Fighting for Child Health: Race, Birth Control, and the State in the Jim Crow South

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In the mid-twentieth century, North Carolina's public medical services were the envy of public health practitioners nationwide. A centerpiece of the state's program was the nation's first state-run birth control program, established in 1937. The program offered pre- and postnatal care as well as access to contraceptives to indigent women. Feminists, civil rights advocates, and historians have contentiously debated the motivations of both proponents and recipients of birth control in the Southern context. Some have held that birth control programs were motivated by racism and a defense of class distinctions. Others have argued that the vulnerable position of black and poor white patients resulted in their exploitation as research subjects. Analyses of these public health efforts assume that the birth control program worked to the detriment of black and poor white interests. A closer examination of North Carolina's birth control program reveals, however, that black health and social work professionals as well as black and poor white clients welcomed the services, participated in them, and helped shape the contraceptive programs offered by the state. Although the programs were often steeped in race and class prejudices, both black and poor white women took advantage of the contraceptive services and quickly responded like educated consumers, making decisions about the continued use of birth control according to their satisfaction with the services provided. Clients and black health care professionals had their own interest in the services, often unanticipated by public health and welfare officials.