While white reformers like Sanger generally emphasized cleansing allegedly unworthy heritable material from the gene pool, Black reformers of the professional classes overwhelmingly embraced eugenics as a method to improve the alleged quality of the Black population. Theirs was a third position, distinct from both white supremacists like Stoddard and Davenport, and Sanger’s white feminist eugenics. Ferebee and famed scholar and National Association for the Advancement of Colored People (NAACP) founder W. E. B. Du Bois objected to violent, cleansing strategies like sterilization. For them, encouraging the reproduction of the fit was the most important aspect of eugenics, for it formed a tactic for uplifting the race. Dr. Ferebee, for her part, endorsed the existence of superior and inferior physical types and advised progressive women that it was their duty to proliferate the superior. At her 1928 Baltimore speech, her biographer Diane Kiesel relates, Ferebee “urged women to seek for themselves mates of the highest type in order that the best possible heritage might be handed down to posterity.” It was a common sentiment among fellow Black elites: eugenic marriages would allegedly improve the physical and mental condition of the race. When Du Bois was president of the NAACP in the 1920s and 1930s, he funded the organization’s antilynching campaign through hosting “prize baby contests” for middle-class Black families who birthed “fit” children. Within three years, over half of the three hundred local NAACP branches held these contests; within six years, the pageants raised over $80,000. At the same time, Du Bois protested sterilization and other measures of state violence that removed personal autonomy.37
In the 1920s and 1930s, Du Bois and Dr. Ferebee were two of the most visible Black campaigners for birth control, and both would join Planned Parenthood’s Negro Project in the 1940s, which aimed to bring contraception to Black women in the South. For them, birth control and “better” marriages were part of larger public health and racial uplift campaigns. Yet eugenics by any method is deeply harmful, for it transforms human variation into the mark of “superior” and “inferior” hereditary material. That eugenics of any kind could be folded so easily into uplift ideology further points to the elitism lurking in the core of its doctrine.
Regulating birth was only one aspect of Dr. Ferebee’s multipronged approach to racial uplift. She folded birth control into her broader goal of improving Black public health during a time in which she was one of fewer than 130 Black women physicians in the entire country. In addition to her clinical and instructional positions at Howard and raising her young twins, she felt a strong calling to serve the race in the Black clubwomen’s tradition. In 1935, while still head of the board of directors of the Southeast Settlement House, Ferebee helped launch one of the nation’s most significant efforts to bring healthcare to impoverished African Americans. Alpha Kappa Alpha (AKA), the prominent Black sorority to which she had belonged since medical school, hosted the Mississippi Health Project, a summer healthcare clinic for sharecroppers in the Delta. Ferebee became the project’s medical director and its principal steward, organizing fundraising, logistics, and volunteers while lobbying local and federal health authorities to bring healthcare directly to fieldworkers in the middle of the Great Depression.38
In the summer of 1935, Ferebee recruited a dozen volunteers for the Mississippi Health Project’s first trip south. They refused to ride in the soot-ridden Jim Crow cars, always located just behind the coal-fired steam engine, and instead drove a caravan of four vehicles over eight hundred miles south in the July heat. In addition to the lack of air conditioning, driving that distance through the segregated South was no easy task: restaurants, lodging, and even gas stations often refused to serve Black customers, and the roads deteriorated into gravel and mud the farther south they reached. The group stayed with friends or at Black colleges along the way and arrived in Holmes County four days after departing Washington.39
Ferebee’s plan was to establish five temporary clinics in Holmes County, one of the poorest regions in the United States. But when they arrived, a dozen plantation owners learned of the project from county health officials and shut it down. Local health authorities complied with the wishes of the richest residents to prevent their workers from accessing basic medical care. “Here we were, in Mississippi,” Ferebee recalled, “with all the materials and drugs that we had bought, all the things necessary for the health of young children, and [we] couldn’t use them.” One plantation owner did consent to allow the hundreds of people who worked his fields to receive healthcare services, but only on one condition: under no circumstances would the laborers be permitted to leave his property. In many respects, sharecroppers in the 1930s were no more free than their enslaved ancestors had been. Throughout the plantation South, more than 99.5 percent of Black adults had never even cast a ballot in an election.40
The AKA clinic would have to come to the cotton fields. The caravan from Washington now proved providential: the cars became the clinics and Ferebee and her team created the very first mobile health clinic in the United States. Six days a week, they left at five o’clock in the morning and set out on roads so poorly maintained that dust clouds obscured the car in front. Their first stop was the icehouse, to keep the vaccines cold. The local health services did not vaccinate African Americans, thus Ferebee’s number one goal with the clinics was to inoculate Black children from fatal but now preventable diseases, especially smallpox and diphtheria.41 When they arrived at a plantation site, they donned their white uniforms, hung draperies from trees to create privacy, and pinned health education posters with explanatory images hopefully legible to a largely illiterate clientele to a clothesline.
