From birth control to planned parenthood: The emergence of the IPPF

The creation of the IPPF was built on a longer tradition of birth control activism dating back to the late nineteenth century. The basic idea of limiting reproduction, of course, was not new: historians have found evidence of rudimentary methods used to prevent pregnancies across societies, dating as far back as the Roman Empire. The vulcanization of rubber in the 1850s allowed for the production of more reliable methods such as the condom and the female diaphragm, and manufacturers developed a range of spermicidal foams, powders, and gels sold at pharmacies in the early twentieth century. Laws, taboos, and lack of education and health services, however, limited the reach of these methods. Local campaigns arising in the late nineteenth and early twentieth centuries thus focused on spreading awareness of and access to contraception by publishing pamphlets, establishing clinics to distribute diaphragms and other methods, and lobbying governments to include birth control services within public health programs. By 1930, birth control organizations existed in at least thirty countries around the world, operated by a mix of sex reform, feminist, eugenicist, and neo-Malthusian associations. ^{Footnote 14} Advocates also worked from the outset to build international connections. The London-based ‘Birth Control International Information Centre’ (BCIIC) was created in 1935 to serve as a hub for these activities, providing practical guidance to local clinics around the world and organizing international lecture tours. From 1935–36, for example, American activist Margaret Sanger and British activist Edith How-Martyn visited India, Burma, Malay, China, the Philippines, Japan, Hawaii, and Canada on a BCIIC ‘World Tour.’Footnote ¹⁵

These activities were disrupted by the outbreak of the Second World War, with clinics in several countries closing their doors or struggling to maintain supplies. The birth control movement was also undermined by its longstanding ties to eugenics, a movement under increasing critique due to its association with the dramatic euthanasia and coerced sterilization policies of the Nazi regime.Footnote ¹⁶ With the end of the war, however, activists moved to revitalize international networks under the new rubric of ‘family planning’ or ‘planned parenthood.’ The Swedish Society for Sexuality Education (RFSU), headed by Elise Ottesen-Jensen, organized a first conference in 1946 attended by advocates from Europe and the USA, who met again in 1948 in England and formed the International Planned Parenthood Committee (IPPC) with headquarters at the FPA of England. The IPPC began to establish contact with old and new associations around the world, culminating in a widely attended conference in Bombay in 1952. India had just launched the world’s first state-funded family planning program that year, making it the perfect site to consolidate networks and launch a more permanent international federation.Footnote ¹⁷ The creation of the IPPF was announced at the end of the conference, with associations from England, Netherlands, Hong Kong, India, Singapore, Sweden, the United States, and West Germany as its eight founding members. The IPPF’s constitution outlined its central goals: to bring about acceptance of ‘voluntary responsible parenthood,’ to assist in the formation of Family Planning Associations (FPAs) around the world, to stimulate and disseminate scientific research, to provide training and support quality standards in contraceptives, and to organize international conferences. Any national FPA could apply for full membership in the federation with representation on the Governing Council, while organizations not national in scope could apply for associate membership.Footnote ¹⁸

The IPPF was one of several organizations formed after the war with planned parenthood, population, or some combination of the two in its mandate. Indeed, Connelly’s Fatal Misconception situates the IPPF as one element of the emerging, male-dominated mid-century ‘population establishment,’ consisting of the IPPF, the Population Council (1952), the Pathfinder Fund (1957), the United Nations Fund for Population Activities (UNFPA) (1969), and the United States Agency for International Development (USAID)’s Office of Population (1969).Footnote ¹⁹ Key IPPF founders such as British eugenicist C.P. Blacker clearly saw ‘planned parenthood’ as an extension of population control activism – with eugenic undertones – under a new, more palatable moniker.Footnote ²⁰ The IPPF’s first president, Margaret Sanger, had also strayed far from her socialist feminist roots by this point, actively mobilizing eugenic and neo-Malthusian arguments and courting male population experts to rally support for the cause.Footnote ²¹ As Connelly argues, the growth of the movement in the post-war period was achieved ‘through a series of political compromises, culminating with the consolidation of a well-funded and well-connected establishment committed to the most conservative version of family planning.’ ^{Footnote 22}

While these statements certainly hold true at some levels, the IPPF – and the family planning movement more broadly – cannot be reduced to the perspectives of its most prominent advocates. Several IPPF board members, such as Ottesen-Jensen, continued to bring more radical, rights-based, and/or individualist understandings of planned parenthood to the table. As Vicky Claeys points out, the very selection of ‘planned parenthood’ in the federation’s name reflected a concerted effort by Dutch and Swedish activists not to have the movement dominated by the ‘American’ interest in population problems (Sanger had preferred ‘The International Population Planning Committee’).Footnote ²³ Caroline Rusterholz’s recent scholarship further illustrates how British doctors such as Helena Wright, Cecily Mure, and Margaret Jackson continued to incorporate feminist principles into their work for the organization. While their efforts often went unrecognized, these women played a crucial role in the movement, promoting family planning through lecture tours, while also conducting research trials of new spermicidal methods, IUDs, and the birth control pill in the late 1950s.Footnote ²⁴

