thereby saving her life.5 In another situation, a woman’s preexisting health situation made delivery precarious. Zillatus drove Constance, the laboring woman, to Fort Defiance. On one section of narrow road, they “met a coal truck. Neither the truck nor our car could pull out soon enough. We crashed into each other,” wrote Zillatus. Fortunately, no one was hurt, but Zillatus now had no way to transfer her patient to the hospital. “Our trip ended then and there. Constance was having pains about 20 minutes apart,” she wrote. “As yet, they were weak and short.” A traveling companion walked back to Pinon, and they called for an ambulance. The ambulance arrived in time, and Constance delivered a healthy baby boy in the hospital.6 Zillatus stayed in Pinon for two years and became friends with many Navajos. After her accident with the coal truck, people came from near

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and far to check on her, including one elderly woman named Nanbah, who drove eight miles by wagon. Despite these friendships and her successful work, the area’s remoteness resulted in Zillatus requesting another assignment.7 Her experiences illustrate the difficulties endured by Navajos and medical professionals in rural areas. During the mid-twentieth century, poor roads, lack of transportation, and isolation continued to have a negative effect on the health of the Navajos in the Four Corners area. Researchers Stephen Kunitz and John C. Slocumb studied maternal mortality among American Indians and described the factors that led to this group experiencing a higher death rate than other women. Even though the maternal mortality rate declined for American Indians during the post–World War II period, sepsis (infection), toxemia (pregnancyinduced hypertension and high blood pressure), and hemorrhage continued to endanger American Indian women. By studying the Indian Health Service data from facilities on the Navajo Nation and in Phoenix offices, Kunitz and Slocumb illustrated that lack of prenatal care, difficulties during labor, and delivery complications led to high rates of maternal mortality. The incidence of hemorrhage among the Navajos was about twice that of the majority population, but the severity of hemorrhage and inadequacy of treatment led to even more serious complications.8 Declining maternal mortality in the Tuba City area coincided with decreasing frequency of home deliveries between 1930 and 1970, Kunitz and Slocumb illustrated. They did not conclude that just giving birth in the hospital led to this decline, but stated that a change in health care delivery and attitudes may have contributed to lowering the maternal mortality rate.9 Researcher and physician Judith B. Vaughan examined maternal death rates in New Mexico and found that from 1956 to 1966, American Indian women had a maternal death rate of 119 per 100,000 live births, whereas white women (excluding those with Spanish surnames) had a death rate of 23.9. Women of Spanish descent had a mortality rate of 69.8 per 100,000 births. Nationally, the maternal death rate for all women was 31.5 in 1966. The mortality rate for New Mexico mothers in rural areas exceeded that of those in urban areas. Among the Native women, toxemia and hemorrhage were the major causes of death, whereas for women of Spanish descent, infection ranked as the most frequent cause of death.10 Vaughan discovered that higher death rates were associated with increased age of the mother and with counties whose population had lower

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median incomes. She also concluded that these high rates of maternal mortality were caused by hemorrhage, toxemia, and infection, all of which were preventable.11 Problems such as hemorrhage and infection could be successfully treated in hospitals during the postwar decades, but researchers estimated that 9 percent of Arizona’s Indian births occurred outside of hospitals in 1959. By this time, the majority of American Indian women saw benefits in hospital births, although isolation and lack of transportation still resulted in a small percentage of births occurring at home. Through radio broadcasts and the distribution of layettes, the Navajo tribe waged a campaign to encourage hospital births, which led to a 30 percent increase in births occurring there between 1956 and 1958. The Tohono O’odham and Navajos had the highest rates of nonhospital births with 11.9 percent of Tohono O’odham and 10.9 percent of Navajo births occurring outside of hospitals.12 Joanne McCloskey also discusses the gradual shift of Navajo women from home births to hospital deliveries during the 1940s and 1950s. Among the grandmothers interviewed by McCloskey, it was common for women to give birth to their older children at home and their younger ones in the hospital. The childbearing years of the older women roughly spanned the 1930s to the 1950s, when the gradual shift to hospital births among Navajos occurred. For their daughters, nearly all births occurred in the hospital, where the women tried to integrate traditions and assistance from relatives into the childbirth experience.13 There was also a long transition from midwife-assisted to hospital births for other women of color. Christina Ellington Hankins, who had helped her mother give birth in 1938 outside of Casa Grande, Arizona, became the first African American to give birth in the Casa Grande Hospital in 1945.14 The slow movement of African American women to hospital births in this central Arizona town again illustrates the late transition to medically managed births in the West in comparison to other parts of the United States. Some American Indian women in urban areas also continued to rely on midwives. Loretta Alvarez, a member of the Pascua Yaqui tribe and living in Tucson, delivered many of the babies born to members of her tribe from the 1920s to the 1960s. A very trusted midwife, she never expected payment and helped both Indian and non-Indian women. With considerable skill, Alvarez used herbs and prenatal massage to successfully deliver breech babies. In 1994, the new labor and delivery ward at Tucson’s Kino Community Hospital was named after her, in honor of her

Battling Poverty and Isolation to Improve Health  •  99

work in the community.15Alvarez’s work and prominence demonstrate that midwifery remained a respected and necessary profession far into the twentieth century.

Infant Mortality Arizona and New Mexico continued to have high infant mortality rates in comparison to the rest of the United States during the decades following World War II. In 1950, Arizona’s infant mortality rate was 45.8 per 1,000, whereas the national rate was 29. In New Mexico, the rate was 54.8 in 1950, and Utah’s was 23.7. By 1960, the states all showed improvement, with Arizona’s rate decreasing to 31.9, New Mexico’s to 33.2, and and Utah’s to 19.6.16 Among the American Indian population, the tragically high infant mortality rate persisted during this time period. L. J. Lull discussed the rate of infant deaths among the region’s tribes in a study titled “Indian Infant Death Study Arizona and New Mexico 1959–1960.” The rate of infant death for all races in the United States in 1959 was 26.4 per 1,000 births, in contrast to the rate of 69.1 for all Arizona Indians and 53.2 for all Indians in New Mexico. At this time, the rate of infant mortality for Arizona American Indians was two to three times that of most industrialized nations.17 Dr. Lull broke the infant mortality rate down by tribal and geographic groups (see table 6). Lull analyzed the statistics in some depth, concluding that the Navajos in Arizona had a higher death rate than members of their tribe in New Mexico because they were more isolated and lacking in professional medical care. Lull also commented that the Pima tribe had a lower infant mortality rate because this group lived near an urban area and used available medical services.18 Common illnesses such as pneumonia and diarrhea had a very detrimental effect on the health of Indian infants, along with three major factors: delay in seeking medical care, lack of health knowledge, and health attitude. The common delay in seeking medical care resulted in many deaths due to diarrhea and pneumonia. These illnesses usually related to the type of home environment and care experienced by the infants, according to Lull. When the Indian families delayed seeking help from a physician, the babies had a lower chance of recovering from their illnesses. A lack of health knowledge influenced the kind of care infants received when they suffered from diarrhea and pneumonia. Factors related

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Table 6.  Indian Infant Deaths, Arizona and New Mexico, 1959–1960 Tribal and Geographic Groups

Rate/1,000 Live Births

All Arizona Indians

69.1

Apache Hopi Papago Pima-Maricopa Phoenix area tribes Navajo

115.6 48.3 89.0 40.3 77.3 67.9

All New Mexico Indian

53.2

Apache Pueblo Navajo

49 43.3 58.6

Source: Vital Statistic Records, Arizona and New Mexico Indian Infant Death Study, U.S. Public Health Service, Division of Indian Health, Health and Medical Research. Table drawn from L. J. Lull, “Indian Infant Death Study, Arizona and New Mexico, 1959–1960.”

to the physical environment that created a negative situation for infants, such as isolation, poor housing, lack of clean water, and unsanitary disposal of waste and food, also increased the infant mortality rate.19 Although Lull stressed the need for professional medical care, a memo written by Dr. John C. Cobb, consultant in Maternal and Child Health, to Dr. Charles R. Mallary, medical officer in charge in the Albuquerque Area Office, focused on the shortage of available medical staff to meet Navajos’ needs. The memo discussed the high Navajo birth rate, which was approximately 46 live births per 1,000 (nearly twice that of the national birth rate average) in the Many Farms area of the reservation.20 Among the Santo Domingo and San Felipe Pueblos in New Mexico, the birth rate was approximately 40 per 1,000. Given these high birth rates, Cobb did not find it surprising that nearly half of all deaths were of women and children. In addition, this group occupied half of those in hospital beds and needed half of the outpatient visits. To meet the needs of this population, the memo stressed that many improvements were needed. Both the Fort Defiance and Tuba City Hospitals each had one overworked pediatrician who could not properly care for their patients. There was a

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tremendous need for additional physicians and trained pediatric nurses to lower the child and infant death rates. Cobb, representing the maternal and child health staff, argued that the available obstetrical and newborn facilities and staff in the Window Rock area should be doubled in five years and that maternity centers should be constructed in isolated areas. At the same time, he pushed for disease control through the agency’s Field Health Programs. According to Cobb, hospitals had to be improved to increase the effectiveness of medical work in the field: “However, until we have demonstrated to the Indians that we are able to save the lives of sick babies in our hospitals, we are not likely to be able to convince them of the importance of the various public health measures necessary for communicable disease control in the field.”21 This candid memo stressed the necessity of improving coordination between field health and hospital care. If prenatal clinics worked with the hospitals where women planned to deliver, they would be better able to coordinate health education. When women left the hospitals with their newborns, hospital staff should inform them of well-baby clinics. In addition, the medical staff pushed for well-child conferences in Navajo camps and hogans. According to Cobb, “This would probably be the mostimportant single thing that we could do to prevent infant mortality.”22 In her memoir Nurse among the Navajos, Ida Bahl discussed some of the same concerns, as she described her work on the Navajo Reservation during the 1930s and 1950s. She worked in the Fort Defiance Hospital in the 1930s before moving to Iowa to care for her ailing mother. When she returned to serve again as a nurse on the reservation in the early 1950s, she found improvements due to the availability of antibiotics, better roads and transportation, and more communication between medical professionals and the Navajos. Bahl attended Navajo “sings” for the sick to gain an understanding of their traditions. She also organized clinics and health education meetings in trading posts, with the assistance of her Navajo interpreter/aide. Still, there were deaths of babies and other family members due to pneumonia, dysentery, tuberculosis, and other diseases. Despite the persistence of health problems, Bahl felt they were making progress. She discussed the importance of Annie Wauneka’s work as a Navajo Tribal Council member who strived to improve her people’s health while serving on the council from 1951 to 1978.23 Annie Dodge Wauneka, the daughter of Chief Henry Chee Dodge, was the first woman elected to the Navajo Tribal Council. She worked for years to eradicate tuberculosis, traveling many miles to encourage those suffering from the disease to see physicians. She helped make inroads be-

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tween traditional healers and medical doctors by writing a glossary defining Navajo medical terms in English and the medical terms used by EuroAmerican physicians in Navajo. Describing germs as “bugs that eat the body,” she brought the physicians and medicine men together to fight deadly diseases.24 Wauneka visited the ill in their homes across the vast reservation and used the radio to reach others. During the 1960s, she had her own radio program, sponsored by the Pet Milk Company through KGAK, Gallup, New Mexico. The program aired every Sunday morning

Annie Wauneka, first woman to serve on the Navajo Tribal Council, was instrumental in fighting tuberculosis and lowering the infant mortality rate among Navajos. Courtesy of the Navajo Nation Tribal Museum, Window Rock, Arizona.

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in the Navajo language, focusing entirely on health education. At that time, many Navajos were illiterate, but a large number had radios.25 Annie Wauneka also encouraged people to improve sanitation and worked with physicians to organize Better Babies contests, at which infants were examined by physicians and the mothers received formula for their babies. Held during the Navajo Tribal Fair in Window Rock, these contests led to improved understanding between mothers and physicians, while also allowing nurses and physicians to spot health problems. Babies that looked alert and healthy won the contests, and their mothers took home prizes of diapers, gift certificates, and Pet Milk.26 Although Better Babies contests have been viewed by historians as a reflection of eugenics ideals, Wauneka used them as a health education tool. Wauneka’s leadership on health issues resulted in her invitation by the U.S. surgeon general to serve on the Advisory Committee on Indian Health in 1956. For her dedication, she earned the Presidential Medal of Freedom Award from President John F. Kennedy in 1963. In addition, she continued her own education, earning a bachelor’s degree in public health from the University of Arizona. Later, her alma mater awarded her an honorary doctorate in recognition of her tireless efforts on behalf of her people.27 Wauneka’s work in bringing health education to Navajos occurred across the immense, rural Navajo Reservation. In urban areas, American Indians generally had more access to medical care; however, in January 1949, the Phoenix Indian Sanatorium-Hospital refused admission to a very ill fourteen-month-old Indian baby. She died the following morning. Her parents, Mr. and Mrs. Harry Sundust, had tried to secure medical assistance for their sick daughter at the hospital but were told to take the baby to the hospital in Sacaton on the Pima Indian Reservation. Hospital officials expressed regret concerning the baby’s death and pointed out that the hospital had only fifty beds, which were usually reserved for cases involving surgery, orthopedic problems, and fractures requiring care by specialists. They also mentioned lack of funding.28 This tragedy occurred in 1949, when Indian health care fell under the jurisdiction of the Department of the Interior. By the early 1950s, the Public Health Service took responsibility for this care, and it gradually improved.29 Poverty and lack of medical care affected the health of women and children from all ethnic groups in both rural and urban Arizona. Working in the Phoenix metropolitan area and rural Maricopa County, Dr. Pearl Tang dedicated her career to improving the health of mothers and children. Tang was born in Shanghai, China to an American-born physician,

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Dr. David Mao, and Mabel Wong Mao, who was Chinese-born. The Maos were progressive in that they encouraged both their sons and daughters to pursue their educational goals and careers.30 Although Pearl began college with a major in engineering, she changed to medicine and earned an undergraduate degree at the Jesuit-run Aurora University in Shanghai in 1939. She performed internships at the university’s Hospital de Sainte Marie and graduated at the top of her class in 1945. From there she traveled for her residency training to Quebec City, Canada. At this time, she corresponded with Tom Tang, a U.S. soldier whom she had met in China during World War II. After she finished her residency, Pearl married Tom Tang at the Chapel of the Basilica in Quebec City.31 Her marriage brought Pearl to Phoenix and into the large Tang family. Tom’s relatives had immigrated to the United States in the early 1900s. His father, Tang Shing, ran a successful grocery business, and his mother, Lucy, was one of the first Chinese American females born in Arizona. While the family welcomed Pearl, the Arizona medical establishment did not. When she applied to take her licensing exam to practice medicine, the Arizona Board of Medical Examiners refused her request because she was a graduate of a foreign medical school. “They didn’t want anyone who was from out-of-state to practice medicine. I had approved hospital training. But in those days there were only 250 doctors in Maricopa County. It was a very closed shop,” said Pearl Tang in an oral history interview.32 Most likely this board also made it difficult for Pearl because she was a Chinese American woman. Tang tried another tactic, applying to American medical schools, but her applications were all denied because she already had a medical degree. In 1948, she and her husband moved to Tucson, where he pursued a law degree at the University of Arizona. Pearl studied for a master’s of science in microbiology, which she completed with honors in 1950, at the same time Tom finished his training in law.33 On returning to Phoenix, the couple found new opportunities. Pearl secured a position studying diarrhea diseases in Arizona, through the U.S. Public Health Service Communicable Disease Center, and Tom found a position working as clerk for Justice DeConcini at the Arizona Supreme Court. DeConcini encouraged Tom to meet with the Arizona Medical Licensure Board to plead for Pearl to have the opportunity of sitting for the medical licensure examinations. When Tom, a young veteran and new lawyer, appeared before the board, it changed its position and allowed Pearl to take the exam. She successfully passed the exam in 1951 and promised the board that she would use her knowledge to assist women

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Dr. Pearl Tang, director of Maricopa County Maternal and Child Health Division, gives a child a shot. Tang devoted her career to helping low-income families in Maricopa County. Courtesy of the Arizona Historical Society, Tempe.

and children as a public health physician, rather than opening a private practice. Dr. Pearl Tang became one of about forty women physicians in the state and the only Asian American female doctor.34 Pearl accepted a position at a hospital on the San Carlos Indian Reservation but did not stay there long because the hospital conditions were poor, as was the pay. After a trip to Korea to see Tom, who was serving in the Korean War, she returned to Arizona. In 1954, she began working for the Maricopa County Health Department, developing an immunization program for children in the county’s schools. Maricopa County, containing the city of Phoenix and several rural communities, covered 9,226 square miles. Tang worked in the schools for a year and then became a physician in county well-baby clinics, caring for the children of farm workers, who often lacked clean water and decent housing. People used water from a variety of sources, including wells, canals, and even irrigation ditches. Tang began to deal with the problem of infant mortality, which had created loss and heartbreak for Arizona’s families for decades.35

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Long-standing health problems continued to plague Arizona’s babies, both on reservations and in rural and urban areas of Maricopa County. Gastrointestinal diseases and low birth weight associated with premature births caused the highest percentage of deaths, Tang found. Arizona infants experienced six times as many deaths due to gastrointestinal diseases as did babies in other locales.36 Lowering the infant mortality rate required dealing with these illnesses. Pearl Tang and other health officials encouraged mothers to breastfeed their babies, but many migrants and farm workers labored in the fields, making breastfeeding difficult. To properly feed their infants, they needed education and assistance. Public health nurses began the type of program that had been needed for decades—visiting mothers in their homes to learn about the living conditions of families. Then Dr. Tang and the nurses devised a means to teach mothers to make sterile formula, even if they lacked a refrigerator or icebox. She explained: We taught them terminal sterilization. Farm workers or poor people in those days, they might have an ice box or they may not even have an ice box. . . . many of the mothers had to work in the fields. They couldn’t nurse. So you had to devise a way so they could make their formula and know it’s gonna stay sterile when feeding time comes around. . . . They make their formula and you know the source of water could be well water or who knows and even tap water. They bring it to a boil and sterilize it for about 20 minutes and then turn off the heat. They boil the formula with it. We told them you could use jam jars or whatever. Make your formula, when it cools, tighten the lids. The milk is good for the next day.37 This method, coupled with teaching demonstrations and home visits by nurses, began to have a significant effect. State health department records demonstrate that deaths due to infant diarrhea went down, and the medical society congratulated the Maricopa County health unit on its achievement. During the 1950s, about one-third of all births in Arizona occurred in Maricopa County; consequently, tackling problems here had a very significant effect on the infant mortality rate statewide. Infant deaths related to premature birth contributed significantly to the high infant mortality rate. To ensure the birth of healthy babies, Tang used statistics to identify the locales with more premature births, and then established prenatal care clinics in these areas—Gila Bend, Buckeye, Gilbert, Chandler Heights, and eventually Queen Creek. Tang also learned

Battling Poverty and Isolation to Improve Health  •  107

Spanish at a local junior college to better communicate with her patients, many of whom spoke Spanish.38 In 1960, Pearl Tang became chief of the Maricopa County Bureau of Maternal and Child Health. The young woman who had fought to practice medicine in Arizona had quickly proven herself as an asset to the medical field.39 While establishing clinics in rural areas, Tang struggled to overcome a severe lack of facilities. The public health program arranged to borrow rooms in buildings like American Legion halls and women’s clubs to conduct exams. Women’s club volunteers acted as receptionists in the makeshift clinics. In 1962, Dr. Tang attributed their success to staff teamwork between doctors and nurses, coupled with “community cooperation, especially by hundreds of women volunteers in clinics.” Still, in some locales the situation was desperate. In Gila Bend, they “cajoled the town to let us use an old jail . . . because it had a bathroom.”40 Dr. Tang secured federal funds to organize a pediatric demonstration project, the First Avenue Clinic, in south Phoenix. Located in an old fire station, the clinic served an impoverished one-square-mile area, where the median family income in 1967 was $3,243 per year. People lacked medical and dental care, so the clinic—staffed all day with a physician, nurses, social workers, including a dental clinic, and pharmacist—was a godsend. Between 1968 and 1975, this project served over 9,000 infants and children up to the age of eighteen. The clinic demonstrated that providing early medical care resulted in fewer hospitalizations.41 Using teamwork, volunteers, and federal funds from the 1950s through the 1970s, Dr. Tang and her staff gradually reduced infant mortality in Maricopa County from 37.3 per 1,000 in 1950 to 19.7 in 1969.42 “It took almost twenty years . . . it was a challenge and it was gratifying,” she said.43 Infant mortality in the entire state also decreased. By 1970, Arizona’s infant mortality rate, at 17.7 deaths per 1,000 infants, was actually lower than the national average of 20. Public health work in Maricopa County was especially significant because from 1968 to 1974, this county recorded over 50 percent of the state’s births. During the postwar decades, the Pima County Health Department also worked to decrease infant mortality in the state’s second most populous county. This county held all of its prenatal clinics at the health department in downtown Tucson during the 1950s. The facility became overcrowded with mothers and their families, so the department encouraged women to begin visiting the clinic after their third month of pregnancy. A 1964 study found that more than half of the women who suffered the loss

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of their infants came to the clinic in the sixth month of pregnancy or later, illustrating that early prenatal care was needed. The study also demonstrated that although the infant mortality rate in the city of Tucson was 29.5 per 1,000 in 1959, it was 114 in Marana, an area of Pima County where many farm workers lived. As in earlier decades and other parts of the state, the infant mortality rate of babies of color was higher than that of white babies, with the former having a rate of 50.4 per 1,000 and the later a mortality rate of 29.7 per 1,000.44 The Pima County Health Department staff recognized the need to expand clinics to areas where patients lived and began offering new clinics at the County Hospital, located in Tucson on south 6th Avenue. The department also established a policy of admitting pregnant women for prenatal care during their first trimester of pregnancy.45 While the health department staff pushed for more funding and additional clinics, the infant mortality rate in Pima County decreased from 1961 to 1971, falling from 25.9 to 19.9 per 1,000, a rate that was similar to that found in the rest of the state.46 Mary Zillatus, the public health nurse among the Navajos in the early 1950s, moved to Pima County and the Papago Reservation (now called the Tohono O’odham) in 1957. Zillatus, working with a physician and interpreter, met with patients in a mobile unit that traveled from village to village. The “15 ton gray monster” had its own water supply, electric generator, x-ray equipment, and toilet facilities. It was “almost a rolling hospital,” wrote Zillatus.47 While the isolated conditions and poor transportation methods on the Navajo Reservation had discouraged Zillatus, she felt better able to meet Tohono O’odhams’ health needs through the mobile clinic. In 1962, she wrote an article for Nursing Outlook, a publication of the U.S. Public Health Service, describing home visits to pregnant women and sick infants. She also discussed health education meetings, which focused on topics proposed by Tohono O’odham women: “Attendance at these meetings is usually good, interest is keen and the women enjoy them, probably because they also serve as a social occasion.”48 Outreach programs, such as those described by Zillatus, helped facilitate a gradual decline in rural counties’ rates of infant deaths from 1950 to 1970. In 1950, Apache and Navajo Counties had the highest infant mortality rates—106.4 per 1,000 and 107.3 per 1,000, respectively. Pinal County had the next highest rate at 68.9 per 1,000. By 1964, the infant mortality rate in Apache County had declined to 34.7, and it was 42.9 in Navajo County and 37.5 in Pinal.49 During the 1960s and early 1970s, a new health care project on the

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White Mountain Apache Reservation had a positive effect on the tribe’s mothers and infants. As late as 1968, this group suffered with an infant mortality rate of 77 per 1,000. As a point of comparison, by the 1970s, China’s infant mortality rate was 50 per 1,000, considerably lower than that of the White Mountain Apache Nation. The birth rate was also high among White Mountain Apaches, at 41.6, and 26 percent of the mothers received no prenatal care. To improve health care, Dr. Baugh, the clinical director, initiated Project Apache “to lower the infant mortality rate by concentrating on the health problems of women of child-bearing age.”50 Baugh formed health teams made up of doctors, public health nurses, project staff, and tribal health representatives, who worked among various tribal communities to improve health education and the delivery of services. The staff implemented new field clinics, additional pediatrician visits, home visits of all prenatal and postpartum patients, and improved health education. They also employed Apaches in community educational work, creating an integrated system of health care to meet the needs of women and children. Within a few years, this project demonstrated considerable results as the infant mortality rate dropped from 71 per 1,000 in 1971 to 30 in 1973.51 Although this was still higher than the national infant death rate, the fact that it fell significantly illustrates the effectiveness of the methods used, including home health visits and the involvement of community health representatives. By 1970, the infant mortality rates in Arizona, New Mexico, and Utah were below or very close to the national average of 20 deaths per 1,000 infants during the first year of life. New Mexico had a rate of 21 per 1,000 at this time, and Arizona’s rate was 17.7. Utah’s infant mortality rate was one of the lowest in the nation at 14.9.52 Lowering the infant mortality rate in Arizona was a decades-long process requiring involvement and assistance from community organizations, public health professionals, community aides, mothers, and fathers. Dr. Baugh’s project among Apache families, like that of Dr. Tang’s program in Maricopa County, relied on home health visits, expanded prenatal care, and education about infant care. Annie Wauneka also worked in these ­areas across the Navajo Reservation. Using programs that relied on expanded cross-cultural communication, these individuals and others helped bring Arizona up to the national standard and lower the consistently high infant death rate. Chinese American Dr. Tang learned Spanish, while Wauneka, a Navajo leader, worked to increase communication between traditional Navajos and medical doctors. During the 1920s, the SheppardTowner Program had failed to address the health and education needs of

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the Mexican and Mexican American populations, but by the 1950s, health professionals realized the need to create programs to meet low-income families from all ethnic groups on their own turf. By doing so, they gradually helped those in isolated rural areas and impoverished urban enclaves improve their families’ health and save their youngest members. Another aspect of reproductive health care, access to birth control, also expanded by the 1960s, in both urban and rural areas. The following chapter describes the growing public health and Planned Parenthood programs that provided contraceptives in the 1960s and 1970s.

cha p te r si x

“Rhythm Babies,” Birth Control, and Planned Parenthood Years of Growth and Change

From the mid-1960s to the 1970s, expanding access to contraception through public health programs became a national issue. However, at the beginning of this period, Lula Stevens, a public health nurse in Mesa, Arizona, was instructed not to broach the subject of contraception with her maternity patients. Instead, at the end of their pregnancies, she mentioned providing prenatal care to them again in nine or ten months: “Of course, they’re miserable at 36 weeks. Their feet are swollen, their back hurts. The idea of being pregnant within the year is not appealing. So they say, ‘Oh no, you won’t.’ I say, ‘Really, so what are you planning on doing to prevent it?’ Then she says, ‘I’m going to do something, I hear they got this stuff.’ ” When her patient brought up the “stuff,” Stevens had the opportunity to discuss contraceptives.1 Stevens’s oral history interview reveals tensions within the Maricopa County Public Health Program as the 1960s began. At this time, Planned Parenthood of Phoenix had just won a court case allowing the agency to distribute information about contraception through public health care facilities.2 The court case and the increasing involvement of Arizona public health programs in family planning led to conflicts related to religion and concerns regarding use of public funds for this purpose. Differing ideas about motherhood, sexuality, and family were at the base of these conflicts. Yet by the 1960s, fears of a population explosion helped facilitate birth control distribution through federal, state, and county health programs. Reflecting trends across the nation, the number seeking contraceptive 111

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assistance through Planned Parenthood and public health programs in Arizona greatly increased by the late 1960s as young women from all ethnic groups embraced contraception. The number of family planning clients in Arizona and New Mexico greatly outpaced the neighboring state of Utah, due to Mormon leaders’ continued condemnation of contraceptives.3 The Arizona birth control movement, which had begun in the late 1930s, showed great strength by this time. However, despite the proliferation of access points for birth control, some in isolated areas still lacked information, and middle-aged women from certain cultural and racial groups, such as Mormons and American Indians, continued to frown on contraceptive use. Due to their religious views, continued reliance on children in the family economy, and traditional ideals, they did not use artificial means to limit their fertility. Many other women embraced new technologies, such as the birth control pill, to plan and space their families. These women did not abandon the role of motherhood but instead tried to regulate the effect of pregnancies on other aspects of their lives. In addition, by the early 1970s, young women from the women’s liberation movement were openly challenging the idea that sex should be confined to marriage and lead to motherhood.

Fertility In Arizona and neighboring southwestern states, such as Utah and New Mexico, the birth rate was much higher than the national average during the post–World War II period. In fact, in 1950, New Mexico had the highest birth rate of any state in the nation, followed by Utah and then Arizona. Mississippi came in fourth in the “baby banner” high birth rate contest.4 These southwestern states mirrored national trends with the highest birth rates occurring during the Baby Boom years from 1946 to 1960, but pronatal values among the region’s Hispanics and Mormons contributed to even higher numbers of births in comparison to other states, in the Baby Boom and later decades.5 Mormon people traditionally favored large families, and the church hierarchy frowned on the use of birth control until the 1990s. David O. McKay, president of the Church of Jesus Christ of Latter-day Saints from 1951 to 1970, wrote that use of contraception put marriage on a level with “the panderer and the courtesan.” He implied that if a married couple’s sexual relationship does not produce children, it resembles prostitution.

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Table 7.  Birth Rates (Live Births per 1,000 Population)

1950 1960 1970 1980 1990

United States

Arizona

New Mexico

Utah

24.1 23.7 18.4 15.9 16.7

30.7 28.2 21.3 18.4 18.8

34.5 32.3 21.8 20 18.1

31.1 29.5 25.5 28.6 21

Sources: U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1970, vol. 1, Natality (Washington: Government Printing Office, 1975), Table 1-41; Vital Statistics of the United States 1965, vol. 1, Natality (Washington: Government Printing Office, 1967), Table 1-33; Vital Statistics of the United States, 1980, vol. 1, Natality (Hyattsville, MD, 1984), I-72; Vital Statistics of the United States, 1991, vol. 1, Natality, Tables 1-1, 1-4, 1-11, 2, 5, (Hyattsville, MD, 1995) 2, 5, 17, 20.

Another Mormon leader, N. Eldon Tanner, called birth control a means that Satan used to belittle the role of motherhood.6 In 1987, President Ezra Taft Benson told his followers that they should not curtail the number of children for personal reasons. However, in 1992, there was a shift related to contraception from the church hierarchy. At that time, Benson and other church leaders changed their position, stating that couples themselves could determine the size of their families.7 Even after lessening their opposition to contraception, Mormon leaders continued to glorify women’s role as mothers. By giving birth, women provided physical homes for waiting spirits, according to church doctrine. Various studies have confirmed that these religious beliefs led to high fertility that persisted even after church leaders supported birth control use.8 However, the birth rate of Mormon women followed national trends to some extent, as demonstrated by the gradual decrease in Utah. Like Mormon women, American Indian women also had a birth rate exceeding that of the general population. In 1956, the birth rate among Navajos was 40 per 1,000. Among the Santo Domingo and San Felipe Pueblos in New Mexico, the birth rate was also about 40 per 1,000 in 1959.9 White Mountain Apache in Arizona women had a birth rate of 41.6.10 Navajo women commonly gave birth to seven or eight babies, bearing children into midlife. However, among Hopi women, the fertility rate began to decline after the 1950s; by the 1960s, it was similar to the birth rate of the United States overall. Most likely this was due to the Hopis’ increasing involvement in the wage labor market and higher educational level. There were also regional differences in the Navajo Reservation, with those

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involved in the labor market bearing fewer children. In addition, Hopi women tended to finish childbearing in their late twenties and early thirties, while Navajo women continued having babies into their forties.11 Anne Wright conducted a study of Navajo women in the late 1970s, interviewing eighty women, half of whom she identified as “traditional,” and the other half was identified as “acculturated.” The traditional women lived in isolated rural areas, had never been to school, spoke no English, and were not employed in the wage economy. They had a higher number of relatives in their extended families and were more likely to be involved in the sheep economy. The acculturated women spoke English, had completed high school, were employed, and lived in nearby towns. This group had a greater reliance on income from wages and higher family incomes. Wright concluded that years of education had a strong impact on fertility. The older traditional women usually had seven or eight children, and the acculturated women had five. Although both groups felt that the role of motherhood was very important in their lives, they had different economic concerns related to their families. The traditional women counted on assistance from their children in the family economy, whereas the acculturated women saw their children as an expense in the wage economy.12 Both groups of women interviewed by Wright mentioned their own health as a reason to control their fertility. However, the acculturated women also chose to limit their fertility for financial reasons. These women were much more likely to choose contraceptives than were the traditional Navajo women.13 This study strongly suggests that a shift occurred among American Indian women by the 1960s. As more attended school and worked for wages, they limited their fertility through contraceptives.14 Even as some Navajo women chose to limit their fertility, Navajos as a whole had a higher birth rate than Euro-American women. Women of color, including those of Mexican, African, and Asian American descent, typically had higher birth rates than those of European heritage from the 1940s to the 1990s. However, the rate of all groups declined during the latter half of the twentieth century.15

Planned Parenthood in Phoenix and Tucson For those who wanted contraception during the 1950s, the main suppliers were private physicians and Planned Parenthood clinics in Tucson and Phoenix. Because public health agencies did not provide family planning

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services until the mid-1960s, the volunteer-run clinics continued to provide vital and necessary assistance to those who did not have private physicians. In Arizona’s largest cities, clinic organizers and backers followed similar patterns in their efforts to raise funds, expand services, and meet the needs of their clientele. In Phoenix, newspaper articles chronicling the efforts of Planned Parenthood volunteers featured several photos of Euro-American women. However, when the group opened their fund-raising drive in 1950, a photo in the Arizona Republic displayed an attractive Mexican American woman, Mrs. Fernando Reaza, making the first contribution to the drive.16 This drive began in early February 1950 with the hope of raising $5,000. From the article and photo, it is difficult to determine if Reaza is a patient or volunteer, but the public relations intent is clear. Organizers wanted to illustrate that minority women favored contraceptives. At the same time, the dress and conservative femininity of all the photographed women reflected the “feminine mystique” of the 1950s, which was later described by author Betty Friedan.17 While Mormon leaders opposed all types of contraception, and Catholic Church leaders frowned on everything except the rhythm method, the Rt. Reverend Arthur B. Kinsolving II, bishop of the Episcopal Missionary District of Arizona, served as honorary president of the Planned Parenthood board of directors in Phoenix. In 1952, Kinsolving urged Phoenicians to support Planned Parenthood’s $4,500 fund-raising campaign because the organization provided a valuable service, especially to lower income groups. Other religious leaders, such as Rabbi A. L. Krohn of Temple Beth Israel, also supported Planned Parenthood.18 Most patients who used the Planned Parenthood clinics could not afford private physicians, according to Lauren Henderson, the fund-raising campaign chair. Henderson stated that supplying contraceptives for one mother cost only $8 per year, whereas maintaining a family on relief “costs about $600 a year and up to $2,000 for very large families.”19 Despite advocacy by religious leaders and arguments related to welfare costs, the drive fell short, generating approximately $2,500 (about half of the goal). In 1953, Planned Parenthood supported two clinics, one at 102 E. Pierce and the other in Memorial Hospital, which was founded by Emmet McLoughlin.20 In November 1950, the African American women’s auxiliary of the Elks Lodge, Daughters of the Nile, which was located in an African American neighborhood, hosted a meeting related to “planned parenthood.” Phoenix physician Dr. James Whitelaw discussed the topic, and Mrs.

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Dennison Kitchell, president of the Planned Parenthood Committee of Phoenix, spoke about work at the clinic on Pierce Avenue. Since the Elks Lodge was a very active, strong organization among the black community, the fact that the auxiliary hosted the gathering indicates their desire to secure birth control information.21 Another Planned Parenthood fund-raising effort in 1961 led to the openings of two new clinics, in Glendale and Scottsdale, to meet the increasing demand for services. The Glendale clinic, housed in the First Christian Church on 59th Avenue, served clients Friday evenings from 7 to 9 p.m.; the Scottsdale clinic, at the Scottsdale Congregational Church on Granite Reef Road, held open hours from 7 to 9 p.m. on Monday evenings. Planned Parenthood served 552 during the first five months of 1961, and the patient number increased to 1,995 during the first five months of 1962.22 In addition to these clinics, which had very limited hours, a Planned Parenthood clinic in the south Phoenix Memorial Hospital began operating in 1953. By 1962, this clinic alone served over 2,200 patients annually. Memorial Hospital was an important community institution, providing vital health care services for people of color and Euro-Americans in the area. With open hours from 9:30 a.m. to 4:30 p.m. daily and Tuesday and Thursday evenings from 7 until 9 p.m., this Planned Parenthood clinic provided family planning and cancer detection screening exams.23 Volunteers served as a vital component in the Planned Parenthood clinics. In 1965, trained and paid staff included nurses and physicians, while fifty-one Phoenix volunteers worked as interviewers, nurse’s aides, office workers, and receptionists.24 During these years, fund-raising was a concern for Tucson Planned Parenthood organizers. In 1956, Delia Kincaid, an African American staffer at the Tucson clinic, stated in an interview that mothers who visited the clinic were distressed, caring for growing families on limited incomes. According to Kincaid, mothers lamented having new babies every year, which necessitated keeping older children out of school, so that they could work and contribute to the family income. Many women desperately needed birth control for both economic and health reasons.25 Margaret Sanger, well respected in Tucson, lent her support to the fund-raising drive, stating that many women still lacked basic knowledge related to fertility control. She also spoke to staff and volunteers of the Planned Parenthood Committee of Phoenix in 1958. Her continued involvement in the Arizona clinics boosted their profile.26 Reyn Voevodsky met Sanger when she was just nine years old, in 1947,

Years of Growth and Change  •  117

because her grandmother, Josephine Thomas, rented a room from Sanger in Tucson. “To a nine-year-old, she was really impressive,” said Voevodsky. “She was the most vital, energetic woman I’d ever met.” During the 1950s and 1960s, Tucson was a small community, and Sanger “had a great following here,” according to Voevodsky, who became a dedicated Planned Parenthood volunteer in 1960.27 During the 1950s, Euro-American women headed the Planned Parenthood board in Tucson, but several women of color administered the clinic. Delia Kincaid, an African American, directed the Tucson Planned Parenthood Clinic when it moved to a new location at 55 E. Jackson Street in 1957. In a newspaper photo, she is pictured shaking Sanger’s hand at the clinic door. Several Hispanic women worked at the clinic, such as Jessie Mendibles, who was Kincaid’s assistant.28 Mrs. Delia Olvara became the clinic’s director in 1962, and in 1965, Mrs. Jessie Mendibles took over that position.29 By 1967, Josephine Leyva was employed there. The new offices of the Planned Parenthood Center of Tucson at 55 Jackson Street soon became overcrowded with patients and volunteers. In the early 1960s, Planned Parenthood organized a fund-raising campaign for a new building. A gift from the Brewster Foundation allowed the organization to construct a new center, which was completed in 1964 at 127 S. 5th Street, doubling the available space for waiting and examination rooms. It was open from 9 a.m. to 5 p.m. most days and remained open until 8:30 p.m. on Mondays.30 In 1963, Judy Tamsen started volunteering at Planned Parenthood of Tucson, beginning what became a forty-year involvement with the organization. She was a provisional member of the Junior League at the time, and the organization required that she volunteer in a community agency. After choosing Planned Parenthood, she began serving as a receptionist on Monday evenings and getting to know the patients, whom she described: The majority of women were Hispanic. They came from the south side of Tucson . . . I had the impression that many of these women were quite poor. They had large families . . . They wanted help to space their pregnancies . . . When you have so many children to care for, to take care of on a daily basis, I mean how many hands do you have? I could understand that because I had three children in less than five years . . . They deserved to have information to space their children . . . The majority of our patients clearly were Catholic. To them it was more important to take care of their children and not to have so many that they were unable to. I guess they were go-

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ing against their church’s beliefs, but they wanted to have a decent living for their children.31 The patients gravitated to Jessie Mendibles and Josephine Leyva because these staff members spoke Spanish, said Tamsen. Some clients had never discussed reproductive issues with anyone; they did not have private physicians. Planned Parenthood provided “their total care,” according to Tamsen. “These women were wanting to space their pregnancies, wanting to delay an unwanted pregnancy, and we had the means to do that.” Services were provided on a sliding scale, and many paid nothing for contraceptives.32 Reyn Voedvodsky also stated that the primary goal of Planned Parenthood was to help women plan their families. “Be there so you wouldn’t have to go down to Nogales and have a back-street hanger abortion.” This was a common occurrence, and doctors treated women after a back-alley abortion, if they needed care, but they would not “take care of you before to prevent you from going to the back street, the back alley,” said Voevodsky.33 Priscilla Robinson, another Junior League member, also volunteered for Planned Parenthood of Tucson, serving on the board beginning in 1965. Board members played active roles, and Robinson worked at the clinic, keeping track of appointments. She also became the volunteer chair, coordinating volunteers. She described working at the front desk: “The waiting room would be full of children. When my daughter was maybe two or three . . . I could take my daughter with me and then she’d play with the children . . . She was kind of a bossy little thing and she knew what they could do and what they couldn’t do.”34 Planned Parenthood staff and volunteers also traveled monthly to Nogales to set up a temporary clinic in a Knights of Pythias Hall, said Voevodsky. They took contraceptive supplies from the Tucson clinic to Nogales and served women from both sides of the international border. Traveling in a white station wagon, they parked the car on the Arizona side, and women were able to identify the station wagon and know the clinic was in operation. A doctor and nurse worked in the clinic while Voevodsky acted as gofer, doing whatever was necessary.35 Volunteers also raised funds for the organization, and Judy Tamsen recalled organizing an art show at the Desert Inn, featuring work donated by Tucson artists. In addition, Planned Parenthood volunteers held rummage sales and approached individuals for contributions. Congressman Morris Udall often lent his support. “He was a delight,” said Tamsen.36 Judy Tam-

Years of Growth and Change  •  119

sen later became an administrative assistant at Planned Parenthood of Tucson and eventually worked there as a counselor for several years. Tamsen and other Planned Parenthood volunteers and employees acquired new contraceptive methods for their clients after the Food and Drug Administration approved the birth control pill in 1960. Backed by Margaret Sanger and funded by philanthropist Katherine McCormick, the pill used synthetic progesterone to suppress women’s ovulation. Both Sanger and McCormick were ardent supporters of the pill, which they believed would further women’s self determination.37 Within a few years, the pill became the birth control method of choice for U.S. women because it offered greater freedom and autonomy. “When the birth control pill came out, that was a savior to millions of women around the world,” said Tamsen, a married mother of three.38 Elaine Tyler May argues in America and the Pill that the pill changed motherhood more than anything else because it allowed women to plan and space their children to take advantage of educational and career opportunities. There were 6.5 million women using the pill by 1964, the vast majority of whom were married.39 The birth control pill was not easily available to single women at first. Planned Parenthood clinics across the nation usually refused to serve the unmarried, but young women borrowed wedding rings or claimed they were going to be wed soon to obtain contraception.40 By 1969, the Planned Parenthood Center in Tucson offered birth control to minors (under age eighteen) without question, although they encouraged parental consent. In 1967, Tucson clinic staff and volunteers aided the national Planned Parenthood organization by participating in a study of the birth control pill with approximately 2,200 of the clinic’s 2,500 patients. The availability of the pill by this time led to increased demand for contraceptive services, and Tucson’s Planned Parenthood served 2,800 in 1969.41 Planned Parenthood employees and volunteers owed their success in part to Sanger, who aided the clinic’s early organizers and volunteers. In 1965, in recognition of Sanger’s pioneering work for birth control, the University of Arizona awarded her an honorary doctorate.42 When she died in a Tucson nursing home on September 6, 1966, at the age of eightythree, local newspapers marked her passing with complimentary articles and editorials. The lead editorial in Tucson’s Arizona Daily Star eulogized her as “more than one of the great women in history, she was one of the constructive personalities of history . . . in the better lives of hundreds of millions scattered all over the world, her spirit goes marching on.”43 News-

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paper articles described her career and impact, but controversy related to her life’s work continued in Arizona for several decades because some equated Planned Parenthood with access to abortions.44 Reverend Raymond G. Manker of the First Unitarian Universalist Church in Phoenix presented a sermon on September 16, 1966, titled “Margaret Sanger: Victimized Saint.” Manker decried “the legal degradation of woman,” which Sanger had fought against and praised her courage and persistence in igniting the birth control movement. He highlighted her efforts to free women from unintended pregnancies and her desire to preserve the “dignity of each individual woman.” Manker ended his sermon by discussing abortion, which was not the focus of Sanger’s career. He called for physicians to provide abortions for those who desired them and to end the “government intrusion into private life” by allowing women to decide whether to carry a pregnancy to term. Manker’s sermon illustrated the ideas of the liberal left in the 1960s as he advocated legalized abortion.45 However, at this point in time, most birth control advocates were not discussing abortion rights. In 1967, Peggy Goldwater, a prominent Planned Parenthood volunteer since the 1930s and wife of Senator Barry Goldwater, received the national Margaret Sanger Award. She continued to support the local organization, working with others to plan a fund-raising event in 1967. She also wrote urgently about the need for contraception and her commitment to the birth control movement in an article in The Arizonian: “Every day that religious, political and medical leaders fail to do something about birth by choice, they are placing themselves on the side of misery, even disasters and against the people of the world who await their guidance for physical, economic and spiritual salvation. Family planning is essential to each of those areas.”46

Public Health and Family Planning The support of women like Peggy Goldwater was vital to Planned Parenthood clinics in Tucson and Phoenix because they relied primarily on private fund-raising drives to operate. However, the largest Planned Par­ enthood Clinic in Phoenix was located in Memorial Hospital, which was funded partially by federal public health dollars.47 Planned Parenthood organizers lacked the funds to reach everyone needing assistance and were aware that many women in rural areas and impoverished urban enclaves lacked access to contraceptives or other components of reproduc-