Ferebee and her team quickly ascertained the best way to recruit people to their mobile clinic: by talking directly with the local midwives. In Holmes County, Black midwives delivered 95 percent of all Black babies. Yet despite their crucial role in keeping Black women and children alive as the main link between rural poor Black people and medical care, Black midwives in Holmes County and across the American South comprised an extremely vulnerable population with little to no power in the white medical establishment. Dismissed as unsanitary, uneducated, and superstitious by white public health officials, Black midwives, who were also often sharecroppers themselves, were often blamed for the systemic issues that underpinned Black illness and mortality. Many became the targets of elimination campaigns led by, among others, white women nurses. While disapproving of some of the midwives’ tactics, AKA did recognize their influence and authority.42
Soon, the group’s dietician secured food donations from the secretary of agriculture, and Ferebee began holding cooking demonstrations of rice, dried apples, and dried potatoes—food unfamiliar to the patients. Sharecroppers were paid only in credits at the plantation commissary, and bosses restricted the available groceries to three low-nutrient carbohydrates: cornmeal, sugar, and flour, and for flavoring, fatback and salt. The sorority sisters learned to offer the food late in the afternoon, when people were too hungry and tired from waiting in line all day, sometimes three hundred people deep, to resist instruction and sustenance. That first summer, they were able to vaccinate more than twenty-six hundred children, conduct over two hundred physical examinations, and hand out nearly seven thousand copies of health information. Most of the clinic’s patients were children who had no other access to the medical establishment. Over the seven years Ferebee ran the Mississippi Health Project, they vaccinated nearly fifteen thousand youth.43 They treated thousands of adults as well, particularly screening for and treating syphilis and other sexually transmitted diseases.
Dr. Ferebee and her colleagues were shocked by the conditions they found on the plantations. Single-room shacks housed more than a dozen people each. The deadly effects of poverty and malnutrition were palpable. She found the children to be “diseased, deformed, aged and wizened all too soon,” while the adults were largely “a saddened, defeated, submissive lot” who stared out at her with faces “stupid, vacant, and void of hope.” Some of her reaction was rooted in th
e clubwomen mentality—theirs was charity work, not solidarity work, and they believed bringing bourgeois Black people down south would nudge the poor closer to civilization. “Enlightened Negroes,” AKA promotional material announced, “must go down, side by side with the humblest, blackest, ‘distorted and soul-quenched’ Negro serf and elevate him by actual contact.”44 Common racial belonging may stimulate sympathy among reformers, but it hardly creates equivalent experiences or generates an automatic alliance between college-educated professionals and the desperately poor. Just as with sex, race is cut through with other dynamics of power, especially class and dis/ability. The AKA women saw themselves as something of saviors who had a duty to help the less fortunate. Nonetheless, this elitist attitude remains a good distance from the attitude of sterilization advocates and others committed to preventing the reproduction of the “unfit.”