The IPPF was also unique from other organizations at the time due to its federation structure. Although the Governing Council – made up of representatives from local associations – outlined standards and provided small grants, publications, contraceptives and materials, the IPPF itself did not open or run clinics abroad. The day-to-day work of the movement thus continued to be undertaken by local FPAs run by local doctors, nurses, social workers, and volunteers, who brought their own diverse interests to the cause.Footnote ²⁵ Often, it was these associations that took the initiative to reach out to the IPPF. In its Fourth Report for the years 1957–58, for example, the IPPF noted that it had responded to some 3,494 letters of inquiry from 89 countries, hosted 170 visitors from 48 countries at its London headquarters, and provided training for 78 doctors and 34 nurses.Footnote ²⁶ Membership in the IPPF grew from its original eight members in 1952 to 34 members by 1963 (see Figure 1), and the organization opened five regional offices to serve Europe, the Near East, and Africa; the Indian Ocean; South East Asia and Oceania; the Western Hemisphere; and the Western Pacific.Footnote ²⁷ As the organization’s monthly Around the World (ATW) newsletter noted, in the first decade of its existence the IPPF had developed from a ‘fledgling organization’ to a ‘world-wide force.’Footnote ²⁸

Figure 1. IPPF Country Membership 1963.

One of the fundamental goals of the IPPF was to try and bring this diverse network of actors together under a common rubric, to provide some sense of shared mission and unity across geographical and ideological diversity. To this end, Sanger saw the creation of the ATW newsletter as a crucial initiative. As she noted, the primary intended audience for the paper were people ‘already interested in BC [birth control] who like to know what is going on elsewhere.’Footnote ²⁹ The paper would serve as a medium to exchange news and practical strategies, while also providing ‘workers’ with ‘the encouraging assurance that they are not struggling alone.’Footnote ³⁰ Sanger argued that the format of a four page newsletter – ‘small and compact and newsy’ – was ideal for busy workers, cheap to mail out, and relatively easy to translate into foreign languages (see Figure 2).Footnote ³¹ The paper started in January 1952 and was initially provided free for all, although from September 1952 onwards American and Canadian readers were charged a $2 annual subscription to fund foreign distribution.Footnote ³² At the end of its first year, ATW was reportedly reaching 6700 people each month, in about 100 countries and colonies; by its second anniversary, this number had doubled to 12,000 readers.Footnote ³³ By January 1956, volunteers regularly translated the paper into German, Spanish, Japanese, Italian, and French, with occasional issues in Chinese, Flemish, and Hausa.Footnote ³⁴

Figure 2. First issue of Around the World, January 1952.

The paper was edited initially by American Dorothy Hamilton Brush until 1956, when she resigned due to ill health and British doctor L.N. Jackson (husband of Dr. Margaret Jackson) took over. Both editors primarily obtained material for ATW by (1) scanning newspapers, scientific journals, and other published materials for relevant news stories; (2) drawing on IPPF fieldworker reports and information provided by the organization’s secretary, Vera Houghton; and (3) soliciting updates directly from local FPAs. Brush, in particular, had close relations with advocates around the world and tapped into these networks to obtain material.Footnote ³⁵ The result was a paper that featured an impressive geographical scope. Although around one-third of the articles published from 1952–62 covered broad issues relating to family planning, tracked new research and/or documented the activities of the IPPF, feature articles covered local developments in some eighty different countries (see Figure 3). As Brush noted in correspondence, she tried to represent as many countries as possible ‘to give people the needed impression that the movement is far more widespread than they think.’Footnote ³⁶

Figure 3. Countries featured in ATW coverage (1952–62).

The narrative constructed by the paper thus documented a broader set of interests and perspectives than we might see in other spaces in the same period. Coverage of United Nations population conferences and new state policies sat alongside intimate stories of local doctors, nurses, and social workers setting up small clinics and conducting outreach activities with mothers and communities. Through ATW and Brush’s broader personal archives, we see a vision of the family planning movement swept up by the post-war population panic, but also rooted in the longer tradition and rhetoric of maternalist humanitarianism, merged with attention to human rights, feminist critique, and the politics of decolonization.

‘Soft songs of love and suffering’: maternalist humanitarianism and the construction of an emotional community

The tone of Around the World was heavily influenced by its first editor, Dorothy Hamilton Brush, and her longer trajectory/vision of the movement. Brush described her involvement in the movement as, above all, ‘accidental,’ driven by experiences she had as a young woman volunteering at a Roman Catholic-dominated pre-natal clinic in Cleveland, Ohio in the early 1920s. As she wrote in an autobiographical article in 1957:

Through her work with the new Maternal Health Association of Cleveland, Brush met and befriended Margaret Sanger, accompanying her on a 1937 world tour as a ‘birth control missionary,’ and sitting on the steering committee for the 1946 IPPC conference in Stockholm.Footnote ³⁸ Brush also conducted several trips on behalf of the organization in the 1950s, through her role as ‘honorary fieldworker.’ When the IPPF launched ATW in 1952, Sanger saw Brush as the perfect person to ‘midwife’ the organization’s newest ‘child‘ into fruition.Footnote ³⁹ Brush also arranged for an annual grant to pay the basic expenses of ATW from The Brush Foundation for Race Betterment, an organization established by the Brush family in honour of Dorothy’s late husband, Charles F. Brush, a physicist with eugenic leanings.