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tive health care. Beginning in the mid-1960s, public health agencies initiated new family planning programs, often through federal funding, with some of the available funds going to Planned Parenthood clinics. For example, Title V funded contraceptives along with other programs related to maternal and child health.48 Expansion in this area required surmounting many obstacles. Planned Parenthood organizers clashed with Maricopa County officials in 1959 when Tom M. Sullivan, the county manager, banned distribution of birth control literature at the county hospital and health department. Sullivan cited the state law (13-213; originally enacted in 1901 and updated in 1913, 1928, and 1939) that made it illegal to facilitate abortion or to provide any notice or advertisement related to contraception.49 Sullivan claimed it was illegal to inform patients about the means to prevent conception. Violating this statute, a misdemeanor, was punishable by a fine up to $300, a jail sentence up to six months, or both.50 Sullivan secured the attention of Mrs. Kenneth Geiser, Planned Parenthood board president, and Jack Laney, the organization’s attorney, with his discussion of legal violations and punishments, and the two attended a meeting with Sullivan pertaining to the law.51 In response to Sullivan’s ban, Dr. S.F. Farnsworth, the county health director, instructed department personnel to refrain from discussing birth control during clinic sessions. The American Civil Liberties Union also became involved, stating in a press release that Farnsworth’s direction to his personnel undercut employees’ right to free speech.52 Tucson birth control advocates quickly jumped to the defense of Planned Parenthood in Phoenix. The editor of the Arizona Daily Star maintained that some believed the Catholic Church was behind Sullivan’s actions. Writing that the “statute books are full of laws as old as or older than the one the Maricopa officials have dug up, and which are equally trivial but which could be enforced to the detriment of general public relations,” the editor stated that if the county attorney brought the case to trial, he would have a “very hard time getting 12 Arizonans to convict, particularly during this day of women jurors.”53 Bishop Daniel Gercke, head of the Catholic diocese that included Phoenix, immediately responded with a letter to editor of the Star, claiming that the Catholic Church was not behind the county attorney’s actions and that the editor was creating prejudice against his religious organization.54 When he adjudicated this conflict, Superior Court Judge Jack L. Ogg upheld the birth control information ban in January 1961. His ruling made it illegal to distribute information pertaining to contraceptives in

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Memorial Hospital and Maricopa County medical clinics. Called from Prescott to hear the case, Ogg maintained that the statute against providing contraceptive information did not violate the First and Fourteenth Amendments of the U.S. Constitution.55 Judge Ogg did not have the last word on this issue. The Planned Parenthood Committee of Phoenix appealed this ruling to the state Supreme Court in late October 1962. The committee won its appeal through the court’s 5–0 decision that upheld the ban on advertising contraception, but interpreted the law to allow Planned Parenthood to continue distributing information related to birth control and contraceptives. Sheldon Mitchell, attorney for Planned Parenthood and the American Civil Liberties Union, called the decision “a tremendous victory.” It allowed counseling of married couples at clinics in Memorial Hospital and Planned Parenthood branches in Glendale and Scottsdale. According to Chief Justice Charles Bernstein, the Arizona statute banned advertising but permitted “articles and press releases in newspapers and periodicals, including editorials, commentaries and informational articles on matters of current public interest,” which are not advertisements. Furthermore, he stated that sharing information about contraceptives by a physician or member of the Planned Parenthood Committee was “person to person consultation” and not advertising. Pamphlets in hospitals were permitted, but they could not provide instructions on the use of particular contraceptives, identified by brand name.56 Although Dr. Farnsworth praised the state Supreme Court’s ruling, Maricopa County Public Health nurses maintained a timid approach to birth control, according to nurse Lula Stevens. As already described, she refrained from bringing up contraceptives herself but would discuss contraception when her patients broached the topic.57 Stevens, an African American, saw a diverse group of patients, including those of African, European, and Mexican descent. She discussed contraception as a means to space the children for women’s health due to “the damage that is done by each pregnancy.” One of Stevens’s patients was a twenty-two-year-old woman with a prolapsed uterus caused by giving birth to three children in a few years. “It wasn’t just prevention of pregnancy but prevention of other kinds of problems that women have,” said Stevens. Some of her Catholic and Mormon patients were not interested in contraceptives. Although she joked with the Catholic women about “rhythm babies” who were born when they were practicing the rhythm method, Stevens still helped them use this method to delay pregnancies.58 Stevens’s

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experiences accent the diversity of opinions related to contraceptives and the effect of these ideas on women’s fertility. During the 1960s, people became increasingly concerned with population control. As the world’s population exploded from 1.6 billion in 1900 to over 3 billion in 1960, both federal and state governments began supporting population control.59 Historian Linda Gordon writes that birth control became synonymous with family planning and population control among some population experts. This coincided with increased approval of contraceptive use to avert the problems caused by overpopulation, such as hunger, poverty, and lack of education.60 However, many who were advocating population control through birth control had the primary goal of lowering fertility rates substantially, whereas those in favor of family planning emphasized women’s individual choice.61 In 1965, the Supreme Court struck down a nineteenth-century Connecticut law that outlawed the use of contraceptives. At this time, Connecticut was the last state in the nation with laws still standing against birth control use. In the Griswold v. Connecticut decision, Justice William O. Douglass stated that a married couple’s right to privacy included the right to use birth control without legal interference.62 This decision later influenced activists’ reliance on the doctrine of privacy to lobby for changes in laws restricting abortion.63 While the Supreme Court legalized contraceptives throughout the nation, some congressional leaders worked to expand birth control access to cope with the population explosion. In 1965, U.S. Senator Ernest Gruening, chair of the Senate Government Operations Subcommittee on Foreign Aid Expenditures, wrote to the nation’s governors, including Arizona Governor Sam Goddard, to gather information about “governmental activities designed to meet the problems created by population explosion.”64 Goddard’s response to Gruening discussed the programs being developed by Arizona’s public health professionals to limit population growth. Goddard mentioned the two Planned Parenthood organizations in Phoenix and Tucson, which were not part of the government. Then he stated that the recent adoption of a formal policy statement by the Board of Health would hopefully provide impetus to local health departments to coordinate with the Maternal and Child Health Section of the state Department of Health to establish more comprehensive public facilities in family planning.65 The Arizona State Department of Health “Policy Statement on Family Planning,” issued on November 26, 1965, discussed its responsibility for

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maintaining, protecting, and improving Arizonans’ health, which was threatened by “unwanted population.” Population growth could result in malnutrition, stress, and loss of educational opportunities. In addition, unchecked growth could threaten the health of women and infants. The report stated that unwanted pregnancies could lead to illegal abortions, high maternal and perinatal mortality, and child abuse. The state Department of Health maintained that people needed family planning medical advice, which should be given with respect to religious creeds. In addition, Arizona health administrators established these guidelines: family planning should be voluntary; the family physician should be the central figure in dealing with issues of family planning and family spacing; public health funds and personnel would be used to supplement private resources and Planned Parenthood facilities to make sure that family planning services are available to all Arizonans.66 It is interesting to note that by this time, public health officials viewed the Planned Parenthood organization as part of the team providing contraception. When officials announced that the state public health care program would provide contraceptives, the Catholic Church protested quickly. The Very Rev. Msgr. John A. Oliver, director of Roman Catholic Social Services in Arizona, called the use of public funds for birth control “tragic and alarming.” Oliver claimed that the funds might be used to promote programs that were insulting and demoralizing to minority groups, “if these programs really are promoted under the false belief that cutting off a given race will solve the problem of poverty.”67 Since the guidelines did not target minorities, and there were many people of color involved in providing birth control, it appears that the monsignor engaged in racebaiting to undercut public funding of contraceptives. Planned Parenthood officials responded that their goal was to make medical facilities available to poor families. “We are completely unconcerned about racial or ethnic backgrounds of those who come to us voluntarily,” said Eileen Strutz, Tucson Planned Parenthood Center’s executive director. Strutz further explained that she had received telephone calls from representatives of the National Association for the Advancement of Colored People, the Mexican American Alliance, and the Committee for Papago Affairs, who feared that Msgr. Oliver’s statement might hinder the expansion of Planned Parenthood through the Office of Economic Opportunity sponsorship.68 While these verbal conflicts played out in southern Arizona, the Maricopa County Maternal and Child Health Program analyzed women’s reproductive health issues and developed the Project for Family Planning

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Services to Reduce Maternal and Infant Mortality and Morbidity in Maricopa County. This project became the first federally funded reproductive health program in the western states from Region 9. It served Maricopa County with its area of 9,231 square miles and an estimated population of 931,000, which was over 50 percent of Arizona’s population in 1967. The Children’s Bureau listed this county as among the fifty-six large metropolitan counties in the United States that held the key to sharply reducing the nation’s infant mortality rate. The area contained impoverished urban and rural areas, with families living in dilapidated housing and a high percentage surviving on an annual income of less than $3,000. In 1969, the median family income in Arizona was approximately $8,200.69 Maricopa General Hospital, which served the county’s medically indigent, had a high number of premature births and a neonatal mortality rate of 41.6 per 1,000 while the national rate was 19.1 per 1,000.70 The Maricopa County Maternal and Child Health Program, directed by Dr. Pearl Tang, provided free family planning as part of their comprehensive health care for indigent women, beginning in 1965. There were thirteen clinic locations throughout the county where women could receive care, in both rural and urban areas. Methods discussed were vaginal contraceptives, pills, intrauterine devices, and rhythm method instruction. Tang described the “phenomenal” growth that occurred in the number of women using the county’s family planning services. From May to December 1965, 208 women used family planning; from January to December 31, 1966, 404 women used it, and during 1967, the number increased to over 1,700 patients. At this time, women also received contraceptives from private physicians and Planned Parenthood clinics. The county program provided maternity care for more than 3,700 women in the clinics. Women were also screened for cervical cancer at the clinics beginning in 1963.71 Tang found it difficult to care for the growing population needing services. Providing information to those who lacked knowledge of family planning options and meeting the basic health needs of the county’s indigent required additional staff. Consequently, she pushed for more public education; greater availability of services through the use of mobile clinics; a program to study and treat infertility and sterility; and an additional focus on follow-up appointments by public health nurses, social workers, and community workers. Tang also proposed coordinating with St. Joseph’s Hospital to offer instruction in the rhythm method of family planning.72 An innovative part of the program involved a “mobile clinic to carry

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services to the neighborhoods of poverty.” Due to poor public transportation and the county’s wide geographic area, many had a difficult time attending clinics. Public health officials estimated that 25,000 women who lived on less than $3,000 a year could use the services. Dr. Tang proposed that the health care van serve areas in Phoenix, Mesa, and outlying rural communities, where many Mexican and Mexican American farm workers lived and worked, including Cashion, Peoria, El Mirage, Aguila, and Gilbert.73 Tang and her staff secured a federal grant through Title V funds and then designed the bus. The mobile unit, staffed by a doctor, two nurses, and a health assistant, had two examining rooms and one preparatory office. According to Dr. Frederick W. Goodrich, director of Family Planning, 75 percent of their patients were under the age of thirty and had an average of four children each.74 “The nurses were so enthusiastic when that bus came,” said Pearl Tang. “It was exciting. We were very proud of it.” Although they called it the Family Planning bus at the beginning, they found that the name discouraged some women in small towns from seeking services, so they renamed it the Maternity Van. Within a few years, this service resulted in great increases in the number of new family planning patients in Maricopa County. By 1970, 8,000 women were being served by Family Planning, a 50 percent increase from 1969.75 Patients were ­accepted without regard to race, religion, nationality, or marital status.76 The nurses and doctors providing the care were of varied ethnicity, including Asian Americans, African Americans, Euro-Americans, and Mexican Americans. Family planning services also expanded in Tucson during the 1960s, with the help of federal funds provided through the Economic Opportunity Act. In 1966, the Planned Parenthood Center applied for funds to provide services in outlying areas. To deal with their expanding patient load, Planned Parenthood personnel proposed adding five additional clinic sessions at their office on 5th Street, while at the same time providing additional clinics in other neighborhoods. Through more federal funding, the clientele of Planned Parenthood Center of Tucson grew, as did the number using family planning services provided by Pima County. By 1971, Planned Parenthood served 3,525, and Pima County Family Planning Project provided services to 3,447. Their numbers increased to 4,590 and 4,770, respectively, in 1972.77 In 1974, leaders in the reproductive health movement organized the Arizona Family Planning Council to administer Title X family planning funds and programs in Arizona. The federal monies funneled to the states

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through Title X were dedicated to establishing and maintaining family planning services along with educational programs. Emily Jenkins, a lawyer and administrator who became the director of this agency, traveled around Arizona meeting with every county health department to determine their needs in relation to reproductive health. She found that in 1974, “There were still issues around women’s abilities to access contraceptives.” Rural counties needed family planning training and assistance, she said in an oral history interview. The Family Planning Council provided basic education to staff who distributed contraceptives. Jenkins also became involved in an effort to upgrade the position of nurse practi­tioners, so they could provide health services under the supervision of physicians.78 Jenkins became aware of the power of county health officials to determine reproductive care for indigent women. She emphasized the difficulties women faced in procuring a sterilization procedure: “If you were a woman, who needed a sterilization, and you had several children, and you felt it was time to get a sterilization, you had to crawl on your belly like a reptile to the county health officer to beg for a procedure. There were lots of individuals who carried their ideology into the decision-making process, so it was very difficult for a woman to get a sterilization funded by the public health care system.” Many of the public health officials wanted the women to have had five or six children before they allowed sterilization.79 While the county health department determined reproductive care for impoverished women, college students at the state’s universities fought for the distribution of birth control on campus. Students’ rights, the Vietnam War, and women’s issues created lively debates during the early 1970s at the University of Arizona.80 The topics of birth control, abortion, and “sexist practices” were also discussed in the student newspaper, Arizona Daily Wildcat.81 Although students pushed for a campus contraceptive clinic, the state Board of Regents would not even allow discussion of birth control on campus in 1970. The organization Associated Students of the University of Arizona worked with Planned Parenthood to sponsor a clinic at the nearby Campus Christian Center. At this time, contraceptives were available to unmarried women at Planned Parenthood clinics but not on any Arizona university campus.82 Fighting this stance, the University of Arizona Women’s Liberation group advocated free access to contraceptives, and distributed a forty-seven-page birth control pamphlet to educate fellow students about fertility control. The group’s actions pressed a hot button for the university president, John P. Schaefer, and he publicly criticized their efforts.83 The University of Arizona students continued working on this issue,

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contracting with Tucson Planned Parenthood to provide birth control counseling. Students organized a concert, featuring the popular rock band Blood, Sweat & Tears, to raise money to provide for contraceptive counseling off campus. Soon these student activities yielded some results when in October 1971 the Board of Regents relaxed the ban on birth control information on the campuses, allowing lectures and distribution of pamphlets but ruling out contraceptive clinics. At this time, President Schaefer stated that he would not approve the pamphlet distributed by Women’s Liberation but would instead develop a more “professional” publication.84 At Arizona State University in Tempe, similar discussions occurred during the next few years. Because the Board of Regents would not allow contraceptive distribution on campus, Planned Parenthood of Phoenix organized a clinic close to the Tempe campus in 1974. The clinic provided screening for venereal disease and cancer, contraceptives, pregnancy tests, and abortion referrals. In not providing birth control through campus health centers, the Board of Regents was “five years behind their ‘conservative colleagues’ in other states,” said Gene Vadies, a national Planned Parenthood official. By 1974, more than half of the large universities in the United States provided contraceptives or referral services on campus, he stated.85 These conflicts reflected changes in sexual practices among young people, who assumed that sexual relationships could exist outside of marriage and need not produce children. The disagreements between administrators, students, and the Board of Regents illustrated that change was in the wind, but it did not arrive without a fight. In the nearby states of Utah and New Mexico, there were also discussions related to family planning during these years. The Utah State Division of Health adopted a Policy Statement on Family Planning in 1965, stating that the division “strongly supports the concept of ‘family planning’” and urging development of educational programs and medical assistance for problems related to conception and family planning.86 The New Mexico Health and Social Services Department did not develop a formal written policy on family planning, but the agency began organizing family planning programs by 1967. In 1970, the state relied on federal funds for these programs, and no state money was allocated.87 The Arizona state legislature allocated $35,000 to family planning programs in 1971 and relied on over $70,000 in federal funds. In Utah, the state relied on $68,000 in federal money for family planning programs, but the state legislature provided no funding. Among Arizona, New Mex-

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ico, and Utah, only the legislature in Arizona allocated state funding for family planning purposes at this time.88

Issue Related to Race and Contraception Women of all ethnic and racial groups became patients at birth control clinics in Arizona beginning in the 1930s. By the 1940s, a number of women of color supported the birth control movement and worked in the clinics as nurses and administrators. They also expanded access to fertility control through community organizations, such as Daughters of the Nile. However, there was never one view regarding contraceptives among women of color. Some eagerly supported birth control, whereas others believed it violated traditional norms. In addition, by the 1960s, some minority women viewed birth control as a eugenics measure to control the African American population. Among American Indian women, religious beliefs, tribal traditions, and educational level all affected attitudes in relation to birth control. A study of three generations of Navajo women in the Crown Point area of New Mexico by Joanne McCloskey found that those of childbearing age in the 1940s and 1950s commonly frowned on contraceptives, holding strong pronatal values. They believed that the number of children in the family should be determined by the Holy People and viewed children as a source of wealth who would help them in old age. Their daughters, however, viewed family size differently. Women who were bearing children in the 1960s and 1970s often worked outside the home and had three to four children, rather than the seven or eight common for their mothers. When these women were offered family planning advice, they were much more likely to use it than the earlier generation was. Studies discussed earlier also indicate that a generational shift occurred among Navajo women, as younger generations were more likely to work outside the home and limit their fertility.89 Another study illustrated that Navajos were less effective in their use of contraception than other populations. They often stopped using birth control soon after starting it due to the resentment of husbands, boyfriends or other family members. In comparison to the neighboring Hopi tribe, Navajo women had low rates of tubal ligations and therapeutic abortions. Those Navajos who were using contraception in the 1970s were more likely to do so during their late childbearing years and when they already

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had five or more children. Researcher Stephen Kunitz analyzed the effects of dependence on kin among Navajo women in relation to birth control and found that when dependence on kin was low, women were more likely to use contraceptives than if dependence was high.90 The Navajos and other American Indian women gained greater access to contraceptives in 1962, when the U.S. Public Health Service for American Indians began providing birth control strictly for medical reasons. In 1965, the agency set a goal of providing birth control to 18,000 Indian women throughout the United States. They reached and exceeded their goal and provided contraceptives for 21,000 women, ages fifteen to fortyfour. These women commonly received the birth control pill and intrauterine devices (IUDs). Women from Tuba City, Arizona, and Gallup, New Mexico, were included in this survey. Administrators found that the birth rate for American Indians in the United States decreased from 43.1 in 1964 to 38.5 in 1966. The number of abortion cases in hospitals decreased 20 percent.91 This national study and those completed by Mc­ Closkey and Kunitz indicate a shift in thinking among American Indian women in relation to family planning by the 1960s. The younger women viewed it much more favorably than their mothers had in earlier decades.92 Although some Indian women chose contraceptive methods freely, others were sterilized under coercive conditions. Sterilization abuse of American Indian women came to light in the 1960s and 1970s as women reported undergoing the life-changing procedure without their full knowledge and consent.93 A General Accounting Office investigation of sterilizations at Indian Health Service hospitals in Phoenix, Albuquerque, Oklahoma City, and Aberdeen, South Dakota, found that physicians usually obtained patient consent before the procedures but did not always comply with regulations related to informed consent. During the period of the study, from 1973 to 1976, they commonly did not document what women were told before signing the consent forms. Sometimes they used consent forms for a medically necessary sterilization rather than the form for voluntary sterilization. Additionally, some physicians sterilized those under the age of twenty-one, which was not allowed by the regulations. According to historian Myla Carpio, “Without evidence showing informed consent, one can definitely conclude that the procedures may have been falsely presented as required sterilizations or that the women were not completely informed of precautions and the permanence of sterilization procedures.”94 Although some accused the Indian Health Service of sterilizing 25 percent of American Indian women during this time, documenting the ac-

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tual number is nearly impossible because women seldom discuss the subject, and medical records are inconclusive regarding consent. No matter how common this abuse was, it harmed American Indian women, their families, and communities, while denying them the right to control their own reproduction.95 During this time, sterilizations without informed consent occurred in other states and regions to Hispanic and African American women, but there is no record of this happening in Arizona.96 Among some Hispanic women, traditional values favoring large families continued to affect women’s views of contraceptives. Although several Mexican American women in Tucson became leaders of the Tucson Planned Parenthood Clinic, and many Hispanics became clinic clients, others believed that God should determine the number of children in their families. When doctoral candidate Margarita Kay studied anthropology at the University of Arizona in the late 1960s, she interviewed women from a Tucson barrio about their views on childbearing and birth control. She found that those who had recently arrived from Mexico were more likely to desire large families. In addition, those who were living in poverty were less likely to use birth control than middle-class Mexican American women.97 Some of the women she interviewed were wary about side effects associated with the birth control pill, and others shied away from contraceptive methods such as the diaphragm, which required touching their own bodies. Women who had ten children by the time they were still in their thirties sought sterilization. Kay also found that those who used contraception hid the practice from their mothers and priests.98 The views of women of Mexican descent in relation to fertility control were not uniform. Mary Montoya, a Mexican American farm worker, wife, and mother in Surprise, Arizona, decided to end her childbearing years after the birth of her seventh child. Going against common traditional norms, she had a hysterectomy at the Maricopa County Hospital. “She was not going to have any more kids,” said her daughter, Francisca Montoya, in an oral history interview. Mary Montoya took the initiative and secured the means to limit her reproduction. Later, as an organizer for the Farm Workers Union, Francisca Montoya met with a women’s group and discussed women’s options in fertility control. Many of the older women did not accept the idea of limiting their families, but Montoya, then in her twenties, helped them understand changes occurring among younger Latinas.99 Tucson Planned Parenthood hired Bill Enriquez in 1970 to work as a community action specialist among the Mexican American community. Enriquez met with several hundred Mexican American men informally

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in bars, pool halls, schools, and other gathering places to discuss their views on contraception. He found that the men usually made the decisions in their families, so they would theoretically be the ones to determine whether to use contraception. However, most outreach workers associated with Planned Parenthood were women who seldom spoke with men. In his discussions with the men, Enriquez discovered that some of the older men would have spaced their children if they had known about the various contraceptive methods available. He did not find that the Catholic Church affected decision making a great deal. Some men were suspicious of the effects of the pill or other contraceptive devices, and others feared their wives might be unfaithful if they did not have to worry about pregnancy. Younger, college-educated men favored use of contraceptives to make it possible to have babies when they could afford them.100 This outreach work by a Mexican American man most likely allowed for greater communication regarding birth control than had happened previously. Sarah Brown, an African American Planned Parenthood educator from the 1960s to the 1980s, also had many conversations about birth control with minority women. Working in Phoenix, Brown found that Hispanic and Euro-American women displayed greater interest in contraception than did African Americans, many of whom had a negative view of birth control. “They had the opinion that ‘The white man can’t tell me what to do,’ ” she said. She told her patients, “It’s your body, take care of your body. You don’t have to have ninety-nine kids running around that you can’t take care of.” As years passed, she noticed that more African Americans began using birth control.101 Many black women feared that birth control was a move by whites to control them, Brown said. In her work, she encouraged them to take care of their bodies and their lives themselves. As a member of the Southminster Presbyterian Church, Brown received support from her pastor, Reverend George Brooks, who had led the NAACP in the 1950s and 1960s. Despite the support of leaders like Reverend Brooks, some African American women believed birth control was part of a negative plot designed to harm the black race. At this time, some in the black nationalist movement saw birth control as one component in the campaign to exterminate African Americans. Brown did not accept these arguments and continued working to educate people about contraceptives, which she saw as necessary for women’s health and for her community. During her career at Planned Parenthood, from 1966 to 1988, she greatly enjoyed her job, talking to a variety of people about contraceptives and sexuality. She moved between groups in prisons, schools, and those at the Planned Parenthood

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clinic. Brown said she became a feminist and was one of the few African American feminists in Phoenix at this time.102 Studies by the U.S. Department of Health, Education, and Welfare document the use of contraceptives by women of all racial groups in Arizona by the 1970s. In a 1974 study based on the number of new patients to Arizona family planning clinics, researchers found that Hispanic women were 21 percent of this group, while whites, not of Hispanic descent, were 64 percent. African Americans were 6 percent, and American Indians were 5 percent.103 At this time, Hispanics were approximately 19 percent of the total population, blacks were 3 percent, and American Indians were 5.4 percent.104 Even though there were cultural and political obstacles related to the use of contraceptives, women were using family planning clinics in numbers approximate to their group’s percentage of the population.105 This 1974 Family Planning Services study documented the numbers using family planning clinics in every state. In Arizona, 43,864 women used the clinics; in New Mexico, 24,093 did; and in the Utah, only 4,143 used the services. Based on population, roughly the same numbers of women per capita used the clinics in New Mexico and Arizona, whereas in Utah, only a very small percentage used birth control. Nationwide, the pill was the method of choice, used by 71 percent of women. The IUD came in second, with 11 percent choosing it as a contraceptive method. Only 1 percent of women chose sterilization. The median age of women served by these family planning sites was twenty-three years.106 Reflecting the generational shift at work, the majority of those using family planning clinics were under the age of thirty. By the 1970s, traditions were changing among younger generations of Latinas and American Indians, as they lowered their fertility through use of contraceptives. Additionally, African American women were likely to use contraceptives, despite the black power movement’s concern with racial genocide. These women saw the benefits to family planning and made decisions based on their own ideas and beliefs. By the 1970s, many young women, including members of the University of Arizona Women’s Liberation group, believed sex need not lead to motherhood and that their ability to pursue education, jobs, and advancement required fertility control. These young single women, along with married women, who desired the pill to control their fertility, fueled the growth of Planned Parenthood operations and public health programs in Arizona and throughout the Southwest. Volunteers remained vital in delivering fertility control, but there were also many professionals involved, including public health

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nurses and doctors. Despite religious conflicts and varying ideals related to family and motherhood, increasing numbers of women from all ethnic groups embraced birth control. At the same time, the fears of a population explosion generated greater public support for family planning, while racism and coercion resulted in the sterilization of American Indian women without informed consent. Younger women acquired more control over their own fertility during this period, while some, such as the coercively sterilized American Indian women, had no decision-making power at all. A woman’s ability to make a choice regarding a pregnancy remained a vital issue during the 1970s as some fought for abortion rights and others campaigned against access to abortion. The following chapter illustrates the contentious Arizona debate surrounding this issue.

c ha p te r s e ve n

Arizona and Abortion Reform Conflict without Resolution

In 1956, when Joanne Goldwater was twenty years old, she discovered that she was pregnant. Attending college and nearly engaged to the man who later became her husband, she was not ready to have a baby. Joanne approached her parents, U.S. Senator Barry Goldwater and Planned Parenthood volunteer Peggy Goldwater, and they supported her decision to have an abortion. After Senator Goldwater arranged for an illegal abortion in Virginia, Joanne went through the “frightening” procedure alone.1 In an oral history interview, Joanne Goldwater described standing in front of a pharmacy with $300 in cash wrapped in a Time Magazine cover. Someone pulled up and identified her by the magazine. She climbed into the car and received instructions to lie down in the back. Then the driver picked up another young woman before driving to a house in an undisclosed location. She described what happened next: I was not allowed to see where we were going. . . . We drove for quite a while. . . . We were put in a room in the attic where there were beds. Someone came in and gave me a shot to start contractions. Then they took us down one by one, and they did it on the dining room table, with stirrups. It was frightening. . . . It was over so fast and then I had all of these cramps, horrible, horrible cramps. And they put me in this bed in this bedroom by myself, and when they felt I was well enough to go back home, they drove me back and let me out at the drugstore. . . . I’ve never felt so empty. I just felt totally empty and very much alone.2 135

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Joanne’s clandestine abortion was alienating and expensive, but she ­recovered quickly afterward, with no negative physical effects.3 Costing $300, it was more expensive than many women could afford. Joanne was part of the upper middle class, who were able to pay for safe abortions. Many other women resorted to trying to perform an abortion on themselves or relying on unsafe abortionists, leading to high incidences of maternal deaths.4 Despite the unseemliness of her experience, Joanne’s abortion was safe. She maneuvered through this precarious time in her life and went on to marry her boyfriend and have four children with him. She came away from the experience with a strong belief that abortion should be legalized. Several years after Joanne Goldwater’s abortion, in 1962, Sherri Finkbine, Phoenix mother of four, became pregnant. Married and the host of the children’s program Romper Room, she had no intention of fueling a debate related to abortion. But when she discovered that thalidomide, a tranquilizer that she had taken to ease morning sickness, caused extreme deformities in babies, she conferred with her doctor. When he advised that she secure an abortion, Sherri and her husband, Robert, agreed. Her doctor quietly helped arrange the abortion at a Phoenix hospital. However, the matter did not remain private because Sherri decided to publicize the negative effects of thalidomide to help other mothers and their families. By doing so, she ignited a controversy surrounding her abortion, and the local hospital refused to allow it. At that time, Arizona law permitted abortion only to save the life of the mother, with no exceptions for rape, incest, or possible fetal deformity.5 Sherri Finkbine decided to end her pregnancy to protect her children, the eldest of whom was seven at the time. She later told a reporter: “I didn’t do it to prove anything to society that I was for or against abortion. I did it for preservation of those things a mother preserves, and that is first and foremost her children. I felt like a mother lion with her cubs. This pregnancy was affecting my children. They already existed, they were real, and nobody had to tell me when their life began because they were there.”6 Finkbine realized that caring for a severely deformed child would undercut her ability to mother her four other young children. After the controversy erupted in Phoenix, the Maricopa County attorney threatened to sue the hospital if staff there performed the procedure. Even though abortion was illegal unless necessary to save the mother’s life, sometimes physicians claimed that their patients were in such mental stress that an abortion was necessary. In this case, the physician had made arrangements for the procedure, but the plans were derailed when Sherri

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discussed the matter publicly. The Finkbines had to fly to Sweden for the abortion of the three-month-old fetus that had no legs and only one arm.7 Sherri Finkbine’s dilemma occurred in the early 1960s, just as the Baby Boom was ending. Her abortion brought public attention to a subject that was usually discussed only in private. A white, middle-class woman, she gave interviews with the press and allowed others to learn of her private turmoil, and in that way, she opened a public conversation. Many Americans who learned of her situation supported her decision because they believed that children deserved a decent quality of life.8 At that time, abortion was illegal throughout the nation, but a reform movement gained traction during the 1950s and 1960s. A coalition of physicians and public health workers, who saw firsthand the grave risks associated with illegal abortion, and social workers, concerned about family poverty and poor health, worked to reform abortion laws. Demographers, anxious regarding overpopulation, also became involved in this effort.9 During the late 1960s and early 1970s, the Arizona legislature and various state courts considered several measures related to abortion reform. However, despite the efforts of activists, legislators, and physicians, Arizona’s abortion laws changed only in response to the 1973 U.S. Supreme Court decision that legalized abortion, Roe v. Wade. While this contentious debate played out in the legislature and courts, some Arizona women became activists for abortion reform, and others dedicated themselves to preserving the status quo. Still others remained on the sidelines in the battle, maintaining their views and pursuing their own courses of action privately. In Arizona’s diverse population, people approached the abortion issue with varying beliefs about motherhood, sexuality, and religion. Some claimed that abortion rights would further promiscuity and that pregnant women should “pay the price” for their ­actions. Others from American Indian tribes, along with Mormons and Catholics, held traditions and beliefs condemning abortion. When the women’s movement gained prominence in the late 1960s and early 1970s, feminists claimed the right to control their own bodies and destinies. Varying ideas about women’s roles and when human life began framed this conflict. By the late 1960s, a great deal of change had occurred in relation to pregnancy and childbirth, and many accepted contraception and women’s ability to control their fertility. But the issue of abortion reignited debates about womanhood, babies, and the female body in a new and fierce arena.10 Abortion reform gained increased attention during the 1960s due to Sherri Finkbine’s predicament and another health issue related to preg-

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nancy. In 1964, there was an outbreak of rubella, or German measles, which was known to cause pregnant women to give birth to damaged babies. In most states, including Arizona, where abortion was legal only to save the mother’s life, the threat of a baby’s birth defect would not qualify a woman for an abortion.11 By 1967, efforts for reform began to bear fruit nationally when Colorado, California, and North Carolina liberalized their abortion laws. The reform statutes implemented in these states were influenced by a model developed by the American Law Institute (ALA) in 1959.12 Made up of elite law professors, lawyers, and judges, the ALA proposed changes in law that could be implemented or rejected by state legislatures. In relation to abortion, the ALA proposed that abortion be allowed “if two doctors certified that the mother’s mental or physical health were at stake, if the child was likely to be deformed, or if the pregnancy was the result of rape or incest.”13 These guidelines did not consider women’s right to choose an abortion and left the decision in the hands of physicians. Although many physicians would approve an abortion for someone like Sherri Finkbine, many other women would not be allowed an abortion if their circumstances fell outside of the narrow guidelines or if they could not afford to see a physician.14

Abortion Convictions in the Courts Arizona’s laws resulted in the conviction of physicians and lay practitioners who performed abortions from the late 1940s into the 1960s.15 Julia Bryant, an African American resident of Globe, was arrested for performing an abortion in 1949. Bryant, known to be a “madam” in Globe, had served time earlier on a similar charge. In November 1949, Judge J. Smith Gibbonds of Apache County Superior Court revoked her parole and sent her to prison for four to five years. Sadly, Bryant died in prison in Florence, at the age of fifty-nine, due to hypertension.16 In 1955, the Arizona Supreme Court heard an appeal of the conviction of Dr. H. T. Boozer, a physician in Superior who had been found guilty of performing an abortion. Court records from the trial in Superior Court of Pinal County discuss Dora Jean Williams, who went to Dr. Boozer with her husband, Donald T. Williams. Pregnant with a baby conceived before her marriage to Donald, Williams reportedly wanted an abortion to avoid the shame of a pregnancy begun before the marriage and also for financial

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reasons. Because the abortion was not necessary to save her life, the court denied Boozer’s appeal.17 To convict a lay practitioner or physician under Arizona’s abortion law (statute 13–3604), the jury had to be convinced that the woman purported to have had the abortion was actually pregnant at the time. In addition, the defendant had to have used instruments to bring about a miscarriage, and the court had to determine that the procedures were not necessary to save the woman’s life.18 These issues were debated by the Court of Appeals of Arizona, Division 1, related to Charles Keever’s conviction. Keever had been found guilty of performing an abortion for a “go-go dancer” from a Phoenix bar. In the jury transcript, the dancer is unnamed, unlike transcripts from earlier years where the women were named. Even though she is unnamed, the transcript discussed the dancer’s health and life in detail, stating that she was a married mother of two who was “generous with men in the use of her body.”19 Although she had used the birth control pill in the fall of 1965, by December, her use of the contraceptive was irregular, as were her menses. According to the transcript, she had “intimate association with men not her husband without the use of contraceptive devices.” She experienced symptoms related to pregnancy and went to her local doctor, who conducted a pregnancy test, which came back positive. Her doctor did not do a pelvic exam. The dancer’s employer contacted the defendant, Dr. Keever, who agreed to perform an abortion after meeting with the young woman.20 Court testimony discussed the procedure (dilation and cutterage or D&C), the painkiller used, along with the physical symptoms experienced by the woman, including the fact that she performed in the bar within hours of the procedure. In addition, the record described the lack of bleeding following the D&C. During the appeal, doctors testified regarding whether the woman was actually pregnant when the so-called abortion was performed. Based on the evidence presented during the appeal, including the woman’s slight discomfort and lack of bleeding, the court determined that she was not pregnant, “at least that pregnancy was not established beyond a reasonable doubt.” Dr. Keever’s appeal was successful, and he was pronounced not guilty.21 This trial and appeal during the 1960s described in a public forum titillating details related to the twenty-year-old dancer’s body and life, including her willingness to engage in sex with a variety of men, her physical symptoms, and private experiences. Although she was unnamed, her ­activities placed in her the camp of “loose women.” At this time, most

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judges, lawyers, and doctors were male, standing as authority figures in the lives of women and those who performed abortions. While the men engaged in what might have been an entertaining debate regarding whether this dancer was pregnant, she continued struggling to support herself and her children.

Arizona’s Legislature and Citizens Debate Abortion Reform Given the court cases and convictions related to abortion, it is not surprising that the issue became a charged topic in the state legislature in the late 1960s. Although reform measures garnered support each year, they failed to pass both houses of the legislature. In 1967, Arizona’s Catholic leadership and laity waged an active and successful battle to stop the abortion law reform advocated by four Democratic senators.22 During the next session, legislators proposed that abortion be permitted in cases of rape or incest, when the health of the mother was threatened, or if the baby was likely to be born deformed, but this measure also failed.23 In 1969, the legislature again debated a bill to reform the state’s abortion laws. The House approved a measure allowing abortion in the following situations: pregnancy resulting from forcible or statutory rape or incest, when the mother’s mental health was threatened, when the pregnancy involved a minor, or if serious birth defects were suspected. The Senate version of the so-called therapeutic abortion bill allowed abortion following similar guidelines, with the exception of statutory rape. The Senate Committee on State, County, and Municipal Affairs, chaired by Republican Scott Alexander, approved the measure, but a month later the Judiciary Committee killed the bill, effectively ending efforts for abortion reform that year.24 As the legislature considered these bills, Arizonans and religious leaders also debated abortion reform. In January 1969, the Most Rev. Francis J. Green, bishop of the Diocese of Tucson, sent out a press release explaining that the church had organized a committee to evaluate abortion statutes because “the state has a duty to protect by its laws the lives of all its citizens, including the unborn child.” The bishop implied that fetuses were citizens. Fearing that efforts to liberalize the state’s abortion laws would lead to abortion on demand, he and another church leader, Father O’Keefe, pressed the Catholic Church position that “abortion is murder.”25 While these discussions played out, women dealt with their fertility in

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different ways. Between 1964 and 1968, Emily Jenkins attended the University of Arizona and served as assistant head resident in her dormitory. During this time, contraceptives were not easily available for unmarried women. She explained how young women dealt with unplanned pregnancies: “What was happening at the U of A is that girls would go to Mexico for illegal abortions. And it became such an issue, that I recall, at the dormitories, that the campus police came around and said, ‘If people go, tell them when they come back that we will take them to a hospital or a doctor to get antibiotics.’ So many people were coming back, and they were having infections and then having serious problems. . . . They were very worried about the health outcomes.” The college students went to Nogales, a border town about fifty miles south of Tucson, said Jenkins.26 In Phoenix in 1969, Harriet F. Pilpel, a New York City civil rights lawyer, moderated a panel discussion on abortion reform at the combined regional and national meetings of Planned Parenthood—World Population, held at the Camelback Inn in Phoenix. Also participating in the panel were Edward Sattenspiel, a physician; Edward Jacobson, an attorney, both of Phoenix; and Donald Minkler, clinical associate professor of the department of obstetrics and gynecology at the University of California Medical School. Together, these panelists discussed the main ideas driving the national effort for abortion reform.27 Pilpel argued that laws permitting abortion only to save the mother’s life were unconstitutional based on the individual’s right to privacy. Pilpel had been involved in the Griswold v. Connecticut case, which struck down Connecticut’s outdated ban on birth control. Jacobson, a member of the Snell and Wilmer law firm, stated that even though the state legislature had failed to reform abortion law, two-thirds of Arizonans favored such reform, according to a study conducted by the Arizona Medical Association among residents of Maricopa and Pima Counties. In his remarks, Dr. Sattenspiel, director of obstetrics and gynecology at Good Samaritan Hospital, declared that abortion laws were originally passed to save the life of the mother, but that the procedure was no longer dangerous when performed by a qualified person. The use of antibiotics and new methods also contributed to the procedure’s safety. However, he cautioned that illegal abortions were still hazardous “because they are performed by untrained, unqualified persons.”28 This panel received positive press in Phoenix newspapers, including the Arizona Republic and the Phoenix Gazette. A few months earlier, Pilpel had also spoken in Tucson, where she discussed the Griswold case and argued that the nation’s abortion laws would be changed eventually based on the right of privacy. Planned Parenthood

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Board member Priscilla Robinson attended Pilpel’s talk and was “absolutely electrified by this message.” Robinson decided to dedicate her time to lobbying for abortion reform, and she “spent the next four years focused almost exclusively on this campaign.”29 As she began lobbying, Robinson met several moderate Republicans, many of them young, who were working on different types of reform in Arizona, including the issue of abortion. These legislators wanted to eliminate the dozens of boards and commissions, made up of unelected officials, who had tremendous influence in the state. Members of this group included Scott Alexander, Bill Jacquin, Tom Goodwin, Dr. Doug Hols­ claw, Tony Buehl, and Sandra Day O’Connor, who went on to serve as a justice in the U.S. Supreme Court. These moderate Republicans viewed the abortion laws in Arizona as negative because they did not prevent abortion and led to maternal deaths.30 Sandra Day O’Connor was majority leader of the state Senate during the early 1970s, when there were not many women in that body. She worked very well with the young progressive Republicans who were advocating abortion reform, said Robinson. She described O’Connor’s work ethic: “She ran that place with an iron fist, but she did it by outworking them. They’d stagger in with their hangovers at 10 o’clock in the morning, and she was there at 7:30, doing all the paperwork, studying and reading, so she always had total command of the facts, all facts, all details.” Although O’Connor did not draft bills, she supported abortion reform.31 In her work as a lobbyist, Robinson consulted with these legislative leaders and with a loose coalition including the following groups: Clergy Counseling Service, Pima County Medical Society, League of Women Voters, Young Women’s Christian Association, students’ organizations from the University of Arizona, Zero Population Growth, and environmental organizations. These groups had different reasons for supporting abortion reform and did not meet together, but they remained in touch as they played different roles in the campaign.32 Obstetricians and gynecologists from the Pima County Medical Society were some of those working for abortion reform. Throughout the nation and in Arizona, physicians debated this issue.33 Dr. William E. Davis of Tucson, chairman of the Arizona Medical Association ad hoc committee on the revision of abortion laws, argued in 1970 that abortion laws in Arizona were unconstitutional. He stated that current law invaded women’s privacy and put them at further medical risk because only those who were already in a dangerous situation were allowed an abortion. The Arizona Medical Association supported House Bill 20, which had been intro-

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duced by John Roeder, a Republican from Maricopa County. According to Davis, they were ready to support any bill stating that “the decision to perform an abortion should be the joint decision of a qualified physician, the woman, her husband, if any, and an accredited hospital.”34 The bill, as passed by the House in late February 1970, would repeal the abortion statutes without setting up any guidelines for abortion.35 The state Senate considered this bill and another measure that would allow a woman to secure an abortion if she agreed to prior counseling from the health department. In addition, this second bill removed civil liability from the doctor who performed the procedure and the hospital where it took place. These bills were passed on to the Senate Judiciary Committee, presided over by Chairman John Conlan, a Republican from Maricopa County and an opponent of reform.36 Despite Conlan’s negative vote, the measure to remove all legal sanctions against abortion passed out of the Judiciary Committee in April but died in the Rules Committee the following month.37 While Davis lobbied for abortion reform, other physicians opposed any change in state abortion statutes. According to Dr. Gennaro Licosati, chief of staff at the Doctor’s Hospital in Phoenix, “abortion is taking the life of an innocent human being, the fetus. If the fetus has any rights at all, isn’t one of them the right to life?” Licosati further stated that often people argued for reform to allow abortion in cases of rape or incest. However, liberalized abortion laws in Colorado resulted in only 3 percent of women securing abortions for these reasons while the great majority claimed “socalled mental reasons. And yet the suicide rate in pregnancy is almost zero.”38 Countering his argument, Dr. Robert Tamis, former head of gynecology at Memorial Hospital, stated that when the sperm and egg meet, “they form a pregnancy, not a human being.” He also addressed practical matters related to pregnancy and abortion. Current state law required physicians to encourage girls who became pregnant at seventeen or eighteen to continue their pregnancies when they “are completely incapable of emotionally handling it.” Furthermore, he stated, “By law we encourage psychiatrists and doctors to lie and say that, because of emotional instability and immaturity, the girls’ life is threatened and therefore her pregnancy must be terminated. And yet almost no mental or physical condition is so severe as to endanger life.” Tamis implied that Arizona women could get abortions by convincing doctors to state their lives were threatened by emotional instability caused by a pregnancy. In Arizona and throughout the United States, this course of action was primarily available to middle-