Ferebee made sure that birth control information and devices were included in clinic offerings. This service enraged plantation owners. Planters wanted sharecropping women continually pregnant issuing a steady supply of unpaid labor into the future. Local white physicians catered to planters’ desires for wealth accumulation, not workers’ health needs, and they not only regularly denied Black women contraception—they also recommended Black girls as young as twelve and thirteen engage in sexual activity. Even as planters eventually agreed that future generations of living workers were preferable to dead children and permitted the clinics to come to their vast fields, they surveilled the AKA’s health project. Ferebee wrote that plantation owners posted “‘riders’ with guns in their belts and whipping prods in their boots; riders who weaved their horses incessantly, close to the clinics, straining their ears to hear what the staff interviewers were asking of the sharecroppers.” This surveillance mission was in part based on a rumor that the sorority sisters were communist organizers fomenting a rebellion. But while terrifying, the riders were easy to dodge—AKA president Ida Louise Jackson reported with some glee that Ferebee and the nurses simply spoke in medical jargon when they needed privacy, and the white riders couldn’t understand a word.45
Dr. Dorothy Boulding Ferebee giving a blood test to a woman at the Alpha Kappa Alpha sorority traveling health clinic, Mississippi, 1938. (Courtesy of Sophia Smith Collection, Smith College)
Dr. Ferebee and her team were far from advocating redistributing planters’ property to their laborers. Theirs was a professional-class reform mission that received glowing coverage in the pages of Reader’s Digest, not a communist seizing of the means of production. But unlike Sanger’s initiatives, Dr. Ferebee brought birth control to severely marginalized women as part of a broader healthcare initiative that addressed multiple needs. She made the case plainly: “People whose economic and health status is lowest have least access to the techniques of planned parenthood.” Thus, she insisted that contraception information be folded into public health programs—not introduced via clinics that solely treated sexual health—and that public health programs adopt creative approaches to reach impoverished communities.46
Ferebee saw disease to be an axis of oppression that intersected with other forces of power in people’s lives, rather than the singular measure of individual worth. The Mississippi Health Project, she wrote at its termination in 1941, “has graphically demonstrated the interrelation of every social and economic activity as a part of a whole.… The problem of health is one of many facets which link it to the entire social order; for disease is both the cause and result of many miserable social and economic conditions.”47 Health was not imprinted on a self-reproducing gene that humans were powerless to shape, apart from reducing childbirth among those deemed to lack it; health emerged at the crossroads of multiple, interconnected social structures such as segregation, poverty, and centuries-old plantation economies based on unfree labor. Dr. Ferebee’s intersectional agenda that placed reproduction within a dense matrix of power was distinct from Sanger’s approach that positioned the quality of children as the singular axis of civilization, even as they were both leaders within the feminist movement for birth control.
Beginning in 1937, Margaret Sanger and her oil magnate second husband J. Noah Slee lived most of the year in a house made of “adobe, trimmed in blue” in the arid Catalina foothills above Tucson, Arizona—about as far from the tenement districts of New York as she could get. Sanger and Slee occupied separate apartments within Casa de Adobe, accommodating her lifelong desire for as much independence as possible within marriage. The foothills estate was a place for rest and retreat, and hosting lavish parties attended by the likes of Elizabeth Arden and Eleanor Roosevelt, when she could convince penny-counting millionaire Slee to spare the expense. Now almost sixty, Sanger was removed from the day-to-day operations of the league and the Research Bureau. She served as the honorary president of the organization, renamed Planned Parenthood Federation of America in 1942. Sanger maintained a large presence in the global birth control movement through occasional travel and regular correspondence. She liked to devote her early mornings to writing movement letters, propped up in bed by a pile of fluffy pillows.48
Sanger’s semiretirement was prompted by two major victories in contraception access she had won in the mid-1930s, following years of legislative lobbying work. One was a legal triumph: a test case of pessaries she had requested from contacts in Japan for use by the Clinical Research Bureau had, as intended, provoked a legal fight with the federal government. The Clinical Research Bureau’s victory ensured that doctors could now engage in legal interstate and international trade of contraceptive devices and information, formalizing access that had already become increasingly possible de facto. Sanger’s second victory was clinical. In 1937, the American Medical Association overturned national policy restricting contraceptive care to patients with sexually transmitted infection. It now endorsed contraception as an integral part of sexual health for all married women, a topic suitable for discussion in medical schools and deserving of further scientific research and stronger legal standing in the courts.49 Contraception was becoming a standard component of healthcare, a sea change in public attitude Sanger had long hoped to achieve. The downside of this arrangement was that birth control access was still firmly under the control of the medical profession, something Sanger supported, and primarily available only to married women who could afford medical visits.