Brush’s profile matched that of many IPPF fieldworkers and mid-level staff: a relatively privileged white woman with a background in maternal health and ties to eugenic and feminist movements. But the language she used to describe her engagement in the movement was also representative of a broader discourse prominent among family planning workers beyond the Anglo-American context. As evident in local-level studies and oral history collections, while eugenic, feminist, and population control discourses certainly held broad sway across the globe, many family planning advocates portrayed their work as driven primarily by an imperative to respond to suffering, rather than as part of any clear political movement or social agenda.Footnote ⁴⁰ Doctors, nurses, and social workers from Taiwan to Indonesia to Venezuela described themselves as having been ‘shocked into action’ after seeing patients struggle with health complications caused by multiple pregnancies, complicated childbirths, and self-administered abortions that had gone awry.Footnote ⁴¹ Some advocates drew on experiences within their own families. As Nurse Campbell of the Jamaica Birth Control League wrote in 1943:

Like Brush, many of these advocates mobilized religious metaphors, describing themselves as ‘missionaries’ who had been ‘converted’ to ‘the gospel of family planning’ through these experiences and their sense of duty as moral actors; others saw their work as part of their ethical responsibility as health professionals, or as a basic human response to the experience of witnessing suffering.Footnote ⁴³

With these narratives, family planning workers likened themselves to modern humanitarians, ‘moved to action by their identification with the suffering of distant others.’Footnote ⁴⁴ As scholars have noted, the history of humanitarianism has included both an ‘emergency branch’ focused on keeping people alive in times of crisis (such as the Red Cross and Doctors Without Borders) as well as organizations that developed broader poverty eradication and development programs aimed at addressing the root causes of suffering, such as Save the Children and Care International.Footnote ⁴⁵ What unites these different initiatives is the embrace of an ethical imperative to act driven by an emotional response, drawing on narratives of sympathy and empathy over ideological or political rationales. For humanitarians, the relief of suffering is portrayed as an end in itself, rather than a means to achieve a larger social agenda.Footnote ⁴⁶ Indeed, many humanitarians portray their work as essentially ‘apolitical’ and embrace an ideal of political neutrality as a fundamental operating principle.Footnote ⁴⁷ Similar to missionaries, humanitarians often share a sense of ‘transcendental significance,’ seeing their work as a ‘calling’ and part of a broader effort to construct a caring international community shaped by ‘common humanity.’Footnote ⁴⁸

As recent scholarship has stressed, women have historically featured heavily in humanitarian activism, not only as suffering victims and targets of humanitarian action, but also as humanitarians themselves. In addition to well-known humanitarians such as Josephine Butler and Florence Nightingale, female aid workers, nurses, social workers, and doctors served on the frontlines and formed the backbone of many twentieth-century humanitarian organizations. Female volunteers also did much of the unpaid work of these movements, knitting blankets for orphaned children, putting together supply packages for refugees, and leading fundraising activities.Footnote ⁴⁹ Many of these women found their entry into the field through a narrative of maternal responsibility, portraying themselves as the natural caretakers of victimized women and children, and appealing to feminized emotions of sympathy and maternal instinct. They also frequently concentrated their work in the fields of maternal and child health and welfare: opening maternity clinics, advocating for child welfare, facilitating child rehabilitation and adoption, distributing milk, and providing for poor mothers. In doing so, scholars have argued, they adopted a ‘maternalist’ approach to both emergency relief and longer-term development projects.Footnote ⁵⁰

In spite of the similarities evident above, historians of humanitarianism in general and maternalist humanitarianism in particular have rarely included family planning organizations within their scope. This may reflect the fact that some humanitarian organizations in the twentieth century distanced themselves in the international arena from the global family planning movement out of fear that such a divisive subject could harm their cause.Footnote ⁵¹ The links between maternalist narratives and family planning have been recognized by some scholars of the family planning movement, particularly when focusing on the interwar period. Sarah Hodges, for example, traces how early South Indian birth control advocates embraced a ‘maternalist biopolitics,’ and Aiko Takeuchi-Demirci argues that Sanger and her Japanese counterpart, Ishimoto Shidzue, mobilized a narrative of ‘maternalist pacifism and liberal internationalism’ in the 1920–40s.Footnote ⁵² This language of maternalism, however, has been tied to biopolitics, pacifism, and liberal internationalism, rather than the specific frame of international humanitarianism with its emphasis on emotion, ethics, and (the impossible ideal of) political neutrality. Scholars of the family planning movement have also largely agreed that any focus on women and maternal suffering was displaced after the Second World War by the widespread panic over rising population growth rates in the Global South and the emergence of the population establishment.Footnote ⁵³

The influence of the population panic is, indeed, evident in the ATW newsletter. As seen in Figure 4, it was the most frequently covered subject under both Brush and Jackson’s editorship.Footnote ⁵⁴ In the paper’s first number, Brush quoted ecologist William Vogt’s assertion that ‘[w]orld over population represents more of a threat to peace than the atom bomb’ and nearly every edition of the paper included a review of a new book or report documenting the rise of world population, a testament to the sheer explosion of literature on the subject during this period.Footnote ⁵⁵ But coverage in ATW also focused considerably on questions of family health and wellbeing, raising this aspect almost as frequently as population. Articles discussed the financial and emotional toll of childbearing on family life and situated this as a central concern of the movement. As the director of the IPPF South East Asia region Nicholas Read-Collins argued: ‘[s]uccess in this work was not measurable only in terms of population figures, but also in parental satisfaction and relief from worry which was not statistically measurable.’Footnote ⁵⁶ Many articles discussing the benefits to the family specifically stressed the issue of women’s health and well-being (71% under Brush and 50% under Jackson), focusing on the physical and mental burden of childbearing and the improved maternal health outcomes linked to child spacing. A multitude of articles discussed the widespread practice of illegal, unsafe ‘kitchen abortions,’ undertaken by women facing unwanted pregnancies, which could lead to sepsis or other serious complications.Footnote ⁵⁷ As evident in Figure 4, a significant number of articles also continued to cover developments in infertility research, suggesting a vision of family planning that was not reducible entirely to population limitation.