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and upper-class women who could afford to see sympathetic physicians and pay for the expensive abortions available in hospitals.39 Clergymen in Tucson organized the Tucson Clergy Counseling Service for Problem Pregnancies to help women make a decision regarding an unintended pregnancy.40 Made up of twenty Unitarian Universalist, Presbyterian, Episcopal, and Jewish clergymen, the group counseled women, advising them of the following options: carrying the pregnancy to term and keeping the baby; carrying the pregnancy to term and giving the baby up for adoption; marrying the father (if unmarried) and keeping the baby; and terminating the pregnancy. Those who wanted an abortion received information about having the procedure in Arizona, where it was allowed only when the mother’s life was endangered, or traveling to California or New York, where it was legal. Indicating the depth of the problem, twenty-five women called for help during the first eight weeks of the counseling program. Of these women, some decided to continue their pregnancies, one couple married, and others received referrals to California for legal abortions, according to the agency’s spokesman, Rev. Russell Lincoln, a minister of the Unitarian Universalist Church. Lincoln commented that no African American clergy had become involved in the group, which was “the biggest, disappointing failure.” They had also faced difficulty in making contact with Mexican Americans, most likely due to conflicts with Catholic doctrines, said Lincoln.41 Reverend Michael D. Smith, a Presbyterian campus minister at the University of Arizona in 1971, joined the Clergy Counseling Service. At this time, he knew from his work on campus that many young women needed counseling due to so-called problem pregnancies. Because abortion was illegal, there were few people with whom they could talk about all of their options. Ministers and members of the clergy were needed because they could provide confidentiality.42 Smith met with individual women about once a week from 1971 to 1974, counseling approximately 250 to 300 women. These women were “all over the range in age, condition, and finances,” he said. “We all, in the Clergy Counseling Service, saw our job as to assist the woman in arriving at the conclusion of what to do with her pregnancy that was consistent with her own beliefs and values . . . to work it out so that they were comfortable with what they really needed to do.” Through his work, he found that Catholics and Hispanics were as likely to choose abortion as others.43 In an oral history interview, Smith explained that he saw abortion as an issue related to both women’s equality and moral agency:

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From a religious perspective, women are created in God’s image the same way men are. Male and female God created them in God’s own image. The equality issue is a no-brainer for me. I’ve always said what personal issue is more important and significant than the issue of bringing a life into the world? And that, of all places, is where a woman has the right to decide for herself. . . . It’s a religious issue because women are created in the image of God . . . with among other things, moral agency. That means they have the power to make moral decisions. That is how God creates each one of us. . . . We have the capacity, as well as the right, to make moral decisions. . . . In the case of the woman who is pregnant, nothing is more personal than that. It affects her way more than anyone else, so that issue of God creating us with moral agency comes down to a bottom line in relation to women having the right to decide for themselves.44 Although Smith and others advocated women’s moral agency and personal decision-making rights, abortion reform did not pass in the state legislature. The Arizona House approved a bill repealing the state’s abortion law by a vote of thirty to twenty-five in February 1971, allowing a woman to make the decision to end a pregnancy, in conjunction with her physician. Similar bills had been passed in the House previously, but they usually became tied up in Senate committees, and this happened again.45 Senator Jim McNulty proposed a bill that would require screening and several counseling sessions before a woman could have an abortion. In opposition to both bills, members of the Public Health and Welfare Committee received hundreds of letters. The Most Reverend Edward A. McCarthy, bishop of the Roman Catholic Diocese of Phoenix, wrote to each lawmaker, stating that any change in abortion laws would be “a denial of the value of human life.”46 Once again, the Senate committee voted down the two abortion reform measures after a lengthy hearing.47 Priscilla Robinson, lobbyist from Planned Parenthood of Tucson, remained committed to the issue from 1970 to 1973, learning a great deal about the legislative process as different bills advanced. Robinson believed that abortion reform would have passed by 1974 if Roe v. Wade had not resulted in national change.48 Sue Alcock of Tempe also volunteered for Planned Parenthood in Phoenix, helping with the intake process in Memorial Hospital, then on the Public Affairs Committee, and eventually as president of the Planned Parenthood Board. As a member and then leader of the Public Affairs

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Committee, Alcock testified often in the state legislature when the body considered bills related to abortion. She was able to quickly assemble a large group to lobby by phone and be present at hearings. Members of the right-to-life group were also on hand, including Dr. Carolyn Gerster, who always made statements opposing abortion reform.49 As these legislative matters played out, physicians, along with pregnant women and girls, operated within the framework of Arizona’s abortion laws. Dr. Herbert E. Pollock, chair of Tucson Medical Center’s (TMC) Therapeutic Abortion Committee, spoke publicly about the case of a thirteen-year-old girl who had been raped and become pregnant but did not qualify for a therapeutic abortion. In addition, pregnancy resulting from incest or cases where the fetus would be severely deformed could not be legally terminated. Pollock claimed the law was punitive: “What we’re saying is ‘suffer, lady. . . . You have sinned, you must be punished.’ ” However, Pollock believed that an unwanted pregnancy entailed enough suffering in and of itself.50 In his role as obstetrician-gynecologist and as chair of TMC’s Therapeutic Abortion Committee, Pollock counseled pregnant women frequently, helping them determine the best course of action. He explained the available options, including securing an abortion in California or New Mexico, which had more liberal abortion laws by this time. The most common abortion involved a D&C and cost between $400 and $1,000, according to Pollock. This cost included operating room charges, anesthesiologist and hospital room fees, and the surgeon’s bill.51 Arizona women who tried to get abortions in their home state had to apply to a therapeutic abortion committee, such as the one headed by Dr. Pollock at the TMC. The process began with the woman’s doctor presenting her case to the committee. At TMC, four physicians, including a psychiatrist, specialist in internal medicine, pediatrician, and obstetriciangynecologist comprised the committee. Each year, they granted only six abortions, although the committee received three times that many requests annually.52 Historian Jennifer Nelson argues that white middle-class women had the vast majority of therapeutic abortions in hospitals throughout the nation because physicians were more willing to bend the rules for this group.53 In the early 1970s, Emily Jenkins, a young graduate of the University of Arizona, worked at Friendly House, a settlement agency in Phoenix. While teaching an English-as-a-second-language class, she met a pregnant and depressed married mother, who was supporting her family with little assistance from her husband. This woman desperately wanted to have an

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abortion because she needed to work and could not support another child. Jenkins and the director of Friendly House helped her petition the therapeutic abortion committee at the county hospital, and they were successful because the woman “was nearly suicidal.” After her abortion, she came back to class and absorbed information, “like a sponge,” said Jenkins. This experience led Jenkins to see that women needed to be able to control their fertility because they were often the ones providing both emotional nurturing and financial support to their families.54 Given the difficulty of obtaining abortions in Arizona, Planned Par­ enthood operations provided information about abortion providers in California and Sonora, Mexico. In the early 1970s, Virginia Yrun helped a friend with a problem pregnancy by calling Ruth Green, director of Planned Parenthood in Tucson. Green referred the young woman to a dentist in Sonora who provided safe abortions at this time.55 In Phoenix, Planned Parenthood referred women to abortion providers in California, according to Sue Alcock. “The pregnant girls would go to the clinic, Planned Parenthood, and then they arranged plane flights to California because it was legal there to terminate pregnancies. . . . Planned Parenthood had taken that extra step to help girls in need,” she said.56 Planned Parenthood of Southern Arizona also coordinated this type of service to Los Angeles for women who wanted to terminate their pregnancies.57 Ruth Green, director of the Tucson Planned Parenthood, traveled to L.A. to check on the services and make sure that the women from Arizona were treated with respect. “Ruth had very, very high standards,” said Judy Tamsen. Despite the checks and the support provided by Planned Parenthood, it was a difficult experience for some women. “It was very frightening. Some of these women had never left the south side of Tucson, let alone get on a plane and go to California . . . it was overwhelming to a lot of them,” said Tamsen.58 In the fall of 1971, another organization, the Problem Pregnancy In­ formation Service, also helped Arizona women fly to California for abortions. Through confidential arrangements with physicians at a fully accredited Los Angeles hospital, the organization aided approximately twenty-five pregnant women each week, according to an article in the Arizona State University student newspaper, the State Press. The estimated cost of the service was $300, including $235 for the hospital, doctor, and necessary medications; $45 for the group-rate, round-trip airfare; and the rest for motel and spending money. The trip and abortion took only twenty-four hours and included counseling and transportation to and from the hospital.59 The $300 all-inclusive fee through this service was

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lower than the $400 to $1,000 amount estimated by Dr. Pollock. This charge was still relatively high, and most likely, only middle- and upperclass women used this service. The New Times, a liberal Phoenix weekly newsmagazine, carried advertisements for the Problem Pregnancy Information Service and even­ tually was charged and convicted of carrying advertisements related to abortion. Under Arizona law, it was illegal to advertise means to prevent conception or end pregnancies. In an editorial, newspaper staff discussed their plan to appeal the decision. The editor also mentioned both the paper’s reliance on advertising and the need to change Arizona’s abortion laws.60 Although some helped women in securing therapeutic abortions out of state, others worked actively against abortion reform. The New Times published a long interview with Dr. Carolina Gerster, founder of Arizona’s Right-to-Life Committee. Gerster described her own miscarriage and examination of the expelled fetus, which she called “a perfectly formed little human being.” This experience and her belief that human life began once the fertilized ovum implanted in the womb led to her determination that abortions should only be allowed to save the mother’s life.61 When queried about back-alley abortions and hazards to women’s health, Gerster replied that there had been nine abortion deaths in Arizona during the previous four years, implying that the number was lower than what the “propaganda” indicated. Countering a question about forcing a woman to raise an unwanted child, Gerster stated that there were long lists of waiting parents who would adopt babies, if mothers would allow it. She stressed the need for birth control, but also believed that once a pregnancy occurred, the woman did not have the right to terminate it. Gerster ended the interview by graphically discussing the physical destruction of a fetus during an abortion.62 Evan Meacham, future state governor and publisher of the Weekly American, a conservative newspaper, also campaigned against abortion reform. In February 1971, Meacham’s editorial titled “It’s Murder” stated that abortion reform would not liberate women; instead, it would lead to the “release of restraint” that would put more women “in bondage of the evil intentions of evil men.” Those who became pregnant while not married should bear the child and “pay the price,” he wrote. Given that a “God given instinct of motherhood” existed in women, he advocated ­protecting women “from the wrong choice that might be too easy to make if it were legalized.”63 According to Meacham’s brand of paternalism, women were not capable of deciding themselves whether to carry a pregnancy to term.

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Jim Skelly, state representative from Scottsdale, was also strongly opposed to abortion reform. “I always had pro-life bills in,” he said. Skelly quarreled with the Arizona Education Association, which he believed wanted to distribute birth control and condoms but would not discuss moral values.64 Skelly’s views were in line with those in Birthright, an antiabortion organization that provided counseling and a referral service for women with unwanted pregnancies. A Phoenix branch of this national organization actively recruited teen members in 1972.65 Also on the pro-life bandwagon were a group of doctors and nurses who held a panel discussion on abortion reform. Fearing that abortion reform would succeed, some nurses, such as Mrs. Musselman, voiced strong opposition to any change in the law. “There is nothing more unethical, immoral or insulting to the value of human life than abortion,” she stated.66

Abortion Reform in the Courts The issue of abortion reform created a lively and contentious debate in Arizona in the early 1970s. Planned Parenthood operations in Tucson and Phoenix were the oldest, most well-established organizations pushing for reform. As legislative attempts failed, Planned Parenthood leaders, physicians, and members of the public challenged Arizona’s abortion laws in the courts. In June 1970, Planned Parenthood Association of Phoenix, the Tucson Planned Parenthood Center, a doctor, and two couples from Phoenix filed a federal lawsuit challenging the constitutionality of these laws. The Arizona attorney general and Maricopa and Pima County attorneys were named as defendants. The suit claimed that abortion statutes limited Planned Parenthood’s ability to counsel pregnant women who suffered from German measles, Down syndrome, hydrocephalus, and other conditions that would confer severe risk of birth defects on fetuses. Dr. Robert Tamis, also a party in the suit, likewise stated that the laws limited his ability to abort pregnancies of women suffering from the conditions cited. The two couples in the suit, the Hoods and the Steiners, each stated that the laws limited their right to privacy and ability to determine whether to bear additional children. This lawsuit challenged the constitutionality of Arizona’s abortion laws under the First, Fourth, Ninth, and Fourteenth Amendments of the U.S. Constitution.67 In June 1971, the federal court declined to interfere with the Arizona antiabortion law and advised the plaintiffs to take their case to a state court.68 One month later, Planned Parenthood of Tucson, ten medical doctors,

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and Jane Roe (an alias for an unwed mother seeking an abortion) filed another suit in Superior Court in Tucson.69 Presiding Judge Jack Marks granted five Tucson doctors and the Tucson Right-to-Life Committee parties of special interest status with the ability to participate in trial testimony at the judge’s discretion.70 Ruth Green, executive director of Planned Parenthood in Tucson, testified in court, informing the judge that Planned Parenthood had counseled women in regard to having abortions performed by qualified doctors in another state. In addition, she stated that women should be able to determine whether to bear a child. Two physicians who worked at St. Joseph’s, a Catholic hospital in Phoenix, also testified, opposing any change in Arizona’s abortion laws.71 In April 1972, Judge Marks dismissed the Planned Parenthood suit, claiming that he lacked jurisdiction in the case because it involved no actual prosecution under the law. He cited similar dismissals in Maricopa Superior Court and federal court.72 Planned Parenthood and the other petitioners then took their case to the Court of Appeals of Arizona. By this time, they were joined in the suit by another unwed pregnant woman because the first plaintiff had secured an abortion out of state. In May, the Court of Appeals vacated the order of dismissal and ordered that Judge Marks try the case on its merits.73 When Judge Marks heard the case on September 29, 1972, he ruled the state’s abortion law unconstitutional because it “violates the fundamental right of marital and sexual privacy of women guaranteed by the 9th and 14th Amendments.” Marks rejected the arguments of the county attorney and attorney general who stated that the state could protect the fetus “against destruction.” Marks held that the fetus was not a person entitled to Fourteenth Amendment rights or constitutional protection. His decision was based in part on recent court rulings in other states. 74 By 1970 Hawaii, New York, Alaska, and Washington had all legalized abortion as an elective procedure, repealing their antiabortion statutes. Influenced by the new feminist movement, these repeal laws gave women the right to make the decision to abort a fetus rather than placing the ultimate authority with physicians. Fourteen other states had “moderately permissive laws,” and the remaining thirty-two (including Arizona), permitted abortion only to save the mother’s life.75 Marks’s ruling against Arizona’s restrictive abortion laws led to celebrations among proreform advocates, but their jubilation was short-lived. Gary K. Nelson, state attorney general, appealed Marks’s decision in the Court of Appeals of Arizona in early January 1973. A divided Court of Appeals ruled in favor of Nelson and upheld the constitutionality of Arizona’s abortion law.76

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Arizona’s abortion laws remained in force for a few more weeks, until the Supreme Court’s Roe v. Wade decision on January 26, 1973, ordered liberalization of abortion statutes in Arizona and forty-five other states. Following that decision, the Arizona Court of Appeals vacated its earlier decision and affirmed Judge Marks’s ruling, declaring the state’s abortion laws unconstitutional.77 Within months of this ruling, convictions related to performing or advertising abortion services were reversed. In April, the Court of Appeals set aside the conviction of J. N. Wahlrab for performing an abortion and dismissed the case against the New Times weekly newspaper in July 1973.78 The Supreme Court based its decriminalization of abortion on the constitutional right to privacy, which extended to reproductive decisions. The court associated Roe v. Wade with the Griswold decision, eight years earlier, which had determined married couples had a right to use birth control. Roe v. Wade held that state law could not prohibit abortion in the first twelve weeks or first trimester of pregnancy. During this time, the woman could make the decision to end a pregnancy, with her doctor, but during the second trimester the state could regulate abortions to protect the mother’s health. After the pregnancy had progressed six months or when the fetus was viable, the state could prohibit abortion except to save the life of the mother. In this way, the court established a means to consider abortion by trimester of pregnancy, with increasing restrictions as the pregnancy progressed.79 According to historian Rickie Solinger, basing the Roe decision on ­privacy acknowledged women’s human dignity and defined their selfownership. However, it was paradoxical that this decision was based on the right of privacy at a time when “women’s fertile, reproducing bodies had never been so visible or publicly consequential in American society as in this era; the reproducing body had become everybody’s business.”80

The Conflict Continues after Roe v. Wade This preoccupation and conflict related to women’s reproduction continued even after the Supreme Court decision. A strong right-to-life movement reorganized to restrict abortions. State legislator Jim Skelly quickly proposed a memorial to petition Congress for a constitutional amendment limiting abortion. “A week after Roe v. Wade, January 22, 1973, I had one of the first memorials to Congress in the United States, right here in Arizona, that I sponsored,” Skelly bragged in an oral history interview.81 He quickly garnered twenty co-sponsors in the state House. According to

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Evan Meacham’s Weekly American, Mormons, conservative Protestant, and Roman Catholic churches were determined “that no abortion-ondemand law will prevail in Arizona.”82 In an editorial titled “Death Penalty for Unborn,” the Phoenix Arizona Republic newspaper supported a “constitutional amendment protecting the unborn.” Citing medical and legal evidence that life begins at conception, the editorial derided the Roe v. Wade decision, which could create an “orgy of permissive abortions.” The editor referred to the “child in embryo,” stating that the Supreme Court’s decision dismissed consideration of the “health and life of the child.”83 While those opposing access to abortion organized in Phoenix, Ruth Green reported that women were getting abortions in Tucson within a month of the Supreme Court decision. However, Planned Parenthood continued to refer patients to California because doctors there had lowered the abortion costs to $150, and the procedure was more expensive in Tucson. Green and other Planned Parenthood personnel were concerned with lowering abortion costs for low-income women. They cited a demand for this service; 119 women received abortion counseling at the Planned Parenthood during January, said Green, and 80 percent decided to have the procedure, while 20 percent decided against it.84 In March 1973, the Arizona Supreme Court rejected a request by the State Court of Appeals to salvage parts of the state law prohibiting abortions.85 This action gave Planned Parenthood of Tucson the green light to proceed with plans to open an abortion clinic, but the agency did not do so until 1982 because leaders were afraid that providing abortion would undercut their ability to provide other reproductive health care. However, hospitals in Tucson began preparing to provide abortions. University Hospital and the Tucson Medical Center were allowing physicians to perform abortions by April, and the Tucson General Hospital consulted with lawyers and the medical staff regarding the procedure. At TMC, they expected most of the abortions to be conducted during the first trimester of pregnancy.86 In Phoenix, two physicians opened the Valley Abortion Center in July 1973. Gynecologists Robert Wechsler and Robert Tamis offered abortions to women during the first thirteen weeks of pregnancy at a fee of $220. Tamis had been involved in reform efforts for years, lobbying the state legislature and participating in legal cases. At this time, Planned Parenthood of Phoenix did not provide abortions; instead, the organization continued referring women to physicians in California at a cost of $225. These prices included all of the lab tests, medical procedures, and anesthesia.

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According to Tamis, hospitals in Phoenix were devising more stringent rules related to abortion and raising their fees. However, qualified women were receiving abortions at no cost in Maricopa County Hospital.87 From 1973 to 1974, the number of abortions performed in Arizona jumped 103 percent, from 2,770 to 5,610.88 The right-to-life movement mobilized against the legalization of abortion. Mothers protested on the opening day of the Valley Abortion Center, many carrying their adopted children. Dr. Gerster, leader of the group, stated that many of the women were motivated by “the fact that their children are adopted, and they believe if abortion were legal when they were conceived, they would not have been born.”89 In January 1974, right-to-life activists marched in Phoenix and throughout the nation, expressing dissatisfaction with women’s access to abortion. A huge crowd of 10,000 at the state capitol demanded that the Arizona legislature pass a memorial asking Congress to invalidate the Roe v. Wade decision through a constitutional amendment. According to sponsors of the rally, over 100 churches joined in support, with the strongest backing coming from Roman Catholics. This energetic crowd marched down Washington Street in central Phoenix, fifteen abreast. Physicians, such as Dr. Wallace McWhirter of Tucson, state president of the right-to-life movement, stated in a speech that regardless of differences, the crowd was “unified in one issue—the sanctity of human life, born or unborn.”90 A Phoenix attorney, Rosemary A. Meyer, also spoke to the group and compared the Roe v. Wade decision to the historic Dred Scott decision that held that blacks were not “persons” under the U.S. Constitution, just as the recent decision held that fetuses were not persons.91 During 1974, antiabortion activists lobbied actively in support of a constitutional amendment to invalidate Roe v. Wade. Congressman Morris Udall received many letters concerning this issue, including one from the bishop of Tucson, Most Rev. Francis J. Green, that was to be read at all masses on January 20, 1974. The bishop derided the Supreme Court decision, which did not allow “any protection for right of life of unborn human beings. . . . The life of every human being is sacred from conception to death.”92 In his responses to several letters, Udall stated that he did not support a constitutional amendment, but did support allowing states to decide on the abortion issue. Later, in a 1976 letter to Tucson educator Maria Urquides, Udall wrote that he supported the Supreme Court decision but believed medical professionals and hospitals should be able to refuse to participate in the procedure.93 State Senator Scott Alexander, a Tucson Republican, also received let-

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ters from constituents supporting and opposing the Roe v. Wade decision. Sally Johnson wrote to Alexander, “If Congress passes such a memorial prohibiting abortion except to save the mother’s life, they are not only forcing a religious belief upon every person in the this country, but they are also telling every woman what she can or cannot do with her own body.”94 Similar debates and discussions occurred in other states as Congress considered various means to reverse Roe v. Wade. Despite a substantial showing of support from the national right-to-life movement, the constitutional amendment did not gain traction.95 As these conflicts continued to play out at the state and national levels, physicians and public health officials noticed a steep drop in abortioncaused deaths in Arizona. Although abortions were the leading cause of maternal death in the early 1970s, by January 1974, one year after Roe v. Wade, abortion rarely caused maternal death, said Dr. William Crisp, past president of the Maricopa Medical Society.96 Nationwide the number of abortion-related deaths dropped from ninety in 1972 to eleven in 1981.97 Just as they had in earlier decades, volunteers continued to support Planned Parenthood during the 1970s. Sue Alcock volunteered many hours “because Planned Parenthood seemed to be the only organization that was really helping, pregnant teens, especially.” During the time of Alcock’s involvement, the primary clients of Planned Parenthood were teenagers and low-income women, she said.98 Jane Canby also became a volunteer for Planned Parenthood of Phoenix in the late 1960s. She had been involved in Planned Parenthood in St. Paul, Minnesota, before moving to Tempe in 1967. She served on the Public Affairs Committee and organized the Speakers’ Bureau. At first, the talks given by Planned Parenthood volunteers focused on the need to curb the population explosion, said Canby: “Those were the days of the environmental movement. Those were the days of Paul Ulrich and The Population Bomb . . . and Earth Day just started. What was going to happen? We were using too many resources of the world. . . . Those were big issues and that is what the Speakers’ Bureau speakers were asked to talk about.” However, soon the mood changed, with the publication of the Boston Women’s Health Collective’s Our Bodies, Ourselves, said Canby. “The women’s movement had arrived. Abortion was provided. . . . The discussions moved very quickly from overpopulation to women’s health, women’s rights, and controlling their own bodies.”99 In Tucson, Janet Marcus began serving on the board for Planned Parenthood of Southern Arizona in 1975. Trained as a counselor, she provided counseling to those considering abortion. “Board members had

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much more hands-on participation in different areas at the affiliate,” during the 1970s, she said. She also became active as a lobbyist in the state legislature and worked in Arizona Right to Choose, supporting Congressman Morris Udall when he was in a close election. When she later served as president of the Planned Parenthood board, she worked against laws requiring parental consent for minors desiring an abortion “because not everyone can go to their parents for permission,” she said. After the law passed requiring parental consent in 1987, they recruited a team of lawyers to help teens get a “judicial bypass” when they could not approach their parents for permission. The volunteer lawyers represented the teenagers in court.100 During this time, the issue of the Equal Rights Amendment (ERA) also generated much activity as a coalition of women’s groups pressed for its passage, while others mobilized to stop it. Susan Stradling, a member of the conservative group Eagle Forum, explained her opposition: “Passing the ERA in those days would have accomplished a lot of things for the groups out there that wanted lesbian rights, homosexual rights, and abortion on demand and equal opportunity in the military for women.”101 Strad­ling and other members of the Eagle Forum lobbied in Arizona and throughout the nation against abortion rights, as they opposed the ERA. Women in the New Right conservative movement opposed any change in the traditional familial roles, and they often linked abortion with the ERA.102 Because they believed women’s most important role was motherhood, they lobbied against any change that they viewed as a threat to women in this domestic realm. Shirley Whitlock, member and later president of Arizona Eagle Forum, believed that women who were “proabortion” were also “antifamily.” Those who supported abortion rights also supported laws that made it harder for mothers to remain at home, caring for their families, she said.103 Conflicting views concerning abortion also affected those providing contraceptives. Jane Canby, co-director of the Arizona Family Planning Council in 1976, felt the effects of the right-to-life movement. Following the Roe v. Wade decision, Canby’s role in expanding access to contraceptives became much more difficult. Planned Parenthood and abortion became “lightning rods,” she said, igniting many conservatives to oppose both access to abortion and family planning.104 Beginning in 1973, some county hospitals began to quietly provide abortions for low-income women in Maricopa, Pima, and Pinal Counties. At this time, Arizona did not accept federal Medicaid funds, so services for low-income women were provided primarily by county health depart-

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ments.105 Pima County funded nontherapeutic abortions from 1973 to 1975, paying for 400 abortions that were not medically necessary during one year. Citizens voiced both opposition and support for this practice in Tucson.106 At the same time, in Phoenix, the Maricopa County Health Department funded approximately 350 abortions for medical reasons, although Planned Parenthood staff argued that many more low-income women needed the service.107 In 1977, the U.S. Supreme Court in Beal v. Doe allowed county health departments to limit abortions paid for by the county indigent medical programs.108 The issue of publicly funded abortions became very political, and within a few years, Arizona’s public hospitals were limiting the number of abortions performed there. In 1977, only 16 percent of public hospitals in the state reported that they provided at least one abortion in the past year.109 The state legislature banned use of public funds for abortion in 1980, following a similar ban implemented through the Hyde Amendment (passed by Congress in 1976) that restricted use of federal funds for abortion unless the mother’s life was in danger.110

How Did Race and Ethnicity Affect the Debate? The issue of limiting reproduction became a charged debate among some people of color during the 1970s. While many young women of color welcomed birth control, others in their communities called family planning a form of genocide. In addition, there was a generational divide related to sexuality and childbearing among some ethnic groups, with the younger women desiring more freedom than their mothers or grandmothers had expected. Some older minority women were not as likely to use birth control or to favor access to abortion. By the 1970s, young Latinas attending college in the Phoenix area were discussing birth control, abortion, and reproductive issues. However, as a high school student during the 1960s, Francisca Montoya, of Surprise, Arizona, learned nothing about these topics. She became pregnant at the age of fifteen and married her son’s father when she was sixteen but divorced him two years later. Then she quickly earned a GED and entered a secretarial program. After her counselor strongly encouraged the highly inquisitive and intelligent Francisca to consider furthering her education, she did so, becoming the first from her farm worker family to enter college.111 At Arizona State University in the 1970s, Francisca encountered a new

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world and the excitement of progressive movements for social change, including the women’s, Chicano, American Indian, civil rights, and environmental movements. She became friends with other young women of Mexican descent whose attitudes were very different from the older generation, as she described in an oral history interview: All my friends believed in freedom of choice. All of my friends were on birth control . . . sexually active but taking care of themselves because they wanted to go to school. . . . Sexuality was much more open when I was in college than when I was in high school. There was much more information starting to be available. There was the whole ERA movement, and we were starting to be influenced by that. We were in full support of it. . . . We had the right to decide what we wanted to do with our bodies. Everywhere you turned you saw information about it. There were conversations. People were very open about it.112 While Francisca had the support of her family as she studied in college, other young Latinas did not. “They were, in many ways, breaking that mold and becoming their own persons,” she said. Even though Montoya supported the women’s movement, there was still resentment among Latinas toward Anglo women and the feminist movement, she said. “There was the perception, ‘Why would you want to join this woman’s group when it’s really just for gringas because that’s who they take care of. They’re not interested in our issues. Our issues are too radical for them. As Latino women, we’re not just looking at ourselves as women, we’re looking at ourselves as women within the Latino culture.’” Montoya and other Latinas dealt with male machismo, struggling with their men and feeling frustrated if they had to struggle with Anglo women. At the same time, they viewed life in a more communal fashion than many Anglo women did. “We look at things differently because of the fact that we’re tied to our community,” she said.113 Like other minority women throughout the United States, they supported the women’s movement in principle but struggled with the attitudes and racism of some white feminists.114 Navajo women also carried specific views related to reproduction and women’s roles. Some elderly women strongly opposed abortion, which they viewed as against their religion. These women saw “reproduction as holy, a sacred process that demanded reverence and a respect for life.”115 Although a few younger women in Joanne McCloskey’s study had abor-

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tions for pragmatic reasons, most young women and teenagers who became pregnant carried their pregnancies to term. They then received assistance from the strong communal and extended family system which assisted young mothers. Navajo women welcomed contraceptive services by the 1970s, but most continued to frown on abortion.116 Given the wide divergence in views related to abortion, it is not surprising that this discussion and debate continued throughout the 1970s. Jim Skelly described his efforts and those of other right-to-life leaders: “We couldn’t overturn Roe v. Wade, but you could nip at the edges,” he said in an oral history interview.117 Skelly and other lawmakers were successful in limiting use of public funding for abortions—a service that had been provided for low-income women. He also secured an important victory that stopped medical training in relation to abortion at the University of Arizona Medical School. In 1974 Skelly attached an amendment to a bill that provided funding to increase the capacity of the stadium at the University of Arizona. Although the bill faced stiff opposition in the Senate, it passed to fund the stadium, with the stipulation that the University’s Medical School could not provide training in abortion procedures. Skelly lauded this victory in an oral history interview in 2007, and the law was still in effect in 2011.118 The University of Arizona Medical School was the only training facility for medical physicians in Arizona at that time. Planned Parenthood of Southern Arizona quickly worked to develop a means to provide medical students specializing in obstetrics with education in conducting an abortion. Planned Parenthood staff made arrangements with the University of Arizona to offer training for medical students and residents in their facilities. The Planned Parenthood program secured some funding from an anonymous private foundation to maintain this program, which was still in operation in 2011.119 Although abortion was legal in Arizona and throughout the nation, abortion services were not easily available to women in rural areas. By 1977, a study through the Alan Guttmacher Institute estimated that 51 percent of women who wanted or needed an abortion in Arizona were unable to obtain one.120 Abortion services were heavily concentrated in the state’s metropolitan areas. Of those having abortions in Pima and Maricopa Counties, only 80 percent were residents of those counties. Women from outlying counties were traveling to the cities for the procedures.121 Eighty-three percent of abortions were performed in clinics and physicians’ offices, whereas only 17 percent occurred in hospitals. Of the state’s sixty-nine hospitals, twelve provided abortion services. Abortions were

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available in three of the state’s fourteen counties. In comparison to the rest of the United States, the rate of abortion in Arizona was low at 17.5 abortions per 1,000 women in Arizona and 26.9 per 1,000 women in the United States. These statistics indicated that Arizona was not meeting women’s needs for abortion services.122 The nearby states of New Mexico and Utah also had high percentages of counties that did not have abortion providers. In New Mexico in 1976, 59 percent of counties did not have abortion providers; 90 percent of Utah counties lacked abortion providers in the same year. In 1978, the rate of legal abortions per 1,000 women was 23.3 for Arizona, 22 for New Mexico, and 12.1 for Utah.123 The majority of those obtaining abortions in Arizona were young, unmarried, and white. Only 17 percent of those who had abortions were women of color. (It is unclear whether researchers included those of Hispanic descent within the racial category labeled white.) Ninety-one percent of all abortions performed in the state were conducted during the first trimester of pregnancy.124 To conclude, the hard-fought battle regarding abortion in Arizona did not change the state’s laws—it took the Roe v. Wade decision for this to occur. Abortion became legal, even though women in rural areas and isolated counties still found it difficult to have the procedure, as did those with low incomes. To terminate a pregnancy in the first trimester cost from $160 to $200, which was more than a monthly welfare check for a mother and one child. These women often had to turn to the private sector for assistance. Yet despite the difficulties, women could legally terminate a pregnancy in cases of fetal deformity, rape, incest, the mother’s poor physical condition, mental stress, or any other concern. Compared to the alienating and frightening experience of Joanne Goldwater in 1956, women definitely had gained more options.125 As this debate raged, the diverse population of women considered the issue from a multitude of viewpoints. Some celebrated newfound freedom to limit their own reproduction following Roe v. Wade, whereas others ­lobbied to stop abortion because they believed life began at conception. Women’s traditions, along with their religious and spiritual beliefs, influenced their views in relation to abortion; Navajos, Catholics, and Mormons often opposed terminating pregnancies. Many did not enter the public debate but instead quietly went about their own business, carrying pregnancies to term because they believed abortion was immoral or ending unintended pregnancies, without ever becoming involved in the struggle. Varying views in relation to motherhood, pregnancy, and childbear-

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ing were at the base of these differences of opinion. Some who opposed abortion reform did not want to separate sex from reproduction—they were afraid that doing so would lead to society’s downfall. On the other hand, those participating in the women’s liberation movement claimed abortion rights to further women’s independent choice and decisions. There was a generational and cultural divide surrounding abortion, with younger women from many cultures supporting abortion rights while middle-aged and older women from certain religious and ethnic groups were more likely to see it as immoral. This very private decision of whether to carry a pregnancy to term ignited public debate and conflict, which continued in Arizona and nationwide long after the Supreme Court decision. The next chapter illustrates how the abortion issue affected every aspect of reproductive health care as those opposing abortion linked it with birth control and fought public funding of contraceptives and Title X.

c ha p te r e i g ht

Providing Reproductive Health Care in a New, More Politicized Era

“The abortion issue has never really politically been resolved and it may never be,” said Jane Canby, former director of the Arizona Family Planning Institute. This statement’s veracity was reflected in a controversy occurring in Phoenix related to abortion and Margaret Sanger’s work. In 1991 the Arizona Women’s Hall of Fame inducted Sanger, even though conservative state legislators protested and threatened to withdraw funding from the program. These lawmakers assumed that Sanger had been an advocate of abortion, although providing access to birth control had been her life’s work. Historians, state librarians, and family planning advocates stood their ground in the face of the legislative protest. Some women of color who were community leaders, such as Erma Revels, head of the Coalition for Law and Social Progress, also protested Sanger’s induction, claiming that her eugenics policies had maligned people of color.1 Sanger’s induction resulted in the state legislature closing the Arizona Women’s Hall of Fame for ten years. Following this controversy, women were not inducted again until 2001, when longtime legislator Polly Rosenbaum negotiated a compromise with legislative leaders.2 Erma Revels’s protest of the induction revealed common tensions related to Sanger’s ideas and the eugenics movement. At the end of the twentieth century, some viewed Sanger’s statements about improving the “race” as an indication of racism. However, Sanger appealed to the public to expand access to birth control to improve the entire human race, not one racial group in particular. Sanger’s work with diverse peoples and her ability to inspire volunteers and professionals in the birth control move161

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ment aided women from all ethnic groups in controlling their fertility, which in turn had the potential to improve all aspects of their lives. As indicated by this conflict, women’s access to reproductive health care, abortion reform, and even females’ reproductive history created conflict during the last decades of the century. By this time Arizona women had made great strides in securing adequate birthing care, along with health care for infants and fertility control; but different people assigned varied meaning to these changes. Some women viewed certain aspects of fertility control, such as abortion, as a step backward. In Arizona and throughout the nation, the availability of abortion led to controversies that played out in the state legislature, courts, initiative measures, and public demonstrations. Despite strong efforts to undermine abortion access, the New Right secured uneven gains in Arizona during these years. Many moderate Republicans, believing in the constitutional guarantee of privacy, refused to support measures that severely limited access to abortion. While these debates played out, Arizona women faced other concerns, including lack of publicly funded contraceptives, loss of abortion providers, and continued inequality in health care services based on ethnicity and income level. For a few years in the 1980s, the state even lost ground as the infant mortality rate climbed. In addition, Arizona faced a huge teenage pregnancy problem. Health care professionals, advocates for reproductive health measures, and individual women and families continued to deal with reproductive health concerns in a new, more politicized era. Nationally, the New Right gained steam during the 1980s, as it attempted to broaden its base by linking economic conservatives with social conservatives.3 As a political movement, the New Right opposed secular humanism and focused on issues related to church and state, such as pornography and abortion. Economic conservatives, on the other hand, advocated the free market system without governmental controls. Many of the economic conservatives, including Senator Barry Goldwater, viewed limiting abortion access as governmental intrusion into one’s private life.4 During the 1980s, the New Right made several advances through the courts and the presidency of Ronald Reagan, who backed the movement’s goals. The right-to-life movement won a Supreme Court victory in 1979 when Bellotti v. Baird allowed states to require minors to get parental consent before having an abortion, as long as they could approach a judge for consent if parents denied it or the minor did not want to ask her parents. This decision put restrictions on minors’ abortion rights, but by allowing teenagers to speak to a judge (judicial bypass), it preserved some safety for

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those who might be victims of incest or abuse.5 In 1980, the Republican Party platform endorsed the Human Life Amendment, which was written to overturn Roe v. Wade. Reagan took office as the first president to adopt a right-to-life position, and his administration reflected these views. The U.S. Department of Health and Human Services, which administered Title X funds, approved regulations prohibiting clinics funded by Title X from providing any information about abortion. During his second term, Reagan again approved these restrictions.6 Among the general population, the emotional debate continued with a thirty-minute film called “The Silent Scream,” which purported to show an ultrasound of a fetus screaming during an abortion procedure. Rightto-life activists showed the film all over the United States. In September 1985, Bernard Nathanson, narrator of “The Silent Scream,” spoke at the Tenth Annual Pro-Life Conference in Phoenix.7 Also in 1985, the National Abortion Rights Action League responded with another film, titled “Abortion Rights, Silent No More.”8 Operation Rescue, the right-to-life group founded by Randall Terry, gained greater prominence during the 1980s, staging demonstrations at the Democratic National Convention in Atlanta in 1981 and later in Phoenix.9 All of these activities—in the courts, Congress, and among ordinary citizens—created a contentious climate for the consideration of women’s private decisions about their pregnancies.

Conflict Concerning Abortion Access Those who opposed access to abortion voiced their opinions by demonstrating at Planned Parenthood and other reproductive health facilities. In 1981, when Planned Parenthood of Central and Northern Arizona (PPCNA) opened a new clinic in Mesa, protesters picketed outside. According to Gloria Feldt, PPCNA executive director (and later Planned Parenthood Federation of America executive director), it was almost impossible to get publicity for clinic openings unless there were picketers. For the opening of the Mesa clinic, Planned Parenthood personnel had tried to attract the media, but none appeared until the protesters arrived, she explained in an oral history interview: Twenty-five picketers brought the media. . . . This created a feeling of tension. . . . After we had the ribbon cutting, we’re inside with a lot of volunteers, the staff, and the doctors were inside. All of a sud-

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den, we saw and heard a big white pick-up truck, four by four, drive up right by the building, slam on the brakes. This man jumps out, and we’re thinking, “Oh, oh, what is going on here?” He walks in and says “Who is the manager of this clinic?” The manager hesitantly raised her hand, and he reached behind himself and pulled out a bouquet of roses and said, “I just wanted to say thank you. Those people out front make me so mad. I wanted to come here and show you that there are many people who support you and support what you do.”10 This incident represented the difficulties faced by Planned Parenthood employees and volunteers during the 1980s, said Feldt. Although the vast majority of people supported access to contraception and Planned Parenthood, the demonstrators garnered attention in the media and created tension and fear as they attempted to intimidate those providing birth control and abortions.11 In 1979, Planned Parenthood organizations in Arizona commissioned a firm to conduct a poll in the Tucson and Phoenix metropolitan areas to assess the general public’s attitudes toward Planned Parenthood. The study by Behavior Research of Arizona demonstrated that 82 percent of those polled had a high regard for this agency. Only 9 percent opposed abortion under all circumstances. Most of the respondents were able to envision situations in which abortions would be the correct course of action.12 Although the majority supported Planned Parenthood and other family planning facilities, a strong right-to-life movement opposed their activities. In the 1980s, demonstrators representing Operation Rescue and Californians for Life began to appear daily at Planned Parenthood clinics in the Phoenix area. This brought increased tension, but staff became adept at providing a sense of calm and order for the patients, said Feldt. In the face of bomb threats, failed bombs, intimidation, and glued locks, they increased security. Fortunately, no one was hurt in these attempts.13 In Tempe, the Family Planning Institute provided abortion services and faced daily picketing from right-to-life groups during the 1980s. Jim Mooney, head of one such group called Project Jericho, opened a new office, the Aid to Women Center, across the street from the Family Planning Institute. Funded by a wealthy businessman, this center offered women free pregnancy tests and counseling. According to Mooney, they planned to provide services “in the hope that women will receive all the care they need to have the baby.” As Mooney attempted to attract support

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Antiabortion protest in Tempe, 1980s. Courtesy of the Tempe History Museum.

for the Aid to Women Center, he picketed the Family Planning Institute daily.14 The Southwestern Medical Clinic in Phoenix was also the site of frequent picketing. This clinic secured an injunction in 1987 to stop threatening behavior from interfering with patient care. It stated “threatening, yelling, intimidating, photographing or preventing someone from entering or leaving this particular health clinic was unlawful.”15 This injunction applied only to the Southwestern Medical Clinic and was tested repeatedly by protesters. In 1993, the city of Phoenix passed an ordinance to create a “bubble” around those using health care facilities, such as abortion and family planning clinics. The ordinance required demonstrators who were within 100 feet of a health care facility to retreat, if so requested. They were to withdraw to at least eight feet from anyone who was entering or leaving the facility. Abortion protesters challenged this city ordinance in federal District Court, saying it was “unconstitutionally vague.”16 After the District Court ruled against the protesters, they appealed to the 9th Circuit Court of Appeals, which found that the bubble law did not violate free speech and met Supreme Court standards.17 Similar conflicts were occurring throughout the United States during this time. The Supreme Court heard a case related to demonstrations in Florida and upheld a judge’s ban on picketing within a thirty-six-foot buf-

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fer of a Florida health clinic.18 A physician named David Gunn, who provided abortions in Georgia, Alabama, and Florida, was murdered outside of a clinic in Pensacola, Florida, in 1993.19 The following year, Congress passed the Freedom of Access to Clinic Entrances (FACE) Act, making it a federal crime to use physical force to disrupt patient care at abortion clinics.20 Planned Parenthood of Southern Arizona did not begin providing abortions until 1982. Opening an abortion clinic was a difficult decision, said former board member Rev. Michael D. Smith. Staff and volunteers realized that providing abortions could potentially undercut the agency’s contraceptive and educational services.21 To keep abortion services and finances separate from Planned Parenthood’s other important functions, volunteers and staff of Planned Parenthood organized the Arizona Women’s Clinic in 1981. This was a nonprofit corporation with its own board and fund lines that worked with Planned Parenthood in providing abortions. It also raised money specifically for the purpose of funding abortions for low-income women.22 Those who opposed access to abortion organized protests in Tucson, as they did in other Arizona cities. Virginia Yrun, executive director of Southern Arizona Planned Parenthood, recalled that the most virulent protests occurred from 1989 to 1991 when protesters arrived from other states.23 Local groups also worked with Operation Rescue during this time. In April 1989, Arizona Right to Life publicized its goals of closing down “three of the state’s abortion clinics,” according to an article in the Tucson Chapter/Arizona Right to Life newsletter.24 Protesters seated themselves at the front entrances of clinics in Tucson, Phoenix, and Flagstaff, delaying the clinics’ opening, until they were arrested. In all, 194 people were arrested during the week of April 23.25 When demonstrations occurred at Planned Parenthood of Southern Arizona, volunteers supporting women’s access to abortion came out to support the agency. Often a coordinator from Planned Parenthood received notification from a member of the police force that right-to-life demonstrations were planned. According to Planned Parenthood counselor Judy Tamsen, police officers often came to Planned Parenthood for vasectomies. “They were treated well, and many had a fondness for Planned Parenthood,” she said. During the demonstrations, police officers remained in the background, and it “was noisy but it was peaceful,” said Tamsen.26 Volunteers locked arms, forming a circle around the clinic so clients could access reproductive services.27

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Political Efforts to Undermine or Overturn Roe v. Wade During the same period, right-to-life groups used an initiative measure to attempt to overturn Roe v. Wade. In 1992, a coalition group called Arizonans for Common Sense, led by former Republican legislator Trent Franks, collected enough petition signatures to place a proposition on the ballot to severely limit abortion. During this presidential election year, the proposition stated: “No preborn child shall be knowingly deprived of life at any stage of biological development except to save the life of the mother.” The proposed measure allowed for exceptions for victims of sexual assault and incest, if they could secure legislative approval.28 Although the coalition garnered strong religious support from Arizona evangelicals, Catholics were not as supportive, believing that the proposition conceded too much to pro-choice advocates.29 A counter organization, called Pro-Choice Arizona, created another coalition made up of Planned Parenthood, Arizona Right to Choose, the American Civil Liberties Union, and the National Organization for Women. Members and volunteers of Planned Parenthood throughout the state were important supporters of Pro-Choice Arizona. Focusing on the idea of personal choice, coalition supporters asked the public who should decide whether abortion was the right choice—the woman or the government? The proposition denied public funding for an abortion, which the opponents said was redundant because this was already illegal. Pro-Choice Arizona claimed that there was no real exception for rape and incest; instead, the proposition allowed for the possibility of legislative action. In addition, they stated that the proposition was clearly in conflict with Roe v. Wade and would result in further lawsuits if it passed.30 On the other hand, advocates pushed Proposition 110 by claiming that it was a civil rights measure for the unborn. Arizonans for Common Sense called the proposition a compromise measure that would stop “permissive abortions” while allowing the procedure for certain situations. In addition, they called abortion a threat to the family. Arizonans for Common Sense walked a thin line, trying not to identify with those in the religious right because they wanted to attract a broad base of support.31 The opponents of Proposition 110 gained a powerful ally when Senator Barry Goldwater came out against it, stating the measure would undermine freedom and choice. Goldwater was uncomfortable with the religious right, and he made an oppositional commercial, urging people to

