the Female Body GOVERNING

The Pill in Puerto Rico and the Mainland United States 163
serve working-class people (Roberts, 1997). In the 1920s and 1930s,
as Margaret Sanger, the American Birth Control League, and other
organizations tried to popularize the diaphragm as the most effective
method available, scientists and organizations such as the Rockefeller
Foundation argued that for working-class and colonized people—who
by defi nition were understood to be not very bright—spermicides and
other similar methods would be simpler and easier to use. In the United
States, a principle promoter of this position was Robert L. Dickinson
and his National Committee on Maternal Health (NCMH). As Dickinson
wrote, “The requests which our Committee receives from foreign
lands like China, India, and the Near East and from some of the slum
districts here stresses the need of protection much more simple than
the vaginal cap [diaphragm], or even...jelly” (R. L. Dickinson to Hon.
Mrs. M. Farrer, personal communication, July 19, 1927). As the Great
Depression wore on in the 1930s, Clarence Gamble, also a member
and supporter of the NCMH, took this orthodoxy to the working-class
whites in the Southern Appalachians and Puerto Ricans on the island,
arguing that spermicidal foam was the answer to their economic woes.
In 1936, over the objections of members of the American Birth Control
League, Gamble closed down diaphragm clinics in Puerto Rico and
substituted house-to-house canvassing by fi eld workers equipped with
foam powder and jellies (Briggs 2002). Social workers who had previously
worked in the program found the shift distasteful; Gladys Gaylord
wrote him that “my experience in Puerto Rico leads me to believe that
it would be unwise to use any but the most approved methods. When I
was there, [we] were loathe to back anything that was not guaranteed a
high percent of success . . . in the critical situations which come into the
clinic.” As Gaylord noted, Gamble knowingly substituted a fairly effective
method for one known to be much less so (G. Gaylord to C. Gamble,
personal communication, October 26, 1936). Nevertheless, Puerto Rican
physicians and birth control activists, unable to raise suffi cient funds for
clinics without help from the mainland, ultimately acceded to Gamble’s
wishes.
In the 1940s and 1950s, researchers’ ideologies of what kinds of
birth control were best for working-class and colonized people changed,
although the notion of a two-tiered system of contraception did not.
As eugenic fear of the feeble-minded poor gave way to anxiety over
the explosive danger of overpopulation, the dominant characteristic
of the birth control method needed shifted from “simple” to “strong.”
During this period some physicians began to advocate sterilization,
not merely for institutionalized women, but for working-class women
generally (efforts in Indiana and California were made to vasectomize