Figure 4. Most frequently mentioned themes under Brush and Jackson.

As scholars have illustrated, some IPPF advocates used the language of family health and well-being as a way to mask underlying eugenic or population control agendas; Blacker, for example, described this as a strategy of ‘crypto-eugenics.’Footnote ⁵⁸ Indeed, although Brush noted that eugenics had become something of a ‘touchy’ subject following the Second World War, coverage in the paper continued to discuss ‘genetic degeneration,’ often under the scope of ‘hereditary counselling.’Footnote ⁵⁹ But Brush’s papers illustrate that the imperative for attention to family welfare also came from member associations more firmly rooted in medical and social work traditions. Letters from local advocates around the world repeatedly called for ‘more emphasis in the bulletin on family health and less on over-population.’Footnote ⁶⁰ Fieldworker reports also frequently noted resistance from local associations and family planning workers to the population focus increasingly pushed in the political and international realm. Some advocates – from Africa to Asia to Latin America – argued that their countries did not have a population problem; others, that it was a question of unequal distribution rather than family size per se.Footnote ⁶¹ Many more saw the population question as simply secondary to their primary focus on health and welfare. Dr. Fahrettin Kenim Gokay of Turkey, for example, did not believe there was a population problem in his country but stressed the need for voluntary parenthood for ‘the welfare of the individual family.’Footnote ⁶² Doctor Percy Boland wrote from Bolivia that regardless of population rates, from ‘a physician’s point of view’ there was a need for family planning in his country, where mothers bore an average of twelve or more children and maternal mortality rates were high.Footnote ⁶³

As scholars of twentieth century maternalist movements have noted, if this language of family health and well-being could draw attention to women’s challenges, it could also reinforce conservative ideas of the family by naturalizing the nuclear family model and women’s primary role as reproducer.Footnote ⁶⁴ Indeed, Sandra Whitworth argues that the IPPF’s promotion of a depoliticized, heterosexual, two child nuclear family in its early years drew the focus of the movement away from the more disruptive language of the early birth control movement.Footnote ⁶⁵ While this is certainly evident in much of the coverage of ATW, a number of articles discussing sex and marriage did take a more liberal stance. An article on ‘The Status of Women’ in West Germany, for example, lamented the fact that ‘a married woman returning from work in the evening may have to forget 20 years of social progress as she enters the house,’ although it noted that this was changing as ‘a wife is becoming more of a partner and less of a servant.’Footnote ⁶⁶ In a book review, Jackson portrayed the argument that ‘a woman should completely own and control her own body whether within or without the matrimonial bond’ as a matter of common sense.Footnote ⁶⁷ Discussions of sex education within the IPPF could also be exceptionally bold for their time. The paper stressed the need to discuss sex ‘simply, clearly, without self-consciousness.’Footnote ⁶⁸ At one conference, Professor Tadeusz Bilikiewicz of Poland (commenting on the sex life of ageing populations) reportedly claimed that: ‘our sexual organs, like our brains, would function longer if kept in proper use!’Footnote ⁶⁹ Indeed, ATW was attacked at the time by the Vatican newspaper Osservatore Romano in November 1959 on the grounds that it promoted ‘propagandistic licentiousness,’ offended religion, and was a ‘foreign importation.’Footnote ⁷⁰

ATW also continued to tap into feminist discourses, praising advances in women’s rights around the world, including the new Hindu Code in India in 1956, the rising feminist movement in Egypt, and political support for the emancipation of women in Tunisia.Footnote ⁷¹ Explicit statements connecting family planning to women’s rights in ATW also came from around the world. Dr. Lin Yutang, vice-chancellor of Nanyang University in Singapore, for example, was quoted in ATW as saying that: ‘[a]ll emancipation of women is a mask and an illusion unless they are given the knowledge whereby they can plan their families wisely.’Footnote ⁷² Funmilayo-Ransome Kuti, founder of the Nigerian Women’s Union, reportedly regarded family planning as ‘a basic right of Nigerian women who bear a heavy economic burden and take full responsibility for the care of their children.’Footnote ⁷³ A group of Eastern European doctors at an IPPF conference in 1962 were apparently particularly adamant in stating that ‘birth control is both an instrument of women’s emancipation from fear and impossible of acceptance without that emancipation.’Footnote ⁷⁴ If this language had disappeared in certain spheres of the movement in the mid-twentieth century, ATW suggests it continued to hold appeal amongst the broader family planning community.

The IPPF and local associations also tapped into an emerging discourse of human rights and child rights. As Caroline Rusterholz points out, already by 1953 the IPPF had begun to recognize contraception as ‘a fundamental human right.’Footnote ⁷⁵ The argument that children had a ‘right’ to be purposefully brought into being was also an oft-repeated mantra in the paper. Again, this seems to have drawn at least in part on the language used by local member associations. ATW noted, for example, a poster on the wall of the All India Institute of Hygiene and Public Health claiming that adults had ‘the right for their own sake to separate the twofold functions of the sexual union,’ and that ‘children have an even better right to be brought into being…only if and when their births are whole-heartedly desired and conscientiously provided for.’Footnote ⁷⁶ The FPA of Ceylon similarly argued in its annual report that planned parenthood was, above all, ‘a humanitarian programme serving individual people,’ noting that ‘doctors, sociologists, philosophers, humanitarians, and religious leaders agree that it is the basic right of parents to have babies only when they want them. A child’s first birth right is to be wanted.’Footnote ⁷⁷