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vote against the proposition. Goldwater, an economic libertarian, appealed to moderate Republicans in the state who did not want government intrusion in their private business.32 Proponents of Proposition 110 had additional problems—Catholic support was limited because the proposition did not forbid all abortions. Some right-to-life leaders felt that it compromised too much by allowing abortions in some situations.33 On Election Day in 1992, Proposition 110 lost by a landslide with 69 percent in opposition and 31 percent in support. The proposition failed in every Arizona county except Apache and Graham and with every category of individual except white evangelicals. Political scientist Daniel O’Neill argues that Arizona’s brand of conservatism did not support the New Right agenda at this time. Opponents of the proposition focused on individual choice and government intrusion, garnering support from independents and Republicans. Goldwater was not viewed as an extremist; therefore, his opposition had weight. In addition, the opposition garnered support from groups with Republican women, such as the League of Women Voters and the Young Women’s Christian Association. Many of these moderate Republicans did not embrace the New Right agenda and social concerns. Some were involved in Planned Parenthood, the American Civil Liberties Union, and women’s organizations. In Tucson, Planned Parenthood boards often included Republicans who supported the agency, said Janet Marcus, a longtime board member. Proponents of Proposition 110 could not expect support from all Republicans. However, at the same time that Arizonans rejected this measure, the electorate supported George Bush in the presidential election and strengthened the Republican control of the state legislature.34

Differing Views of Pregnancy and Morality The Arizona Right-to-Life organization backed George Bush and had lobbied for him during his presidential victory in 1988. A year later the or­ ganization’s president, Dr. Carolyn Gerster, stated that they opposed ­abortion but supported contraception; however, the group did not support teenagers’ access to contraception.35 A right-to-life group called Reachout gave assistance to pregnant women and new mothers. They provided free pregnancy tests, food, clothing, cribs, medical and legal referrals, and shelter in host homes for women who agreed to carry their pregnancies to term. They did not “con-

Reproductive Health Care in a New, More Politicized Era  •  169

done the methods some organizations use to advance the pro-life cause such as violence, force, or deception.”36 They tried to educate the “girl as we have in the past in a kind, caring, Christian non-judgmental way.” They also talked to the young women about the development of the baby, while showing fetal models and films about fetal development. During 1985, the organization assisted 906 Arizona women, and their quarters were overcrowded. They asked for financial assistance so that “the Abortion Holocaust will one day be in the past.”37 Organizations, like Reachout and the Tucson Chapter/Arizona Rightto-Life, viewed abortion as a religious issue, writing in their newsletter, “We must have faith that God will help us to overcome the scourge of abortion on demand in our land.” They urged their members to get involved through activities, financial donations, or prayer.38 Tony West opposed access to abortion and served in the Arizona House of Representatives and Senate during the 1970s and 1980s. Ordained as a deacon in the Catholic Church, he continued working in the ministry while serving in the legislature on the Judiciary and Appropriations Committees. West believed strongly that abortion was “terminating a human life . . . that there truly is an innocent unborn child in the woman’s womb that she’s choosing to kill. You can put it in any other terms but she’s choosing to kill and murder that baby, and women are not created to kill their unborn children. You know most women love their children, although it sure changes somewhat today.”39 Reverend Michael D. Smith also saw abortion as a religious issue, as discussed in the preceding chapter. Following the Roe v. Wade decision, he occasionally testified during hearings at the state legislature, stating that God had given women “moral agency” to decide themselves whether to carry a pregnancy to term.40 Other clergy also supported women’s right to choose abortion, and in 1991, a group called Clergy for Choice began a TV ad campaign in southern Arizona to counter the idea that all church leaders opposed abortion. “A woman’s right to choose is an inalienable right of personal conscience,” said Reverend Philip Zwerling of the Unitarian Universalist Church of Tucson. Other denominations included in the organization were Lutheran, United Methodist, Jewish, Presbyterian, Episcopalian, Disciples of Christ, and Church of Christ.41 As reflected in these contrasting ideas, the abortion issue divided people along varying religious and political lines. Differing ideals related to motherhood, the beginning of human life, family, and women’s roles continued to create conflict in relation to pregnancy and abortion. While religious and legislative leaders quarreled about abortion access,

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women went about their business, making reproductive decisions. The typical woman choosing abortion in Arizona during the 1980s was unmarried and under the age of twenty-five. According to an Arizona State Department of Health study, 91 percent of those having this procedure had completed nine or more years of schooling. The vast majority of abortions were performed in nonhospital clinics and physicians’ offices. There were no abortion-related deaths in the state from 1982 to 1987. Reflecting their long-held views about the procedure, American Indians had the lowest ratio of abortions among all ethnic groups.42 From 1985 to 1995, African American women had a higher rate of abortion than other ethnic groups in Arizona. The number of abortions per 1,000 females of childbearing age was 26.2 for African Americans, 16 for non-Hispanic whites, 13.6 for Hispanics, 17.6 for Asians, and 6 for American Indians.43 A national study in the early twenty-first century indicated that African American women had higher abortion rates because they had higher rates of unintended pregnancies due to lack of access to contraceptives.44 Nationally, the number of abortion providers declined 14 percent between 1982 and 1996, with the greatest decline in hospitals and physicians’ offices. Some geographic areas had very limited access to abortion providers; in 1996, 86 percent of counties in the nation had no known abortion provider, and 32 percent of women aged fifteen to forty-four lived in these counties. The lack of providers and increased access to contra­ ceptives (for some sections of the population) are possible factors in the decreasing abortion rate nationwide. In 1982, there were 28.8 abortions per every 1,000 women (aged fifteen to forty-four) in the United States, and the rate decreased to 22.9 in 1996.45 The rate of abortions was lower in Arizona—24.1 percent in 1992 and 19.8 percent in 1996. Arizona’s rate of abortion was higher than that of other states in the Rocky Mountain West, such as Idaho, Montana, New Mexico, Utah, and Wyoming. Some of these states, including Utah and Wyoming, had very few abortion providers. However, Colorado and Nevada had higher rates of abortion than Arizona did during these years.46 Between 1982 and 1996, the number of abortion providers in Arizona decreased from thirty-seven to twenty-four. The number of providers fell in all census districts in the nation from 1992 to 1996, creating a 14 percent loss nationwide. In Arizona there was a 4 percent loss of abortion providers from 1992 to 1996.47 Although the loss of abortion providers ­occurred throughout the nation, Arizona fared better in this regard than

Reproductive Health Care in a New, More Politicized Era  •  171

many other states. Nationally, 32 percent of women lived in counties without abortion providers, whereas in Arizona, 19 percent did so.48

Young Women and Reproductive Health Care Those providing reproductive health care services adapted to many shifts over the years, including a sea change in Planned Parenthood clientele, according to Gloria Feldt. Whereas in earlier decades the clients were married with children, by the 1970s, over 70 percent of clientele at PPCNA was composed of young women, age twenty-five and younger who used birth control to delay childbearing. In fact, 89 percent were thirty years old or younger, and 90 percent were on the pill. The relaxing of sexual mores and legalization of contraceptives for single women contributed to this shift. Planned Parenthood met these young women’s needs while also providing vital services for low-income women. In 1983, the majority of new patients of PPCNA were below the poverty level; 61 percent were white, 9.8 percent were black, and 22.4 percent were Mexican Americans. Through Feldt’s strong leadership, the number of clinics serving women in central and northern Arizona expanded from 3 to 16. Planned Parenthood of Southern Arizona also provided care to many young women whose demographic profile mirrored that of the state’s ethnic breakdown.49 For many women, Planned Parenthood and publicly funded family planning clinics provided their first “well woman” check-up, including pelvic and breast exams, Pap smears, and blood pressure checks, in addition to discussing and choosing contraceptives.50 While Planned Parenthood served larger numbers of unmarried women, many teens were not using contraceptives successfully. During the 1970s and 1980s, the rate of teen pregnancy increased nationally, and the proportion of teen births to unmarried women grew substantially.51 To meet the needs of this age group, Planned Parenthood operations throughout Arizona provided sex education, contraceptives, and needed information. Through classes with adolescents and their parents, staff at Southern Arizona Planned Parenthood helped improve communication about sexuality and topics such as menstruation. Likewise, a Teen Clinic provided answers to Tucson teenagers with questions regarding sex, pregnancy, and contraception.52 PPCNA offered sex education in the schools and continuing education classes in human sexuality for professionals in counseling, education, medicine, mental health services, and social services.

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These classes featured authors and specialists who discussed sexuality and sex education for young people.53 Despite these efforts, Arizona had a higher rate of teenage pregnancy and birth than most other states. In 1988, 13.8 percent of all Arizona births were to adolescents, with the highest teen birth rates occurring in Pinal and Maricopa Counties.54 At this time, the United States had one of the highest rates of teenage pregnancy in the developed world. Arizona had the dubious distinction of ranking near the top among the states in relation to teenage pregnancy. In 1992, the highest teenage pregnancy rates occurred in western states with California at number one, followed by Nevada, Hawaii, Arizona, and New Mexico.55 In Arizona, birth to teens increased by 28 percent from 1985 to 1992. The Arizona Family Planning Council attributed these high rates to “sexual ignorance, lack of family planning or teen pregnancy prevention programs.” Because Arizona did not provide family planning services for women or teens with incomes exceeding 50 percent of the federal poverty level, many poor women lacked contraceptive access.56 In addition, Arizona teens were at risk of receiving inadequate or no prenatal care.57 The Arizona Right-to-Life group opposed some of Planned Parenthood’s activities in relation to teens. The organization did not believe contraceptives should be made available to teenagers and instead advocated abstinence. They were especially concerned that birth control would be distributed through school-based clinics and sex education programs.58 During the 1980s, activists from the right-to-life movement spoke in Tucson’s high school classrooms about abstinence and preserving human life by limiting access to abortion. On the other hand, Presbyterian minister and Planned Parenthood board member Mike Smith discussed sex education and advocated women’s ability to determine themselves whether to carry a pregnancy to term.59 Shirley Whitlock, president of the conservative Eagle Forum in Arizona during the late 1970s and 1980s, opposed the sex education offered by Planned Parenthood. She thought it was too permissive because it allowed masturbation, did not condemn homosexuality, and gave teens permission “to do anything,” thereby undermining the family.60 Despite the efforts of those promoting abstinence and those providing contraceptives, there were mixed results in efforts to lower Arizona’s teenage pregnancy rate. From 1980 to 1990, the rate of teenage pregnancy for Euro-American teenagers fell, whereas it increased for teens of Hispanic and African American descent. Pregnancy rates of black, Hispanic, and American Indian teens exceeded the rate of Euro-American teenagers

Reproductive Health Care in a New, More Politicized Era  •  173

by 26 percent in 1980 and 55 percent in 1990. African American teens had the highest rates of pregnancy among all ethnic groups from 1980 to 1990.61 Only 19.9 percent of these teenagers had private health insurance to pay for labor and delivery. Arizona teenagers were more likely to give birth than their peers around the United States. In 1990, it was estimated that 50 percent of all pregnant teens in the United States gave birth, whereas during the 1980s, 72.6 percent of pregnancies to fifteen- to nineteen-yearolds in Arizona ended with childbirth.62 Nationally, the teenage pregnancy rate peaked in 1990 and then began to decrease, due to both increased abstinence and changes in contraceptive practices. By the 1990s, youth across the nation were using contraceptives more effectively or abstaining from sex. Arizona’s teenage pregnancy rate decreased by 1995, but the state still had the fourth highest rate in the nation.63

Providing Care for Mothers and Babes Access to contraceptives services could potentially lower the teenage pregnancy rate and improve the lives and health of all women during their reproductive years. However, those providing reproductive health care in Arizona struggled to maintain adequate funds to care for low-income women during the 1980s and 1990s. At this time, contentious conflicts related to abortion affected Planned Parenthood’s ability to distribute contraceptives. In 1980, the Arizona legislature excluded Planned Parenthood as a recipient of federal Title XX appropriations for contraceptive and reproductive care because the agency provided abortion services and referrals.64 Planned Parenthood leaders challenged this restriction in court and won by proving they could keep their fund lines separate, using the federal monies for educational and contraceptive services only.65 In 1998 a national study demonstrated that almost 50 percent of pregnancies were unplanned and unwanted, resulting in 1.4 million abortions annually. The United States had one of the highest rates of unintended pregnancy among all ages and teenage pregnancy among the Western nations. Approximately half of the pregnancies occurred because the contraceptive method did not work as it should have or was used incorrectly or inconsistently. For the rest, no contraceptive method was used, due to financial inability to buy birth control, lack of access to clinics, or embarrassment felt by the young women.66

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This study examined poverty rates by state, the percentage of women without Medicaid or insurance, and the percentage receiving reproductive health services. Nationally 15 percent of women aged fifteen to fortyfour lived in poverty, and in Arizona 18 percent did. In Arizona, 24 percent of women of reproductive age had neither insurance nor Medicaid. The state ranked among the top in this category. Several other southwestern states also had high percentages of women without Medicaid or insurance, such as New Mexico with 29 percent and California with 25 percent. Despite these negative marks, the report estimated that 46 percent of those needing contraceptive service received it in Arizona, whereas for the nation as a whole, 39 percent received the services.67 The study indicates that the United States in general did an abysmal job of providing contraceptives to low-income women. Although a higher percentage had access to contraceptives in Arizona, providing these reproductive health services required overcoming several obstacles. To expand the numbers of those able to provide reproductive health care, Planned Parenthood and other agencies, such as the Arizona Family Planning Council, worked to upgrade the position of nurse practitioners. The federally funded Title X provided educational services for nurse practitioners in reproductive health. Often in rural areas of Arizona, the nurse practitioners were vitally important in the delivery of services because they conducted the well woman exams at family planning clinics, under the supervision of physicians. Consequently, upgrading their position during the 1980s helped serve needy populations.68 Although Arizona had provided some funds for family planning services in earlier years, beginning in 1981, the state legislature provided no funds for this purpose. At this time, Arizona initiated the Arizona Health Care Cost Containment System (AHCCCS), which was a Medicaid program. Arizona received a waiver allowing it to stop funding family planning services. In 1988, after conflict and a lawsuit against the state, new legislation allowed family planning services under AHCCCS, but only for women whose incomes were less than 50 percent of the federally designated poverty level. However, those who became pregnant could receive free services during pregnancy and childbirth, even if their incomes were 140 percent of federal poverty income levels.69 In 1985, federal funds provided more than 50 percent of public funds spent in Arizona for family planning. County governments also provided approximately 15 percent, and patient fees and donations to organizations like Planned Parenthood funded the remaining cost of these services.70 The state legislature’s actions at this time demonstrated an uncaring

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attitude toward low-income women. In limiting contraceptive access through AHCCCS, state leaders guaranteed that poor women would have to rely on Planned Parenthood or county health programs to avoid pregnancy. During a time when unplanned pregnancy was a common problem throughout the nation, these actions indicate a belief that sex and reproduction should go hand in hand, at least for low-income women. Family planning advocates won a victory in 1994, when the state legislature approved a bill to provide expanded family planning services for women under AHCCCS. The new law funded family planning for those who had AHCCCS coverage for pregnancy but whose coverage ended sixty days after the end of the pregnancy. Under this law, family planning was provided for two years.71 Despite these advances, AHCCCS assistance was not available to many women with low incomes, such as the working poor, who made too much to qualify for this assistance but not enough to purchase health care. These members of the working poor relied on services of agencies, like Planned Parenthood, that had sliding scales for payment based on income.72 Limited access to contraception may have contributed to Arizona’s high birth rate during the last decades of the twentieth century. Arizona, New Mexico, and Utah continued to have high birth rates in the 1980s in comparison to the rest of the United States. While the national birth rate in 1985 was 15.7, it was 18.5 in Arizona, 19.9 in New Mexico, and 23.4 in Utah. The latter state had one of the highest birth rates in the nation, with only the District of Columbia and Alaska coming in higher.73 This trend continued into the 1990s; in 1995, Arizona’s birth rate was 17.3, while the U.S. rate was 14.9.74 The high teenage pregnancy rate also contributed to the high number of births. Although securing contraceptives was not easy for the working poor in Arizona, by the end of the twentieth century public health programs guaranteed much better care for women and infants than they had received earlier. Infant and maternal mortality decreased substantially all over the United States, including the Southwest.75 During the 1980s, the infant mortality rate in Arizona was at or below the national average, ranging from 12.4 infant deaths per 1,000 in the first year of life in 1980 to 8.7 in 1990. Nearby states New Mexico and Utah also had infant death rates at or below the national average, with Utah continuing to have a lower rate of mortality than New Mexico and Arizona. In 1988, Utah’s rate of infant mortality was 8 per 1,000 infants; New Mexico’s was 10.76 Even though Arizona’s infant mortality rate was slightly below the national average, public health professionals had much higher standards

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than in earlier years, and they were concerned when the Arizona rate increased in 1988. Lack of prenatal care or inadequate prenatal care resulted in a higher number of low-birth-weight babies. This problem was more common in rural counties. The high teenage pregnancy rate also negatively influenced this situation because teens were less likely to receive adequate prenatal care, and babies born to teenage mothers had an infant mortality rate much higher than those born to older mothers.77 In comparison to the rest of the nation, Arizona fared poorly in this regard. Seventy-four percent of women in the United States received prenatal care in the first trimester; 68.7 percent of Arizona women did so.78 There were still distinct disparities between different ethnic groups. Women of color were less likely to receive prenatal care than were EuroAmerican women, and those receiving no prenatal care were much more likely to have low-birth-weight babies. African American women were twice as likely to have babies with a low birth weight as were EuroAmerican women.79 This factor contributed to a higher infant death rate. In Pima County, the black infant mortality rate in 1990 was 26.4 per 1,000 births; the American Indian rate was 23.6 per 1,000. Both American Indian women and black women were more likely to receive inadequate prenatal care and to be young mothers.80 National statistics also reflected a lower rate of prenatal care for women of color. In 1989, 60 percent of black, 59 percent of Hispanic, and 60.5 percent of American Indian mothers had prenatal care during the first trimester of pregnancy, whereas 79 percent of white women did so.81 Race, ethnicity, and socioeconomic class still greatly influenced health care outcomes. The infant mortality rate of babies of color compared unfavorably with that of nearly all industrialized nations in the world, demonstrating that health care in the United States was distributed unevenly, with devastating effects for families of color. In addition, the infant mortality rate for African American infants in Arizona was higher than the national rate for this group.82 Arizona’s overall rate of infant mortality was at or below the national level, but there were still large disparities based on race and ethnicity, which continued throughout the 1990s.83 During the 1980s and 1990s, Arizona’s reproductive health care advocates and providers struggled to maintain a high level of care, including access to contraceptives, abortion, and prenatal and maternal care. The conflicts related to abortion affected nearly all of these components of reproductive health care due to legislative attempts to cut contraceptive services if agencies also provided abortion. Through persistence, ingenuity,

Reproductive Health Care in a New, More Politicized Era  •  177

and volunteer help, reproductive health care providers were able to maintain contraceptive and abortion services, despite these controversies. Arizona women’s decisions concerning reproduction continued to reflect their diverse views in relation to motherhood, sexuality, religion, and family. Some supporters of the right-to-life movement, who believed abortion was antifamily, opposed changes in women’s roles and access to abortion because they thought women’s expanded options outside the home and reproductive freedom would undercut the roles of traditional homemakers. Other conservatives, including some Republican women, rejected the right-to-life movement as an intrusion of government into women’s personal decisions. Even though Arizona contained a strong right-to-life movement and active social conservatives, there were also many Republicans who did not support the New Right agenda. Therefore, the gains of social conservatives were uneven during these decades. Although they were successful in stopping medical education in relation to abortion procedures and limiting access to publicly funded abortion and contraceptives, they could not overturn Roe v. Wade. Social conservatives also secured limitations on a minor’s ability to get an abortion through the law requiring parental consent. During these decades, social and economic inequality continued to plague low-income women, especially women of color. These women had lower rates of prenatal care than Euro-American women, higher infant mortality, and difficulties in securing birth control. Many ideas relating to sexuality and motherhood had changed during the course of the twentieth century, and nearly everyone supported access to contraceptives for those over eighteen years of age, but inequality related to income level and ethnicity persisted, with a detrimental effect on women’s reproductive health as the century ended.

cha p te r n i n e

Pregnancy and Choice Reproductive Health in Twentieth-Century Arizona

Women’s ability to give birth and the gender roles associated with motherhood have greatly influenced, and at times even defined, women’s lives throughout history. This vital component of women’s experiences— reproduction and the choices related to it—has been affected by environmental, political, and cultural factors in Arizona and the West during the course of the twentieth century. Whether attempting to find good childbirth attendants or properly care for their infants, western rural women were sometimes threatened by the region’s isolation, lack of infrastructure, and geography, especially during the early part of the century. At the same time, racism and segregation undercut the ability of some women of color to secure health care and education. Women’s ethnicity, income level, and religious and spiritual beliefs all strongly influenced choices and options related to reproduction in Arizona and throughout the region. Ideals relating to motherhood, sexuality, and marriage determined whether women chose fertility control, how they gave birth, and their family size. As the century progressed, Arizona moved from an isolated territory to a well-developed urban state where women’s access to health measures and ability to successfully care for their infants greatly improved by the late 1960s. However, disparities in reproductive health care based on ethnicity and income level continued to exist at the end of the century. In addition, political conflicts related to reproductive health and women’s ability to control their fertility continually reappeared, even into the twenty-first century. When the twentieth century began, the territory’s sparse population, 178

Reproductive Health in Twentieth-Century Arizona  •  179

along with poor transportation methods and rugged geography, limited women’s options regarding caregivers during childbirth. Due to several factors, including women’s personal choices, Arizona’s isolation, and lack of qualified medical personnel, women made a later transition to medically managed childbirth than those in other sections of the United States. Indeed, this was the situation throughout the rural West, where women tended to rely on lay attendants and midwives to deliver babies well into the twentieth century. Though many of these midwives were untrained, they were very competent in uncomplicated births.1 They commonly assisted urban women in delivery until the 1920s, and many rural women continued to rely on midwives and other lay attendants into the 1940s or later. Mexican American and African American women usually called on parteras or midwives, and American Indians commonly relied on female relatives. African American women also contended with segregated medical facilities. After giving birth, women typically assumed the role of caring for their infants, and for many this was a difficult task. During the 1920s, Arizona and New Mexico had higher infant mortality rates than nearly every state in the union. The first federally sponsored health care initiative, the Sheppard-Towner Program, was designed to decrease both infant and maternal deaths throughout the nation. By providing improved prenatal care, health education for mothers, and midwife training, this Children’s Bureau program lowered infant and maternal mortality nationwide from 1922 to 1929.2 However, in Arizona, ethnic prejudice and discrimination resulted in program administrators failing to meet the needs of those of Mexican descent, who had one of the highest infant mortality rates in the state. American Indians, with health care provided by the Bureau of Indian Affairs, also suffered an incredibly high rate of infant death. The Better Babies movement has been studied in other states, where it illustrated ethnic divisions and eugenics principles. However, in Arizona, the Sheppard-Towner Program figured more prominently because it had a much larger effect than the Better Babies movement. Under this program, the lack of care afforded to those of Mexican descent demonstrated institutionalized prejudice in relation to reproduction, which had a very harmful impact on those of Mexican descent, who were approximately onequarter of the state’s population during the 1920s. Examining infant mortality and the Sheppard-Towner Program in the nearby states of Utah and New Mexico provides further understanding of this issue. New Mexico, another sparsely populated, rural state, also had a very high rate of infant death, whereas Utah had one of the lowest rates in

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the nation. The homogeneous nature of Utah, where the majority of residents were Euro-American Mormons, resulted in communities working together to guarantee the health of families and babies. The Mormon women’s Relief Society became a powerful force in implementation of the Sheppard-Towner Act. In Arizona, public health officials and nurses failed to reach those families of color who suffered disproportionately from infant mortality. The unhealthy status of the most vulnerable—infants of minority families—reflected the racial and ethnic stratification of Arizona’s society. New Mexico also suffered high rates of infant mortality, but Sheppard-Towner personnel consistently worked with the Spanishspeaking people who made up over half of the population.3 In both states, poverty, isolation, lack of prenatal care, and improper bottle feeding led to difficulties for infants. By 1940, public health programs did lower infant mortality, although these two states still had very high rates in comparison to the rest of the nation.4 Women’s ability to determine the size of their families could potentially improve their health and capacity to care for their children. During the 1930s, Arizona women gained new options in fertility control through an expanding birth control movement. Margaret Sanger’s enthusiastic work in Tucson and Phoenix encouraged committed groups of middle-class volunteers who opened clinics in the barrios and segregated neighborhoods of both cities. Facing down opposition from the vocal Catholic hierarchy, these women provided fertility control to women of diverse races and classes. Women went to these clinics and used contraceptives not to avoid the role of motherhood but to plan and space their families and preserve their own health. While a multiethnic clientele in Phoenix and Tucson became patients at the Mothers’ Health Clinics in the 1930s, other women believed contraception was immoral and against God’s laws. Navajo women traditionally opposed birth control, embracing large families and viewing children as a source of wealth. Many Mormon, Catholic, and Mexican American women also frowned on the use of contraceptives at this time and had high rates of fertility. Catholic leaders claimed that “the selfish love of pleasure” led to birth control use, whereas Mormon leaders implied that contraceptive use would put a wife in the role of a “courtesan.” These religious leaders affirmed the idea that sexuality belonged in marriage and should result in childbearing. Despite these varying beliefs, the new birth control clinics remained open, providing expanded options in fertility control in Tucson and Phoenix. However, others lost the ability to give birth when they were sterilized

Reproductive Health in Twentieth-Century Arizona  •  181

in Arizona’s State Asylum for the Insane. The state legislature approved involuntary sterilization in 1929, and approximately twenty sterilizations occurred in the state during the 1930s and 1940s. Although approval of this legislation demonstrates acceptance of eugenics principles, few involuntary sterilizations were carried out in Arizona in comparison to other states, where thousands occurred. At the end of the 1930s, Mildred Delp, a Farm Security Administration nurse, traveled to migrant camps in central and western Arizona, distributing contraceptives to migrant mothers. Meeting with women of every ethnic group, this public health nurse taught women how to use contra­ ceptive foam spermicide, while also discussing the spacing of children. Delp logged thousands of miles traveling throughout the state, sharing her knowledge of birth control with the impoverished women in cotton camps. She also met with physicians, nurses, and volunteers in Phoenix, including Margaret Sanger, Peggy Goldwater, and Lucy Cuthbert, to learn about the state’s birth control network. Delp’s work expanded access to fertility control for the migrant women during a decade of discontent. Her daily reports on these activities reflect both her enthusiasm and her implied condescension toward women of color.5 By the 1940s, even a Catholic priest, Father Emmet McLoughlin, was providing contraceptives devices through St. Monica’s Clinic in segregated south Phoenix. Founded to help the poor of the area, this clinic eventually became Memorial Hospital, which housed a Planned Parenthood Clinic by the early 1960s. Along with volunteers and employees of Planned Parenthood in Phoenix and Tucson, McLoughlin worked to expand clinics and their hours to meet the needs of a growing Arizona population following World War II. Arizona’s cities began their great expansion during the 1950s, but many in the state continued to live in isolated areas in the country. This was certainly true of rural American Indians, who struggled to secure adequate health care during the 1950s. Across the vast Navajo Reservation, poor transportation and lack of medical personnel led to high maternal and infant mortality rates into the 1960s. Similar conditions affected other tribes, such as the White Mountain Apache, who suffered one of the highest infant mortality rates of any group in the nation.6 Even in the midtwentieth century, the region’s vast distances and lack of infrastructure hampered health care delivery. Poverty and lack of healthcare were not confined to rural areas. In Arizona cities, impoverished families also suffered from a lack of reproductive health care. Race, ethnicity, income level, and location continued to

182  •  Pregnancy, Motherhood, and Choice

have a monumental effect on women’s access to safe childbirth, health care for infants, and contraceptives. While middle- and upper-class urban women had many options in reproductive care, these privileges did not extend to the urban poor. Leaders, such as Dr. Pearl Tang and Annie Wauneka, realized the need to create greater cross-cultural communication to lower the infant mortality rate and improve general health care. As chief of the Maricopa County Bureau of Maternal and Infant Health, Tang used her position to expand basic health care to mothers and children, providing additional prenatal clinics, home visits, and contraceptive services. Because this was the most populous county in the state, Tang’s leadership had a vital impact. She also learned Spanish to aid communication and assembled a multicultural group of nurses who met the needs of women from every ethnic group. Annie Wauneka, Navajo Tribal Council member, worked for years to make inroads between traditional healers and physicians to lower the devastating effect of tuberculosis on the Navajo Reservation. She also used health education to decrease the infant mortality rate, organizing baby contests so mothers would meet physicians and become more comfortable with securing medical care, if it was necessary. This type of crosscultural communication was vital in lowering Arizona’s infant mortality rate, which remained very high in the 1950s but gradually decreased until it was slightly lower than that of the national rate by 1970. While the administrators of the Sheppard-Towner Program had failed to reach out to those of Mexican descent, by the mid-twentieth century, those concerned with health care knew that improving intercultural relations and health education were vital necessities for lowering death rates and boosting general health. Providing reproductive health care and safe childbirth is a greater challenge when the birth rate is high. In 1950, New Mexico, Utah, and Arizona had the highest birth rates in the nation.7 Mormon, Catholic, and American Indian women celebrated large families during this time of the Baby Boom. Many from these groups were not interested in birth control, but researchers found that certain American Indian tribes, such as the Hopi, were more likely to use contraceptives. Among American Indians, the movement into the paid labor force and higher educational levels often correlated with increased use of birth control. For those desiring means to control their fertility, access to birth control greatly expanded from 1950 to 1970 as Planned Parenthood clinics reached greater numbers of clients and public health programs began providing contraceptives. Following the Supreme Court decision Griswold vs.

Reproductive Health in Twentieth-Century Arizona  •  183

Connecticut, which removed any remaining state restrictions on contraceptive distribution to married couples, the government increased support of family planning. Fears of a population explosion also contributed to the public funding of contraceptives. In addition, the advent of the birth control pill in the early 1960s expanded Planned Parenthood clientele. In the urban areas of Arizona, women from all ethnic groups used Planned Parenthood clinics for their reproductive health care, as they tried to space their pregnancies and limit fertility. Rather than abandoning the role of motherhood, these women limited family size to best care for the children they already had and to take advantage of opportunities outside of the home. By the early 1970s, birth control clinics were also providing contra­ ceptives for minors, serving many young women from all ethnic groups. There were generational differences among women of color in relation of contraceptives and abortion by this time. Typically, younger women desired access to these reproductive services, while many older women from certain religious and cultural groups frowned on fertility control. As more American Indian women entered the wage labor market in the 1960s and 1970s, an increasing number choose to use contraceptives. Mexican American women also turned increasingly to fertility control. Oral histories and secondary sources point to a strong generational shift that resulted in a gradual lowering of the birth rate for these cultural groups. The women’s liberation movement also affected change during the last decades of the century as young women separated sexuality from reproduction and marriage while claiming self-determination in relation to fertility control. Volunteers and activists in Arizona succeeded in developing a strong birth control movement in the state early on, but they were not successful in reforming the state’s abortion laws. In Arizona, abortion remained illegal until 1973, except to save the life of the mother, with no exceptions for fetal deformity, rape, incest, or the mother’s mental health. Abortion laws resulted in women like Joanne Goldwater, Senator Barry Goldwater’s daughter, having an unpleasant and frightening illegal abortion in Virginia. Likewise, Sherri Finkbine, mother and host of the children’s program Romper Room, had to travel to Sweden to secure an abortion of a severely deformed fetus. To remedy these circumstances and secure greater freedom for Arizona women, activists, volunteers, and professionals lobbied the legislature and worked through the courts to reform the state’s abortion laws. However, they contended with strong opponents who were against any change in the law. Abortion reform occurred in Arizona only in response to the Supreme Court decision Roe v. Wade, which legal-

184  •  Pregnancy, Motherhood, and Choice

ized the procedure throughout the nation. During the years of this debate, Planned Parenthood volunteers and staff assisted women in many ways, by providing counseling; arranging travel and access to safe, legal abortion providers in California; and raising funds for all components of reproductive health care. The commitment of volunteers in the birth control movement began in the 1930s and continued throughout the century as new generations of women became involved and worked to provide reproductive health care in their communities. As it had in earlier decades, the Catholic Church remained a strong force against contraception and abortion. The Church helped mobilize an active right-to-life movement, which successfully fought reform before Roe v. Wade and then worked for a constitutional amendment “to protect the unborn” following the 1973 Supreme Court decision. Women became leaders in the pro-life movement, just as others were active in the movement for reform. Still others remained on the sidelines of the debate, carrying their views privately. At the end of the twentieth century, Arizona women’s lives and decisions in relation to reproduction continued to reflect their diverse ideals in relation to motherhood, sexuality, religion, and family. During the 1980s and 1990s, the continuing conflict related to abortion access led to controversies in the courts, the streets, and state legislature. Despite many challenges originating from social conservatives, the New Right secured uneven gains in Arizona during these years because many moderate Republicans refused to support measures that severely limited access to abortion. Those providing reproductive health care at the end of the twentieth century had other concerns besides abortion services, as they worked to provide contraceptives and general health care for low-income women and babies. In Arizona and throughout the nation, social and economic inequality affected access to these services, resulting in lower rates of prenatal care for women of color, high infant mortality, and difficulties in securing birth control.8 Despite the efforts of reproductive health care providers, inequality related to income level and ethnicity continued to affect women all over the nation. During the first decade of the twenty-first century, debates from prior years resurfaced, but important changes in Arizona’s political landscape resulted in loss of options for women needing abortions. Janet Napolitano served as Arizona’s governor from 2002 to 2008, during which time she repeatedly vetoed bills restricting abortion access. As the state legislature became more conservative during these years, it passed several bills, in-

Reproductive Health in Twentieth-Century Arizona  •  185

cluding a “partial birth abortion ban,” one that required counseling and a waiting period before an abortion, and more stringent requirements for parental permission, but Napolitano vetoed all of these bills.9 However, in 2008, she accepted a position in President Barack Obama’s Cabinet as head of the Homeland Security Department, and Arizona’s secretary of state, Jan Brewer, took over as governor. In 2010, Brewer won a full term as governor, and she signed into law several bills restricting abortion access.10 One bill requires abortion doctors to offer patients the opportunity to look at ultrasound images of the fetus, while another states that only physicians can administer pills that bring about early term abortions. Planned Parenthood filed suit against this law because implementation will severely cut abortion services outside of the state’s metropolitan areas.11 In smaller cities, many abortion clinics are staffed by nurse practitioners who have been providing this service. In another situation, the Catholic stance on abortion received intense publicity after an administrator at St. Joseph’s Hospital in Phoenix, Sister Margaret McBride, allowed physicians to perform an abortion to save the life of a mother in November 2009. Bishop Thomas J. Olmsted declared McBride was automatically excommunicated because “She consented in the murder of an unborn child.” Reverend John Ehrich, medical ethics director for the Diocese of Phoenix, further stated that there were some situations in which a mother “may in fact die along with her child. But— and this is the Catholic perspective—you can’t do evil to bring about good. The end does not justify the means.”12 The conflict continued as administrators at St. Joseph’s claimed the decision was “appropriate under church guidelines that allow certain exceptions for saving a mother’s life.” However, Bishop Olmsted disagreed and declared that St. Joseph’s Hospital was no longer a Catholic hospital. Founded by a religious order, the Sisters of Mercy, in 1895, this hospital has been serving the Phoenix population for over 100 years. Hospital administrators accepted the bishop’s decision, which they claimed would have little financial impact. Linda Hunt, the hospital’s chief executive, stated, “We are the same hospital as we were yesterday and will be tomorrow. The Sisters of Mercy are still here, and we will still follow the directives as well as we can.”13 Varying ideas related to abortion and reproductive care also fueled a national conflict over Title X during the early months of 2011. The conservative, Republican-dominated U.S. House of Representatives attempted to cut all Title X funds, claiming that they were used to provide abortions by Planned Parenthood. Even though federal regulations forbid the use of these funds for this purpose, lawmakers took aim at Title X, which pro-

186  •  Pregnancy, Motherhood, and Choice

vides reproductive health care to low-income women across the United States. Democrats in the Senate refused to defund Title X and used the media to blast the cuts, which were holding up a budget deal. The House and Senate eventually negotiated a plan that allowed the beleaguered and maligned program to continue operating.14 This national debate was once again a replay of conflicts that occurred in the 1980s when Planned Parenthood fought for federal funding for contraceptives and general reproductive health care and won a lawsuit by demonstrating that they could maintain separate fund lines for abortion and contraceptive services.15 These recent incidents demonstrate that beyond a doubt, the past continues to inform the present. At the beginning of the twenty-first century, women’s ability to limit their reproduction or to give birth, along with the role of motherhood and the health of families, continue to be vital concerns in daily life and also hot-button political issues. In addition, race, ethnicity, and income level continue to affect political rhetoric, access to care, and health outcomes. Women’s stories of their experiences in childbirth, their struggles to care for their babies, and their attitudes, beliefs, and experiences related to fertility control are a vital part of our past. By examining the experiences of those who came before, in Arizona and the Southwest, we learn how geography, income level, ethnicity, culture, and laws have affected this area of life, providing greater knowledge of women’s lives in this place and time and more understanding of how to move forward into the future.

Notes

Abbreviations Used in the Notes ABME Arizona Board of Medical Examiners, Scottsdale ADHS Arizona Department of Health Services, Phoenix AHF Arizona Historical Foundation, Hayden Library, Arizona State University, Tempe AHS-Tempe Arizona Historical Society, Central, Archives Collection, Tempe AHS-Tucson Arizona Historical Society, Southern, Archives Collection, Tucson Arizona State Board of Health, Phoenix ASBH ASLAPR Arizona State Library, Archives, and Public Records, Archives Division, Phoenix Children’s Bureau Records, National Archives, Washington, D.C. CBR GPO Government Printing Office MHL Church of Jesus Christ of Latter-day Saints History Library (Mormon History Library), Salt Lake City, Utah NA National Archives, Washington, D.C. NAUCL.SC Northern Arizona University Cline Library, Special Collections, Flagstaff PPCNA Planned Parenthood Central and Northern Arizona Collection, AHSTempe PPFA.SCA Planned Parenthood Federation of America collection, Sophia Smith Collection, Smith College Archives, Northampton, Massachusetts University of Arizona Special Collections UASC

Introduction   1.  Christina Ellington Hankins interview with author, Phoenix, Arizona, 28 May 1992, transcript and tape recording in the Casa Grande Valley Historical Society, Casa Grande, Arizona.

187

188  •  Notes   2.  Mary Melcher, “Times of Crises and Joy: Pregnancy, Childbirth and Mothering in Rural Arizona, 1910–1940,” Journal of Arizona History 40, no. 2 (Summer 1999): 181–200.   3.  Mary Melcher, “‘Women’s Matters’: Birth Control, Prenatal Care and Childbirth in Rural Montana, 1910 to 1940,” in Montana Legacy, edited by Harry W. Fritz, Mary Murphy, Robert R. Swartout Jr., (Helena: Montana Historical Society Press, 2002), 132–151.   4.  Bureau of the Census, Twelfth Census of the United States, 1900 Population of the States and Territories (Washington: GPO, 1904), Table 1. Arizona’s population in 1900 was approximately 123,000, whereas Colorado’s was nearly 540,000; Idaho, approximately 162,000; Montana, 248,000; New Mexico, 105,000; Utah, nearly 277,000; and Wyoming, 92,531.  5. Sandra Schackel, Social Housekeepers: Women Shaping Public Policy in New Mexico, 1920–1940 (Albuquerque: University of New Mexico Press, 1992), 103–106; Michael Anne Sullivan, “Walking the Line: Birth Control and Women’s Health at the Santa Fe Maternal Health Center, 1936–1970,” master’s thesis, University of New Mexico, 1995; Richard N. Ostling and Joan K. Ostling, Mormon America (San Francisco: Harper San Francisco, 1999), 168–169. Birth control clinics existed in Denver and Los Angeles by the 1930s. See Jimmy Elaine Wilkinson Meyer, Any Friend of the Movement: Networking for Birth Control 1920–1940 (Columbus: Ohio State University Press, 2004), 33–34.   6.  The federal Comstock Law outlawing contraceptives was reversed by the “One Package” decision in 1936. See Linda Gordon, The Moral Property of Women: A History of Birth Control Politics in America (Chicago: University Illinois Press, 2002), 226–227; Rickie Solinger, Pregnancy and Power: A Short History of Reproductive Politics in America (New York: New York University Press, 2005), 185.   7.  The centrality of reproduction in women’s lives is discussed by Gerda Lerner in The Majority Finds Its Past (New York: Oxford University Press, 1975).   8.  In 1906, approximately two-thirds of Arizona’s population was Roman Catholic, while 15 percent were Mormon, and less than 20 percent were Protestant. See Richard Etulain, “Contours of Culture in Arizona and the Modern West,” in Arizona at Seventy-Five: The Next Twenty-Five Years, edited by Beth Luey and Noel Stowe (Tucson: University of Arizona Press, 1987), 11–53.   9.  Bureau of the Census, Vital Statistics of the United States 1940, Part I (Washington: GPO, 1943), 27. These differences in infant mortality are discussed in detail in chapter 2. 10.  Arizona State Department of Health, Annual Report of Vital Statistics, 1964, Table 25, “Comparison of Selected Infant Mortality Rates for United States and Arizona, 1950–1964.” 11. Solinger, Pregnancy and Power, 182–185. 12.  During the past twenty years, several excellent anthologies and monographs detailing women’s history in the western United States have been published, including Western Women’s Lives: Continuity and Change in the Twentieth Century, edited by Sandra Schackel (Albuquerque: University of New Mexico Press, 2003); Portraits of Women in the American West, edited by Dee Garceau-Hagen (New York: Routledge, 2005); and The Women’s West (Norman: University of Oklahoma Press, 1987) and Writing the Range: Race, Class, and Culture in the Women’s West (Norman: University

Notes  •  189 of Oklahoma Press, 1997), both edited by Elizabeth Jameson and Susan Armitage. See also Joan Jensen, Promise to the Land: Essays on Rural Women (Albuquerque: University of New Mexico Press, 1991), and Laura Woodworth-Ney, Women in the American West (Santa Barbara, CA: ABC-CLIO, 2008). 13.  For the past twenty years, historians have stressed the need to study the multifaceted and multicultural experiences of women in the West. Creating an inclusive history is “essential because all people are historical actors,” write Susan Armitage and Elizabeth Jameson in their introduction to Writing the Range, 5. See also Antonia I. Castaneda, “Women of Color and the Rewriting of Western History: The Discourse, Politics and Decolonization of History,” Pacific Historical Review 61 (Fall 1992): 501– 534; Virginia Scharff, “Else Surely We Shall All Hang Separately: The Politics of Western Woman’s History,” Pacific Historical Review 61 (Fall 1992): 535–556. 14.  For example, Karl Jacoby’s Shadows at Dawn: An Apache Massacre and the Violence of History (New York: Penguin, 2008) illustrates how the Tohono O’Odham, Apache, Hispanics, and Anglos all viewed the Camp Grant massacre from different perspectives with tragic results for the Apache people. See also Samuel Truitt’s Fugitive Landscapes: The Forgotten History of U.S.–Mexico Borderlands (New Haven, CT: Yale University Press, 2006). 15.  Katherine Benton-Cohen, Borderline Americans: Racial Division and Labor War in the Arizona Borderlands (Cambridge, MA: Harvard University Press, 2009) describes the manner in which Euro-Americans and Mexican Americans sometimes cooperated and worked together in Arizona’s Cochise County, while at other times, especially in mining towns, Euro-Americans discriminated against and harmed those of Mexican descent. 16.  Thomas Sheridan, Arizona: A History (Tucson: University of Arizona Press, 1995), xv, 50–78. 17.  Inter-tribal Council of Arizona, “Population and Acreage of Tribal Reservations in Arizona,” 2003. 18. Sheridan, Arizona, 50–78; Peter Iverson, Diné: A History of the Navajos (Albuquerque: University of New Mexico Press, 2002); Timothy Braatz, Surviving Conquest: A History of the Yavapai Peoples (Lincoln: University Nebraska Press, 2003); Ian W. Record, Big Sycamore Stands Alone: The Western Apaches, Aravaipa,and the Struggle for Place (Norman: University of Oklahoma Press, 2008); Henry C. James, Pages from Hopi History (Tucson: University of Arizona Press, 1974); Winston P. Erikson, Sharing the Desert: The Tohono O’odham in History (Tucson: University of Arizona Press, 1994); Henry F. Dobyns, The Pima-Maricopa (New York: Chelsea House, 1989). 19.  Eric Stone, Medicine among the American Indians (New York: Hufner, 1962), 70; Virgil Vogel, American Indian Medicine (Norman: University of Oklahoma Press, 1970), 48; Amadeo M. Rea, At the Desert’s Green Edge: An Ethnobotany of the Gila River Pima (Tucson: University of Arizona Press), 15, 220–223, 278. 20. Vogel, American Indian Medicine, 148–151, 161. 21.  Russell Thornton, American Indian Holocaust and Survival: A Population History since 1492 (Norman: University of Oklahoma Press, 1987), 43, 48–54, 60–90. 22.  Russell Thornton, Gary D. Sandefur, and C. Matthew Snipp, “American Indian Fertility Patterns: 1910 and 1940 to 1980,” American Indian Quarterly (Summer 1991): 359–367. 23.  Mary Melcher, “ ‘This Is Not Right’: Rural Women Challenge Segregation and

