Clarence Gamble - National Expansion, State By State

National Expansion, State By State

He was also convinced that there should be many more birth control clinics. “The best way to get a birth control program started,” he wrote, “is to put a field worker on the spot to get things organized and operating while I contribute the needed initial expense.” He hired Elsie Wulkop, a social worker whom he had known at Massachusetts General Hospital. She began work in Detroit in 1930 and during the next four years helped to open clinics in Michigan, Indiana, Missouri, Kansas, and Nebraska.

Throughout the late 1930s, always with an eye to strengthening the US birth control movement, Clarence Gamble urged the unification of Margaret Sanger’s Clinical Birth Control Research Bureau with the competing American Birth Control League. In 1939, the two organizations became the Birth Control Federation of America.

As he worked to expand access to birth control, Clarence followed a pattern of careful spending, making grants just sufficient to allow a clinic to open, and at the same time moving in response to local politics. He did not have a fortune the size of the Rockefellers; he was both unable to and uninterested in permanently subsidizing the impoverished. Working with a public often upset by birth control, he made sure that his fieldworkers educated the community to the point where members understood the importance of contraception, and would thus be willing and able to take over the work and its costs without further outside assistance. Clarence was then able to explore new frontiers and disseminate the workings of birth control more widely.

With his carefully calculated cash outlays, Clarence planted seeds that years later flourished. He funded early research for the Southeastern Pennsylvania League’s work to identify effective spermicidal jellies. After the American Medical Association (AMA) acknowledged in 1937 that contraception merited a physician’s attention, Gamble’s research became the basis of the AMA Standards Program for testing contraceptives—which was the measure of the AMA for endorsing contraceptive products, and finally the basis for state and federal legislation.

In 1937, he began to fund education and distribution of birth control supplies through the North Carolina State Board of Health, making North Carolina the first state to incorporate birth control in a public health program. This influenced five nearby states—South Carolina, Alabama, Florida, Mississippi, and Virginia—to incorporate birth control into their public health programs.

Throughout the 1930s, Clarence’s time was devoted to working with existing birth control organizations, often holding overlapping executive positions. He was president and delegate-at-large of the Pennsylvania Birth Control Federation; state delegate, one of five vice-presidents, and member of the Executive Committee of the Board of the American Birth Control League; medical field director of Margaret Sanger’s Birth Control Clinical Research Bureau; and treasurer and member of the board of Robert Dickinson’s National Committee on Maternal Health. By 1938, Clarence had left Philadelphia and the University of Pennsylvania. He purchased a house outside of Boston, Massachusetts, and funded eight field workers who were nurturing the beginnings of community-supported birth control clinics in Montana, Tennessee, Virginia, Florida, throughout the East Coast, and in the Midwest. During this decade, Clarence and his fieldworkers were responsible for helping to establish birth control clinics in 40 cities in 14 American states.

Dr. Gamble and his workers explained and promoted simple methods—not the expensive and often impractical diaphragm, but spermicidal jellies, foam powders, sponges to be dipped in salt or other inexpensive solutions—to women who otherwise would never have known of nor been able to afford contraceptives. At the same time, he recognized the need for scientific data to back his promotion of the simple methods, and he set up extensive clinical trials, with his visiting nurses collecting data that measured the effectiveness of the simple methods. Again and again, it was shown that birth rates were reduced by as much as two-thirds or more using these simple methods.

In Logan County, West Virginia, Clarence conducted the most thorough field trial of a chemical contraceptive that had ever been undertaken in the United States. The trial involved 1,345 women who used contraceptive jelly over a three-year period, from June 1936 to August 1939, and decreased their birth rate by 41 percent.