ATW merged this language of rights with the traditional emotional repertoire of maternalist humanitarianism, making the case for family planning on the basis of compassion, empathy, and love as much, if not more so, than through an appeal to a rational discourse of population management. While the paper regularly published population statistics at the beginning of its articles on local countries, Brush published an op-ed in the second volume of the paper reminding readers that ‘The Masses are People,’ made up of individuals who should not be regarded as an abstract entity. ^{Footnote 78} The editors of ATW also spoke of the ‘desperate letters from hard-pressed parents’ they received and occasionally published them in the paper.Footnote ⁷⁹ One, from a ‘Nicaraguan mother,’ read: ‘I am badly in need of your help. I am thirty-two years and have six children under 12. My privation is very great. My husband is but a humble carpenter, wages low. Please assist me!’Footnote ⁸⁰ A letter from a man in India noted that he and his wife had an ‘undesired son’ and were seeking the ‘100% safest methods of birth control,’ noting that abstinence was no remedy ‘for a young couple like us who love each other most heartily.’ ^{Footnote 81} The paper also covered the emotional content of IPPF conferences as much as the scientific findings. In a report on an IPPF conference in 1953, for example, ATW reported how Japanese nurse Chimo Mashima broke down into tears recounting the desperate situation of women facing multiple abortions; attendees left ‘with the plea ringing in their hearts.’Footnote ⁸² At a regional conference in Puerto Rico in 1954, a ‘Spanish girl’ sang ‘soft songs of love and suffering’ that ‘echoed the unspoken message of our movement – human love should not be penalized by human suffering.’Footnote ⁸³ Indeed, Brush claimed that IPPF conferences could take on ‘a truly spiritual atmosphere,’ due to the passion and emotional draw of the family planning cause.Footnote ⁸⁴

Scholarship on humanitarianism has stressed the power of mobilizing empathy; as Wilson and Brown note: ‘[a]ffect binds us together as much as laws and political institutions.’Footnote ⁸⁵ Ilaria Scaglia argues that this mobilization of emotion was essential to many internationalist projects of the twentieth century, which sought to build ‘emotional communities’ bound together by shared feeling and a common emotional stylistics as much as through more formal mechanisms.Footnote ⁸⁶ Indeed, Sanger attributed ATW’s success primarily to the warmth of Brush as editor, ‘whose love for this work pulsates throughout each issue.’Footnote ⁸⁷ Sanger, Brush, and others also lamented the somewhat less emotive approach taken by Jackson after he took over the paper in 1957. In an editorial in 1960, for example, Jackson argued that while on the family level the movement was ‘primarily a matter of the heart,’ on the global level it was ‘very much a matter of the head, for when man is trying to prescribe for the betterment of humanity he must use his reason.’ ^{Footnote 88} In spite of his personal proclivities, however, the paper’s coverage of the movement’s female leaders continued to illustrate the blending of heart and head at the global level. Swedish advocate Elise Ottesen-Jensen, who took over the presidency of the IPPF in 1959, for example, continually reminded people that ‘“statistics” referred to living human beings who could rejoice and suffer.’Footnote ⁸⁹

ATW also painted a portrait of a global family planning movement that continued to be dominated by women’s work at its core (see Figure 5). The various presidents of the organization received much of this attention: Sanger purportedly inspired large crowds around the world and admirers marveled at Rama Rau’s ability to ‘do all she does and yet remain so serene and poised.’Footnote ⁹⁰ Ottesen-Jensen was described as a ‘human dynamo’ with ‘boundless energy,’ and even as ‘something of a prophet, who speaks this gospel [of family planning] in six foreign tongues.’Footnote ⁹¹ But local birth control pioneers were also regularly highlighted in ATW and the reports of international fieldworkers. There was ‘the indefatigable Dr. [Siva] Chinnatamby’ in Ceylon; Dr. Hameda Malik, the ‘Mother of Family Planning in Dacca;’ ‘dynamo of energy’ Dr. Celestina Zalduondo in Puerto Rico; and ‘cheerful, enthusiastic Dr. Lotte Fink,’ who escaped Nazi Germany for Australia. ^{Footnote 92} Perhaps the most inspiring tale was that of Dr. Hoon Pierra Vejjabul, who left Thailand for Paris as a young woman against her parents’ wishes, washing dishes in hotels to pay for medical school. Upon returning to Bangkok, she advocated for birth control access while also running an institute that housed forty abandoned children she had legally adopted. ^{Footnote 93}

Figure 5. ‘Six Great Women of international family planning’. Listed: Mrs. Goh Kok Kee, Singapore; Mrs. Margaret Sanger, U.S.A.; Mrs. Elizabeth M. Jolly, Hong Kong; Mrs. Elise Ottesen-Jensen, Sweden; Shrimati Dhanvanthi Rama Rau, India; Mrs. Shidzue Kato, Japan.Footnote ⁹⁴