190  •  Notes Ethnic Division,” Frontiers A Journal of Woman Studies 20, no. 2 (1999): 190–214; Bradford Luckingham, Minorities in Phoenix: A Profile of Mexican American, Chinese American, and African American Communities, 1860–1992 (Tucson: University of Arizona Press, 1994); Matthew Whitaker, Race Work: The Rise of Civil Rights in the Urban West (Lincoln: University of Nebraska Press, 2005). 24.  Henry P. Walker and Don Bufkin, Historical Atlas of Arizona, 2nd ed. (Norman: University of Oklahoma Press, 1986), 61. 25.  Odie B. Faulk, Arizona: A Short History (Norman: University of Oklahoma Press, 1970), 184–188; U.S. Government, Department of Commerce and Labor, Bureau of the Census, Fourteenth Census of the United States, vol. 2 (Washington: GPO, 1922), 87. Mary Rothschild and Pamela Hronek’s book, Doing What the Day Brought: An Oral History of Arizona Women (Tucson: University of Arizona Press, 1992) illustrates women’s roles in community building. 26.  Heidi Osselaer, Winning Their Place: Arizona Women in Politics, 1883–1950 (Tucson: University of Arizona Press, 2009), 48–52; Rothschild and Hronek, Doing What the Day Brought, xxiv–xxvi. 27.  U.S. Government, Department of Commerce and Labor, Bureau of the Census, Fourteenth Census of the United States, vol. 2 (Washington: GPO, 1922), 87. 28. Sheridan, Arizona, 145–186, 206–211; Faulk, Arizona, 157–159. 29.  Arizona: The Grand Canyon State: A State Guide (New York: Hastings House, 1966), 9. 30. Sheridan, Arizona, 192; Land Use of North America, Colorado Plateau, “The ‘Ferry’ of Lees Ferry,” Northern Arizona University, http://cpluhna.nau.edu/index .html. 31.  Walker and Bufkin, Historical Atlas of Arizona, 3. 32. Peggy Pascoe, What Comes Naturally: Miscegenation and the Making of Race in America (New York: Oxford University Press), 2009; Peggy Pascoe, “Race, Gender and Intercultural Relations: The Case for Interracial Marriage,” in Writing the Range, edited by Elizabeth Jameson and Susan Armitage, 42–68; Ian F. Haney López, White by Law: The Legal Construction of Race (New York: New York University Press, 1996). 33. Faulk, Arizona, 143; Sheridan, Arizona, 78–98, 151–152, 175–181.  Whitaker, Race Work; Melcher, “ ‘This Is Not Right’ ”; Luckingham, Minorities in Phoenix; Mary Melcher, “Blacks and Whites Together: Interracial Leadership in the Phoenix Civil Rights Movement,” Journal of Arizona History (Summer 1991): 195–216. BentonCohen, Borderline Americans, 81–92. 34.  Neil Foley, “Partly Colored or Other White: Mexican Americans and Their Problem with the Color Line,” in Beyond Black and White: Race, Ethnicity and Gender in the U.S. South and Southwest, edited by Stephanie Cole and Alison M. Parker (College Station: Texas A & M University Press, 2004); Melcher, “ ‘This Is Not Right.’ ” 35. Sheridan, Arizona, 52–57. 36.  University of Arizona, Arizona’s Hispanic Perspective, Thirty-Eighth Arizona Town Hall (Phoenix: Arizona Academy, 1981), 79–87; Oscar J. Martinez, “Hispanics in Arizona,” in Arizona at Seventy-Five: The Next Twenty-Five Years, ed. Beth Luey and Noel J. Stowe, 93–99. 37. Truett, 111; Arizona’s Hispanic Perspective, 97–97; Martinez, “Hispanics in Arizona,” 103–5, 109–110; Mario Barrera, Race and Class in the Southwest: A Theory

Notes  •  191 of Racial Inequality (Notre Dame: University of Notre Dame Press, 1979), 68–70. See also Benton-Cohen, Borderline Americans, 84. 38.  Census Bureau, Fifteenth Census, vol. 3, part 1 (Washington: GPO, 1933), 1431, 7, 27. In the 1930 census, demographers counted as Mexican anyone born in Mexico or whose parent or grandparents were born in Mexico. They reevaluated the 1920 census using this same method. Arizona, Sixteenth Biennial Report, 27. 39.  Martinez, “Hispanics in Arizona,” 109–110. 40. Luckingham, Minorities in Phoenix, 40–45; Thomas Sheridan, Los Tucsonenses: The Mexican Community in Tucson 1854–1941 (Tucson: University of Arizona Press, 1986); Mary Ruth Titcomb, “Americanization and Mexicans in the Southwest: A History of Phoenix’s Friendly House, 1920–1983,” master’s thesis, University of California, Santa Barbara, 1984; Arizona Women’s Heritage Trail, Carmen Soto de Vas­ quez, http://www.womensheritagetrail.org/women/CarmenVasquez.php. 41. Arizona, Sixteenth Biennial Report of the State Superintendent of Public Instruction, 1940–1942 (Phoenix: State of Arizona, 1942), 27. Campbell Gibson and Kay Jung, “Historical Census Statistics on Population Totals by Race, 1790 to 1990, and by Hispanic Origin, 1970 to 1990, for the United States, Regions, Divisions, and States,” Population Division, U.S. Census Bureau, Washington, September 2002, Working Paper Series no. 56. 42.  For a discussion of African American migration throughout the United States, see Joe William Trotter Jr., The Great Migration in Historical Perspective (Bloomington: Indiana University Press, 1991). 43.  Charles E. Hall, Negroes in the United States 1920–1932 (Washington: GPO, 1935), 9. U.S. Department of Commerce, Census Bureau, Sixteenth Census Agriculture (Washington: GPO, 1942), 346. 44. Hall, Negroes, 15. 45.  Richard Harris, The First Hundred Years: A History of Arizona Blacks (Apache Junction: Relmo, 1983), 45–51. Harland Padfield and William E. Martin describe the sharecropping background of many blacks in Farmers, Workers and Machines: Technological and Social Change in Farm Industries of Arizona (Tucson: University of Arizona Press, 1965), 233–234. Census studies document the disparity of landowning patterns among Arizona black and white farmers. In the 1920s and 1930s, Euro-Americans’ farms were worth more than twice that of African Americans and six to ten times as large. In 1940, after the ravages of the Great Depression, the average value of African American– owned farms was $3,541, whereas that of white-owned farms was $13,722. Furthermore, few African Americans owned farms—only thirty-two in 1920 and eighty-seven in 1930. U.S. Department of Commerce, Census Bureau, Sixteenth Census of the United States 1940 Reports on Agriculture Arizona (Washington: GPO, 1942), 392–393. Mary Melcher, “Tending Children, Chickens, and Cattle: Southern Arizona Ranch and Farm Women,” diss., Arizona State University, 1994; Julie A. Campbell, Studies in Arizona History (Tucson: Arizona Historical Society, 1998), 236–237. 46. U.S. Department of Commerce, Census Bureau, Fourteenth Census of the United States, 1920, vol. 4, Population-Occupations (Washington: GPO, 1921), 877– 878; Fifteenth Census of the United States, 1930 Occupations by States, vol. 4 (Washington: GPO, 1931), 141–143; Sixteenth Census of the United States, 1940, vol. 3 (Washington: GPO, 1941), 131.  According to Lawrence B. de Graaf, domestic service was the most common occupation of African American women in the West. See De Graaf,

192  •  Notes “Race, Sex, and Region: Black Women in the American West, 1850–1920,” Pacific Historical Review 49 (May 1980): 297. 47.  J. Morris Richards, History of the Arizona State Legislature (Phoenix: Arizona Department of Library, Archives and Public Records and Arizona Legislative Council, 1990), 244. 48.  Jackie Lynn Byrd Thul, “African American School Segregation in Arizona from 1863–1954,” master’s thesis, Arizona State University, 1993, 54, 61–63, 128–129. Yuma did not separate black and white pupils until 1941, when an irate parent demanded that the school board follow state law. Several segregated schools existed in Yuma County, but Yuma School District hesitated to segregate because officials did not want to fund a separate school or to create “class hatred.” 49.  Revised Statute of Arizona of 1928, Civil Code, chapter 21, article 1085, 240– 241. 50.  California ended de jure segregation of African Americans in 1880. See Charles Wollenberg, All Deliberate Speed Segregation and Exclusion in California Schools, 1855–1975 (Berkeley: University of California Press, 1976), 26–27. Sherman W. Savage, Blacks in the West (Westport, Conn.: Greenwood Press, 1976). 51.  Thul, “African American School Segregation,” 73–84. See also Melcher, “Blacks and Whites Together,” 195–216. Surely segregation and exclusionary policies affected African Americans’ ability to gain a high school education in Arizona. In 1940 EuroAmericans spent an average of 9.6 years in school and African Americans spent 7.4. At this time, three times as many of the former graduated from high school as did the latter. U.S. Department of Commerce, Sixteenth Census of the United States, 1940, Population vol. 2, 361. 52. Whitaker, Race Work, 53, 98–100; David R. Dean and Jean A. Reynolds, African American Historic Property Survey (City of Phoenix: Historic Preservation Office, 2004), 28–29. 53.  See Whitaker, Race Work; Luckingham, Minorities in Phoenix; and Melcher, “Blacks and Whites Together.” 54. Luckingham, Minorities in Phoenix, 79–81; Lawrence Michael Fong, “Sojourners and Settlers: The Chinese Experience in Arizona and Northern Mexico,” in The Chinese Experience in Arizona and Northern Mexico (Tucson: Arizona Historical Society, 1980); Grace Pena Delgade, “Of Kith and Kin: Land, Leases and Guanxi in Tucson’s Chinese and Mexican Communities, 1880s–1920s,” Journal of Arizona History 46, no. 1 (2005). 55. Luckingham, Minorities in Phoenix, 86. The Arizona Territorial Legislature passed an antimiscegenation law in 1901, forbidding Chinese from marrying Anglos. See Luckingham, Minorities in Phoenix, 81. U.S. Department of the Interior, Census Office, Tenth Census, Table I (Washington: GPO, 1883). 56.  Fifteenth Census of the United Sates 1930, vol. 3, part 1, Table 35; Karen J. Leong, “A Different Public, a Different History: The Japanese Americans in Arizona Oral History Project,” http://www.jaazoralhistory.org/?page_id=13. 57. Luckingham, Minorities in Phoenix, 108–109. 58.  Ibid., 109; Leong, “A Different Public, a Different History.” 59. Luckingham, Minorities in Phoenix, 108. The Arizona Historical Society archival collection in Tempe contains papers of the Japanese Association of Arizona. 60.  Karen Leong and Dan Killoren, “Enduring Communities: Japanese Ameri-

Notes  •  193 cans in Arizona,” 30 May 2008, Discover Nikkei Japanese Migrants and Their Descendants, http://www.discovernikkei.org/en/journal/2008/5/30/enduring-communities/. 61.  Leong, “A Different Public, A Different History”; Andrew B. Russell, “Arizona Divided,” in Arizona Goes to War: The Home Front and the Front Lines during World War II, edited by Brad Melton and Dean Smith (Tucson: University of Arizona Press, 2003), 38–55. 62. Whitaker, Race Work, 85–87; Mary Melcher, “Judge Thomas Tang and Dr. Pearl Tang: Path Breakers in Law and Medicine,” Journal of the West 44, no. 3 (Summer 2005): 70–77. 63.  Who’s Who in Arizona, vol. 1 (Jo Conners, 1913), 329–330. Mrs. Charles R. Howe, “Child Hygiene Division,” ASBH Bulletin 9, no. 18 (July 1921): 9. 64.  Carole R. McCann, Birth Control Politics in the United States, 1916–1945 (Ithaca, N.Y.: Cornell University Press, 1994), 99–101. 65.  Emmet McLoughlin, The People’s Padre (Boston: Beacon Press, 1954), 43–44. 66. U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1965, vol. 1, Natality (Washington: GPO, 1967), Table 1–33.

Chapter 1   1.  David Nagel Morales Sr. interview by Peter Booth, 8 November 2001, tape recording, Desert Caballeros Western Museum, Wickenburg, Arizona.   2.  U.S. Department of Census, Bureau of the Census, Sixteenth Census of the United States: Population Differential Fertility, 1910 and 1940 (Washington: GPO, 1943), 4.  3. Hall, Negroes in the United States, 202–203.   4.  Arizona Criminal Code, Title 13, 1901 (rev. 1913, 1928, 1939). Laws forbidding the advertisement of birth control were not challenged in Arizona until the 1960s, when Planned Parenthood of Phoenix sued Maricopa County. In a 1962 ruling, the Arizona Supreme Court allowed distribution of Planned Parenthood literature, stating that such distribution was not “advertising” as defined by earlier statutes. See Planned Parenthood Committee of Phoenix v. Maricopa County, Oct. 31, 1962. Solinger, Pregnancy and Power, 56.  5. Melcher, “Tending Children,” 136; Nan Elsasser, Kyle MacKenzie, and Yvonne Tixier y Vigil, Las Mujeres: Conversations from a Hispanic Community (Old Westbury, N.Y.: Feminist Press, 1980), 9; Margarita B. Melville, ed., Twice a Minority: Mexican American Women (St. Louis: Mosby, 1980), 11.  6. Joanne McCloskey, Living through the Generations: Continuity and Change in Navajo Women’s Lives (Tucson: University of Arizona Press, 2007), 16–17, 129– 130.   7.  Anne Wright, “An Ethnography of the Navajo Reproductive Cycle,” American Indian Quarterly 6, no. 1/2 (Spring–Summer 1982): 59.   8.  Melcher, “Tending Children,” 139; Linda P. Willcox, “Mormon Motherhood: Official Images,” in Sisters in Spirit: Mormon Women in Historical and Cultural Perspective, edited by Maureen Ursenback Beecher and Lavina Fielding Anderson (Chicago: University of Illinois Press, 1987), 208–226.   9.  Patricia Preciado Martin, Songs My Mother Sang to Me: An Oral History of

194  •  Notes Mexican American Women (Tucson: University of Arizona Press, 1992), 97, 124–126, 147. 10. Gordon, Moral Property of Women, 87; Tucson Daily Citizen, “Catholics Attack Proposed Clinic,” 24 November 1934. 11.  Ann Hibner Koblitz, “Advice for Women in Two Languages: Medical Almanacs in Early Prescott,” Sharlot Hall Museum Days Past, 9 March 2003, Sharlot Hall Museum, Prescott. 12. Andrea Tone, Devices and Desires: A History of Contraceptives in America (New York: Hill and Wang, 2001), 152. Solinger, Pregnancy and Power, 126. 13.  Jessie M. Rodriquez, “The Black Community and the Birth Control Movement,” in “We Specialize in the Wholly Impossible”: A Reader in Black Women’s History, edited by Darlene Clark Hine, Wilma King, and Linda Reed (Brooklyn, N.Y.: Carlson, 1995), 505–520; Joseph A. McFalls Jr. and George Masnick, “Birth Control and the Fertility of the U.S. Black Population, 1880 to 1980,” Journal of Family History 6, no. 1 (Spring 1981): 89–106. McCann, Birth Control Politics, 139. 14. Vogel, American Indian Medicine, 4–5, 240–243. 15. Thornton, American Indian Holocaust and Survival, 43, 48–54, 60–90. Thornton, Sandefur, and Snipp, “American Indian Fertility Patterns,” 359–367. 16.  Thornton, Sandefut, and Snipp, “American Indian Fertility Patterns.” 17.  Melcher, “Tending Children,” 138–139; Rothschild and Hronek, Doing What the Day Brought, 68–69. 18. Thornton, American Indian Holocaust and Survival, 184. 19.  Myla Carpio, “Lost Generation: The Involuntary Sterilization of American Indian Women,” master’s thesis, Arizona State University, 1995, 8–9. 20. U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1950, vol. 1 (Washington: GPO, 1954), 128–129. 21. Melville, Twice a Minority: Mexican American Women, 11. 22. Sheridan, Los Tucsonenses, 135. 23.  Michael R. Haines and Myron P. Gutmann, “Fertility of the Hispanic Population of the United States in Historical Perspective: Evidence from the Census of 1910,” paper presented at the Annual Meeting of the Population Association of America, Chicago, April 1998. 24. Hall, Negroes in the United States 1920–1932, 202. 25.  Ibid., 202. 26. Nancy Schrom Dye, “History of Childbirth in America,” Signs: Journal of Women in Culture and Society 6 (Autumn 1980): 98; Judith Waltzer Leavitt, Brought to Bed: Childbearing in America, 1750–1950 (New York: Oxford University Press, 1986) 36–63. 27.  Laurel Thatcher Ulrich, A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812 (New York: Knopf, 1990). 28. Stone, Medicine among the American Indians, 1; Carpio, “Lost Generation,” 8–9; Carl A. Hammershlag, The Dancing Healers: A Doctor’s Journey of Healing with Native Americans (New York: Harper and Row, 1989), 9, 45. 29. Rea, At the Desert’s Green Edge, 15. 30.  Eva Tulene Watt with assistance from Keith H. Basso, Don’t Let the Sun Step over You: A White Mountain Apache Family Life, 1860–1975 (Tucson: University of Arizona Press, 2004), 203.

Notes  •  195 31.  Ibid., 203–204. 32. Vogel, American Indian Medicine, 232; Stone, Medicine among the American Indians, 74–75. 33.  John Adair and Kurt W. Deuschle, The People’s Health: Medicine and Anthropology in a Navajo Community (New York: Meredith, 1970), 22. 34.  Watt with Basso, Don’t Let the Sun Step over You, 203. 35.  Dorothea Leighton and Clyde Kluckhohn, Children of the People (New York: Octagon Books, 1974), 14–15. “Chasing the Baby Out: Awéé’ hanidzóód,” with Bahe A. Begay, Leading the Way: The Wisdom of the Navajo People, April 2008, 4–5. 36.  Leighton and Kluckhohn, Children of the People. See also McCloskey, Living through the Generations, 131–133. 37. Ruth McDonald Boyer and Narcissus Duffy Gayton, Apache Mothers and Daughters: Four Generations of a Family (Norman: University of Oklahoma Press, 1992), 119. Dilth-cleyten belonged to the Chiricahua band of Apaches that moved between Arizona, New Mexico, and Mexico. See pp. 4–5. 38.  Ibid., 159–160. 39.  Anna Moore Shaw, A Pima Past (Tucson: University of Arizona Press, 1974), 154. Helen Sekaquaptewa, as told to Louise Udall, Me and Mine: The Life Story of Helen Sekaquaptewa (Tucson: University of Arizona Press, 1969), 178–179. 40.  Frances Manuel and Deborah Neff, Desert Indian Woman Stories and Dreams (Tucson: University of Arizona Press, 2001), 50. 41.  Adair and Deuschle, The People’s Health, 22–24; Flora A. Bailey, “Suggested Techniques for Inducing Navajo Women to Accept Hospitalization during Childbirth and for Implementing Health Education,” American Journal of Public Health 38 (October 1948): 1420. Ida Bahl, Nurse among the Navajos (Shepherd, 1984), 6–7. 42.  Diana Hadley, Environmental Change in Aravaipa, 1870–1970: An Ethnoecological Survey (Phoenix: Bureau of Land Management, 1991), 83; Martin, Songs My Mother Sang, 5–6; See also Fabiola Cabeza de Baca, We Fed Them Cactus (Albuquerque: University of New Mexico Press, 1954), 59–61. Fran Leeper Buss, La Partera (Ann Arbor: University of Michigan Press, 1980), describes the life of a Mexican American midwife. 43.  David Estrella interview by Delia Muˇnoz, Los Recuerdos Oral History Project, transcript, NAUCL.SC, Interview 68–21. 44.  Margarita Artschwager Kay, “Health and Illness in a Mexican American Barrio,” in Ethnic Medicine in the Southwest, edited by Edward H. Spicer (Tucson: University of Arizona Press, 1979), 156; Buss, La Partera, 63. 45.  Margarita A. Kay, “Mexican, Mexican American, and Chicana Childbirth,” in Twice a Majority: Mexican American Women (St. Louis: Mosby, 1980), 52–65. 46.  Ibid., 59. Sandra Schackel discusses midwives and their work in New Mexico among Hispanic and native women in Social Housekeepeers, 56–57. 47.  Melcher, “Tending Children,” 144. 48.  Rachel Herrera manuscript, MS 351, AHS-Tucson. 49. Hankins interview. Historian Carolyn Leonard Carson illustrates that black Southern women who migrated to the urban North increasingly turned to physicians for assistance in childbirth. See Carolyn Leonard Carson, “And the Results Showed Promise. . . . Physicians, Childbirth, and Southern Black Migrant Women, 1916–1930: Pittsburgh as a Case Study,” Journal of American Ethnic History (Fall 1994): 32–64.

196  •  Notes 50.  Olive Stoddard interview with the author, 24 November 1984, Sonoita, Arizona, tape recording, AHS-Tucson. Juanita Claridge, “We Tried to Stay Refined Pioneering in the Mineral Strip,” Klondyke and the Aravaipa Canyon (Safford, Ariz.: n.p., 1989), 89–97. A similar situation existed in rural Montana. See Melcher, “Women’s Matters,” 132–151. In The Important Things of Life: Women, Work and Family in Sweetwater County, Wyoming, 1880–1929 (Lincoln: University of Nebraska Press, 1997), Dee Garceau describes childbirth difficulties in rural Wyoming in the early twentieth century. Garceau argues that the hazards of pregnancy and childbirth on the frontier may have resulted in a lower birth rate among the second generation of immigrant women in the area. See pp. 84–88. 51.  Memoir by Minnie Guenther, Arizona Women’s Hall of Fame file, Minnie Guenther, ASLAPR. See also the Arizona Women’s Hall of Fame website, http://www .lib.az.us/awhof/women/guenther.cfm. 52.  Arthur A. Guenther, “That’s My Mom!” Guidepost (May 1968): 22–24. 53.  Arizona Women’s Hall of Fame file, Minnie Guenther, ASLAPR. 54.  Melcher, “ ‘Women’s Matters,’ ” 139–140. 55.  Stoddard interview. 56.  Patty Bartlett Sessions kept a diary describing her experiences as a Mormon midwife. She was born in Maine and traveled with other Mormons to Missouri; Nauvoo, Illinois; and on to Salt Lake City, Utah. Her diary recorded her daily activities while also illustrating community life, like the diary of Maine midwife Martha Ballard. See Mormon Midwife: The 1846–1888 Diaries of Patty Bartlett Sessions, edited by Donna Toland Smart (Logan: Utah State University Press, 1997). 57. Ellis Reynolds Shipp, While Others Slept: Autobiography and Journal (Salt Lake City: Bookcraft, 1985), xi, xiii, 282–285. 58. Chris Rigby Arrington, “Pioneer Midwives,” in Mormon Sisters: Women in Early Utah, edited by Claudia C. Bushman (Cambridge, Mass.: Emmeline Press, 1976), 44–57; Grace McBride Larson and Laura McBride Smith, Story of Matthewsville (n.p., n.d.), copy in Mesa Genealogical Library, Mesa, Arizona. Sarah E. Vance, “The Story of My Life,” n.p., 1995. 59.  Verna Rae Colvin, ed., The Garden and How it Grew: Eden, 1881–1981 (n.p., n.d.), 141–142, copy in Mesa Genealogical Library. 60.  For midwife and physician mortality rates, see Leavitt, Brought to Bed, 187; Judy Barrett Litoff, American Midwives, 1860 to the Present (Westport, Conn.: Greenwood Press, 1978), 27–30. 61.  Arturo Rosales interview with author, 28 September 1993, Tempe, Arizona, tape recording, AHS-Tucson. 62. Leavitt, Brought to Bed, 23–25; See also Viola Paradise, Maternity Care and the Welfare of Young Children in a Homesteading County in Montana (Washington: GPO, 1919), 10. 63.  ASBH, “Midwife Safety Rules,” 14 March 1920, ASLAPR. 64.  Ibid.; Bureau of Vital Statistics, Arizona Territorial Board of Health, Report from Douglas, Cochise County, 12 February 1912; ASBH, Minutes, 29 December 1923, ASLAPR. Later in life, some of Anna Mae Ellington’s children discovered that they lacked birth certificates because they had not been delivered by registered midwives. See Christina Ellington Hankins interview. Frances Manuel learned to deliver babies from her grandmother but did not register as a midwife. In her memoirs, she

Notes  •  197 describes being told by the court not to deliver babies after officials discovered that she was not writing birth certificates. See Manuel and Neff, Desert Indian Woman, 50. 65.  Margaret Glenn interview with author, 13 August 1992, Sierra Vista, tape recording; Rothschild and Hronek, Doing What the Day Brought, 64–65. 66. Judith Walzer Leavitt, “Birthing and Anesthesia: The Debate over Twilight Sleep,” Signs: Journal of Women in Culture and Society 6, no. 1 (1980): 147–164. 67. Ibid. 68.  Boido’s arrest and case are discussed in more detail in chapter 3. Maricopa County Superior Court, State of Arizona vs. Rosa G. Boido, 5 March 1918. Arizona Republican, “Mrs. Rosa Boido Arrested upon Serious Charge,” 10 February 1918. 69.  Bonnie Henry, “Stork’s Nest Cradles Pleasant Memories,” Arizona Daily Star, 29 April 1987; Arizona Daily Star, “City’s Growth Means End of ‘Stork’s Nest’ Hos­ pital,” 23 July 1961. 70.  Nancy Dana Norton, “Helen Marion Millett Grey Dana,” paper presented at the Arizona History Convention. 71.  Oral history with Winstona Hackett Aldridge, by author, 29 April 2004, Phoenix, Arizona, tape recording, City of Phoenix, African American Historic Property Survey, 2004.

Chapter 2   1.  Rita Ruiz interview with author, Cementerio Lindo Project, 13 March 2008, digital recording, City of Phoenix.   2.  Bureau of the Census, Vital Statistics of the United States 1940, part I (Washington: GPO, 1943), 27.  3. Schackel, Social Housekeepers. Schackel’s work examines the SheppardTowner Program in depth in chapter 2, pp. 30–61.  4. Molly Ladd-Taylor, Mother-Work: Women, Child Welfare, and the State, 1890– 1930 (Urbana: University of Illinois Press, 1994), 86–87.   5.  In nearby New Mexico, public health officials designed a program to reach out to the Hispanic majority there and made progress in lowering infant mortality even as they dealt with problems related to isolation and poor roads. See Schackel, Social Housekeepers, 30–61. In Arizona, discriminatory practices played out most significantly through the federally funded Sheppard-Towner Program, whereas in other locales ethnic prejudice was expressed through the Better Babies movement and baby contests. These contests also existed in Arizona, in the guise of expanding public health knowledge, but in comparison to the Sheppard-Towner Program, their effect was limited. Alexandra Minna Stern, “Making Better Babies: Public Health and Race Betterment in Indiana, 1920–1935,” American Journal of Public Health 92, no. 5 (May 2002): 742–752. See also Alexandra Minna Stern, “Beauty Is Not Always Better: Perfect Babies and the Tyranny of Paediatric Norms,” Patterns of Prejudice 36, no. 1 (2002): 68–78.   6.  In 1940, Arizona’s infant mortality rate was 84.5, and New Mexico’s was 99.6. Utah’s was 40.6. See Vital Statistics of the United States 1940, 27.   7.  Loretta L. Hefner, “Relief Society and the U.S. Sheppard-Towner Act,” Utah Historical Quarterly 50, no. 3 (1982): 255–267.

198  •  Notes   8.  Territorial Board of Health, Secretary’s Report, 28 November 1903.  RG 50, ASLAPR, vol. 1.  9. Report of the Territorial Board of Health to the Governor of Arizona for the Fiscal Year Ending June 30, 1910, 4–6, ASLAPR. 10. Ladd-Taylor, Mother-Work, 85. 11. ASBH, Bulletin 2, no. 4 (January 1913): 8–9. 12. Schackel, Social Housekeepers, 15–19. 13. Ladd-Taylor, Mother-Work, 85. 14.  Karen Blair, The Clubwoman as Feminist: True Womanhood Redefined, 1868– 1914 (New York: Holmes and Meier, 1980), 95–100. Osselaer, Winning Their Place, 66. 15. ASBH, Bulletin 4, no. 4 (October 1915): 15. 16.  Janolyn LoVechio, “BPW Arizona Legislative History,” in Arizona Federation of Business and Professional Women: Women Who Made a Difference 1921–2003, vol. 3 (Arizona Business and Professional Women’s Foundation, 2003), 7. 17.  U.S. Department of Commerce, Birth, Stillbirth and Infant Mortality Statistics, Twelfth Annual Report, part 1 (Washington: GPO, 1929), 7. Bureau of the Census, Vital Statistics of the United States, 1938, part 1 (New York: Greenwood Press, 1968), 5. By 1929, forty-six states were complying with the birth registration mandate, according to Ladd-Taylor, Mother-Work, 86. 18.  Marilyn Irwin Holt, Linoleum, Better Babies and the Modern Farm Woman, 1890–1930 (Albuquerque: University of New Mexico Press, 1995), 111. 19. Stern, “Making Better Babies,” 742–752. According to Ruth Clifford Engs, positive eugenics included educational programs that provided advice on mate selection, parenting, and childrearing to improve the human race. Negative eugenics, on the other hand, discouraged reproduction among the “unfit.” See Ruth Clifford Engs, The Eugenics Movement: An Encyclopedia (Westport, Conn.: Greenwood Press, 2005), 182. 20. ASBH, Bulletin 5, no. 2 (April 1916): 10–11. 21.  C. W. Sult, “Conservation of Babies,” address before the Flagstaff Woman’s Club during Better Babies Week. ASBH, Bulletin 6, no. 1 (January 1917): 5–8. 22.  Stern, “Beauty Is Not Always Better,” 68–78. 23. Arizona, Premium List Rules and Regulations of the 14th Annual State Fair, 1918, 33–34. 24.  Laura L. Lovett, Conceiving the Future: Pronatalism, Reproduction, and the Family in the United States, 1890–1938 (Chapel Hill: University of North Carolina Press, 2007), 135–136. 25. Arizona, Arizona State Fair 1920, Sixteenth Annual State Fair, “Entries Limited to 200 Babies,” 156; ASBH, Bulletin 9, no. 16, (January 1921), 7, Mrs. Charles Howe, Child Welfare Bureau. In her discussion of children’s health, Maude Howe mentioned a Better Babies contest at the state fair in 1921. 26.  Arizona Republican, “Virginia Drey Is Champion Baby of This County,” 14 November 1920, 13. 27. Arizona, Arizona State Fair 1920, Sixteenth Annual State Fair, “Entries Limited to 200 Babies,” 156. 28.  When settlement house workers in Philadelphia judged immigrant babies in Better Babies contests, they did so to separate those who were victims of poor condi-

Notes  •  199 tions from those seen as truly unfit. Daniel E. Bender writes about the combination of reform and eugenics impulses in these activities in “Perils of Degeneration: Reform, the Savage Immigrant, and the Survival of the Unfit,” Journal of Social History 42, no. 1: Fall 2008, 5–29. In Arizona, the lack of health education offered to minority and immigrant families most likely contributed to their continued high rate of infant mortality. 29. Grace Abbott, “The Federal Government in Relation to Maternity and Infancy,” CBR. See also Linda Gordon, The Great Arizona Orphan Abduction (Cambridge, Mass.: Harvard University Press, 1999), 120–121. 30. Luckingham, Minorities in Phoenix, 36–37; Michael Kotlanger, “Phoenix, Arizona: 1920–1940,” diss., Arizona State University, 1983, 429–430. 31.  Herbert B. Peterson, “A Twentieth Century Journey to Cibola: Tragedy of the Bracero,” master’s thesis, Arizona State University, 1975, 32, 46, 89–90; Mark Reisler, By the Sweat of Their Brow: Mexican Immigrant Labor in the United States, 1900–1940 (Westport, Conn.: Greenwood Press, 1976), 83–85. 32. Ladd-Taylor, Mother-Work, 87; Sheridan, Los Tucsonenses, 106, 176. Robert N. McLean, “Mexican Workers in the U.S.,” in Proceedings of the National Conference of Social Work (Chicago: University of Chicago Press, 1929). 33. ASBH, Bulletin 6, no. 2 (April 1917): Editorial Comment, 3. 34. ASBH, Bulletin 7, no. 10 (July 1919): 6; Bulletin 7, no. 11 (October 1919): 7; Melanie Sturgeon, “For Every Baby a Square Deal: Arizona Women and the Child Welfare Movement,” unpublished paper, AHF, Arizona State University Libraries. Arizona Federation of Women’s Clubs Yearbook, 1919, 36. 35.  Mrs. Charles R. Howe, “Child Hygiene Division,” ASBH, Bulletin 9, no. 18 (July 1921): 9. 36. ASBH, “Shepherd-Towner Report, 1922–1929”; U.S. Department of Commerce, Statistical Abstract of the United States 1930 (Washington: GPO, 1930), 88. Schackel, Social Housekeepers, 45, 49. 37.  Richard W. Wertz and Dorothy C. Wertz, Lying In: A History of Childbirth in America (New Haven, Conn.: Yale University Press, 1989), 206–207. 38. Ladd-Taylor, Mother-Work, 74–97; J. Stanley Lemons, The Woman Citizen: Social Feminism in the 1920s (Urbana: University of Illinois Press, 1973), 154–155; Molly Ladd-Taylor, Raising a Baby the Government Way: Mothers Letters to the Children’s Bureau 1915–1932 (New Brunswick, N.J.: Rutger’s University Press, 1986). 39.  C. Louise Boehringer, “Report of the Legislative Committee, 1921–1922,” in Arizona Federation of Women’s Clubs Yearbook, 1922, 71; Sturgeon, “For Every Baby a Square Deal,” 24. 40.  ASBH, “Shepherd-Towner Report, 1928–29”; “Report to the Children’s Bureau, Jan. 1–June 30, 1925,” U.S Department of Commerce Bureau of the Census, Historical Statistics of the United States Colonial Times to 1970 (White Plains, N.Y.: Kraus, 1989), 57. 41.  ASBH, “Biennial Report, 1923 and 1924,” 45; Ladd-Taylor, Mother-Work, 27, 88. 42.  Adair and Deuschle, The People’s Health, 19–20. 43.  Wade Davies, Healing Ways: Navajo Health Care in the Twentieth Century (Albuquerque: University of New Mexico Press, 2001), 22–24. 44.  Abbott, “The Federal Government in Relation to Maternity and Infancy”; U.S.

200  •  Notes Census Bureau, Abstract of the Fourteenth Census, 1920 (Washington: GPO, 1923), 75. 45.  State of Arizona, Correspondence and Reports, CBR; ASBH, Department of Health Services, Minutes, 23 December 1923, ASLAPR. 46.  ASBH, Department of Health Services, Minutes, 23 December 1923, ASLAPR; Walker and Bufkin, Historical Atlas of Arizona, 1; Mrs. Charles R. Howe to Anna E. Rude, 28 May 1923, Children’s Bureau Files, State of Arizona, National Archives, RG 102; ASBH, Minutes, 28 June 1923, ASLAPR; U.S. Census Bureau, Fifteenth Census of the United States, 1930 (Washington: Government Printing Office, 1930), 27; ASBH, “An Arizona Public Health Nurse,” Arizona Public Health News 47, no. 5 (June 1954): 6–8. Valenzuela was assigned to all counties except Mohave and Yuma. 47.  Mortality rates for Negro, Japanese, and Chinese groups were combined and listed as “other.” In 1925 Howe reported a mortality rate of 36 deaths per 1,000 in the “other” category—most likely this was an anomaly. In 1928 the rate was 218 per 1,000. ASBH, Bulletin (October 1928): 20–21; Bulletin (April 1929): 21. 48.  Mrs. Charles Howe to Grace Abbott, 1 April 1925, RG 102, State of Arizona, National Archives. ASBH, Sheppard-Towner Activities Reports, 1926–27 and 1927–28 from Mrs. Charles Howe to Blanche M. Haines, Children’s Bureau, July 1, 1926–June 30, 1927, July 1, 1927–June 30, 1928; letter from Blanche M. Haines, Director, Division of Maternal and Infant Hygiene to Mrs. C.R. Howe, Director, Child Hygiene Division, September 6, 1925, Children’s Bureau Files, State of Arizona, NA. 49.  Sturgeon, “For Every Baby a Square Deal,” 34. 50.  ASBH, “Midwife Safety Rules”; ASBH, Minutes, 29 December 1923, ASLAPR; Molly Ladd-Taylor, “ ‘Grannies’ and ‘Spinsters’: Midwife Education under the Sheppard-Towner Act,” Journal of Social History 22, no. 2 (Winter 1988): 255–276. ASBH, “Narrative Report on Field Work, July 1924–December 1924,” CBR from Mrs. Howe to the Children’s Bureau, Children’s Bureau Files, State of Arizona, NA. 51.  Letter from Nellie Willcox to Harriet Leete, 25 January 25, Children’s Bureau Files, State of Arizona, NA. 52.  Letter from Mrs. Charles Howe to Dr. Blanche Hanes, 20 October 1925, Children’s Bureau Files, State of Arizona, NA. 53.  Ladd-Taylor, “‘Grannies’ and ‘Spinsters,’” 255–276. Litoff, American Midwives, 27–30. Leavitt, Brought to Bed, 187. In Arizona and throughout the nation, the EuroAmerican middle-class bias of many female health care professionals influenced the design and administration of the Sheppard-Towner Program. For further discussion see Ladd-Taylor, Mother-Work, 187–188. 54. Schackel, Social Housekeepers, 47, 49, 51–54, 59. 55. Ibid. 56.  ASBH, Sheppard-Towner Reports, 1926–1927, 1928–1929, ASLAPR. 57.  ASBH, Sheppard-Towner Reports, July 1, 1927–June 30, 1928, ASLAPR; July 1, 1928–June 30, 1929, submitted by Mrs. Charles Howe, RG 102, State of Arizona, NA. There were 4,279 white births and 333 white deaths in contrast to 3,494 Mexican births and 717 Mexican deaths. 58. Ibid. 59.  U.S. Department of Commerce, Fifteenth Census of the United States: 1930, part 2, 1087. From 1850 to 1960, whites were approximately 98 percent of Utah’s

Notes  •  201 population. See Pamela S. Perlich, “Utah Minorities: The Story Told by 150 Years of Census Data,” Bureau of Economic and Business Research, University of Utah, Salt Lake City. 60.  Even though the decisions of Relief Society leaders had to be approved by male church leaders, the organization still functioned with independence for several decades, according to Cheryl Lynn May, “Charitable Sisters,” in Mormon Sisters: Women in Early Utah, edited by Claudia L. Bushman (Cambridge, Mass.: Emmeline Press, 1976), 233. 61.  Hefner, “Relief Society,” 255–267. 62.  May, “Charitable Sisters,” 233; Leonard Arrington, “The Economic Role of Pioneer Mormon Women,” Western Humanities Review 9 (Spring 1955): 145–164. 63.  Hefner, “Relief Society,” 259–260. 64.  Ibid., 261. 65. Ibid. 66.  Relief Society Minutes, 1 April 1924, History of Mesa 2nd Ward Relief Society, Mesa 2nd Ward, Mesa Stake, Microfilm, LR 5453 14, MHL. 67.  Relief Society Minutes, 2 January 1929; History of Chandler Ward Relief Society, Chandler Ward, Mesa West Stake (LR 1603 14), MHL. 68.  For example, the Report of Activities from the Thatcher, Arizona, Relief Society in 1922 demonstrated that 80 members from this organization made over 400 visits to the sick in one year. In 1924, they assisted a family who lost their home due to fire by making quilts; they helped homeless children the following year. See History of Thatcher Ward Relief Society, Thatcher Ward, Saint Joseph Stake (LR-9102 #2), MHL. 69.  Hefner, “Relief Society,” 264. 70. Grace Abbott, “The Federal Government in Relation to Maternity and Infancy,” speech prepared for the Annals of the American Academy of Political and Social Sciences, 11 July 1930, RG 102, NA. Wertz and Wertz, Lying In, 210, 219. 71.  ASBH, Eighth Biennial Report, 1927 and 1928, 31; U.S. Department of Commerce, Bureau of the Census, Historical Statistics of the United States Colonial Times to 1970 (White Plains, N.Y.: Kraus, 1989), 57. The rate of maternal mortality is calculated by considering the number of deaths related to complications of pregnancy, childbirth, and puerperium. John C. Slocumb and Stephen J. Kunitz, “Factors Affecting Maternal Mortality and Morbidity among American Indians,” Public Health Reports 92, no. 4 (July–August 1977): 349–356. 72.  Hefner, “Relief Society,” 263, Schackel, Social Housekeepers, 31. Historical Statistics of the United States Colonial Times to 1970, 57. 73.  ASBH, Ninth Biennial Report, 1929–1930, 12; Tenth Biennial Report, 1931– 1932, 9–13. 74.  ASBH, Biennial Report of Vital Statistics, 1930–1931, Phoenix, Arizona, 3–5. 75. McLoughlin, The People’s Padre, 43–44.  Placida Garcia Smith interview by Beth Morton, 12 May 1976, Phoenix, Arizona, tape recording, Arizona Historical Society, Tempe. Bradford Luckingham, in Minorities in Phoenix, also describes impoverished living conditions of minorities in the 1930s. 76. ASBH, Bulletin 58 (November 1930): 11; ASBH, Tenth Biennial Report, Phoenix, Arizona, 9–13.

202  •  Notes 77.  See Luckingham, Minorities in Phoenix, 39–44; Sheridan, Los Tucsonenses, 301; U.S. Department of Commerce, Bureau of the Census, Vital Statistics 1937, part 1, 30; Placida Garcia Smith interview. 78. Schackel, Social Housekeepers, 49, 105–109. 79.  Bureau of the Census, Vital Statistics of the United States 1940, part 1 (Washington: GPO, 1943), 27.  Hefner, “Relief Society,” 267. 80.  Ida Bahl, a public health nurse at Fort Defiance Hospital on the Navajo Reservation discussed the difficulties caused by lack of transportation during the 1930s. Often those with sick babies could not find a way to get to the hospital when they needed medical care. See Bahl, Nurse among the Navajos, 42–46. 81.  Arizona Public Health News 35, no. 2 (February 1942): 3. 82.  See Melcher, “Tending Children”; Rothschild and Hronek, Doing What the Day Brought; and Martin, Songs My Mother Sang to Me. Oral histories of middle-class women of color rarely mention infant mortality.

