Clarence Gamble - Tension and Disagreement in The Field

Tension and Disagreement in The Field

As the field expanded, tensions arose among PPFA, IPPF, the Population Council, and Clarence Gamble. Many in these organizations regarded Dr.Gamble’s simple methods and straightforward approach with disdain; his appointment of nonmedical personnel (and women over 50) as fieldworkers, unprofessional; his travels through Asian countries, patronizing; his intrusion into areas staked out by IPPF as their own, intolerable. This was the attitude of Lady Bengal Rama Rau, charismatic chair of IPPF and leader of its India Ocean region, and of Helena Wright, powerful medical director of IPPF. Declaring themselves highly sensitive to the years of oppression waged by white colonists, Rama Rau, Wright, and IPPF maintained that women of whatever color deserved the best that Western medicine could offer—in this case birth control provided by a fitted diaphragm after a preliminary exam by a professional gynecologist.

From Clarence’s perspective, IPPF ignored the reality faced by women wanting to be fitted for a diaphragm. He advocated that health workers could be trained to fit diaphragms. His idea sparked controversy because of the implications that it was appropriate to use different standards of care for women in the developing world than for women in the developed world. While provoking disagreement, Clarence’s pragmatic approach reflected the reality of patient-to-physician ratios, which in 1947 was estimated to be 6,000:1 in India, making it impossible for physicians to meet patient demand for diaphragms.

IPPF maintained that white Europeans should not go uninvited into foreign countries to offer birth control information, but as Clarence knew well, many undeveloped countries did not know what birth control was. Unless education and exposure created the demand for birth control, neither the government nor community groups would ever provide it. And so for his efforts, his dedication, his time, and his money, Clarence originally received little thanks from many in the professional birth control community.

At the 1955 Tokyo IPPF conference, which he had helped to organize in committee beginning in 1953, and to which he contributed $3,000, he was refused admittance to most of the conference sessions. The reports of his fieldworkers were dismissed as mere “travelogues.” “Here at the conference,” wrote Clarence, “the isolation of our team seems complete.”

The Japanese, on the other hand, expressed great gratitude. Dr. Kageyasu Amano acknowledged that it was Clarence who had brought together the roughly 30 Japanese birth control groups into a cohesive organization. At the celebratory dinner for Margaret Sanger on the last night of the Tokyo conference, the Japanese awarded Clarence the Margaret Sanger Trophy, a silver loving cup 18 inches tall, inscribed, “Clarence J. Gamble, the Benefactor of the Family Planning Movement in Japan.”

The Margaret Sanger Trophy was an especially appropriate award for Clarence. Over the years, his relationships with Robert Latou Dickinson and Margaret Sanger were warm and professional. Clarence worked closely with and financially supported Dickinson’s National Committee on Maternal Health until Dickinson’s death in 1950. Clarence gave both financial support and time to Margaret Sanger’s Clinical Birth Control Research Bureau.

After the IPPF Japan conference, Clarence, accompanied by his oldest son, Richard, visited the doctors who had agreed to test the simple methods. Their results were encouraging: typically a reduction from 70 to 20 pregnancies per 100 couples per year. On that first Asia trip, Clarence and Richard promoted birth control in 13 countries, including Singapore, Hong Kong, and Burma, and assisted local leaders in forming family planning associations in Pakistan, Bangladesh, Sri Lanka, Thailand, and Japan.

From 1954 through 1956, Clarence was traveling constantly, visiting and revisiting over a dozen countries on each four- or five-month trip, laying the groundwork for the availability of birth control throughout Asia. Whether traveling or remaining in the States, “Clarence Gamble,” as one distressed IPPF worker wrote, “was everywhere and into everything.” But the task needed more workers.