Through these descriptions, ATW drew on a ‘narrative of heroics’ common to humanitarian propaganda.Footnote ⁹⁵ These narratives have been rightly critiqued for their tendency to gloss over the more complex personal biographies of individuals: for some of the women in family planning, this included connections to the eugenics movement. But the emphasis on these women in IPPF records also reminds us that, if conferences in Rome and board meetings in New York on the subject of population had been taken over by men after the Second World War, women continued to feature heavily in the family planning movement in other spaces. As with maternalist movements more broadly in this period, this included a disproportionate number of white European and American women abroad.Footnote ⁹⁶ Some had missionary backgrounds, such as Mrs. H.B. Amstutz, wife of the Methodist Bishop of Southeast Asia, who addressed organizations in the region on the subject of family planning.Footnote ⁹⁷ Others, such as Barbara Cadbury, who sent in materials and occasionally wrote for ATW, represented a new brand of socially active wives of United Nations bureaucrats.Footnote ⁹⁸ But these international advocates were not engaged directly in delivering contraceptive services, a domain dominated by local doctors, nurses, and social workers, a majority of whom were women.Footnote ⁹⁹ Most local organizations also relied on a veritable army of (mostly female) volunteers, who hung posters, contacted patients, filed records, and reached out to potential members. They organized fund-raising campaigns: tea parties, dances, lectures, Christmas cards, raffles, and thrift shops.Footnote ¹⁰⁰ As ATW noted: ‘[o]f the devoted field workers in family planning, we hear too little. Their reports – like their lives – are concentrated on the plight of those they serve. Only in letters do we ever glimpse personal hardships and then tossed off with humor.’ ^{Footnote 101} The paper tried to rectify this by covering even the most seemingly mundane aspects of activism, illustrating the daily labour involved in constructing both local and international movements.

The appeal of this message is evident in excerpts from letters written to Brush in the early years of the paper. Dr. Marui Rouhunkoski of Finland, for example, wrote that the newsletter meant a great deal ‘to people like myself who work in comparative isolation. Its regular arrival gives us contact with others who have the same interests and we no longer feel alone.’Footnote ¹⁰² Although the majority of these letters came from the USA, UK, and India, letters from Malaysia, Chile, Italy, Haiti, France, Kenya, Pretoria, Belgium, Canada, Japan, Switzerland, Puerto Rico, and Australia suggest the newsletter’s vision held broader appeal.Footnote ¹⁰³ Brush’s correspondence also illustrates the role of gift-giving and favours in cementing ties among advocates. Brush received dresses and paintings from Italian advocate Vittoria Olivetti and added two hearts to her charm bracelet to represent Olivetti’s twins, calling them her ‘adopted grandchildren.’Footnote ¹⁰⁴ She sent a raincoat to Purai na Bangxang of Thailand who in turn sent her jewels, silk, and a sapphire, while appealing to Brush to help her son settle in the United States.Footnote ¹⁰⁵ Brush attended Singaporean Goh Kok Kee’s daughter’s commencement at Oberlin college and called Tze-kuan Shu Khan of Taiwan her ‘adopted daughter.’Footnote ¹⁰⁶ In doing so, these actors illustrated how international relationships were cemented through affective ties, gift giving, and regular correspondence in addition to formal associational memberships and conferences. Indeed, as Sasson argues, the global idea of humanity ‘could be produced in the most local and intimate spheres of everyday life, as much as it could take place in national and international spaces.’Footnote ¹⁰⁷

By tapping into narratives of empathy and suffering and mobilizing local women’s volunteer work, mid-twentieth century family planners continued to locate their work within a tradition of maternalist humanitarianism, although one which was compatible with feminist principles and a broader concept of human rights. In Mary Ladd-Taylor’s classification, family planners might fit best within a tradition of ‘progressive’ maternalists committed to more liberal causes rather than ‘sentimental’ maternalists with traditional or religious leanings.Footnote ¹⁰⁸ Still, in some places, these points of connection and crossovers in personnel appear to have fueled direct cooperation even with more traditional humanitarian organizations that distanced themselves from the cause on the international stage. Local chapters of the Red Cross, for example, reportedly supported family planning work in Poland, South Africa, and El Salvador, and the family planning clinic in Southern Rhodesia operated out of the Red Cross Centre in Harari Township.Footnote ¹⁰⁹ In Nairobi, the local FPA screened films at the Young Women’s Christian Association (YWCA) and held a booth at World Health Organization (WHO) conferences.Footnote ¹¹⁰ Indeed, although the WHO did not openly support family planning until the late 1960s out of concern for opposition from Roman Catholic countries, these records suggest that some local representatives collaborated unofficially.Footnote ¹¹¹

Brush’s papers thus illustrate how personal bonds and a language of maternalist humanitarianism could cut through some of the intense political divisions operating on the international stage during this period. Indeed, if prominent advocates and philanthropists during this period had become keen political strategists, IPPF fieldworkers, and local advocates alike often saw themselves as operating outside of the realm of politics, mobilizing a language of global humanity and an ideal of political neutrality to affirm their distance from the geopolitical conflicts dominant in other spaces. As discussed in the next section, this discourse allowed ATW to present a unique vision of global struggle that challenged traditional hierarchies in some areas. This discourse, however, was undermined by colonialist mentalities and concepts of racial superiority that continued to shape the practice of international movement building, as well as the very real political conflicts that shaped their work in spite of – or perhaps precisely because of – their proclaimed political neutrality.