Chapter 3   1. Solinger, Pregnancy and Power, 106–107; Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkeley: University of California Press, 2001), 19–20.  2. In Social Housekeepers, Sandra Schackel describes the establishment of a Maternal Health Center in Santa Fe. Due to strong opposition from the Catholic Church, the center focused on providing prenatal, postnatal, and infant care classes, rather than birth control, although staff still distributed some contraceptives. See Social Housekeepers, 104–106.  See also Sullivan, “Walking the Line,” 6–14.  Harold L. Smith describes the establishment of birth control clinics in Texas during the 1930s in “ ‘All Good Things Start with the Women’: The Origin of the Texas Birth Control Movement, 1933–1945,” Southwestern Historical Quarterly, no. 114 (Jan. 2011), 253–85.  3. Andrea Tone, Devices and Desires: A History of Contraceptives in America (New York: Hill and Wang, 2001), 152; Solinger, Pregnancy and Power, 126. Arizona’s law that outlawed birth control was Arizona Criminal Code, Title 13, 1901 (rev. 1913, 1928, and 1939) (13–212). The federal Comstock Law outlawing contraceptives was reversed by the One Package decision in 1936. See Gordon, Moral Property of Women, 226–227.  4. Gordon, Moral Property of Women, 149–155; Margaret Sanger, Margaret Sanger, an Autobiography (New York: Cooper Square Press, 1999); David M. Kennedy, Birth Control in America: The Career of Margaret Sanger (New Haven, Conn.: Yale University Press), 1970.  5. Gordon, Moral Property of Women, 152–153, 160–161; Sara M. Evans, Born for Liberty: A History of Women in America (New York: Free Press, 1989), 168–173.  6. Evans, Born for Liberty, 166–168; McCann, Birth Control Politics, 48–50; Rosa­lind Pollack Petchesky, Abortion and Woman’s Choice: The State Sexuality and Reproductive Freedom (New York: Longman, 1984), 95.  7. Kennedy, Birth Control in America, 94, 100, 102, 201.  8. Kline, Building a Better Race, 14; Christine Rosen, Preaching Eugenics: Reli-

Notes  •  203 gious Leaders and the American Eugenic Movement (London: Oxford University Press, 2004), 6–15.  9. McCann, Birth Control Politics, 107, 111. 10.  Ibid., 11.  “For Sanger, birth control, made accessible to all, was the first and greatest step toward racial betterment,” McCann states. 11. Gordon, Moral Property of Women, 86–89. 12. Solinger, Pregnancy and Power, 82, 90. 13. “The Sanger-Hitler Equation,” Margaret Sanger Papers Newsletter, no. 32 (Winter 2002/2003), http://www.nyu.edu/projects/sanger/sanger-hitler_equation.htm1; Kennedy, Birth Control in America, 118. 14.  Constance M. Chen, “The Sex Side of Life”: Mary Ware Dennett’s Pioneering Battle for Birth Control and Sex Education (New York: New Press, 1998), 237–238; Kennedy, Birth Control in America, 106; David J. Garrow, Liberty and Sexuality: The Right to Privacy and the Making of Roe v. Wade (New York: Macmillan, 1994), 30–31. 15.  David Kennedy discusses Margaret Sanger’s international ties, writing that by 1922 she had traveled to Europe four times, been received with honors in Japan, and “won worldwide recognition as the foremost leader in the birth control movement.” See Kennedy, Birth Control in America, 90. 16. Gordon, Moral Property of Women, 226–227; Garrow, Liberty and Sexuality, 91–95; Solinger, Pregnancy and Power, 107. 17. Darby Moore, “The United States Birth Control Movement and Arizona Women: Biography, Social Action, and Community,” master’s thesis, Arizona State University, 1999, 75–77; Osselaer, Winning Their Place, 139. 18.  However, in some Southern states, such as South Carolina, Reilly argues that a rise in sterilizations was racially motivated. Philip R. Reilly, The Surgical Solution: A History of Involuntary Sterilization in the United States (Baltimore, Md.: Johns Hopkins University Press, 1991), 138; Kline, Building a Better Race, 19–20, 58–60. 19.  Johanna Schoen, Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare (Chapel Hill: University of North Carolina Press, 2005), 76; Kline, Building a Better Race, 59. 20.  Arizona Legislative Journal, House of Representatives, 14 March 1915, 267; Arizona Legislative Journal, Senate, 8 March 1915, 294. 21. Solinger, Pregnancy and Power, 93–94. 22. Reilly, The Surgical Solution, 86–87. 23. Solinger, Pregnancy and Power, 92–93; Reilly, The Surgical Solution, 46– 49.  Between 1907 and 1921, 2,558 of the total 3,233 sterilizations in the United States were in California. See Reilly, The Surgical Solution, 49. 24.  Journal of the Senate of Ninth Legislature of the State of Arizona, Senate, 249; Journal of the House of Representatives of the Ninth Legislature of the State of Arizona, 498. 25.  Acts and Resolutions and Memorials of the Regular Session Ninth Legislature of the State of Arizona, 1929, 114–119. 26. State Hospital Patients’ Register, 1876–1954, Film 29.1.1, Department of Health, RG 50, History and Archives Division, ASLAPR; Verna May Hillman Order of Commitment, 4 March 1930, Film 90.50.109, Cochise County, RG 101, History and Archives, ASLAPR; Insanity Docket, Superior Court, Yavapai County, State of Ari-

204  •  Notes zona. “In matter of an application for the commitment of Mrs. Carrie Davis,” 11 October 1928, RG 50.15, ASLAPR. 27.  Minutes, Arizona Board of Medical Examiners, 1 and 2 July 1930. Minutes are in the possession of the ABME. 28.  Minutes, ABME, 4 and 5 January 1938. 29.  Dan Madden, “Hospital Head Planning Sterilization Law Revival,” Phoenix Gazette, 20 March 1947, 1. 30.  Ibid.; Editorial Board, “Sterilization of the Unfit,” Phoenix Gazette, 21 March 1947. 31.  ABME Minutes, 8 January 1949. 32.  Arizona Republic, “Larson Ouster Talk Is Revived,” 28 January 1949. 33.  Arizona State Hospital, Milestones: A History of Seventy-Five Years of Progress at the Arizona State Hospital, Phoenix, Arizona 1887–1962 (Phoenix: State of Arizona, 1962), 10. 34. Reilly, The Surgical Solution, 98–99. 35.  Tucson’s population was 32,506 in 1930 and 35,752 in 1940 according to the City of Tucson Department of Urban Planning and Design, Population, Estimates and Projections, 1870–2060. 36. Moore, “The United States Birth Control Movement,” 47; Bonnie Henry, “Determined Women’s Work Goes On,” Arizona Daily Star, 30 September 1991, 3. 37. U.S. Department of Commerce, Bureau of Census, Fifteenth Census 1930 Population, vol. 3, part 1 (Washington: GPO, 1933), 143. 38. Sheridan, Los Tucsonenses, 93–109, 250–251. 39.  Interview with Virginia Yrun by the author, 3 November 2009, Tucson, Arizona, digital recording, UASC. 40.  Tucson Daily Citizen, “Catholics Attack Proposed Clinic,” 24 November 1934. 41.  Arizona Daily Star, “Bishop’s Letter Hits Club Resolution on Birth Control,” 13 June 1935. 42. Solinger, Pregnancy and Power, 108. 43. Schackel, Social Housekeepers, 103–105; Sullivan, “Walking the Line,” 13–17. 44. Solinger, Pregnancy and Power, 135. In 1942, the Birth Control Federation of America changed its name to Planned Parenthood Federation of America. At that time, the organization sponsored more than 200 clinics around the country. 45.  “Birth Control in Tucson: The Tucson Mothers’ Clinic for Planned Parenthood,” pamphlet, 1939, AHS-Tucson. 46. Schoen, Choice and Coercion, 22–23; McCann, Birth Control Politics, 95–96. 47.  Arizona Daily Star, “Birth Control Advocate Talks This Afternoon,” 23 November 1934.  Tucson Daily Citizen, “Margaret Sanger Addresses Women,” 23 November 1934. 48.  Melcher, “Blacks and Whites Together”; Whitaker, Race Work; Julie A. Campbell, Studies in Arizona History (Tucson: Arizona Historical Society, 1998), 271– 274. 49. McCann, Birth Control Politics, 168, 152–155. 50.  Arizona Republic, “Margaret Sanger, Award Winner, Here: Plans Birth Control Clinic,” 19 February 1937. 51.  Melcher, “Times of Crisis and Joy,” 181–200. 52.  Moore, “The United States Birth Control Movement,” 23, 47–48; Bess Prather,

Notes  •  205 bio file, Casa Grande Valley Historical Society, Casa Grande, Arizona; Arizona Republic, “Birth Control to Be Discussed,” 30 July 1935. 53.  Supreme Court of Arizona, Kinsey v. State, no. 850, March 8, 1937; Kinsey v. Real Detective Pub. Co., Inc., et al., no. 3988, July 5, 1938.  Hightower v. State, no. 950, 13 April 1945. 54.  LoVechio, “BPW Arizona Legislative History,” 6. 55.  Maricopa County Superior Court, State of Arizona v. Rosa G. Boido, 5 March 1918, trial records; Judgment and Commitment, 9 April 1918; Arizona Republican, “Dr. Rosa Boido Arrested upon Serious Charge,” 10 February 1918; Arizona Republican, “Dr. Boido Is Reticent over Grave Charge,” 11 February 1918; Arizona Republican, “Dr. Rosa Boido Given Minimum,” 10 April 1918. 56. In her unpublished paper, “Criminal Case No. 98 Territory of Arizona v. Nancy Pickens,” Maria Hernandez discusses the criminal case against Dr. Nancy Pickens in Phoenix in 1883.  Pickens was accused of performing an abortion but was acquitted in a case that Hernandez believes was an attempt to discredit her as the first female physician in Arizona territory. 57.  Leslie Reagan, When Abortion Was a Crime: Women, Medicine and Law in the United States, 1867–1973 (Berkeley: University of California Press, 1997), 11–12, 73– 79, 105–106. 58.  Citation Title 65 P.2d 1141, 49 Ariz. 201, Kinsey v. State, Supreme Court of Arizona, no. 850, 8 March 1937. In this case, Billie Kinsey appealed her conviction of second-degree murder. 59. Ibid. 60. Reagan, When Abortion Was a Crime, 130–135. 61.  Supreme Court of Arizona, Hightower v. State, no. 950, 13 April 1945. 62. Reagan, When Abortion Was a Crime, 137–139. 63.  Ibid., 135. 64.  Leonard Arrington, “Arizona in the Great Depression Years,” Arizona Review 17, no. 12 (December 1968); William S. Collins, The New Deal in Arizona (Phoenix: State Parks Board, 1999). 65. Gordon, Moral Property of Women, 226–227; Solinger, Pregnancy and Power, 124–125. 66.  Margaret Sanger to Maie Heard, 16 March 1937, Arizona Historical SocietyTempe, PPCNA, Arizona Republic, “Margaret Sanger, Award Winner Here; Plans Birth Control Clinic,” 19 February 1937; Bradford Luckingham, Phoenix: History of a Southwestern Metropolis (Tucson: University of Arizona Press, 1989), 90–92, 105–109; Moore, “The United States Birth Control Movement,” 75. 67.  Arizona Republic, “Mothers Health Clinic to Be Opened Here This Morning,” 1 October 1937; Arizona Republic, “Mother’s Health Talks Scheduled by Phoenix Clinic,” 5 April 1938. 68.  Jeanne Williams, “Founder to Be Honored,” Arizona Republic, 21 February 1965; Moore, “The United States Birth Control Movement,” 83–85; Peter Iverson, Barry Goldwater, Native Arizonan (Norman: University of Oklahoma Press, 1997), 16. 69.  Joanne Goldwater interview with author, 27 August 2009, digital recording, AHF. 70. Ibid. 71.  Heard, Goldwater, and Cuthbert all belonged to the St. Luke’s Board of Visi-

206  •  Notes tors, a women’s organization that assisted St. Luke’s Sanitarium. See Mary Melcher, The Board of Visitors: One Hundred Years 1908–2008 (Phoenix: Board of Visitors, 2008). 72.  Arizona Living, “Foresighted Parenting,” November 1982. 73.  Johanna Schoen also found that many impoverished women in North Carolina from all races were motivated to use birth control even though those distributing contraceptives may have espoused views considered racist, classist, or in favor of eugenics. See Schoen, Choice and Coercion, 52–53.

Chapter 4   1. Schoen, Choice and Coercion, 37.  2. Michael Grey, New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore, Md.: Johns Hopkins Press, 1999), 3.   3.  Malcolm Brown, “Migratory Cotton Pickers in Arizona,” WPA Division of Research (Washington: GPO, 1939). Throughout the nation, 85 percent of the migrants were Euro-Americans, according to Grey, New Deal Medicine, 27.   4.  Ann Stephens interview by Marsha Weisiger, 28 May 1992 tape recording and transcript, AHS-Tempe.  5. Ibid.  6. Grey, New Deal Medicine, 27–28.   7.  Ibid., 49, 81, 85.  8. Marsha Weisiger, Land of Plenty: Oklahomans in the Cotton Fields of Arizona, 1933–1942 (Norman: University of Oklahoma Press, 1995), 70–73.   9.  Ibid., 107–115, 130–131. 10. Mildred Delp, “Baby Spacing Report on California and Arizona,” March– August 1940; Mildred Delp, “My Day,” report, 1941, both in PPFA.SCA. 11.  Delp, “Baby Spacing Report on California and Arizona.” 12. Ibid. 13.  Delp, “My Day,” 11, 12 April 1939. 14.  Ibid., 12–14 April 1939; 16 January 1940. Gordon, Moral Property of Women, 217. 15.  Delp, “My Day,” 12–14 April 1939; Grey, New Deal Medicine, 81. 16. Weisiger, Land of Plenty, 106. 17.  Delp, “My Day,” 18 April 1939. 18. Ibid. 19.  Ibid., 11 January 1940. 20.  Ibid., 19 January 1940. 21.  Ibid., 2, 9 May 1940. 22.  Letter, Mildred Delp to Margaret Sanger, 24 April 1940, Phoenix, Arizona; Letter from Margaret Sanger to Mildred Delp, 1 May 1940, New York, New York. Margaret Sanger papers [microform]: documents from the Sophia Smith Collection and College Archives, Smith College (Series 2), edited by Esther Katz et al. 23.  Delp, “My Day,” 10 May 1940. 24.  Ibid., 26 July 1940. 25. Gordon, Moral Property of Women, 236–237. 26.  Leah S. Glaser, “The Story of Guadalupe, Arizona: The Survival and Preserva-

Notes  •  207 tion of a Yaqui Community,” master’s thesis, Arizona State University, 1996, 29, 43–44, 50, 64. 27.  Delp, “My Day,” 21 January 1941. 28.  Ibid., 29 January 1941. 29.  Ibid., 4, 5 November 1941. 30.  Ibid., 24 January 1941. 31.  Ibid., 4 February 1941; 27 October 1941; 3, 4 November 1941. 32.  Ibid., 15–16 December 1941. 33.  Ibid., 8 April 1942. 34.  Ibid., 9 April 1942. 35. Grey, New Deal Medicine, 130–138. 36.  J. C. Martin, “Woman Who Changed the World,” Arizona Daily Star, 9 November 1979. 37. Solinger, Pregnancy and Power, 135. 38. Luckingham, Phoenix, 151–157. 39. Gordon, Moral Property of Women, 242–243. Gordon argues that even though Planned Parenthood challenged neither “sexual inequities within the family nor the sexual or class inequities of the medical system,” its impact created conditions that led to a revived feminist movement by the late 1960s. 40.  Arizona Republic, “Planned Parenthood Clinic to Open New Offices Here,” 31 March 1947. 41. Melcher, Board of Visitors, 19; Solinger, Pregnancy and Power, 101. 42.  Tucson Planned Parenthood Committee stationery lists the Tucson sponsors. Letter, Margaret Sanger to Francoise (no last name given), 26 March 1947, Tucson, The Margaret Sanger papers [microform]: documents from the Sophia Smith Collection and College Archives, Smith College (Series 2), edited by Esther Katz et al. 43.  Letter, Mrs. Benson Bloom to Margaret Sanger, 7 May 1946, Tucson, Margaret Sanger papers [microform] (Series 2). 44.  Letter, Daniel J. Gercke to Mr. Morrow, 26 January 1946, Tucson, Margaret Sanger papers [microform] (Series 2). 45. Ibid. 46.  Letter, Mrs. Benson Bloom to Margaret Sanger, 7 May 1946, Tucson, Margaret Sanger papers [microform] (Series 2). 47.  Arizona Daily Star, “Margaret Sanger Speaking on Planned Parenthood,” 23 March 1947; Arizona Daily Star, “Planned Parenthood Thesis Defended by Margaret Sanger,” 26 March 1947. 48.  Arizona Daily Star, “Bishop Gercke Tells Church View on Planned Parenthood,” 2 April 1947. 49.  David R. Dean and Jean A. Reynolds, African American Historic Property Survey (Phoenix: Historic Preservation Office, 2004), 53. 50. McLoughlin, The People’s Padre, 43–44. 51.  Ibid., 137–138. 52. Ibid. 53. Luckingham, Minorities in Phoenix, 155–156.  McLoughlin, The People’s Padre, 137–138. 54.  Dean and Reynolds, African American Historic Property Survey, 55, 57; Luckingham, Minorities in Phoenix, 154–157. 55. Luckingham, Minorities in Phoenix, 154–157. Memorial Hospital Annual Re-

208  •  Notes port, 1963, ephemera file, Arizona Collection, Hayden Library, ASU Libraries. Arizona Republic, “Local Organization Grows from Idea to Real Thing,” 30 April 1961. 56.  Arizona Sun,“Parenthood Campaign to Include All Racial Groups,” 21 November 1947; Phoenix Gazette, “View New Planned Parenthood Clinic,” 1 April 1947. 57. Solinger, Pregnancy and Power, 124–125; McCann, Birth Control Politics, 141–147. 58.  Phoenix Gazette, “State Medical Units Support Planned Parenthood Group,” 13 April 1948. 59.  Phoenix Gazette, “Second Planned Parenthood Clinic Opened,” 28 April 1949. 60.  Arizona Sun, “Planned Parenthood Clinic Changes Location,” 31 March 1950; Arizona Republic, “Planned Parenthood Clinic Open House Set,” 12 November 1950. 61. Solinger, Pregnancy and Power, 100–101.

Chapter 5   1.  Melcher, “Judge Thomas Tang and Dr. Pearl Tang,” 74–75. For example, China’s infant mortality rate in 1970 was 50 per 1,000, whereas the rate on the White Mountain Apache Reservation in 1968 was 77. See Maternal and Infant Care Project, “An Evaluation of Maternal and Child Health Care at Whiteriver Service Unit and its Relation to ‘Project Apache,’ ” MS 269, Box 1, folder 68, NAUCL.SC; Dejian Lai, “Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study,” Social Indicators Research 70, no. 3 (February 2005): 313–326.   2.  L. J. Lull, “Indian Infant Death Study, Arizona and New Mexico, 1959–1960,” 14–15, Table 12, MS 269, Box 5, Folder 150, NAUCL.SC.   3.  See http://www.navajo.org/history.htm (Navajo Nation website).   4.  Mary Zillatus, “Transfer to Nowhere—1953 Pinon,” Virginia Brown, Ida Bahl, and Lillian Watson Collection, MS 269, Box 1, Folder 38–39, NAUCL.SC.  5. Ibid.   6.  Mary Zillatus, “Living in Pinon, 1953–1955,” MS 269, NAUCL.SC.  7. Ibid.   8.  Kunitz and Slocumb, “Factors Affecting Maternal Mortality and Morbidity,” 349–355.  9. Ibid. 10. Judith B. Vaughan, “Maternal Deaths in New Mexico, 1956–1966,” Rocky Mountain Journal 66, no. 9 (September 1969): 65–70. 11. Ibid. 12.  Lull, “Indian Infant Death Study.” 13. McCloskey, Living through the Generations, 133–135. 14.  Hankins interview. 15.  John Jennings, “A Tribal Treasure,” Tucson Daily Citizen, 30 August 1994. 16. Robert D. Grove and Alice M. Hetzel, Vital Statistics Rates in the United States 1940–1960 (Washington: U.S. Department of Health, Education and Welfare, 1968), 215, 227, 233. 17.  Congressional Budget Office, “Factors Contributing to the Infant Mortality

Notes  •  209 Ranking of the U.S.,” 1992. Table 2, International Infant Mortality Rates by Ranking, 11. 18. Ibid. 19.  Ibid., 19–20, 100–103. 20. U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1965, vol. 1, Natality (Washington: GPO, 1967), Table 1–33. 21.  Memo to Charles R. Mallary, Area Medical Officer in Charge, from Maternal and Child Health, Albuquerque Area Office, Division of Indian Health, 27 July 1959, MS 269, Box 5, F. 142, NAUCL.SC. 22.  Ibid., 4. 23. Bahl, Nurse among the Navajos, 55–63, 127–129, 174–179, 199–207. 24. Virginia Hoffman and Broderick H. Johnson, Navajo Biographies (Chinle, Ariz.: Rough Rock Demonstration School, 1970). 25.  Marion E. Gridley, ed., Indians of Today, 3rd ed. (Chicago: Indian Council Fire, 1960), 49–50. 26.  Carolyn Niethammer, I’ll Go and Do More: Annie Dodge Wauneka Navajo Leader and Activist (Lincoln: University of Nebraska Press, 2001), 166. 27.  Arizona Women’s Hall of Fame files, Annie Wauneka, ASLAPR. 28.  Arizona Republic, “Indian Hospital Balks Admittance; Baby Dies,” 28 January 1949. 29.  Deborah A. Sullivan, and Ruth Beeman, “Utilization and Evaluation of Maternity Care by American Indians in Arizona,” Working Paper no. 10, Southwest Institute for Research on Women, Women’s Studies, University of Arizona, Tucson, 1982, 1. 30.  Pearl Tang interview with author, Tapes 1 and 2, 21 September 1999, 28 September 1999, Paradise Valley, Arizona. The author conducted several interviews with Pearl Tang between 1999 and 2002. They are in the collection of the Arizona Historical Society in Tempe and will be identified as Tape 1, Tape 2, and so on, including the date of the interview in the first reference note. 31.  Pearl Tang interview, Tape 6, 12 September 2002, AHS-Tempe. 32.  Pearl Tang interview, Tape 1, AHS-Tempe. 33. Ibid. 34. Ibid.; U.S. Department of Commerce, Census, 1950 Arizona (Washington: GPO, 1952), 204–212. 35.  Pearl Tang interviews, Tape 1, Tape 3, 28 September 1999, AHS-Tempe; State of Arizona, Vital Statistics Tables 1950, Table 11. 36.  Arizona State Department of Health, Annual Report of Vital Statistics, 1964, Table 25, “Comparison of Selected Infant Mortality Rates for United States and Arizona, 1950–1964.” 37.  Pearl Tang interview Tape 1, AHS-Tempe. 38.  Melcher, “Judge Thomas Tang and Dr. Pearl Tang,” 74–75. 39. Ibid. 40.  Pearl Tang interview, Tape 3, 28 September 1999, AHS-Tempe. 41.  Melcher, “Judge Thomas Tang and Dr. Pearl Tang,” 75. 42.  Arizona State Department of Health, Annual Report, Arizona Vital Statistics Tables, 1950–1951; Arizona Regional Medical Program, Arizona Health Data Book, County Comparisons, Table 11, 1969. 43.  Pearl Tang interview, Tape 3, 28 September 1999, AHS-Tempe.

210  •  Notes 44.  Robert Lukacs, “A Statistical Analysis of the Pima County Health Department Prenatal Records,” master’s thesis, University of Arizona, 1964, 19, 28, 30. 45. Ibid. 46.  Pima County Department of Health and Hospital Services, Tucson, Arizona, Annual Report Fiscal Year 1970–1971, Division of Vital Records and Statistics. 47.  Zillatus, “Home of the Desert People,” MS 269, Box 1, folder 40, NAUCL.SC. 48.  Zillatus, “Public Health Nursing in Papagoland,” Nursing Outlook 10, no. 12 (December 1962), a publication of the U.S. Department of Health, Education and Welfare, Public Health Services, MS 269, Box 6, Folder 401, NAUCL.SC. 49.  Arizona Department of Health, Annual Report, Arizona Vital Statistics Tables, 1950–1951, Vital Statistics Summary by County, 1950. Annual Report, Arizona Vital Statistics Table, 1964, Table 21, Infant Deaths and Death Rates by Color and County of Residence, Arizona, 1964. 50. Maternal and Infant Care Project, “An Evaluation of Maternal and Child Health Care at Whiteriver Service Unit”; Lai, 313–326. 51. Maternal and Infant Care Project, “An Evaluation of Maternal and Child Health Care,” 52. U.S. Department of Health Education and Welfare, Public Health Services, Vital Statistics of the United States, 1974, vol. 2, Mortality, part A (Hyattsvelle, Md., 1978), Table 2–7.

Chapter 6   1.  Lula Stevens interview with author, 11 February 2005, Mesa, Arizona, tape recording, AHS-Tempe.   2.  Don Bolles, “Planned Parenthood Committee Wins Supreme Court Victory,” Arizona Republic, 1 November 1962.   3.  U.S. Department of Health, Education and Welfare, Public Health Service, Annual Report: National Reporting System for Family Planning Services, 1974 (Rockville, Md., 1977), 181.  These studies relied on data reported from participating family planning clinics and service sites. Most of these facilities received federal funds. In addition, some Planned Parenthood/World Population agencies also reported. See U.S. Department of Health Education and Welfare, Public Health Service, Background and Development of the National Reporting System for Family Services (Hyattsville, Md., 1978), 3, 19, 49, 63.  4. U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1965, vol. 1, Natality (Washington: GPO, 1967), Table 1–33.   5.  In 1990, the birth rate for Hispanic women in Arizona was 28.6, leading to a higher overall rate for Arizona in comparison to other states. See Paul D. Sutton and T. J. Mathews, “Trends in Characteristics of Births by State: United States, 1990, 1995, and 2000–2002,” National Vital Statistics Reports, Division of Vital Statistics, vol. 52, no. 19 (2004): Table 4.   6.  Willcox, “Mormon Motherhood: Official Images,” 216.  7. Richard N. Ostling and Joan K. Ostling, Mormon America (San Francisco: Harper San Francisco, 1999), 168–169.   8.  Michael B. Toney, Benu Golesorkhi, and William F. Stinner, “Residence Ex-

Notes  •  211 posure and Fertility Expectations of Young Mormon and Non-Mormon Women in Utah,” Journal of Marriage and Family 47, no. 2 (May 1985): 459–465.   9.  Memo to Charles R. Mallary, 27 July 1959. 10.  Lull, “Indian Infant Death Study Arizona and New Mexico.” 11.  Stephen J. Kunitz, “Navajo and Hopi Fertility, 1971–1972,” Human Biology 46, no. 3 (September 1974): 435–451. Stephen J. Kunitz and John C. Slocumb, “The Use of Surgery to Avoid Childbearing among Navajo and Hopi Indians,” Human Biology 48, no. 1 (February 1976): 9–21. For Navajos age twenty-five and above, the median value for years of education was 4.1, whereas among the population on the Hopi Reservation, it was 9.6. 12.  Anne Wright, “An Ethnography of the Navajo Reproductive Cycle,” American Indian Quarterly 6, no. 1/2 (Spring–Summer 1982): 52–70. 13. Ibid. 14.  Douglas Southgate describes the worldwide trend of declining fertility rates as more women participate in the labor market. See Southgate, “Population Growth, Increase in Agricultural Production and Trends in Food Prices,” Electronic Journal of Sustainable Development 1, no. 3 (2009), http://www.ejsd.org/public/journal_article/13. 15.  U.S. Department of Health and Human Services, Vital Statistics of the United States, 1991, vol. 1, Natality (Hyattsville, Md.: Public Health Service, 1995), Tables 1–1, 1–4, 1–11, 2, 5, 17, 20. Child Trends Data Bank, “Birth and Fertility Rates,” n.d., http://www.childtrendsdatabank.org/pdf/79_PDF.pdf. Between 1960 and 1970, the average fertility of Mexican American women decreased, as it did for other ethnic groups, but it remained higher than that of other groups. See also Sally J. Andrade, “Family Planning Practices of Mexican Americans,” in Twice a Minority: Mexican American Women, edited by Margarita Melville (St. Louis: Mosby, 1980), 24. 16.  Arizona Republic, “Committee Receives First Contribution,” 1 February 1950. 17. Linda Gordon argues that the “feminine mystique” had a strong effect on Planned Parenthood. According to this mystique, women were to be satisfied with living a domestic life as housewives in sexually fulfilling marriages. Many women were not sexually satisfied, and they turned to Planned Parenthood for advice, argues Gordon. See Gordon, Moral Property of Women, 256–267. Records in Arizona are not available to assess this aspect of the program. Betty Friedan, The Feminine Mystique (New York: Norton, 1963). 18.  Phoenix Gazette, “Protestants Assail Catholic Bishop for Stand on Birth Control,” 26 November 1959; Phoenix Gazette, “Bishop Urges Parenthood Drive Aid,” 26 March 1952; Phoenix Gazette, “Parenthood Group Reports Fund Goal,” 19 March 1952. 19.  Phoenix Gazette, “Parenthood Group Reports Fund Goal,” 19 March 1952. 20.  Phoenix Gazette, “Fund Drive Nears End,” 8 April 1953. 21.  Phoenix Gazette, “Parenthood Group Calls Negro Meet,” 15 November 1950. Dean and Reynolds, “African American Historic Property Survey.” This report describes the prominence of the Elks Lodge among the African American community. During the 1930s and 1940s, African Americans throughout the United States debated the use of contraceptives. Some, including W. E. B. Du Bois and the National Council of Negro Women, favored family planning programs and others, such as Marcus Garvey and Dr. Julian Lewis, feared that birth control would lead to race suicide. See

212  •  Notes Robert G. Weisbord, Genocide? Birth Control and the Black American (Westport, Conn.: Greenwood Press, 1975), 46–53. 22.  Phoenix Gazette, “Planned Parenthood Unit to Be Formed,” 13 March 1962; Phoenix Gazette, “Parenthood Group Plans New Clinics,” 5 June 1962. 23.  Memorial Hospital Annual Report, 1963, ephemera file, Arizona Collection, Hayden Library, ASU Libraries; Arizona Republic, “Local Organization Grows from Idea to Real Thing,” 30 April 1961. 24.  Jeanne Williams, “Founder to Be Honored,” Arizona Republic, 21 February 1965. 25. Mrs. David Rosentiel, “Planned Parenthood Clinic Needs Funds,” Arizona Daily Star, 16 January 1955. 26. Ibid.; Arizona Republic, “Margaret Sanger Will Speak Here,” 18 May 1958. 27.  Reyn Voevodsky interview with author, 23 November 2010, Tucson, Arizona, UASC. 28.  Arizona Daily Star, “Moving Day Visitor,” 11 December 1957; Katie Supinski, “Planned Parenthood Clinic Marks 32nd Year Helping Tucson Women,” Arizona Daily Star, 29 May 1966, D1–D2; Tucson Daily Citizen, “Planned Parenthood an Answer,” 10 February 1967, 13. 29.  Photo above article titled “World’s Children Deserve to Be Wanted Planned Parenthood Head Tells Leaders,” Tucson Daily Citizen, 20 August 1965; Arizona Daily Star, “Birth Control Instruction Available for Families,” 28 October 1962. 30.  Supinski, “Planned Parenthood Clinic.” 31. Judy Tamsen interview with author, 20 September 2010, Tucson, Arizona, UASC. 32. Ibid. 33.  Voevodsky interview. 34. Priscilla Robinson interview with author, 20 September 2010, Tucson, Arizona, UASC. 35.  Voevodsky interview. 36. Ibid. Rehn Voedvodsky commented that Morris Udall provided legal assistance to Planned Parenthood during the early 1960s. See Voevodsky interview. 37.  Elaine Tyler May, America and the Pill: A History of Promise, Peril, and Liberation (New York: Basic Books, 2010), 21–34. 38.  Tamsen interview. 39.  Marilyn Drago, “2,800 Given Advice by Parenthood Unit,” Arizona Daily Star, 23 December 1969.  In 1971, the Pima County Health Department began giving minors birth control advice. See Marilyn Drago, “Minors Get Birth Control Aid,” Arizona Daily Star, 9 August 1971; May, America and the Pill, 79; Elaine Tyler May, “The Pill: Making Motherhood Better for 50 Years,” Washington Post, 9 May 2010. 40. Gordon, Moral Property of Women, 286–288, 298; Solinger, Pregnancy and Power, 166–168.  Drago, “2,800 Given Advice by Parenthood Unit.” 41.  Tucson Daily Citizen, “Family Planning Center Opens; New Era Begins,” 27 January 1967. Drago, “2,800 Given Advice by Parenthood Unit.” 42.  Tucson Daily Citizen, “UA to Give 4 Arizonans Honorary Degrees May 26,” 8 May 1965. 43.  Editor, “One of History’s Great Figures Dies,” Arizona Daily Star, 8 September 1966.  Other articles marking her death are in the Arizona Republic, “Mrs. Sanger,

Notes  •  213 Birth Control Pioneer, Dies,” 7 September 1966; Editor, “Margaret Sanger, RIP,” Arizona Republic, 8 September 1966; Phoenix Gazette, “Margaret Sanger Dies in Tucson,” 7 September 1966. 44.  After the Supreme Court decision Roe v. Wade legalized abortion, a strong right-to-life movement cast Sanger as an abortion proponent and linked birth control with abortion. When Sanger was inducted into the Arizona Women’s Hall of Fame in 1991, conservative lawmakers vehemently protested her induction and succeeded in shutting down the Arizona Women’s Hall of Fame for approximately ten years. For more information on this event, see chapter 8. 45.  Reverend Raymond G. Manker, “Margaret Sanger: Victimized Saint,” 18 September 1966, First Unitarian Universalist Church, Phoenix Arizona, PPCNA, AHSTempe. Rickie Solinger discusses the Clergy Consultation on Abortion, which began in New York in 1967. See Solinger, Pregnancy and Power, 184. 46.  “Mrs. Barry Goldwater Gets Award,” April 1967, PPCNA, AHS-Tempe; Peggy Goldwater, “Why I Believe in Planned Families,” Arizonian, 14 April 1967. 47.  Ralph Alden, “Memorial Hospital,” July 1966. Memorial Hospital Annual Report 1963, EPH-VH-18, Arizona Collection, Arizona State University Libraries. 48. Gordon, Moral Property of Women, 289; Tang interview, Tape 5, 22 November 1999. 49.  Arizona Criminal Code, Title 13, 1901 (rev. 1913, 1928, 1939). 50.  The state statute cited by Sullivan had not been undermined by Judge Hand’s decision in 1938, which had removed all federal bans on birth control but left state laws untouched. Gordon, Moral Property of Women, 226–227. In 1965, the Supreme Court’s Griswold v. Connecticut decision cut down the last remaining state law against contraception. See Gordon, Moral Property of Women, 289. 51.  W. R. Harrod, “Parenthood Group Here Gets Rebuke,” Arizona Republic, 10 September 1959, 1. 52. Ibid. 53.  Arizona Daily Star, “Tolerance and Judgment Are Needed,” 11 September 1959. 54.  Daniel J. Gercke, Letter to the editor titled “Bishop Replies,” Arizona Daily Star, 12 September 1959. Sanger also entered the fray, defending the Planned Parenthood organization of Phoenix. Sanger claimed that she and other organizers of the first birth control clinic in Arizona’s capital city had looked into potential conflict with state law in 1935 and had been told that it was only illegal if they advertised contraceptives publicly. Pearl Aldrich, “Planned Parenthood Group Defended by Mrs. Sanger,” Arizona Daily Star, 12 September 1959. 55.  Gene Lindsey, “Birth Control Information Ban Upheld,” Phoenix Gazette, 12 January 1961. 56.  Don Bolles, “Planned Parenthood Committee Wins Supreme Court Victory,” Arizona Republic, 1 November 1962. Arizona Daily Star, “Parenthood Group Wins Court Case,” 1 November 1962. 57.  Stevens interview, AHS-Tempe. 58. Ibid. 59.  See http://www.infoplease.com/ipa/A0762181.html. 60. Gordon, Moral Property of Women, 279–280. Editor, “Population Control a Must in War against Poverty,” Tucson Daily Citizen, 23 April 1964.

214  •  Notes 61. May, America and the Pill, 39.  Schoen, Choice and Coercion, 237. The population explosion was used to justify state control of reproduction, argues Schoen in Choice and Coercion. 62. Solinger, Pregnancy and Power, 177. 63.  Mary C. Segers and Timothy A. Byrnes, eds., Abortion Politics in American States (New York: M. E. Sharpe, 1995), 3. 64.  Letter, Ernest Gruening to Sam Goddard, 13 August 1965, Washington, D.C. 65.  Letter, Samuel P. Goddard to Ernest Gruening, 2 December 1965, Phoenix, Arizona. 66.  Arizona State Board of Health, “Policy Statement on Family Planning,” 26 November 1965. 67.  Arizona Daily Star, “State Health Board Approves Use of Public Funds and Personnel for Control Aid,” 27 November 1965; Arizona Daily Star, “Catholics Criticize Decision,” 28 November 1965. 68.  Arizona Daily Star, “Oliver’s Birth Control Views Arouse Criticism,” 30 November 1965. 69.  U.S. Department of Commerce, Census Bureau, Median Household Income by State, 1969, 1979, 1989, 1999, http://www.census.gov/hhes/www/income/histinc/ state/state1.html. 70.  Maricopa County Health Department, “Project for Family Planning Services to Reduce Maternal and Infant Mortality and Morbidity in Maricopa County,” 21 May 1968, 1–2. Pearl Tang interview, Tape 1. 71.  Maricopa County Health Department,“Project for Family Planning Services,” 3–5. 72.  Ibid., 8–12. 73.  Pearl Tang interview, 22 November 1999, Tape 5, AHS-Tempe. 74.  Linda Helser, “Family Planning Hits the Road,” Phoenix Gazette, 18 December 1970. 75.  Ibid.; Pearl Tang interview, Tape 5.  Letter from Pearl Tang to Sheridan Weinstein, 21 May 1976, Phoenix, Arizona. 76.  Maricopa County Health Department, “Project for Family Planning Services,” 21. 77.  Planned Parenthood Center of Tucson, “Family Planning in Low Income Areas,” proposal for consideration by Committee for Economic Opportunity for participation in federal funds provided in the Economic Opportunity Act of 1964. Tucson Daily Citizen, “Planned Parenthood an Answer,” 10 February 1967. Pima County Department of Health and Hospital Services, Annual Report Fiscal Year 1971–1972, Tucson, Arizona. 78. Emily Jenkins interview with author, 16 October 2009, Phoenix, Arizona, AHF. 79. Ibid. 80.  Arizona Daily Wildcat, “Administrators Deny Charges Involving Student Rights Group,” 24 November 1970; Arizona Daily Wildcat, “30 Protest ‘Sexist’ Practices,” 10 November 1970; Arizona Daily Wildcat, “Sex Bias Investigated at U A,” 24 November 1970. 81.  Nancy Louk, “Out-of-State Abortions Are All ‘Very, Very’ Legal,” Arizona Daily Wildcat, 24 September 1971; Arizona Daily Wildcat, “Panel Tonight Probes Birth Control, Abortion,” 7 December 1970.

Notes  •  215 82.  Arizona Daily Star, “Planned Parenthood Relies on Corps of Volunteers,” 2 June 1967.  Arizona Daily Wildcat, “ASUA Birth Counseling Clinic Opens Doors Tomorrow Night,” 5 October 1971. 83. Renee Calderon, “Birth Control Leaflet Handout Not Breaking Law, Tufts Says,” Arizona Daily Wildcat, 7 October 1971. 84.  Steve Auslander, “Birth Control Ban Relaxed,” Arizona Daily Star, 24 October 1971; Arizona Daily Star, “UA to Provide Information on Birth Control,” 27 October 1971. 85.  John Phillips, “Unofficial Opinion Supports Regents,” State Press, 27 September 1973; Athia Hardt, “Birth Control Clinic Planned Close to ASU,” Arizona Republic, 10 September 1974. See also Beth Bailey, Sex in the Heartland (Cambridge, Mass.: Harvard University Press, 1999), 124.  Bailey argues that in 1970, 72 percent of U.S. college health services did not offer contraceptives to single or married students. However, changes were occurring rapidly during this time, and by 1974, many university campuses did so. 86.  U.S. Department of Health, Education and Welfare, National Center for Family Planning Services, Health Services and Mental Health Administration, “Family Planning, Contraception, and Voluntary Sterilization: An Analysis of Laws and Policies in the United State, Each State and Jurisdiction,” DHEW Publication no. (HAS) 74–16001, September 1971, 301. 87.  Ibid., 143–144, 250; American Public Health Association, Program Committee on Population and Public Health, “Family Planning: A Guide for State and Local Agencies,” 1968, 4–5. 88. “Family Planning, Contraception, and Voluntary Sterilization,” 143, 250, 301.  “Family Planning: A Guide for State and Local Agencies,” 6–7. 89. McCloskey, Living through the Generations, 135–141.  See Kunitz, “Navajo and Hopi Fertility, 1971–1972,” and Wright, “An Ethnography of the Navajo Reproductive Cycle.” International studies also indicate that women’s employment and education affect contraceptive use. See Daniel Shapiro and B. Oleka Tambashe, “The Impact of Women’s Employment and Contraceptive Use and Abortion in Kinshasa, Zaire,” Studies in Family Planning 25, no. 2 (March–April 1994): 96–110. 90.  Stephen J. Kunitz and Michael C. Tsianco, “Kinship Dependence and Contraceptive Use among Navajo Women,” Human Biology 53, no. 3 (September 1981): 439–452. 91.  Ervin S. Rageau and Angel Reaud, “Evaluation of PHS Program Providing Family Planning Services for American Indians,” American Journal of Public Health 59, no. 8 (August 1969): 1355–1360. 92.  Kunitz and Tsianco, “Kinship Dependence and Contraceptive Use,” 439–452; McCloskey, Living through the Generations, 146–147. 93.  Jane Lawrence, “The Indian Health Service and the Sterilization of Native American Women,” American Indian Quarterly 24, no. 3 (2000): 400–419. 94.  Carpio, “Lost Generation,” 46–51. 95. Ibid. 96. Virginia Rose Espino, “Women Sterilized as They Give Birth: Population Control, Eugenics, and Social Protest in the Twentieth-Century United States,” dissertation, Arizona State University, 2007. Espino discusses coerced sterilization of Mexican American women during the 1970s in California and the social protest movement, which challenged this practice.

216  •  Notes   97.  Sheryl Kornman, “Most Mexican-Americans Reject Family Planning,” Tucson Citizen, 16 November 1970.  Margarita Kay, “Health and Illness in the Barrio: Women’s Point of View,” dissertation, University of Arizona, 1972, 196–197.   98.  Kay, “Health and Illness in the Barrio.”   99.  Francisca Montoya interview with author, 25 June 2009, Phoenix, Arizona, AHF. 100.  Sheryl Kornman, “Mexican Americans and Contraception,” Tucson Citizen, 27 November 1970. 101.  Sara Brown interview with author, 26 March 2005, Phoenix, Arizona, AHSTempe. 102.  Ibid. Jennifer Nelson discusses black feminists’ issues and disagreements with male leaders of the Black Power movement in Women of Color and the Reproductive Rights Movement (New York: New York University Press, 2003), 57–65. 103.  U.S. Department of Health, Education and Welfare, Public Health Service, Annual Report: National Reporting System for Family Planning Services, 1974 (Rockville, Md., 1977), 181.  These studies relied on data provided by participating family planning clinics and service sites. Most of these facilities received federal funds. In addition, some Planned Parenthood/World Population agencies also reported. See U.S. Department of Health Education and Welfare, Public Health Service, Background and Development of the National Reporting System for Family Services (Hyattsville, Md., 1978), 1. 104.  U.S. Department of Commerce, 1970s Census of the Population, Arizona, vol. 1, part 4 (Washington: GPO, 1973), Table 4–29; U.S. Department of Health, Education and Welfare, National Center for Health Service Research, Research Report Series, 1960 and 1970 Spanish Heritage Population of the Southwest by County (Hyattsville, Md., 1978), 13, 14. 105.  Elaine Tyler May notes in America and the Pill that regardless of the motives of those who offered them contraceptives, poor women and minority women took advantages of these services for their own reasons and on their own terms (see pp. 47–49). 106.  “Annual Report: National Reporting System for Family Planning Services, 1974,” 3, 19, 49, 63.  U.S. Department of Commerce, 1970s Census of the Population, Arizona, Table 1; 1970s Census of the Population, New Mexico, vol. 1, part 33, Table 1; 1970s Census of the Population, Utah, vol. 1, part 46, Table 1.

Chapter 7   1.  Goldwater interview.   2. Ibid.   3. Ibid.   4. Solinger, Pregnancy and Power, 157.  Priscilla Robinson in her memoir, Tucson Planned Parenthood and Abortion Law Reform—1968–1973: A Personal Memoir, also discusses abortions that “were fairly easily obtained for a price.” Those with money could afford to find safe abortions. Robinson’s memoir is housed in Special Collections at the University of Arizona.    5.  Arizona Revised Statutes 13–3604; Patricia Myers, “Shades of Grey,” Phoenix Magazine (October 1988): 40–45.

Notes  •  217   6.  Myers, “Shades of Grey,” 40.  7. Ibid., 44.  8. Solinger, Pregnancy and Power, 180; N. E. H. Hull and Peter Charles Hoffer, Roe v. Wade: The Abortion Rights Controversy in American History (Lawrence: University Press of Kansas, 2001), 100.   9.  Segers and Byrnes, Abortion Politics, 3. 10.  Evan Meacham, “It’s Murder: An Editorial,” Weekly American, 11 February 1971. 11.  Ibid., 3; Hull and Hoffer, Roe v. Wade, 101. 12.  Segers and Byrnes, Abortion Politics, 3. 13.  Hull and Hoffer, Roe v. Wade, 97–98, 103. 14. Nelson, Women of Color (New York: New York University Press, 2003), 12. 15.  Some earlier cases and convictions for performing abortions are discussed in chapter 3. 16.  Arizona Republic, “Old Offender Again Named for Surgery,” 3 May 1949; Arizona Silver Belt, “Parole Revoked for Julia Bryant,” 1 December 1949; Arizona State Department of Health, Certificate of Death, Bryant, Julia Hettie, Pinal County, 9 September 1950, ASLAPR. 17.  Supreme Court of Arizona, State of Arizona, Appellee, v. H.T. Boozer, Appellant, no. 1076, 13 December 1955.  Westlaw: 80 Ariz. 8, 291 P.2d 786. 18.  Arizona Revised Statutes 13–3604; Court of Appeals of Arizona, Division 1, Department A, State of Arizona, Appelle, v. Charles Keever, Appellant, no. 1 CA-Cr 172; 17 September 1969, Westlaw: 10 Ariz.App. 354, 458 P.2d 974. 19.  State of Arizona v. Charles Keever. 20. Ibid. 21.  Ibid., 3–4. 22.  Daniel J. O’Neil, Church Lobbying in a Western State: A Case Study of Abortion Legislation, Arizona Government Studies 7 (Tucson: University of Arizona Press, 1970). 23.  Arizona Daily Star, “Revisions in State Law Curbing Abortions Urged,” 8 November 1968; Richard Casey, “State Senate Kills Liberal Abortion Bills,” Tucson Citizen, 5 April 1971.  Casey mentioned that abortion reform bills had died in the Senate every year for four years by 1971. 24.  Bernie Wynn, “Rules Unit Stalls Senate Abortion Bill,” Arizona Republic, 28 February 1969; Bill King, “House Passed Abortion Bill Cleared by One Senate Unit,” Arizona Republic, 5 March 1969; Arizona Republic, “Abortion Bill Beaten,” 2 April 1969. 25.  Paul Dean, “Bishop Clarifies Catholic Position on Abortion Laws,” Arizona Republic, 9 January 1969. 26. Emily Jenkins interview with author, 16 October 2009, Phoenix, Arizona, AHF. 27. Nelson, Women of Color, 10. 28.  Barbara Shumway, “Most in State Favor Liberal Abortion Law,” Arizona Republic, 2 May 1969; Phoenix Gazette, “Legal Therapeutic Abortions Skyrocket in California,” 2 May 1969. 29.  Robinson, “Tucson Planned Parenthood and Abortion Law Reform—1968– 1973.”