Nursing a failing gallbladder and an arm broken while promoting birth control in Japan, yet confident in her professional success, Sanger took reprieve in Tucson. Over the next few years, she chose to maintain a firm hand in just one of Planned Parenthood’s various initiatives. It was a brainchild of hers that she trusted only her longtime secretary, Florence Rose, to put into action: the Negro Project. The Negro Project’s stated goals were to demonstrate that a birth control program among southern Black working-class women would reduce maternal and infant mortality and disease as well as reduce state health and welfare expenditures. As with Sanger’s general eugenic approach to contraception, the Negro Project leaders didn’t frame their agenda as ensuring Black women’s reproductive self-determination. Instead, they presented reducing individual women’s fertility as a solution for relieving burdens on the community as a whole—a tactic that both reflected their own goals and was designed to appeal to white-led public health departments. Yet Sanger was particularly concerned about sky-high rates of maternal and infant death. Black women died during childbirth at nearly twice the rate white women did, and the mortality rate among infants was similarly skewed. A devastating 9 percent of Black infants didn’t live to see their first birthday, 2.5 times the rate of white infant mortality.50
On a Sunday in early December 1939, Sanger wrote to her close associate Dr. Clarence Gamble, physician, philanthropist, leading eugenicist, and an heir to the Procter & Gamble fortune, about the Negro Project’s design. She insisted that the federation hire and train a Black physician, rather than a white one, to promote contraception, a progressive move that Gamble had been resisting. “While t
he colored Negroes have great respect for white doctors they can get closer to their own members and more or less lay their cards on the table which means their ignorance, superstitions and doubts,” she explained to Gamble in her concerned, yet patronizing, tone. “We do not want word to go out that we want to exterminate the Negro population,” she wrote, “and the minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members.”51
It has proven to be a fateful choice of phrasing. Today, “we do not want word to get out that we want to exterminate the Negro population” has been reverberating throughout the anti-abortion movement for more than twenty-five years. It ricochets across billboards, websites, pamphlets, documentaries, book-length exposés, and Supreme Court opinions, assassinating Sanger’s reputation via a shot fired by her own hand. Over the decades, activists with politics as opposing as conservative author Dinesh D’Souza and leftist feminist Angela Davis have both cited the passage to indict the Negro Project as a plan for exterminating African Americans. Particularly to those familiar with Sanger’s beliefs that one-quarter of the population should not be allowed to have children, beliefs that the pro-life movement circulates aggressively, her words seem entirely believable at face value. Yet the truth is more complicated.
Throughout the Negro Project’s short run, tension simmered between its leaders about the true nature of the initiative. The Negro Project meant different things to the various people involved: Sanger, Rose, Planned Parenthood’s white male leadership, the white southern affiliates, and the Black reformers Sanger and Rose recruited to play an advisory role—including Dr. Ferebee.
The arguments started in late 1939, before the project got off the ground. When Sanger returned from a short, rain-soaked Thanksgiving trip to Skull Valley in northwestern Arizona, she fired off letters from her first-floor quarters in the Tucson estate. Sanger insisted that the project launch as she initially intended: with a year-long outreach campaign conducted by a Black doctor and Black minister, trained “by the Federation as to our ideals,” who would “arouse and educate the colored people.” She knew white officials would never have the same effect that Black professionals could. “There could be an awakening in the South which would work like yeast,” she enthused. Sanger envisioned a mass of activated people rising like fermented dough. Then, the project would open clinics to serve the demand. She also insisted that leading Black professionals be consulted in the project’s development. There was “no use in asking the advice of… any white person” about bringing birth control to Black communities, Sanger emphasized. “They are always wrong.”52
The Trouble with White Women Page 17