Estranged daughters and the impossible ideal of political neutrality: tensions of the maternalist humanitarianism project

If the tradition of humanitarianism has provided a powerful international mobilizing force in the past century, critical studies have pointed to a series of contradictions underlying its core principles of compassion, global humanity, and political neutrality. As Michael Barnett notes, compassion can easily transform into paternalism, with self-appointed caretakers justifying the violation of an individual’s liberty for the sake of their own perceived welfare and interests.Footnote ¹¹² Humanitarianism also has deep ties to colonialism and imperialism: discourses of humanitarian need have been mobilized to justify imperial interventions, while humanitarian organizations have historically cooperated with European colonial states, providing the daily labour undergirding the paternalistic ‘civilizing mission.’ Indeed, Susan Pederson describes British women’s maternal and child welfare work abroad as a form of ‘maternalist imperialism,’ serving as ‘the feminine component of the ideology of trusteeship.’Footnote ¹¹³ Narratives of ‘global humanity’ may also continue to reinforce Western-centric assumptions that unite the world primarily around European or American models.Footnote ¹¹⁴ Efforts to portray humanitarianism as an ethical or technical project can further fail to recognize that any intervention into the lives of others is inherently a political project, with political implications. The humanitarian narrative can even stymie the articulation of political solutions, by channeling energy towards ‘emotional responses to victims’ rather than broader movements for political change.Footnote ¹¹⁵

While these critiques have gained more visibility within scholarship in the past few decades, Brush’s papers remind us that anti-imperialists were already making many of these points in the immediate post-war period, and humanitarians were already attempting to respond to them. As Brush wrote in her coverage leading up to the Bombay conference in 1952: ‘We of the West are going to the conference to offer our “know-how” but also to learn. We are not going to impose it….The West needs to learn as well as the East.’ She quoted Indian philosopher Sir Sarvepalli Radhakrishnan as saying: ‘None of us has been appointed to educate humanity.’ ^{Footnote 116} Brush echoed this sentiment in a fieldwork report from the late 1950s, noting that: ‘[p]robably due to the rise of racial nationalism, the Lady Bountiful approach is obsolete…People no longer expect us to organize…they want to do it themselves.’ Local leaders, she noted, were ‘high calibre, well-educated,’ and mostly seeking access to materials and shared experiences, rather than leadership.Footnote ¹¹⁷ In a letter to a professor in Ghana, she noted that ‘[t]imes have changed entirely and it is a very good change. The International Planned Parenthood Federation does not impose its ideas on anyone…As a rule we do not go into any country except on invitation or where we have reasons to believe that different individuals would welcome us.’Footnote ¹¹⁸ Other IPPF members similarly argued against aggressive international intervention or universalist approaches. Dr. Edris Rice-Wray, an American based in Mexico in the 1950s, for example, critiqued those who might think that ‘whatever was done in the United States or other parts of the world could be picked up as a package and repeated here…unless we direct our program in accordance with the needs of the people and their particular desires, and what they think is important, we fail before we start.’Footnote ¹¹⁹

In fact, ATW questioned whether the USA, or the West more broadly, really had much guidance to offer in the field of family planning. Asian countries were generally portrayed as more advanced in this realm, due to the early endorsement of family planning and its incorporation into government health services, starting with India in 1952. ^{Footnote 120} Governments in Ceylon (Sri Lanka) and Pakistan followed suit in the early 1960s, meeting the approval of the paper. As Brush noted: ‘The most exciting change for the future of planned parenthood is the emergence of brilliant leadership in most of the Asiatic countries.’Footnote ¹²¹ Egypt also received ‘resounding “Bravos” from all over the world’ for endorsing birth control in 1956 and financing the creation of family planning clinics.Footnote ¹²² Several other colonies and newly independent countries were further commended either for the leadership taken by their governments (as in Barbados, Mauritius, and Puerto Rico), or their particularly strong/innovative FPAs (as in Singapore, Hong Kong, South Africa, Kenya, and Jamaica).

The United States, in contrast, was chastised for its slow progress: although most large cities had private family planning clinics by 1952, only eight states incorporated it into public health services and contraceptives remained banned in the two ‘backward states’ of Massachusetts and Connecticut.Footnote ¹²³ This was deemed particularly problematic by the paper because of the ‘startling population boom’ in the USA following the Second World War.Footnote ¹²⁴ Indeed, in contrast to claims that there was a ‘clear shift’ in the movement in the 1950s to focus on the ‘Third World’ as the site of over-population and family planning intervention, ATW continued to devote space to population growth in the USA and focused much of its coverage on ‘backward’ countries in Europe.Footnote ¹²⁵ Sometimes this categorization was based on sweeping generalizations about cultural patterns; after receiving a letter from one Greek reader, for example, Brush concluded that ‘so far as we can discover, Greece knows nothing of family planning.’Footnote ¹²⁶ Most of the countries in this category were considered backward, however, on the basis of hostile governments or the influence of the Catholic church. Italian and French governments, for example, continued to ban any publicity surrounding birth control in the 1950s, making even private, voluntary FPAs difficult to operate.Footnote ¹²⁷ The only real leader among ‘the West’ appeared to be Sweden, which had, the paper noted, ‘the most comprehensive population policy undertaken anywhere in the world.’Footnote ¹²⁸

This vision likely enhanced the appeal of the paper – and the IPPF more broadly – to family planning advocates around the world who saw their work recognized and placed on par, or even above, states with more international power in other spheres. Still, paternalist and racist colonial discourses continued to crop up in the coverage of ATW. Brush described voodoo religious ceremonies in Haiti as ‘barbaric’ and published articles on the ‘primitive’ beliefs in areas of Africa that clearly situated the populations of these countries – if not their family planning advocates – on a racist civilizational scale.Footnote ¹²⁹ At times, coverage of women’s rights in the paper replicated the tropes of ‘feminist Orientalism,’ focusing on ‘exotic’ practices such as child marriage, polygamy, the veil, and purdah, and/or attributing gender inequality to ‘medieval’ local practices.Footnote ¹³⁰ The paper also downplayed the tensions surrounding decolonization, claiming for example that Ceylon achieved its independence from Britain ‘with hardly a pinprick of exasperation on either side’ and describing the controversial intervention of Britain in Guyana in 1953 as ‘necessary.’Footnote ¹³¹ Jackson also appeared less concerned with challenging Western claims to superiority than Brush. For example, responding to arguments that Western nations should not ‘preach or impose birth control’ on other countries but rather let them take the lead themselves, Jackson wrote in ATW: ‘If this is true we must expect that, in many cases, little will be done.’Footnote ¹³²