218  •  Notes 30. Serving as a Planned Parenthood board member during the 1970s and 1980s, Janet Marcus also discussed the importance of moderate Republicans in the state legislature who fought against undermining the Roe v. Wade decision. See Janet Marcus interview with author, 2 September 2010, Tucson, Arizona, digital recording, UASC. 31. Ibid. 32. Ibid. 33. Solinger, Pregnancy and Power, 184; Hull and Hoffer, Roe v. Wade, 99–100. 34.  Marilyn Drago, “Doctors Prepare to Combat Abortion Law,” Arizona Daily Star, 10 February 1970. 35.  Arizona Republic, “House Vote Eases Ban on Abortion; Senate Action Dim,” 27 February 1970. 36.  Arizona Republic, “Bill for Legal Abortion Clears Senate Committee,” 24 March 1970; “No Abortion Reform?” Editorial, Arizona Daily Star, 3 March 1970. 37.  Arizona Republic, “Abortion Reform Fails to Clear Rules Unit,” 1 May 1970. 38.  Arizona Republic, “Abortion: The Pros and Cons of a Controversial Issue,” subheading “The Medical Viewpoint,” 17 July 1970. 39.  Ibid.; Solinger, Pregnancy and Power, 158; Nelson, Women of Color, 9. 40.  Sheryl Kornman, “Clergymen on Call Daily to Help Pregnant Women,” Tucson Daily Citizen, 19 December 1970. This local group is similar to the organization formed in New York in 1967, Clergy Consultation Service on Abortion. See Solinger, Pregnancy and Power, 184; Nelson, Women of Color, 10–11. 41.  Kornman, “Clergymen on Call.” 42.  Michael D. Smith interview with author, 8 September 2010, Tucson, Arizona, UASC. 43. Ibid. 44. Ibid. 45.  Tucson Citizen, “Abortion Repeal Given House OK,” 9 February 1971. 46.  Don Warne, “Abortion Bills Bog Down,” Tucson Citizen, 19 February 1971. 47.  Richard Casey, “State Senate Kills Liberal Abortion Bills,” Tucson Citizen, 5 April 1971. 48.  Robinson interview. 49. Ibid. 50.  Sheryl Kornman, “Arizona Abortion Law Demands Suffering, Doctor Charges,” Tucson Citizen, 1 February 1971. 51. Ibid. 52.  Ibid.; Sheryl Kornman, “Fate of Unwanted Pregnancy Rests with 4-Man Committee,” Tucson Citizen, 2 February 1971. 53. Nelson, Women of Color, 8–9. 54.  Jenkins interview. 55.  Yrun interview. 56.  Sue Alcock interview with author, 19 May 2009, Tempe, AHF; Julian DeVries, “California Abortions Attract State,” Arizona Republic, 11 August 1972. 57.  Smith interview. 58.  Tamsen interview. 59.  State Press, “Phoenix Service Sends 25 Women to California Weekly for Abortions,” 21 October 1971.

Notes  •  219 60.  Editorial, “Abortion Lawsuit,” New Times, 5 January 1972. 61.  Gayle Pyfrom, “Fetus Killing Foe,” New Times, 8 March 1972. 62.  Ibid. According to Arizona State Board of Health Records, Gerster’s discussion of the number of abortion deaths may have been correct. Deaths due to complications of abortion ranged from zero to four a year during the 1960s. However, it is likely that deaths due to illegal abortion may have been underreported. See Arizona State Board of Health, Vital Statistics Section, Annual Report of Vital Statistics, 1964, 1965, 1966, 1967, 1968. 63.  Evan Meacham, “It’s Murder: An Editorial,” Weekly American, 11 February 1971. 64.  Interview with Jim Skelly by Patricia Roeser, Arizona Division of History and Archives Legislative Oral History Project, 31 October 2007, tape recording, ASLAPR. 65. Peggy Pietuch, “Phoenix Anti-Abortion Unit Recruits Teen-Age Auxiliary,” Phoenix Gazette, 2 October 1972. 66.  Barbara Shumway, “Doctors, Nurses Present Opposition to Abortion,” Arizona Republic, 2 March 1971. 67.  Arizona Republic, “Federal Court Suit Attacks Arizona’s Abortion Law,” 11 June 1970; Tucson Citizen, “Abortion Lawsuit Defendants Include Pima County Attorney,” 11 June 1970. 68.  Arizona Republic, “Federal Court Won’t Interfere with State’s Antiabortion Law,” 12 June 1971. 69.  Arizona Republic, “Suit Filed in Tucson to Test Abortion Law,” 23 July 1971. 70.  Phoenix Gazette, “Abortion Issue Goes to Court in Tucson Case,” 11 November 1971. 71.  Phoenix Gazette, “Abortion Testimony Presented,” 12 November 1971. 72.  Phoenix Gazette, “Antiabortion Law Suit Dismissed,” 6 April 1972. 73.  Court of Appeals of Arizona, Division 2, Planned Parenthood Center of Tucson, Inc., a corporation, et al., Petitioners, v. Hon. Jack G. Marks, Judge of Superior Court of the State of Arizona, et al., Respondents, and D.E. Clark, M.D., et al, Amici Curiae, no. 2 CA-CIV 1222, May 30, 1972, Westlaw: 17 Arizona App. 308, 497 P.2d 534. 74.  Phoenix Gazette, “Court Okays Reopening of Lawsuit,” 18 April 1972; Ben MacNitt and Judy Donovan, “Arizona’s Abortion Laws Ruled Unconstitutional,” Arizona Daily Star, 30 September 1972; Court of Appeals of Arizona, Division 2, Gary K. Nelson, The Attorney General of the State of Arizona, et al., Appellants and CrossAppellees, v. Planned Parenthood Center of Tucson, Inc., et al., Appellees and CrossAppellants, no. 2 CA-Civ 1302.  Westlaw: 19 Ariz. App. 142, 505 P.2d 580; Phoenix Gazette, “Antiabortion Statutes Dealt Blow by Court,” 22 January 1973. 75.  Segers and Byrnes, Abortion Politics, 4, 5.  By 1973, these states had also adopted some version of conditional abortion: Arkansa, Delaware, Georgia, Kansas, Mary­ land, New Mexico, Oregon, South Carolina, and Virginia. See Dorothy McBride, Abortion in the United States: A Reference Handbook (New York: ABL-CIO, 2007), 15. 76.  Tucson Citizen, “State’s Antiabortion Statues Will Be Erased This Week,” 27 March 1973. 77.  Court of Appeals of Arizona, Division 2, Gary K. Nelson, The Attorney General of the State of Arizona, et al., Appellants and Cross-Appellees, v. Planned Parenthood Center of Tucson, Inc., et al., Appellees and Cross-Appellants, no. 2 CA-Civ 1302. Westlaw: 19 Ariz. App. 142, 505 P.2d 580.  Ben MacNitt, “Abortion Law Books Closing,” Arizona Daily Star, 27 March 1973.

220  •  Notes   78.  Court of Appeals of Arizona, Division 1, Department B, State of Arizona Appellee, v. J.N. Wahlrab, Appellant, no. 1 CA-CR 463, April 24, 1973. Westlaw: 19 Ariz. App.552, 509 P2d.245; Court of Appeals of Arizona, Division 1, Department B, State of Arizona Appelle, v. New Times, Inc., Appellant, no. 1 CA-CR 518. July 3, 1973. West­law: 20 Ariz. App. 183, 511 P.2d 196.  79. Solinger, Pregnancy and Power, 185–186.  80. Ibid., 186.  81. Skelly interview.  82. Weekly American, “Anti-Abortionists Gather Forces,” 7 February 1973.  83. Arizona Republic, “Death Penalty for the Unborn,” 3 February 1973.  84. Arizona Daily Star, “Clinic Director Says Women Are Getting Abortions in Tucson,” 15 February 1973.  85. Arizona Daily Star, “Court Action Clears Way for Abortion Clinic Here,” 22 March 1973.   86.  Marilyn Drago, “Catching Up with the Law: City Hospitals Preparing for Abortions,” Arizona Daily Star, 21 April 1973.   87.  Edythe Jensen, “Mothers Protest Opening of Abortion Center Here,” Phoenix Gazette, 13 July 1973; F. McDonald and Marsha Carter, “Abortion de Jure and Not de Facto,” New Times, 19 September 1973.   88.  Alan Guttmacher Institute, “Abortion: Need, Services and Policies, Arizona,” New York, 1979, 13.   89.  Jensen, “Mothers Protest Opening.”   90.  Jack Crow, “10,000 March to Protest Abortions,” Arizona Republic, 28 January 1974.  91. Ibid.; Tucson Citizen, “Marchers Decry Abortion Ruling,” 28 January 1974.   92.  Letter, Most Rev. Francis J. Green to Morris Udall, 10 January 1974, Tucson, Arizona. Morris Udall Collection, Box 656, 93rd, 1973–1974, UASC.   93.  Letters, Morris K. Udall to Mr. M. V. Bennette, 6 March 1974, Washington, D.C.; Morris K. Udall to Maria Urquides, 23 March 1976, Washington, D.C., Udall Collection, UASC.   94.  Letter, Sally Johnson to Scott Alexander, Tucson, Arizona, March 1974. Scott Alexander collection, AHS-Tucson.   95.  Hull and Hoffer, Roe v. Wade, 186–187.   96.  Athia L. Hardt, “Abortion-Caused Deaths Drop,” Arizona Republic, 17 January 1974.   97.  Willard Cates Jr., “The First Decade of Legal Abortion in the United States: Effects on Maternal Health,” in Abortion, Medicine and the Law, 3rd ed., edited by J. Doublas Butler and David F. Walbert (New York: Facts on File, 1986), 305–319.  98. Alcock interview.   99.  Jane Canby interview with author, 7 July 2009, Scottsdale, Arizona, AHF. 100.  Marcus interview; , Hanna Arterian Furnigh, ed., Arizona Women and the Legal System, Third Annual Arizona Women’s Town Hall (Phoenix: Soroptimist International of Phoenix, 1988), 88–89. 101.  Susan Stradling interview by Carol Palmer, 16 June 2005, Mesa, Arizona, ASLAPR. 102. Petchesky, Abortion and Woman’s Choice, 245, 276.  Gordon, Moral Property of Women, 303; Rebecca E. Klatch, Women and the New Right (Philadelphia: Temple University Press, 1987), 129–130.

Notes  •  221 103.  Shirley Whitlock interview by Carol Palmer, 23 June 2005, Gilbert, Arizona, ASLAPR. 104.  Canby interview. 105.  Ibid.; Guttmacher Institute, “Abortion: Need, Services and Policies, Arizona,” 2. 106.  Tucson Citizen, “Abortion Factions Gird Public Hearing Positions,” 1 July 1975. 107. Don Warne, “County’s Abortion Policies Questioned,” Phoenix Gazette, 1 July 1975. Emily Jenkins served on a policy committee set up to help Maricopa County Hospital determine how to implement abortion services. She found that many committee members and physicians were willing to provide abortions only in cases of medical necessity. See Jenkins interview. 108. McBride, Abortion in the United States, 123. 109.  Guttmacher Institute, “Abortion: Need, Services and Policies, Arizona,” 19. 110.  Robert Packwood, “The Rise and Fall of the Right-to-Life Movement in Congress,” in Abortion, Medicine, and the Law, 3rd ed., edited by J. Douglas Butler and David F. Walbert (New York: Facts on File, 1986), 3–18; Planned Parenthood Pilot State Case Studies, Arizona Project Dates: June 1980–June 1981, PPCNA, AHSTempe. 111.  Montoya interview. 112. Ibid. 113. Ibid. 114.  Alma M. Garcia, “The Development of Chicana Feminist Discourse, 1970– 1980,” in Unequal Sisters: A Multicultural Reader in U.S. Women’s History, 2nd ed., edited by Vicki L. Ruiz and Ellen Carol DuBois (New York: Routledge, 1994), 531– 544. 115. McCloskey, Living through the Generations, 138. 116.  Ibid., 138–139, 152–154. 117.  Skelly interview. 118. Ibid. 119.  Marcus interview. 120.  The well-respected Guttmacher Institute produces a wide range of resources on topics pertaining to sexual and reproductive health. It was founded in the 1970s and continues to conduct research and issue reports. 121.  Guttmacher Institute, “Abortion: Need, Services and Policies, Arizona,” 2, 3; Emily Jenkins-Reed and Jane Canby, Family Planning in Arizona 1977: A Needs Assessment (Phoenix: Arizona Family Planning Council, 1979), 41. 122.  Ibid., 2, 3. 123. Stanley K. Henshaw, Kathryn Kost, and Guttmacher Institute, “Trends in the Characteristics of Women Obtaining Abortions, 1974 to 2004,” 2008, http://www .guttmacher.org/pubs/2008/09/23/TrendsWomenAbortions-wTables.pdf. 124.  Ibid., 17. 125.  Jenkins-Reed and Canby, Family Planning in Arizona 1977, 42.

Chapter 8   1.  Pat Flannery, “Sanger-Go-Round,” Phoenix Gazette, 28 September 1991.

222  •  Notes  2. Arizona Women’s Hall of Fame, History, http://www.lib.az.us/awhof/history. cfm, AWHOF files, ASLAPR.  3. McBride, Abortion in the United States, 20–21.   4.  Daniel J. O’Neil, “Arizona: Pro-Choice Success in a Conservative Republican State,” in Abortion Politics in American States, edited by Mary C. Segers and Timothy A. Byrnes (New York: M. E. Sharpe, 1995), 84–101.   5.  Arizona passed a similar law in 1987. See Arizona Women and the Legal System, 88–89.  6. McBride, Abortion in the United States, 122–124.  7. Tucson Chapter/Arizona Right to Life, Newsletter, “Action News,” August 1985, UASC.  8. McBride, Abortion in the United States, 126.  9. Ibid., 127. 10.  Gloria Feldt interview with author, 15 October 2009, Tempe, Arizona, AHF. 11. Ibid. 12.  Feldt interview; Planned Parenthood Survey, PPCNA, B11 S2 F4, AHS-Tempe 13.  Feldt interview. 14.  Simon Fisher, “Pro-Lifers Rally on Anniversary of Ruling,” Tempe Daily News, 23 January 1985. 15.  Arizona Family Planning Council, Nancy Hicks Marshall, ed., Sex and the Law: Arizona Legal Guide on Reproduction, Sexual Conduct and Families (Phoenix, 1995), 50–51. 16.  Ibid., 51. 17. Ibid. 18. Ibid. 19. McBride, Abortion in the United States, 129. 20.  Ibid., 129–130. 21.  Smith interview. 22.  Voevodsky interview. Arizona Women’s Clinic, Notes to Financial Statements, 31 December 1986. 23.  Yrun interview. Virginia Yrun was executive director during the late 1980s and 1990s. 24.  “Hundreds Participate in ‘Operation Rescue’ during April in Arizona,” Tucson Chapter/Arizona Right to Life newsletter, June 1989, UASC. 25.  Ibid. In February 1991, a pro-life group demonstrated across the street from the Planned Parenthood facility on 5th Street in Tucson. They held antiabortion signs and protested the injunction against demonstrators obtained by Planned Parenthood in January 1991. See Arizona Daily Star, “Anti-Abortion Protestors Stage Silent Rally,” 17 February 1991. 26.  Tamsen interview. 27.  Yrun interview. 28.  O’Neil, “Arizona: Pro-Choice Success,” 84–101. 29.  Ibid., 89. 30.  Ibid., 89–90. 31. Ibid. 32.  Ibid., 91. 33.  Ibid., 92.

Notes  •  223 34.  Ibid., 94–99.  Marcus interview. 35.  Carolyn Gerster, “From the President’s Desk,” Tucson Chapter/Arizona Right to Life newsletter, October 1989, UASC. 36.  “Report from Reachout,” Tucson Chapter/Arizona Right to Life newsletter, November 1986, UASC. 37. Ibid. 38.  “It Takes Prayer and Faith,” Tucson Chapter/Arizona Right to Life newsletter, November 1988, UASC. 39.  Tony West interview by Patricia Roeser, 7 February 2008, Phoenix Arizona, Arizona State Archives Legislative Oral History Project, tape recording, ASLAPR. 40.  Smith interview. 41.  Kim Mattingly Kelliher, “Clergy Backing Abortion Rights Begin TV Ad Campaign,” Arizona Daily Star, 27 June 1991. 42.  ADHS, Christopher K. Mrela, “Abortion Surveillance Report, Arizona, 1982– 1987,” Office of Planning Health Status, 1988. 43.  ADHS, Public Health Services, “Abortion Surveillance Report Arizona, 1985– 1995, Table 24, Abortion Rate Average Annual.” 44.  Susan A. Cohen, “Abortion and Women of Color: The Bigger Picture,” Guttmacher Policy Review 11, no. 3 (Summer 2008). 45.  Stanley K. Henshaw, “Abortion Incidence and Services in the United States, 1995–1996,” Guttmacher Family Planning Perspectives 30, no. 6 (November/December 1998): 263–287. 46.  Ibid., 265. 47.  Ibid., 267–268.  In Susan Wickland’s This Common Secret: My Journey as an Abortion Doctor (New York: Public Affairs, 2007), the author describes the dangers and threats she faced as an abortion provider in the northwestern United States. Her book illustrates why many people stopped providing abortions in the face of life-threatening dangers. 48.  Henshaw, “Abortion Incidence and Services,” 267. 49.  Yrun interview. 50.  Feldt interview, PPCNA, B7 S1 F1, AHS-Tempe. In Arizona and the rest of the nation, unmarried motherhood became common as the twentieth century ended. The percentage of households containing married couples with children under the age of eighteen declined in Arizona and throughout the United States. See Ken Bryson, “Household and Family Characteristics: March 1995,” Census Bureau, Current Population Reports (October 1996). U.S. Department of Commerce, Bureau of Census, 1990 Census of Populations Social and Economic Characteristics, Arizona (Washington: GPO, 1993), Table 35. U.S. Department of Commerce, Census Bureau, 2000 Census of Population and Housing, Arizona: 2000 (Washington: GPO, 2002), Table 7. 51. Gordon, Moral Property of Women, 348; Guttmacher Institute, “U.S. Teenage Pregnancy Statistics National and State Trends and Trends by Race and Ethnicity,” New York, updated 2006. 52.  Carla McClain, “Teen Clinic Will Help with Sex Problems,” Tucson Citizen, 18 April 1979; Cheryl Levenbrown, “Teen Mothers: Pima’s Rise in Unmarried Births Is Below Maricopa and State Level,” Arizona Daily Star, 26 July 1979; Judith Ratliff, “Adolescence: Keeping One Aspect from Being a ‘Big Deal,’ ” Arizona Daily Star, 5 February 1981.

224  •  Notes 53.  “PPCNA Education Department Launches Continuing Education Courses,” Central and Northern Arizona Planned Parenthood Press 24, no. 3 (Autumn 1981), PPCNA, AHS-Tempe. 54.  Kate Zipsnis, ADHS, Division of Family Health Services, “Arizona Perinatal Statistics: A Report on Prenatal Care, Low Birth Weight, and Infant Mortality,” May 1990, 7. ADHS, “Teenage Pregnancy Arizona 1990,” 4–5. 55.  Rebekah Saul, Guttmacher Institute, “Teen Pregnancy: Progress Meets Poli­ tics,”Guttmacher Report on Public Policy 2, no. 3 (June 1999); Stanley K. Henshaw, “Teenage Abortion and Pregnancy Statistics by State, 1992,” Guttmacher Family Planning Perspectives 29, no. 3 (May/June 1997). Jane Harris Aiken, “Reproductive Issues,” in Arizona Women and the Law: Third Annual Arizona Women’s Town Hall (Phoenix: Soroptimist International of Phoenix, 1988), 79–99; ADHS, “Teenage Pregnancy Arizona 1990,” 4–5. 56. Marshall, Sex and the Law, 293. 57.  Zipsnis, “Arizona Perinatal Statistics,” 16. 58.  “ ‘Let’s Talk’ Completes First Year with More Questions than Answers,” Tucson Chapter/Arizona Right to Life newsletter, November 1987, UASC. 59.  Smith interview. 60.  Whitlock interview. 61.  ADHS, “Teenage Pregnancy in Arizona,” 4. 62.  Ibid., 5. 63.  Saul, “Teen Pregnancy: Progress Meets Politics.” Nationally in 1990 and 2000, Hispanic teenagers had the highest birth rates, followed by blacks, then American Indians, whites, and with the lowest rate, Asians or Pacific Islanders. Among unmarried and married mothers, Hispanics also had the highest birth rates. See Brady E. Hamilton, Paul D. Sutton, and Stephanie J. Ventura, “Revised Birth and Fertility Rates for the 1990s and New Rates for Hispanic Populations, 2000 and 2001: United States,” National Vital Statistics Reports 51, no. 12 (4 August 2003). 64.  Title XX, part of the Social Security Act—Aid to Families with Dependent Children, provided some funds for family planning. See Arizona Family Planning Council, Nancy Hicks Marshall, ed., Arizona Legal Guide on Reproduction, Sexual Conduct and Families (Phoenix, 1985), 10. 65.  Planned Parenthood Press 23 (Winter 1980), PPCNA, AHS-Tempe; Feldt and Yrun interviews. 66. Guttmacher Institute, “Contraception Counts: State by State Information,” 1998, http://www.guttmacher.org/pubs/ib22.html. 67. Ibid. 68.  Feldt and Jenkins interviews. 69. Marshall, Sex and the Law, 20–21. 70. Marshall, Arizona Legal Guide on Reproduction, 10–11. 71. Marshall, Sex and the Law, 17. 72.  Marcus and Smith interviews. 73.  Statistical Abstract of the United States, 1987, Section 2, Vital Statistics, Table 84, “Live Births—Number and Rate, by State: 1970 to 1985.” 74.  ADHS, Arizona Vital Statistics, Birth Statistics, Births by County of Residence, Arizona, 1995 http://www.azdhs.gov/plan/menu/for/births.htm. 75.  Statistical Abstract of the United States, 1992, Vital Statistics, Table 109, “In-

Notes  •  225 fant, Maternal, and Neonatal Mortality Rates; and Fetal Mortality Ratios, by Race: 1970 to 1989” (Washington: GPO, 1994). 76.  Statistical Abstract of the United States, 1992, Vital Statistics, Table No. 112, “Infant Mortality Rates, by Race—States: 1980 to 1988.” 77.  Zipsnis, “Arizona Perinatal Statistics,” 1–4. 78.  Ibid., 15. 79.  Ibid., 3–4. 80.  Hal Strich, “Maternal and Infant Health Status,” Pima County Health Department, 1992. 81.  Statistical Abstract, United States 1992, Vital Statistics, Table 87, “Live Births, by Race and Type of Hispanic Origin—Selected Characteristics 1985 and 1989”; Zipsnis, “Arizona Perinatal Statistics,” 5. The report by Zipsnis notes that African American infants in Arizona had an infant mortality rate twice that of any other racial/ethnic group. In the 1990s, reproductive rights remained constrained for the poor, those in rural areas, young women, women of color, and immigrant women, argue Dianne J. Forte and Karen Judd in “The South within the North: Reproductive Choice in Three U.S. Communities,” in Negotiating Reproductive Rights: Women’s Perspectives across Countries and Cultures, edited by Rosalind P. Petchesky and Karen Judd (London: Zed Books, 1998), 267. 82.  Congressional Budget Office Staff Memorandum, “Factors Contributing to the Infant Mortality Ranking of the United States,” February 1992, Tables 1 and 3. 83.  ADHS, Public Health Services, “Differences in the Health Status among Ethnic Groups: Arizona, 1999,” Infant Mortality, Table 4–6, 38.

Chapter 9   1. Leavitt, Brought to Bed, 187; Litoff, American Midwives, 27–30.   2.  Bureau of the Census, Vital Statistics of the United States 1940, part 1 (Washington: GPO, 1943), 27.  3. Schackel, Social Housekeepers, 47. Assessing the success of the SheppardTowner Program in New Mexico through infant mortality statistics is difficult because an accurate reading of infant mortality was not available there until 1929, the first year that New Mexico qualified as birth and death registration state. See Schackel, Social Housekeepers, 31.  4. Vital Statistics of the United States 1940, 27.   5.  Delp, “Baby Spacing Report on California and Arizona,” March–August 1940; “My Day” report, 1941, both held in PPFA, SSC.   6.  Lull, “Indian Infant Death Study.”  7. U.S. Department of Health, Education and Welfare, Vital Statistics of the United States 1965, Table 1–33.   8.  A recent study in an urban, federally funded clinic in Phoenix indicates that better health education is needed to help patients understand various methods of contraception. Follow-up appointments after starting a contraceptive method will improve patients’ use of a specific method, according to Jesselyn Rose Melcher-Post. See “Contraception Use among Women in an Urban Clinic,” thesis, University of Arizona, 2011.   9.  Robbie Sherwood, “Napolitano Vetoes 4th Abortion Bill This Month,” Ari-

226  •  Notes zona Republic, 26 April 2006; Matthew Benson, “Napolitano Vetoes Two Abortion Bills,” Arizona Republic, 4 April 2008; Steven Ertelt, “Arizona Gov. Janet Napolitano Vetoes Partial-Birth Abortion Ban, Parental Consent,” LifeNews, 4 April 2008, http:// www.lifenews.com/2008/04/04/state-3091. 10.  Connie Lone Sexton, “Brewer Signs Arizona Bill on Abortion Clinics,” Arizona Republic, 2 April 2011. Associated Press, “Brewer Signs Another Anti-Abortion Bill,” 28 April 2011, http://www.azcentral.com/news/election/azelections/articles/2011/ 04/18/20110418arizona-abortion-bill-nurses-brewer.html. 11.  James King, “Planned Parenthood Files Lawsuit Challenging Arizona’s New Scare-Tactic Abortion Law,” New Times, 30 June 2011. 12.  Barbara Bradley Hagerty, “Nun Excommunicated for Allowing Abortion,” National Public Radio, 19 May 2010, http://www.npr.org/templates/stoary/story.php?story ID=126985072. 13.  Arizona Women’s Heritage Trail, Sisters of Mercy, http://www.womensheritage trail.org/women/SistersOfMercy.php; Michael Clancy, “Phoenix Diocese Strips St. Joseph’s Hospital of Catholic Status,” Arizona Republic, 22 December 2010. 14.  Sarah Kliff, “GOP Targets Family Planning Program,” Politico Pro, 9 February 2011, http://www.politico.com/news/stories/0211/49197.html. Stephanie Samuel, “Senate Votes against Defunding Planned Parenthood amid Outcry,” Christian News, 4 April 2011. 15.  Planned Parenthood Press 23 (Winter 1980), PPCNA, AHS-Tempe; Feldt and Yrun interviews.

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Oral History Interviews Sue Alcock. Interview by author. 19 May 2009. Tempe, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries. Winstona Hackett Aldridge. Interview by author. 29 April 2004. Phoenix, Arizona. Tape recording. City of Phoenix, African American Historic Property Survey. Sarah Brown. Interview by author. 26 March 2005. Phoenix, Arizona. Tape recording. Arizona Historical Society, Tempe, Arizona. Jane Canby. Interview by author. 7 July 2009. Scottsdale, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries. David Estrella. Interview by Delia Munˇ oz. Los Recuerdos Oral History Project. Transcript. NAU Cline Library, Special Collections, Interview 68-21. Gloria Feldt. Interview by author. 15 October 2009. Tempe, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries. Margaret Glenn. Interview by author. 13 August 1992. Sierra Vista, Arizona. Tape recording. Arizona Historical Society, Tucson. Joanne Goldwater. Interview by author. 27 August 2009. Scottsdale, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries. Christina Ellington Hankins. Interview by author. 28 May 1992. Phoenix, Arizona. Transcript and tape recording. Casa Grande Valley Historical Society, Casa Grande, Arizona. Emily Jenkins. Interview by author. 16 October 2009. Phoenix, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries. Janet Marcus. Interview by author. 2 September 2010. Tucson, Arizona. Digital recording. University of Arizona Special Collections. Francisca Montoya. Interview by author. 25 June 2009. Phoenix, Arizona. Digital recording. Arizona Historical Foundation, Arizona State University Libraries.

227

228  •  Bibliography David Nagel Morales Sr. Interview by Peter Booth. 8 November 2001. Tape recording. Desert Caballeros Western Museum, Wickenburg, Arizona. Priscilla Robinson. Interview by author. 20 September 2010. Tucson, Arizona. Digital recording. University of Arizona Special Collections. Arturo Rosales. Interview by author. 28 September 1993. Tempe, Arizona. Tape recording, Arizona Historical Society, Tucson. Rita Ruiz. Interview by author. Cementerio Lindo Project. 13 March 2008. Digital recording, City of Phoenix. Jim Skelly. Interview by Patricia Roeser. 31 October 2007. Arizona Division of History and Archives Legislative Oral History Project. Tape recording. Arizona State Archives, Phoenix. Mike Smith. Interview by author. 8 September 2010. Tucson, Arizona. Digital recording. University of Arizona Special Collections. Placida Garcia Smith. Interview by Beth Morton. 12 May 1976. Phoenix, Arizona. Tape recording. Arizona Historical Society, Tempe. Ann Stephens. Interview by Marsha Weisiger. 28 May 1992. Tape recording and transcript. Arizona Historical Society, Tempe. Lula Stevens. Interview by author. 11 February 2005. Mesa, Arizona. Tape recording. Arizona Historical Society, Tempe. Olive Stoddard. Interview by author. 24 November 1984. Sonoita, Arizona. Tape recording. Arizona Historical Society, Tucson. Susan Stradling. Interview by Carol Palmer. 16 June 2005. Mesa, Arizona. Tape recording and transcript. Equal Rights Amendment Collection, Arizona State Archives, Phoenix. Judy Tamsen. Interview by author. 20 September 2010. Tucson, Arizona. Digital recording. University of Arizona Special Collections. Pearl Tang. Interviews by author. September 1999–September 2002. Paradise Valley, Arizona. Tape recordings. Arizona Historical Society, Tempe. Reyn Voevodsky. Interview by author. 23 November 2010. Tucson, Arizona. Digital recording. University of Arizona Special Collections. Tony West. Interview by Patricia Roeser. 7 February 2008. Arizona Division of History and Archives Legislative Oral History Project. Tape recording and transcript. Arizona State Archives, Phoenix. Shirley Whitlock. Interview by Carol Palmer. 23 June 2005. Gilbert, Arizona. Tape recording. Equal Rights Amendment Collection, Arizona State Archives, Phoenix. Virginia Yrun. Interview by author. 3 November 2009. Tucson, Arizona. Digital recording. University of Arizona, Special Collections.

Government Documents American Public Health Association. Program Committee on Population and Public Health. “Family Planning: A Guide for State and Local Agencies.” 1968. Arizona, Sixteenth Biennial Report of the State Superintendent of Public Instruction, 1940–1942. Phoenix: State of Arizona, 1942. Arizona Territorial Board of Health, Secretary’s Report, 28 November 1903. RG 50, Vol. 1. Arizona State Library, Archives, and Public Records, Phoenix.

Bibliography  •  229 Arizona Board of Medical Examiners, Minutes. Scottsdale, Arizona. Arizona Criminal Code, Title 13, 1901 (rev. 1913, 1928, 1939). Arizona State Board of Health. Bulletin 1913–1920. ______. “Shepherd-Towner Report, 1922–1929.” Arizona State Library, Archives, and Public Records. ______. “Midwife Safety Rules.” March 1920, Arizona State Library, Archives, and Public Records. ______. Minutes, 1920–1928. Arizona State Library, Archives, and Public Records. ______. State Hospital Patients’ Register, 1876–1954, Film 29.1.1, RG 50, History and Archives Division, Arizona State Library, Archives, and Public Records. ______. “Teenage Pregnancy Arizona 1990.” Arizona State Department of Health. Annual Report of Vital Statistics, 1964. ______. Annual Report, Arizona Vital Statistics Tables, 1950–1951. ______. Vital Statistics Section, Annual Report of Vital Statistics, 1964, 1965, 1966, 1967, 1968. Arizona State Hospital. Milestones: A History of Seventy-Five Years of Progress at the Arizona State Hospital, Phoenix, Arizona 1887–1962. Phoenix: State of Arizona, 1962. Maricopa County Health Department. “Project for Family Planning Services to Reduce Maternal and Infant Mortality and Morbidity in Maricopa County.” May 21, 1968. Pima County Department of Health and Hospital Services. Tucson, Arizona. Annual Report Fiscal Year 1970–1971. Division of Vital Records and Statistics. U.S. Children’s Bureau. Grace Abbott. “The Federal Government in Relation to Maternity and Infancy.” ______. State of Arizona. National Archives, RG 102. U.S. Department of Commerce and Labor, Bureau of the Census. Fourteenth Census of the United States, Vol. 2. Washington, D.C.: GPO, 1922. ______. Birth, Stillbirth and Infant Mortality Statistics. Twelfth Annual Report, Part 1. Washington, D.C.: GPO, 1929. ______. Statistical Abstract of the United States 1930. Washington, D.C.: GPO, 1930. ______. Fifteenth Census of the United States, 1930. Washington, D.C.: GPO, 1933. ______. Fifteenth Census of the United States, 1930. Occupations by States Vol. 4. Washington, D.C.: GPO, 1933. ______. Sixteenth Census, Agriculture. Washington, D.C.: GPO, 1942. ______. Sixteenth Census of the United States: Population Differential Fertility, 1910 and 1940. Prepared by Leon F. Truesdell. Washington, D.C.: GPO, 1943. ______. Vital Statistics of the United States 1940, Part 1. Washington, D.C.: GPO, 1943. ______. Census, 1950 Arizona. Washington, D.C.: GPO, 1952. ______. Vital Statistics of the United States, 1938, Part 1. New York: Greenwood Press, 1968. ______. 1970s Census of the Population, Arizona, Vol. 1, Part 4. Washington, D.C.: GPO, 1973. ______. Historical Statistics of the United States, Colonial Times to 1970. White Plains, N.Y.: Kraus International, 1989. U.S. Department of Health, Education and Welfare. National Center for Family Plan-

230  •  Bibliography ning Services, Heath Services and Mental Health Administration. “Family Planning, Contraception, and Voluntary Sterilization: An Analysis of Laws and Policies in the United States, Each State and Jurisdiction.” DHEW Publication No. (HAS) 74-16001, September 1971. ______. “Annual Report: National Reporting System for Family Planning Services, 1974.” Rockville, Md., 1977. ______. Background and Development of the National Reporting System for Family Services. Hyattsville, Md., 1978. ______. Vital Statistics of the United States 1950, Vol. 1. Washington, D.C.: GPO, 1954. ______. Vital Statistics of the United States 1965, Vol., 1. Natality. Washington, D.C.: GPO, 1967. ______. Vital Statistics of the United States, 1974. Vol. 2, Mortality, Part A. Hyattsville, Md., 1978. ______. Vital Statistics of the United States, 1991, Vol. 1, Natality. Hyattsville, Md.: Public Health Service, 1995. U.S. Department of the Interior, Census Office. Tenth Census. Table I. Washington, D.C.: GPO, 1883.

Manuscript Collections Arizona Historical Foundation, Hayden Library, Arizona State University, Tempe, Planned Parenthood Central and Northern Arizona Collection. Arizona Historical Society, Tucson, manuscript collections. Alexander Scott collection. Arizona State Library, Archives and Public Records, Phoenix, Arizona Women’s Hall of Fame collection; public health collection. Church of Jesus Christ of Latter-day Saints History Library, Salt Lake City, Utah. Mormon Women’s Relief Society Minutes, Arizona Stakes. Cline Library Special Collections, Northern Arizona University, Flagstaff. Virginia Brown, Ida Bahl, and Lillian Watson Collection. Sophia Smith Collection, Smith College, Northampton, Mass. The Margaret Sanger papers [microform]: (Series 2) edited by Esther Katz et al.; Planned Parenthood Federation of America Collection. University of Arizona Special Collections, Morris Udall Collection. Planned Parenthood of Southern Arizona scrapbooks. MS 371.

Periodicals Arizona Republic (formerly Arizona Republican) Arizona Daily Star Arizonian New Times Phoenix Gazette Tempe Daily News

Bibliography  •  231 Tucson Daily Citizen (called Tucson Citizen beginning in 1971) State Press Weekly American Wildcat

Secondary Sources Adair, John, and Kurt W. Deuschle. The People’s Health: Medicine and Anthropology in a Navajo Community. New York: Meredith, 1970. Aiken, Jane Harris. “Reproductive Issues.” In Arizona Women and the Law: Third Annual Arizona Women’s Town Hall. Soroptimist International of Phoenix, Phoenix 1988, 79–99. Andrade, Sally J. “Family Planning Practices of Mexican Americans.” In Twice a Minority: Mexican American Women, ed. Margarita B. Melville. St. Louis: Mosby, 1980, 17–32. Arizona Business and Professional Women Foundation. Arizona Federation of Business and Professional Women: Women Who Made a Difference, 1921–2003, vol. 3. 2003. Arizona Family Planning Council. Arizona Legal Guide on Reproduction, Sexual Conduct and Families. Phoenix, 1985. ______. Nancy Hicks Marshall, ed. Sex and the Law: Arizona Legal Guide on Reproduction, Sexual Conduct and Families. Phoenix, 1995. Arizona Federation of Women’s Clubs. Yearbook, 1919. Arizona Women’s Heritage Trail. “Carmen Soto de Vásquez.” http://www.womensheritagetrail.org/women/CarmenVasquez.php. Armitage, Susan and Elizabeth Jameson, eds. The Women’s West. Norman: University of Oklahoma Press, 1987. Arrington, Chris Rigby. “Pioneer Midwives.” In Mormon Sisters: Women in Early Utah, ed. Claudia C. Bushman. Cambridge, Mass.: Emmeline Press, 1976. Arrington, Leonard. “Arizona in the Great Depression Years.” Arizona Review 17, no. 12 (Dec. 1968). ______. “The Economic Role of Pioneer Mormon Women.” Western Humanities Review 9 (Spring 1995): 145–164. Bahl, Ida. Nurse among the Navajos. Northvale, New Jersey: Shepherd Publishing, 1984. Bailey, Flora A. “Suggested Techniques for Inducing Navajo Women to Accept Hospitalization during Childbirth and for Implementing Health Education.” American Journal of Public Health 38 (Oct. 1948): 1420. Barrera, Mario. Race and Class in the Southwest: A Theory of Racial Inequality. Notre Dame, Ind.: University of Notre Dame Press, 1979. Bender, Daniel E. “Perils of Degeneration: Reform, the Savage Immigrant, and the Survival of the Unfit.” Journal of Social History 42, no. 1: 2008, 5–29. Benton-Cohen, Katherine. Borderline Americans: Racial Division and Labor War in the Arizona Borderlands. Cambridge, Mass.: Harvard University Press, 2011. Blair, Karen. The Clubwoman as Feminist: True Womanhood Redefined, 1868–1914. New York: Holmes and Meier, 1980.

232  •  Bibliography Boyer, Ruth McDonald, and Narcissus Duffy Grayton. Apache Mothers and Daughters: Four Generations of a Family. Norman: University of Oklahoma Press, 1992. Braatz, Timothy. Surviving Conquest: A History of the Yavapai Peoples. Lincoln: University Nebraska Press, 2003. Brown, Malcolm. “Migratory Cotton Pickers in Arizona.” WPA Division of Research. Washington, D.C.: GPO, 1939. Bufkin, Don and Henry P. Walker. Historical Atlas of Arizona, 2nd ed. Norman: University of Oklahoma Press, 1986. Buss, Fran Leeper. La Partera. Ann Arbor: University of Michigan Press, 1980. Cabeza de Baca, Fabiola. We Fed Them Cactus. Albuquerque: University of New Mexico Press, 1954. Campbell, Julie A. Studies in Arizona History. Tucson: Arizona Historical Society, 1998. Carpio, Myla. “Lost Generation: The Involuntary Sterilization of American Indian Women.” Master’s thesis, Arizona State University, 1995. Carson, Carolyn Leonard. “And the Results Showed Promise . . . Physicians, Childbirth, and Southern Black Migrant Women, 1916–1930: Pittsburgh as a Case Study.” Journal of American Ethnic History (Fall 1994): 32–64. Castaneda, Antonia I. “Women of Color and the Rewriting of Western History: The Discourse, Politics and Decolonization of History.” Pacific Historical Review 61 (Fall 1992): 501–534. Cates, William Jr. “The First Decade of Legal Abortion in the United States: Effects on Maternal Health.” In Abortion, Medicine and the Law, 3rd ed, ed. Douglas Butler and David F. Walbert. New York: Facts on File, 1986, 305–319. Chen, Constance M. “The Sex Side of Life”: Mary Ware Dennett’s Pioneering Battle for Birth Control and Sex Education. New York: New Press, 1998. Claridge, Juanita. “We Tried to Stay Refined Pioneering in the Mineral Strip.” In Klondyke and the Aravaipa Canyon. Safford, Az.: n.p., 1989. Cohen, Susan A. “Abortion and Women of Color: The Bigger Picture.” Guttmacher Policy Review 11, no. 3 (Summer 2008). Collins, William S. The New Deal in Arizona. Phoenix: State Parks Board, 1999. Colvin, Verna Rae, ed. The Garden and How it Grew: Eden, 1881–1981. N.p., n.d. Copy in Mesa Genealogical Library, Mesa, Arizona. Davies, Wade. Healing Ways: Navajo Health Care in the Twentieth Century. Albuquerque: University of New Mexico Press, 2001. Dean, David R., and Jean A. Reynolds. African American Historic Property Survey. Phoenix: Historic Preservation Office, 2004. De Graaf, Lawrence B. “Race, Sex, and Region: Black Women in the American West, 1850–1920.” Pacific Historical Review 49 (1980): 285–313. Delgade, Grace Pena. “Of Kith and Kin: Land, Leases and Guanxi in Tucson’s Chinese and Mexican Communities, 1880s–1920s.” Journal of Arizona History 46, no. 1 (2005). Delp, Mildred. “Baby Spacing Report on California and Arizona,” March–August 1940. Planned Parenthood Federation of America Collection, Sophia Smith Collection, Smith College Archives. ______. “My Day” report, 1941. Planned Parenthood Federation of America Collection, Sophia Smith Collection, Smith College Archives.

Bibliography  •  233 Dobyns, Henry F. The Pima-Maricopa. New York: Chelsea House, 1989. Dye, Nancy Schrom. “History of Childbirth in America.” Signs: Journal of Women in Culture and Society 6 (Autumn 1980). Elsasser, Nan, Kyle MacKenzie, and Yvonne Tixier y Vigil. Las Mujeres: Conversations from a Hispanic Community. Old Westbury, N.Y.: Feminist Press, 1980. Engs, Ruth Clifford. The Eugenics Movement: An Encyclopedia. Westport, Conn.: Greenwood Press, 2005. Erikson, Winston P. Sharing the Desert: The Tohono O’odham in History. Tucson: University of Arizona Press, 1994. Espino, Virginia Rose. “Women Sterilized as They Give Birth: Population Control, Eugenics, and Social Protest in the Twentieth-Century United States.” Dissertation, Arizona State University, 2007. Etulain, Richard W. “Contours of Culture in Arizona and the Modern West.” In Arizona at Seventy-Five: The Next Twenty-Five Years, ed. Beth Luey and Noel Stowe. Tucson: University of Arizona Press, 1987, 11-53. Evans, Sara M. Born for Liberty: A History of Women in America. New York: Free Press, 1989. Faulk, Obie B. Arizona: A Short History. Norman: University of Oklahoma Press, 1970. Foley, Neil. “Partly Colored or Other White: Mexican Americans and Their Problem with the Color Line.” In Beyond Black and White: Race, Ethnicity and Gender in the U.S. South and Southwest, ed. Stephanie Cole and Alison M. Parker. College Station: Texas A&M University Press, 2004. Fong, Lawrence Michael. “Sojourners and Settlers: The Chinese Experience in Arizona and Northern Mexico.” In The Chinese Experience in Arizona and Northern Mexico. Tucson: Arizona Historical Society, 1980. Friedan, Betty Friedan. The Feminine Mystique. New York: Norton, 1963. Garceau-Hagen, Dee. The Important Things of Life: Women, Work and Family in Sweet­ water County, Wyoming, 1880–1929. Lincoln: University of Nebraska Press, 1997. ______. Portraits of Women in the American West. New York: Routledge, 2005. Garcia, Alma M. “The Development of Chicana Feminist Discourse, 1970–1980.” In Unequal Sisters: A Multicultural Reader in U.S. Women’s History, 2nd ed., ed. Vicki L. Ruiz and Ellen Carol DuBois. New York: Routledge, 1994, 531–544. Garrow, David J. Liberty and Sexuality: The Right to Privacy and the Making of Roe v Wade. New York: Macmillan, 1994. Gibson, Campbell, and Kay Jung. “Historical Census Statistics on Population Totals by Race, 1790 to 1990, and by Hispanic Origin, 1790 to 1990 for the United States, Regions, and Division, and States.” Population Division, U.S. Census Bureau, Washington, D.C., September 2002, Working Paper Series No. 56. Glaser, Leah S. “The Story of Guadalupe, Arizona: The Survival and Preservation of a Yaqui Community.” Master’s thesis, Arizona State University, 1996. Gordon, Linda. The Great Arizona Orphan Abduction. Cambridge, Mass.: Harvard University Press, 1999. ______. The Moral Property of Women: A History of Birth Control Politics in America. Chicago: University of Illinois Press, 2002. Grey, Michael. New Deal Medicine: The Rural Health Programs of the Farm Security Administration. Baltimore, Md.: Johns Hopkins University Press, 1999.

234  •  Bibliography Grove, Robert D., and Alice M. Hetzel. Vital Statistics Rates in the United States 1940–1960. Washington, D.C.: U.S. Department of Health, Education, and Welfare, 1968. Guttmacher Institute. “Abortion: Need, Services and Policies, Arizona.” New York, 1979. ______. “Conception Counts: State by State Information,” 1998. http://www.gutt macher.org/pubs/ib22.html. ______. “U.S. Teenage Pregnancy Statistics: National and State Trends and Trends by Race and Ethnicity.” New York, updated 2006. Hadley, Diana. Environmental Change in Aravaipa, 1870–1970: An Ethnoecological Survey. Phoenix: Bureau of Land Management, 1991. Haines, Michael R., and Myron P. Gutmann. “Fertility of the Hispanic Population of the United States in Historical Perspective: Evidence from the Census of 1910.” Paper presented at the Annual Meeting of the Population Association of America, Chicago, April 1998. Hall, Charles E. Negroes in the United States 1920–1932. Washington, D.C.: GPO, 1935. Hammershlag, Carl A. The Dancing Healers: A Doctor’s Journey of Healing with Native Americans. New York: Harper and Row, 1989. Harris, Richard. The First Hundred Years: A History of Arizona Blacks. Apache Junction, Az.: Relmo, 1983. Hefner, Loretta L. “Relief Society and the U.S. Sheppard-Towner Act.” Utah Historical Quarterly 50, no. 3 (1982): 255–267. Henshaw, Stanley K. “Abortion Incidence and Services in the United States, 1995– 1996.” Guttmacher Family Planning Perspectives 30, no. 6 (Nov./Dec. 1998): 263– 287. Holt, Marilyn Irwin. Linoleum, Better Babies and the Modern Farm Woman, 1890– 1930. Albuquerque: University of New Mexico Press, 1995. Hoffman, Virginia and Brederick H. Johnson. Navajo Biographies. Chinle, Az.: Rough Rock Demonstration School, 1970. Hull, N. E. H., and Peter Charles Hoffer. Roe v Wade: The Abortion Rights Controversy in American History. Lawrence: University Press of Kansas, 2001. Inter-tribal Council of Arizona. “Population and Acreage of Tribal Reservations in Arizona.” 2003. Iverson, Peter. Barry Goldwater, Native Arizonan. Norman: University of Oklahoma Press, 1997. ______. Diné: A History of the Navajos. Albuquerque: University of New Mexico Press, 2002. Jacoby, Karl. Shadows at Dawn: An Apache Massacre and the Violence of History. New York: Penguin, 2008. James, Henry C. Pages from Hopi History. Tucson: University of Arizona Press, 1974. Jameson, Elizabeth, and Susan Armitage, eds. Writing the Range: Race, Class and Culture in the Women’s West. Norman: University of Oklahoma Press, 1997. Jenkins-Reed, Emily, and Jane Canby. “Family Planning in Arizona 1977: A Needs Assessment.” Phoenix: Arizona Family Planning Council, 1979. Kay, Margarita Artschwager. “Health and Illness in the Barrio: Women’s Point of View.” Dissertation, University of Arizona, 1972.

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236  •  Bibliography López, Ian F. Haney. White by Law: The Legal Construction of Race. New York: New York University Press, 1996. LoVechio, Janolyn. “BPW Arizona Legislative History.” In Arizona Federation of Business and Professional Women: Women Who Made a Difference 1921–2003, vol. 3. Arizona Business and Professional Women’s Foundation, 2003. Lovett, Laura L. Conceiving the Future: Pronatalism, Reproduction, and the Family in the United States, 1890–1938. Chapel Hill: University of North Carolina Press, 2007. Luckingham, Bradford. Phoenix: History of a Southwestern Metropolis. Tucson: University of Arizona Press, 1989. ______. Minorities in Phoenix: A Profile of Mexican American, Chinese American, and African American Communities, 1860–1992. Tucson: University of Arizona Press, 1994. Lukacs, Robert. “A Statistical Analysis of the Pima County Health Department Prenatal Records.” Master’s thesis, University of Arizona, 1964. Lull, L. J. “Indian Infant Death Study, Arizona and New Mexico, 1959–1960.” MS 269. Cline Library, Special Collections, Northern Arizona University. Manuel, Frances, and Deborah Neff. Desert Indian Woman: Stories and Dreams. Tucson: University of Arizona Press, 2001. Martin, Patricia Preciado. Songs My Mother Sang to Me: An Oral History of Mexican American Women. Tucson: University of Arizona Press, 1992. Martin, William E., and Harland Padfield. Farmers, Workers and Machines: Technological and Social Change in Farm Industries of Arizona. Tucson: University of Arizona Press, 1965. Martinez, Oscar J. “Hispanics in Arizona.” In Arizona at Seventy-Five: The Next Twenty-Five Years, ed. Beth Luey and Noel J. Stowe, Tucson: University of Arizona Press, 1987, 93–99. May, Cheryl Lynn. “Charitable Sisters.” In Mormon Sisters: Women in Early Utah, ed. Claudia L. Bushman. Cambridge, Mass.: Emmeline Press, 1976. McBride, Dorothy E. Abortion in the United States: A Reference Handbook. Santa Barbara, Calif.: ABC-CLIO, 2008. McCann, Carol R. Birth Control Politics in the United States, 1916–1945. Ithaca, N.Y.: Cornell University Press, 1994. McCloskey, Joanne. Living through the Generations: Continuity and Change in Navajo Women’s Lives. Tucson: University of Arizona Press, 2007. McFalls, Joseph A. Jr., and George Masnick. “Birth Control and the Fertility of the U.S. Black Population, 1880 to 1980.” Journal of Family History 6, no. 1 (1981): 89–106. McLean, Robert N. “Mexican Workers in the U.S.” Proceedings of the National Conference of Social Work. Chicago: University of Chicago Press, 1929. McLoughlin, Emmet. The People’s Padre: An Autobiography. Boston: Beacon Press, 1954. Melcher, Mary. “Blacks and Whites Together: Interracial Leadership in the Phoenix Civil Rights Movement.” Journal of Arizona History (Summer 1991). ______. “Tending Children, Chickens, and Cattle: Southern Arizona Ranch Women, 1910–1940.” Dissertation, Arizona State University, 1994.

Bibliography  •  237 ______. “‘This Is Not Right’: Rural Women Challenge Segregation and Ethnic Division,” Frontiers A Journal of Woman Studies 20, no. 2 (1999): 190–214. ______. “Times of Crises and Joy: Pregnancy, Childbirth and Mothering in Rural Arizona, 1910–1940.” Journal of Arizona History 40, no. 2 (1999): 181–200. ______. “‘Women’s Matters: Birth Control, Prenatal Care and Childbirth in Rural Montana, 1910 to 1940.” In Montana Legacy, ed. Harry W. Fritz, Mary Murphy, and Robert R. Swartout Jr.. Helena: Montana Historical Society Press, 2002, 132– 151. ______. “Judge Thomas Tang and Dr. Pearl Tang: Path Breakers in Law and Medicine.” Journal of the West 44, no. 3 (2005): 70–77. Melcher-Post, Jesselyn Rose. “Contraception Use among Women in an Urban Clinic.” Thesis, University of Arizona College of Medicine, Phoenix, 2011. Melville, Margarita B., ed. Twice a Minority: Mexican American Women. St. Louis: Mosby, 1980. Moore, Darby. “The United States Birth Control Movement and Arizona Women: Biography, Social Action, and Community.” Master’s thesis, Arizona State University, 1999. Morris, J. Richards. History of the Arizona State Legislature. Phoenix: Arizona Department of Library, Archives and Public Records and Arizona Legislative Council, 1990. Myers, Patricia. “Shades of Grey.” Phoenix Magazine (Oct. 1988). Nelson, Jennifer. Women of Color and the Reproductive Rights Movement. New York: New York University Press, 2003. Niethammer, Carolyn. I’ll Go and Do More: Annie Dodge Wauneka Navajo Leader and Activist. Lincoln: University of Nebraska Press, 2001. Northern Arizona University, Cline Library. Land Use of North America, Colorado Plateau. “The ‘Ferry’ of Lees Ferry.” http://cpluhna.nau.edu/index.html. O’Neil, Daniel J. Church Lobbying in a Western State: A Case Study of Abortion Legislation. Arizona Government Studies 7. Tucson: University of Arizona Press, 1970. ______. “Arizona: Pro-Choice Success in a Conservative Republican State.” In Abortion Politics in American States, ed. Mary C. Segers and Timothy A. Byrnes. New York: M. E. Sharpe, 1995, 84–101. Osselaer, Heidi. Winning Their Place: Arizona Women in Politics, 1883–1950. Tucson: University of Arizona Press, 2009. Packwood, Robert. “The Rise and Fall of the Right-to-Life Movement in Congress.” In Abortion, Medicine, and the Law, 3rd ed., ed. J. Douglas Butler and David F. Walbert. New York: Facts on File, 1986, 3–18. Paradise, Viola. Maternity Care and the Welfare of Young Children in a Homesteading County in Montana. Washington, D.C.: GPO, 1919. Pascoe, Peggy. “Race, Gender and Intercultural Relations: The Case for Interracial Marriage.” In Writing the Range, ed. Elizabeth Jameson and Susan Armitage, 69– 80. Norman: University of Oklahoma Press, 1997. ______. What Comes Naturally: Miscegenation and the Making of Race in America. New York: Oxford University Press, 2009. Perlich, Pamela S. “Utah Minorities: The Story Told by 150 Years of Census Data.” Bureau of Economic and Business Research, University of Utah, Salt Lake City.

238  •  Bibliography Petchesky, Rosalind Pollack. Abortion and Woman’s Choice: The State, Sexuality, and Reproductive Freedom. New York: Longman, 1984. Peterson, Herbert B. “A Twentieth Century Journey to Cibola: Tragedy of the Bracero.” Master’s thesis, Arizona State University, 1975. Rageau, Ervin S., and Angel Reaud. “Evaluation of PHS Program Providing Family Planning Services for American Indians.” American Journal of Public Health 59, no. 8 (1969): 1355–1360. Rea, Amadeo M. At the Desert’s Green Edge: An Ethnobotany of the Gila River Pima. Tucson: University of Arizona Press, 1992. Reagan, Leslie. When Abortion Was a Crime: Women, Medicine and Law in the United States, 1867–1973. Berkeley: University of California Press, 1997. Record, Ian W. Big Sycamore Stands Alone: The Western Apaches, Aravaipa, and the Struggle for Place. Norman: University of Oklahoma Press, 2008. Reilly, Philip R. The Surgical Solution: A History of Involuntary Sterilization in the United States. Baltimore, Md.: Johns Hopkins University Press, 1991. Reisler, Mark. By the Sweat of Their Brow: Mexican Immigrant Labor in the United States, 1900–1940. Westport, Conn.: Greenwood Press, 1976. Rodriguez, Jessie M. “The Black Community and the Birth Control Movement.” In “We Specialize in the Wholly Impossible”: A Reader in Black Women’s History, ed. Darlene Clark Hine, Wilma King, and Linda Reed. Brooklyn: Carlson, 1995, 505– 520. Rosen, Christine. Preaching Eugenics: Religious Leaders and the American Eugenic Movement. London: Oxford University Press, 2004. Rothschild, Mary, and Pamela Hronek. Doing What the Day Brought: An Oral History of Arizona Women. Tucson: University of Arizona Press, 1992. Russell, Andrew B. “Arizona Divided.” In Arizona Goes to War: The Home Front and the Front Lines during World War II, ed. Brad Melton and Dean Smith. Tucson: University of Arizona Press, 2003, 38–55. Sandefur, Gary D., and C. Matthew Snipp. “American Indian Fertility Patterns: 1910 and 1940 to 1980.” American Indian Quarterly (Summer 1991): 359–367. Sanger, Margaret. Margaret Sanger, An Autobiography. New York: Cooper Square Press, 1999. Saul, Rebekah. “Teen Pregnancy: Progress Meets Politics,” Guttmacher Institute 2, no. 3 (July 1999). Savage, Sherman. Blacks in the West. Westport, Conn.: Greenwood Press, 1976. Schackel, Sandra K. Social Housekeepers: Women Shaping Public Policy in New Mexico, 1920–1940. Albuquerque: University of New Mexico Press, 1992. ______, ed. Western Women’s Lives: Continuity and Change in the Twentieth Century. Albuquerque: University of New Mexico Press, 2003. Scharff, Virginia. “Else Surely We Shall All Hang Separately: The Politics of Western Woman’s History.” Pacific Historical Review 61 (Fall 1992): 535–556. Schoen, Johanna. Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare. Chapel Hill: University of North Carolina Press, 2005. Segers, Mary C., and Timothy A. Byrnes, eds. Abortion Politics in American States. New York: M. E. Sharpe, 1995. Sekaquaptewa, Helen, as told to Louise Udall. Me and Mine: The Life Story of Helen Sekaquaptewa. Tucson: University of Arizona Press, 1969.

Bibliography  •  239 Shaw, Anna Moore. A Pima Past. Tucson: University of Arizona Press, 1974. Sheridan, Thomas. Los Tucsonenses: The Mexican Community in Tucson 1854–1941. Tucson: University of Arizona Press, 1986. ______. Arizona: A History. Tucson: University of Arizona Press, 1995. Shipp, Ellis Reynolds. While Others Slept: Autobiography and Journal. Salt Lake City: Bookcraft, 1985. Slocumb, John C., and Stephen J. Kunitz. “Factors Affecting Maternal Mortality and Morbidity among American Indians.” Public Health Reports 92, no. 4 (July–Aug. 1977): 349–356. Smart, Donna Toland, ed. Mormon Midwife: The 1846–1888 Diaries of Patty Bartlett Sessions. Logan: Utah State University Press, 1997. Smith, Harold L. “’All Good Things Start with the Women’: The Origins of the Texas Birth Control Movement, 1933-1945.” Southwestern Historical Quarterly, 114 (Jan. 2011): 253-285. Solinger, Rickie. Pregnancy and Power: A Short History of Reproductive Politics in America. New York: New York University Press, 2005. Stern, Alexandra Minna. “Making Better Babies: Public Health and Race Betterment in Indiana, 1920–1935.” American Journal of Public Health 92, no. 5 (May 2002): 742–752. ______. “Beauty Is Not Always Better: Perfect Babies and the Tyranny of Paediatric Norms.” Patterns of Prejudice 36, no. 1 (2002): 68–78. Stone, Eric. Medicine among the American Indians. New York: Hufner, 1962. Strich, Hal. “Maternal and Infant Health Status.” Pima County Health Department, 1992. Sturgeon, Melanie. “For Every Baby a Square Deal: Arizona Women and the Child Welfare Movement.” Unpublished paper. Arizona Historical Foundation, Arizona State University Libraries. Sullivan, Deborah A., and Ruth Beeman. “Utilization and Evaluation of Maternity Care by American Indians in Arizona.” Working Paper no. 10, Southwest Institute for Research on Women, Women’s Studies, University of Arizona, Tucson, 1982. Thornton, Russell. American Indian Holocaust and Survival: A Population History since 1492. Norman: University of Oklahoma Press, 1987. Thul, Jackie Lynn Byrd. “African American School Segregation in Arizona from 1863– 1954.” Master’s thesis, Arizona State University, 1993. Titcomb, Mary Ruth. “Americanization and Mexicans in the Southwest: A History of Phoenix’s Friendly House, 1920–1983.” Master’s thesis, University of California, Santa Barbara, 1984. Tone, Andrea. Devices and Desires: A History of Contraceptives in America. New York: Hill and Wang, 2001. Toney, Michael B., Benu Golesorkhi, and William F. Stinner. “Residence Exposure and Fertility Expectations of Young Mormon and Non-Mormon Women in Utah.” Journal of Marriage and Family 47, no. 2 (May 1985): 459–465. Trotter, Joe William Jr., The Great Migration in Historical Perspective. Bloomington: Indiana University Press, 1991. Truitt, Samuel. Fugitive Landscapes: The Forgotten History of U.S.-Mexico Borderlands. New Haven, Conn.: Yale University Press, 2006.

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Index

Page numbers in italics refer to tables and figures. Abbott, Grace, 43, 46, 47, 53 abortion counseling, 128, 147, 150, 152, 184 abortion legislation, 19–20, 138, 162– 163; Arizona, 19–20, 136, 139, 140– 146, 148–152, 159, 167–168, 183– 185; abortion providers, 35, 71–73, 138–140; Planned Parenthood, 16, 141–142, 145–146, 149–150, 155, 167–168, 185; reform, 140–146, 148– 152, 183–185. See also Roe v. Wade abortion protests, 164–166, 165, 222n25 abortion providers, 166, 170–171; California, 144, 146, 147–148, 152– 153, 184; hospitals, 152–153, 155– 156, 158–159; midwives, 72, 73; physicians, 60, 71–72, 72–73, 138–140, 143–144, 145, 146, 152–153; Planned Parenthood, 152, 158, 166; prosecution of, 35, 71–73, 138–140 abortion rate, 73, 156, 159, 170, 173 abortion reform, 4, 16, 135–160, 162, 183–185 abortions, 170; Sherri Finkbine, 136– 137, 138, 183; Joanne Goldwater, 73, 135–136, 183; Hispanics, 144, 170;

maternal mortality, 75, 148, 154; Navajos, 157–158, 159; New Mexico, 159, 170; low-income women, 152, 155–156, 158, 166; teenagers, 155, 162–163; therapeutic, 129, 136–137, 138, 140, 146–147, 149, 159, 183; Utah, 159, 170 African Americans, 10–12, 11, 15, 75, 91, 170, 174–175; birth rates, 19, 22, 24, 114, 172–173; childbirth, 1, 29, 35, 36, 54–55, 91, 98, 196; contraceptive use, 21–22, 23, 84, 92–93, 115–116; infant mortality, 22, 48, 82, 92, 176, 225n81; maternal mortality, 22, 92; midwives, 14, 29, 34, 36; migrant workers, 78, 83; Planned Parenthood, 93, 115–116, 117, 122, 132–133; population, 10, 11, 11, 48, 133; rural women, 22, 29, 34; segregation, 8, 10– 12, 70, 178 Alcock, Sue, 145–146, 154 Alexander, Scott, 140, 142, 153–154 American Indians, 5–7, 16, 19, 176; abortion, 137, 170; birth control, 22, 112; birth rates, 6, 22, 23, 24, 100, 113, 172, 182, 224n63; childbirth, 25–26,

241

242  •  Index American Indians (cont.) 27–28, 97–98, 98–99; contraceptive use, 86, 114, 183; health care, 47, 96– 97, 108–109; family size, 36, 129; infant mortality, 6, 26, 46, 46, 47, 56, 86, 95, 99–100, 100, 108, 109, 113, 179, 181; maternal mortality, 26, 27– 28, 53, 97, 181; midwives, 26–27, 98– 99; motherhood, 19, 20; population, 6, 11, 23, 133; prenatal care, 97, 109. See also Apaches, Hopis, Navajos, Pascua Yaqui, Pimas, Pueblos, Tohono O’odham Apaches, 5–6, 25–26, 27, 30, 100, 108– 109, 113, 181 Arizona Federation of Women’s Clubs (AFWC), 44, 46, 47, 71 Asian Americans, 11, 12–14, 114, 170, 200n47, 224n63 Barker, Clyde, 74, 82, 84, 87 Better Babies movement, 41, 42–43, 103, 179 birth control. See also contraceptive provision; contraceptive use; and contraceptives birth control attitudes: 58, 89; African Americans, 92–93, 115–116; Catholic Church, 15, 21, 57, 67–69, 76, 82, 89–90, 180; Church of Jesus Christ of Latter-day Saints, 2, 3, 31, 112–113; medical profession, 58, 93; Mexican Americans, 20, 21, 23, 156–157, 180 birth control clinics, 4, 82, 171, 180; Margaret Sanger, 57, 58, 65, 66, 68, 69–70, 73–75, 88, 89, 116–117, 119, 180; Mothers’ Health Clinic, Phoenix, AZ, 74, 75; Phoenix, AZ, 2, 57, 58, 70, 73–76, 84, 87, 120, 180; Mothers’ Health Clinic, Tucson, AZ, 58, 65–67, 66, 68, 69–70, 75, 180; Planned Parenthood, 15, 16, 88–89, 92, 93, 114–15, 116, 117, 126, 127, 128, 131, 181; St. Monica’s Clinic, Phoenix, AZ, 15, 55–54, 74, 75, 77, 91–92, 107, 181; Tucson, AZ, 2, 4, 57, 87, 89

birth control methods: birth control pill, 22, 112, 119, 131, 132, 133, 171, 183; diaphragms, 61, 82, 131; nursing, 20, 21, 22, 23; rhythm method, 69, 115, 122, 125; spermicide, 74, 77, 84, 181 birth control movement, 2, 15, 56, 57– 76, 88. See also Planned Parenthood; Margaret Sanger birth control pill, 22, 112, 119, 131, 132, 133, 171, 183 birth defects, 136–137, 138, 140, 149, 159, 183 birth rates, 24, 77, 112, 113, 114, 173, 182, 196n50; African Americans, 19, 22, 114, 172–173; American Indians, 22, 23, 24, 100, 113–114; Arizona, 3, 16, 23–24, 112, 113, 175, 182; EuroAmericans, 22, 24, 172; Hispanics, 24, 112, 172, 224n63; Mexican Americans, 22, 24, 114; migrant workers, 77, 81; Mormons, 3, 23–24, 112, 113, 182; New Mexico, 3, 16, 23, 24, 112, 113, 175, 182; rural women, 19, 22, 24; urban women, 19, 22, 24; Utah, 3, 23–24, 112, 113, 113, 175, 182 birth registration, 24, 40–41, 44 Brown, Sara, 132–133 California, 5, 9, 24, 172, 174, 192n50; abortion providers, 144, 146, 147–148, 152–153, 184; abortion reform, 4, 138; migrant workers, 81, 82–83; sterilization, 62, 63, 64, 65, 215n96 Canby, Jane, 154–155, 161 Casa Grande, AZ, 1, 11, 12, 13, 71, 98 Catholic Church, 3, 67–69; abortion beliefs, 2, 15, 67–69, 140, 152, 153, 169, 184, 185; birth control opposition, 15, 21, 57, 67–69, 76, 82, 89–90, 180; conflicts with Planned Parenthood, 89, 121, 213n54; Daniel Gercke, 21, 67, 89–91, 90, 121; Francis J. Green, 140, 153; Emmett McLoughlin, 77, 91–92, 115, 181; Tucson, AZ, 21, 67, 89–90, 90, 121, 140, 153, 180

Index  •  243 Catholics, 3; abortion beliefs, 137, 144, 153, 159, 167; contraceptive use, 19, 20, 23, 66–67, 117–118, 182 childbirth, 25, 29, 30–33, 179; accounts of, 18–19, 25–26, 29, 30; African Americans, 1, 29, 35, 36, 54–55, 91, 98; American Indians, 25–26, 27–28, 96–98, 98–99; Euro-Americans, 33, 36; home births, 26, 28–29, 97, 98; hospital births, 27–28, 34–36, 96, 97, 98, 100, 101, 179; midwives, 1, 14, 25, 26–27, 28–29, 32–34, 36, 50, 98–99, 179; Mexican Americans, 28–29, 34; physicians, 31, 33–35, 36; rural women, 1, 4, 25, 28–29, 30, 34, 179; transportation factors, 1, 25, 98, 126, 178–179, 202n80; urban women, 25, 34–36, 44, 85, 98, 179 Children’s Bureau, 30, 39–44, 47, 53, 179 Church of Jesus Christ of Latter-day Saints: birth control attitudes, 2, 3, 31, 112–113; National Women’s Relief Society of the Church of Jesus Christ of Latter-day Saints, 39, 52–53, 55–56, 180. See also Mormons; Utah Cochise County, AZ, 14, 54, 189n15 Colorado, 4, 31, 138, 143, 170, 188n4 Comstock Law, 20, 21, 59, 61, 65, 77, 202n3 contraceptive provision: physicians, 58, 60, 82–84, 93–94, 114; Planned Parenthood, 16, 88–89, 111–112, 114–115, 119, 124, 125, 171, 183 contraceptive use: 16, 58, 93, 181–182; African Americans, 21–22, 23, 84, 92– 93, 115–116; American Indians, 86, 114, 158, 159, 183; economic factors, 114, 181–182, 184; Catholics, 19, 20, 23, 66–67, 117–118, 182; Griswold v. Connecticut, 123, 141, 151, 182–183, 213n50; Hispanics, 24, 117–118, 131, 132, 133; legislation, 20, 21, 59, 61, 65, 77, 193n4, 202n3; low-income women, 73, 131, 172, 171, 174–175, 216n105; Mexican Americans, 117– 118, 156–157, 183; migrant workers,

77–78, 81, 81, 84, 86, 87, 181; rural women 4, 22, 93; urban women, 21, 22, 77, 88–89, 93–94 contraceptives: birth control pill, 22, 112, 119, 131, 132, 133, 171, 183; diaphragms, 61, 82, 131; spermicide, 74, 77, 84, 181 Curtis, Elizabeth Hanks, 31–32, 32 Delp, Mildred, 77, 79, 80–88, 181 diaphragms, 61, 82, 131 economic factors: contraceptive use, 114, 181–182, 184; health care, 14, 95, 178, 181–182, 184. See also lowincome women Ellington, Anna Mae, 1, 29, 196 ethnic prejudices, 8, 14, 39, 42, 176, 179; eugenics, 15, 129; health care, 14, 50, 56, 176, 181–182; Mexican Americans, 10, 14, 39, 42, 45, 50, 51, 179, 189n15; segregation, 8, 10–12, 70, 178; Sheppard-Towner Program, 7, 14, 39, 45, 50, 51, 179 eugenics, 57, 60, 62–65, 69, 75; Better Babies movement, 41, 42–43, 103, 179; Catholic Church, 67–69; ethnic prejudices, 15, 129; Margaret Sanger, 15, 59–61, 70, 75, 161–162; lowincome women, 60, 62; sterilization, 16, 62, 63–65, 75, 180–181 Euro-Americans, 7, 9, 11, 78, 97, 170, 189n15; birth rates, 22, 24, 172, 200n57, 224n63; childbirth, 33, 36; contraceptive use, 23, 24; infant mortality, 6, 45, 46, 46, 51, 55 family size, 15, 36, 75, 76, 178, 183; American Indians, 36, 129; Mexican Americans, 20, 36; Mormons, 21, 36 Farm Security Administration (FSA), 4, 77–78, 80–88, 85, 93, 181; Delp, Mildred, 77, 79, 80–88, 181. See also migrant workers Feldt, Gloria, 163–164, 171 Finkbine, Sherri, 136–137, 138, 183

244  •  Index geographic factors: contraceptive use, 7–8, 23; health care, 1–2, 7–8, 16, 18, 25, 126, 178–179, 181–182. See also rural women Gercke, Daniel, 21, 67, 89–91, 90, 121 Gerster, Carolina, 148, 153, 168 Goldwater, Barry, 74, 135, 162, 167–168, 183 Goldwater, Joanne, 73, 135–136, 183 Goldwater, Peggy, 74–75, 82, 87, 93, 120, 135, 181 Green, Ruth, 147, 150, 152 Griswold v. Connecticut, 123, 141, 151, 182–183, 213n50 Hankins, Christina Ellington, 1, 29, 98, 196 health care, 54–55, 105–107; American Indians, 47, 96–97, 100–103, 108– 109, 181, 182; economic factors 14, 95, 178, 181–182, 184; ethnic prejudices, 14, 39, 56, 176, 181–182; geographic factors,1–2, 7–8, 16, 18, 25, 126, 178–179, 181–182; low-income women, 54–55, 56, 73, 77, 91, 93, 95, 110, 124, 173, 174, 181, 184, 186; New Mexico, 40, 55, 69, 112, 128, 202n2; rural women 2, 4, 47, 97, 108, 176; urban women, 95, 99, 103–108. See also Farm Security Administration (FSA); Planned Parenthood; prenatal care; Sheppard-Towner Program; and Pearl Tang Hispanics, 10, 11, 24, 38, 42, 66, 78, 131, 176; abortions, 144, 170; birth rates, 24, 112, 172, 224n63; contraceptive use, 24, 117–118, 131, 132, 133; ethnic prejudices, 39, 42. See also Mexican Americans home births, 26, 28–29, 97, 98. See also midwives Hopis, 22, 27, 100, 113–114 hospitals, 35, 48, 55, 98, 125, 146, 152, 185; abortions, 152–153, 155–156, 158–159, 185; childbirth, 27–28, 34– 36, 96, 97, 98, 100, 101, 179

Howe, Maude H., 14, 42, 44–45, 47–48, 49, 51 incest, 138, 140, 159, 167, 183 infant health care, 41–42, 44–45, 181– 182; Better Babies movement, 41, 42– 43, 103, 179, 198–199n28. See also Sheppard-Towner Program infant mortality, 3–4, 32–33, 46, 53, 56; African Americans, 22, 48, 82, 92, 176, 225n81; American Indians, 6, 26, 46, 46, 47, 56, 86, 95, 99–100, 100, 108, 109, 113, 179, 181, 182; Arizona, 3–4, 38, 39–40, 44–45, 46, 50–51, 51, 55, 175–176, 179, 182; causes of, 38– 39, 43–44, 46–47, 56, 99–100, 106– 107; Euro-Americans, 6, 45, 46, 46, 51, 55; low-income women, 43, 44, 45, 56, 177, 180; Mexican Americans, 40, 44–45, 46, 46, 51, 55, 179; migrant workers, 47, 51; New Mexico, 3–4, 38, 39, 45, 50, 55, 99, 109, 175, 179–180, 197n5; prenatal care, 38–39, 44, 106; Sheppard-Towner Program, 14, 39, 46–47, 46, 48–53; Utah, 3–4, 38, 39, 45, 53, 56, 99, 109, 175, 179–180 Jenkins, Emily, 127, 146–147 Jewish, 89, 115, 144, 169 Kinsolving, Arthur B., II, 88, 89, 115 legislation, 33–34, 165; abortion, 19–20, 136, 138, 140–146, 148–152, 159, 162–163, 167–168, 183–185; Comstock Law, 20, 21, 59, 61, 65, 77, 202n3; contraceptive use, 19–20, 21, 59, 61–62, 65, 77, 193n4, 202n3; sterilization, 57, 63–65, 75, 130, 181. See also Arizona Supreme Court; Roe v. Wade; U.S. Supreme Court low-income women, 8; abortions, 152, 155–156, 158, 166; contraceptive use, 73, 131, 172, 171, 174–175, 216n105; eugenics, 60, 62; health care, 54–55, 56, 73, 77, 91, 93, 95, 110, 124, 173,

Index  •  245 174, 181, 184, 186; infant mortality, 43, 44, 45, 56, 177, 180; Planned Parenthood, 124, 154, 171, 174–175, 184, 185–186. See also Farm Security Administration (FSA); migrant workers; Pearl Tang Marcus, Janet, 154–155, 168, 218n30 Maricopa County, AZ, 43, 93, 95; abortions, 155, 156, 158; birth control legislation, 111, 121–122; health care, 54, 82, 103, 105–107, 124–125. See also Phoenix, AZ; Pearl Tang maternal mortality, 45, 53–54, 92, 97– 98, 175, 181–182, 201n71; abortions, 75, 148, 154; African Americans, 22, 92; American Indians, 26, 27–28, 53, 97, 181; midwives, 32–33, 50; Sheppard-Towner Program, 14, 39, 53–54, 179 maternity homes, 35–36, 52–53, 55–56 McLoughlin, Emmett, 77, 91–92, 115, 181 Mexican Americans, 8–10, 24, 28–29, 43–44, 66, 75, 131–132, 215n96; birth control attitudes, 20, 21, 23, 156–157, 180; birth rates, 22, 24, 114; childbirth, 28–29, 34; contraceptive use, 15, 21, 66–67, 75, 117–118, 183; ethnic prejudices, 10, 14, 39, 42, 45, 50, 51, 179, 189n15; family size, 20, 36; infant mortality, 40, 44–45, 46, 46, 51, 55, 179; motherhood, 15, 19, 21, 24; Planned Parenthood, 115, 117–118, 131–132; population, 9, 10, 11, 24, 48, 54, 66, 133, 179, 180; segregation, 8–10, 42, 70, 178; Sheppard-Towner Program, 14, 51, 109–110, 179, 180, 182. See also Hispanics midwives: 1, 25, 32–34, 49–50, 55, 179; abortions, 72, 73; African Americans, 14, 29, 34, 36; American Indians, 26– 27, 98–99; childbirth, 1, 14, 25, 26– 27, 28–29, 32–34, 36, 50, 98–99, 179; maternal mortality, 32–33, 50; Mexican Americans, 14, 28–29, 48;

Mormons, 30–31, 31–32, 32, 35–36; Utah, 31, 31–32, 32 migrant workers, 51, 77–80, 79, 81, 85; African Americans, 78, 83; birth rates, 77, 81; contraceptive use, 77–78, 81, 81, 84, 86, 87, 181; infant mortality, 47, 51; living conditions, 43, 78–79, 80, 85, 86–87. See also Farm Security Administration (FSA) mining towns, 7, 9–10, 12, 34, 45, 189n15 minors, 162–163, 177, 183. See also teenagers Montana, 30, 45, 170, 188n4, 196n50 Montoya, Francisca, 131, 156–157 Mormons, 23, 24, 51–52, 112–113, 180, 182; abortion beliefs, 137, 152, 159; birth rates, 3, 23–24, 112, 113, 182; birth control attitudes, 2, 14, 19, 21, 23, 112–113, 180; childbirth, 30–33; family size, 21, 36; midwives, 30–31, 31–32, 32, 35–36; motherhood, 19, 21; Sheppard-Towner Program, 39, 52–53, 180. See also Church of Jesus Christ of Latter-day Saints; Utah Mothers’ Health Clinic, Phoenix, AZ, 74, 75 Mothers’ Health Clinic, Tucson, AZ, 58, 65–67, 66, 68, 69–70, 75, 180 National Women’s Relief Society of the Church of Jesus Christ of Latter-day Saints, 39, 52–53, 55–56, 180 Native Americans. See American Indians Navajos, 5–6, 7, 20, 96, 211n11; abortion, 157–158, 159; birth control, 22, 23, 114, 129–131, 158, 180; birth rates, 23, 100, 113–114; childbirth, 26–27, 27–28, 96–97, 98; contraceptive use, 114, 158; health care, 47, 96–97, 100– 103, 181, 182; hospital births, 97, 98; infant mortality, 47, 99, 100, 101, 108, 181, 182; maternal mortality, 27–28, 97, 181; motherhood, 20, 114, 157; transportation factors, 47, 97, 98, 108, 181, 202n80. See also Annie Dodge Wauneka

246  •  Index New Mexico, 3, 5, 9, 12, 18, 24, 41; abortions, 159, 170; birth control opposition, 57, 69, 202n2; birth rates, 3, 16, 23, 24, 112, 113, 175, 182; health care, 40, 55, 69, 112, 128, 202n2; infant mortality, 3–4, 38, 39, 45, 50, 55, 99, 55, 100, 109, 175, 179–180, 197n5; maternal mortality, 54, 97–98; Navajos, 129, 130; population, 1–2, 180, 188n4; Santa Fe, NM, 2, 69, 202n2; Sheppard-Towner Program, 45, 46, 46, 49, 50, 51, 55, 180 New Right, the, 155, 162, 168, 177, 184 nursing, 20, 21, 22, 23 Pascua Yaqui, 6, 85–86, 98–99 Phoenix, AZ, 156; birth control clinics, 2, 57, 58, 70, 73–76, 84, 87, 120, 180; health care, 12, 36, 91, 54–55, 107; St. Monica’s Clinic, 15, 77, 91–92, 181. See also Pearl Tang; Planned Parenthood, Phoenix, AZ physicians, 32–33, 80; abortion reform, 141, 142–144, 146; abortion providers, 60, 71–72, 72–73, 138–140, 143–144, 145, 146; childbirth, 31, 33–35, 36; contraceptive provision, 58, 60, 82– 84, 93–94, 114. See also Clyde Barker; Pearl Tang Pimas, 23, 27, 99, 100, 103 Pinal County, 11, 80, 84, 93, 108, 138 Planned Parenthood, 88, 93, 174, 184, 207n39, 211n17, 212n36; abortion legislation, 16, 141–142, 167–168, 185; abortion providers, 158, 166; conflicts with Catholic Church, 89, 121, 213n54; contraceptive provision, 16, 111–112, 119, 183; fundraising, 158, 166, 184; low-income women, 124, 154, 171, 174–175, 184, 185–186; Margaret Sanger, 116–117, 119–120, 213n54; Morris Udall, 118–119, 153, 155, 212n36; minorities, 15, 16, 93, 115, 116, 124, 183; opposition to, 163–164, 172, 173; volunteers, 74, 117–118, 120, 133–134, 154, 184 Planned Parenthood, Phoenix, AZ, 115,

123–124; abortion counseling, 128, 147, 152; abortion legislation, 145– 146, 149; African Americans, 115– 116, 122, 132–133; birth control counseling, 111, 121–122, 128, 193n4; clinics, 88–89, 92, 93, 114– 115, 116, 128, 181; fundraising, 93, 115, 116, 120; Peggy Goldwater, 74– 75, 82, 87, 93, 120, 135, 181; protests, 164–165, 165; volunteers, 115, 116, 145–146, 154 Planned Parenthood, Tucson, AZ, 114– 115, 118, 119, 123, 124, 171; abortion counseling, 147, 150, 152; abortion legislation, 145, 149–150, 155; African Americans, 116, 117; birth control counseling, 121, 127–128, 171; board members, 117, 154–155, 168, 218n30; clinics, 89, 114–115, 117, 126, 127, 131; fundraising, 116, 117, 118–119, 120; Mexican Americans, 117–118, 131–132; protests, 166, 222n25; volunteers, 117–118, 120, 154–155 Planned Parenthood Federation of America (PPFA), 88, 163, 204n44 Planned Parenthood of Central and Northern Arizona (PPCNA), 74, 163– 164, 171 Planned Parenthood of Southern Arizona, 66, 68, 147, 158, 166, 171 population, 11: African Americans, 10, 11, 11, 48, 133; American Indians, 6, 11, 23, 133; Arizona, 1–2,4, 7, 9, 10, 11, 24, 40–41, 47, 51, 88, 133, 188n4; Asian Americans, 11, 13; Mexican Americans, 9, 10, 11, 24, 48, 54, 66, 133, 179, 180; New Mexico, 1–2, 180, 188n4; Tucson, AZ, 65, 204n35; Utah, 51, 188n4 population explosion, 16, 89, 90, 111, 123–124, 134, 137, 142, 154, 183, 214n61 pregnancy, teenage, 154, 155, 158, 162– 163, 172–173, 175, 176 prenatal care, 38–39, 44, 55, 101, 106– 108, 172, 176, 177, 184; American Indians, 97, 109; infant mortality, 38–

Index  •  247 39, 44, 106; Sheppard-Towner Program, 39, 48–49, 52, 80, 179 pro-life movement. See right-to-life movement Protestants, 59, 88–89, 115, 120, 151– 152, 172, 188n8; Arthur B. Kinsolving II, 88, 89, 115 protests, anti-abortion, 164–165, 165, 166, 222n25 Pueblos, 100, 100, 113 racial factors: segregation, 8, 10–12, 70, 178, 192n48, n50, n51. See also ethnic prejudices rape, 136, 138, 140, 143, 146, 159, 167, 183 rhythm method, 69, 115, 122, 125 right-to-life movement, 4, 146, 148–155, 158, 162–163, 167–169, 177, 184 Robinson, Priscilla, 118, 142, 145 Roe v. Wade, 4, 16, 137, 151–154, 163, 167–168 rural women, 19, 77–94, 158–159; African Americans, 22, 29, 34; birth rates, 19, 22, 24; childbirth, 1, 4, 25, 28–29, 30, 34, 179; contraceptive use, 4, 22, 77–94, 93; health care, 2, 4, 47, 97, 108, 176; infant mortality, 44, 55. See also migrant workers Sanger, Margaret, 2, 56, 66, 82, 84, 85, 88–89, 161; abortion beliefs, 71, 73; birth control clinics, 57, 58, 65, 66, 68, 69–70, 73–75, 88, 89, 116–117, 119, 180; Comstock Law, 59, 61; eugenics, 15, 59–61, 70, 75, 161–162; Phoenix, AZ, 2, 57, 58, 70, 73–76, 84, 87, 120, 180; Planned Parenthood, 116–117, 119–120, 213n54; Santa Fe, NM, 2, 69, 202n2; Tucson, AZ, 73, 75, 88, 89, 116–117, 119–120, 180 segregation: African Americans, 8, 10–12, 70, 178, 192n48, n50, n51; Mexican Americans, 8–10, 42, 70, 178 Sheppard-Towner Program, 39, 45–54; Arizona, 46, 47–49, 50–51, 179; ethnic prejudices, 7, 14, 39, 45, 50, 51,

179; infant mortality, 14, 39, 46–53, 46, 51, 180; maternal mortality, 14, 39, 53–54, 179; Mexican Americans, 14, 51, 109–110, 179, 180, 182; New Mexico, 45, 46, 46, 49, 50, 51, 55, 180; Mormons, 39, 52–53, 180; prenatal care, 39, 48–49, 52, 80, 179; Utah, 39, 51–53, 54, 179—180 Skelly, Jim, 149, 149, 151, 158 Smith, Michael D., 144–145, 166, 169, 172 spermicide, 74, 77, 84, 181 St. Monica’s Clinic, Phoenix, AZ, 15, 77, 91–92, 181 sterilization, 16, 62, 63–65, 75, 180–181, 203n18, 215n96; legislation, 57, 63– 65, 75, 130, 181 Stevens, Lulu, 111, 122 Supreme Court, Arizona, 64, 72, 74, 122, 138–139, 152, 193n4 Supreme Court, U.S., 63, 123, 151, 156, 162–163, 165–166; Griswold v. Connecticut, 123, 141, 151, 182–183, 213n50; Roe v. Wade, 4, 16, 137, 151– 154, 163, 167–168 Tamsen, Judy, 117–119, 147, 166 Tang, Pearl, 14, 16, 95–96, 103–107, 105, 109, 125–126, 182 Title X, 126–127, 160, 163, 174, 185–186 Tohono O’odham, 25, 98, 108, 189n14 transportation factors, 7, 8, 16, 23; childbirth, 1, 25, 126, 178–179, 202n80; Navajos, 47, 97, 98, 108, 181, 202n80 Tucson, AZ, 9, 10, 12, 24, 28, 29, 35, 107–108, 144, 145, 172; birth control clinics, 2, 4, 57, 58, 65–71, 66, 68, 69– 70, 75, 87, 89, 108, 180; Catholic Church, 21, 67, 89–91, 90, 121, 140, 153, 180; population, 65, 204n35; Margaret Sanger, 73, 75, 88, 89, 116– 117, 119–120, 180. See also Planned Parenthood, Tucson, AZ Udall, Morris, 118–119, 153, 155, 212n36 urban areas, 43, 44, 91, 97, 117–118

248  •  Index urban women: birth rates, 19, 22, 24; childbirth, 25, 34–36, 44, 95, 98, 179; contraceptive use, 21, 22, 77, 88–89, 93–94; health care, 95, 99, 103–108 Utah, 3, 8, 18, 41, 51, 54, 96, 188n4; infant mortality, 3–4, 38, 39, 45, 53, 56, 99, 109, 175, 179–180; population, 51, 188n4; Sheppard-Towner Program, 39, 51–53, 54, 179–180. See also Church of Jesus Christ of Latterday Saints; Mormons

Voevodsky, Reyn, 116–118 Wauneka, Annie Dodge, 16, 96, 101– 102, 102, 103, 109, 182 Whitlock, Shirley, 155, 172 Yrun, Virginia, 66–67, 68, 147, 166 Yuma County, AZ, 54, 82, 192n48, 200n46 Zillatus, Mary, 96–97, 108

About the Author

Mary Melcher, public historian and consultant, completed her doctorate in American history at Arizona State University in 1994, with concentrations in the twentieth century, women’s history, and the West. For the past twenty years, she has worked as a curator and consultant on numerous public history projects. She has conducted over 110 oral histories with Arizonans, which have been featured in her publications, exhibits, radio programs, and videos. She runs her own consulting business, Melcher History Services, and is the lead historian for the Arizona Women’s Heritage Trail, a public history project combining women’s history with interpretation of historic sites. This statewide project has developed driving and walking tours, a traveling exhibit, and an online trail. The topics of women’s reproduction and the multicultural history of Arizonans have occupied Melcher for years. Her dissertation, “Tending Children, Chickens and Cattle: Ranch and Farm Women in Southern Arizona,” uses oral histories, government documents, and memoirs to explore ranch women’s lives from 1910 to 1940, including Euro-American, Mexican American, and African American women. She has published articles on the civil rights movement in Phoenix and women’s struggles to break down ethnic division in rural Arizona. In addition, her work related to birth control, childbirth practices, and infant mortality has been published in the Montana Magazine of Western History and the Journal of Arizona History. Her article, “‘Women’s Matters’: Birth Control, Prenatal Care and Childbirth in Rural Montana, 1910–1940,” was included in the anthology Montana Legacy: Essays on History, People and Place (Mon-

About the Author tana Historical Society Press, 2002). Another article, “Times of Crisis and Joy: Pregnancy, Childbirth and Mothering in Rural Arizona, 1910–1940,” won the C.L. Sonnichsen Award for the best article published in the Journal of Arizona History in 1999. Melcher serves on the board of the National Collaborative for Women’s History Sites and is co-chair of the national Trails Committee. In 2004, the Arizona Humanities Council honored her with the Dan Shilling Distinguished Public Scholar Award.