Internal correspondence also illustrates the deeply rooted nature of racist attitudes and the tensions they could provoke between IPPF staff and local advocates in practice. Although these incidents were often elusively referred to as ‘friction,’ some local actors were frank in calling out the patronizing or racist attitudes of IPPF advisors.Footnote ¹³³ Goh Kok Kee, for example, wrote to Brush in the mid-1950s that one particular IPPF director for the Southeast Asia region held ‘warped’ attitudes towards Asian people and would do ‘a great deal of harm to our cause’ if not removed (he was).Footnote ¹³⁴ Several local actors – including Sylvia Fernando of Ceylon and Beth Jacobs of Jamaica – also complained about statements made by C.P. Blacker which they saw as marginalizing their role in the movement or creating double standards between countries. Blacker responded defensively in a letter to Brush, complaining that ‘I will be afraid soon to say anything at all!’ ^{Footnote 135} While Brush generally defended local advocates in these affairs, she did so in ways that revealed her own deeply rooted sense of racial superiority. In one letter, for example, she described her efforts to seek solutions ‘whenever I think my little brown brothers may get brushed off either accidentally or on purpose.’Footnote ¹³⁶ In spite of the claims to partnership and equality evident in ATW, Brush and other international fieldworkers clearly saw themselves as superior to and in a parental role above local advocates.

The close bonds Brush formed with local advocates could also be stressed by political tensions. In 1959, for example, Brush found herself in a row with Tze-Kuan Shu Kan when the FPA of China (located in Taiwan) refused the IPPF’s recommendation to change its name to the ‘FPA of Nationalist China’ to avoid confusion with Communist China. Writing to ‘my dear adopted daughter,’ Brush quickly added: ‘Perhaps I shouldn’t call you that anymore!’ She expressed her shock that there had been no change in the name since their last meeting, and implored Tze-Kuan: ‘for the sake of our friendship, won’t you at least write and explain.’ ^{Footnote 137} Tze-Kuan responded by noting that although ‘Nationalist China’ was used in foreign newspapers, the Taiwanese government had ruled that ‘The Republic of China’ or simply ‘China’ should be used. She held firm that the association would not change the name ‘merely for facilitating our admission to IPPF’ and felt that it was ‘entirely unjustified for IPPF to take its present attitude toward our Association.’ ^{Footnote 138} Although the two appear to have reconciled in later years, the dispute illustrates the very personal tensions that could form due to international fieldworkers’ ignorance surrounding the finer points of local politics and sense of entitlement to determine the direction of the movement from abroad. ^{Footnote 139}

The incident also reveals the fundamental difficulty – impossibility, even – of maintaining the humanitarian ideal of political neutrality in a politically complex world. This tension often came to a head in ATW and the IPPF’s treatment of communist regimes, which vacillated between condemnation and attempts to form bridges across the Iron Curtain. Both Brush and Jackson were critical of early Marxist regimes that portrayed ‘over-population’ as a capitalist façade and family planning as a false panacea. Brush commented sarcastically in the paper on communists who sang ‘their same old song of the heaven on earth at home’ and Jackson argued that China’s population growth illustrated that ‘Marxism has so far failed to find the answer.’Footnote ¹⁴⁰ However, both covered communist regimes more favourably when they shifted course to promote family planning, as most did over the course of the 1950s–70s. For example, the paper praised the integration of contraception into health services in the Soviet Union, Hungary, and Czechoslovakia in the 1950s, and IPPF representatives visited these countries to provide advice and support.Footnote ¹⁴¹ The IPPF also invited representatives of communist China to their conferences on the grounds that ‘the population-control movement is international in scope and not subject to politics.’^{Footnote 142}

The paper also wavered its treatment of more aggressive state-led population programs initiated in several countries in the 1960s. On the one hand, annual reports and conference speeches repeatedly stressed that the IPPF was ‘strongly opposed to any method of family limitation being forced on people.’Footnote ¹⁴³ And yet, ATW praised state programs, particularly in Asia, for their ‘leadership,’ even as they turned to increasingly aggressive tactics such as mass sterilization or IUD insertion camps. To be sure, some IPPF stalwarts expressed concern from early on; according to an article in 1959, for example, Lady Rama Rau argued against the use of incentives for sterilization patients in India or the paying of extra fees for social workers who brought in volunteers. She warned that ‘extraordinary precautions’ had to be taken to avoid the exploitation of the poor in family planning programs.Footnote ¹⁴⁴ But the paper did not delve into the details of these tensions within the movement, or spell out clearly where the line should be drawn between coercion and free will. Sometimes, an article on the importance of free choice lay in the same issue as one about the need for aggressive sterilization programs, without ackowledgment of the inherent contradictions between these goals. As would become apparent in the following decades, political neutrality was not entirely compatible with the principles of care and rights at the core of the maternalist humanitarian tradition.