My heroes and sheroes

September 27, 2011


                Public health interventions are often controversial and family planning over the years has faced a veritable minefield of extraordinarily contentious issues. Fitzhugh Mullan of the George Washington University School of Public Health, suggests that behaviors exemplified by the philosophies and actions of the dreamer, Don Quixote, the cunning strategist, Machiavelli, and Robin Hood, who took from the rich in order to give to the poor, have played an important role in 20th century public health. People like Don Quixote, Machiavelli and Robin Hood have contributed to the fields of contraception, family planning and reproductive health, for sure.

                Don Quixote-like dreams are the dreams of determined idealists. Margaret Sanger was such a person. She dared to dream that women could actually vote intelligently and go to birth control clinics for confidential, dignified, safe and effective contraceptive services. It was she and her friends who coined the term “birth control” in 1914 and some 40 years later it was she and other friends who found the funds to do the research that led to birth control pills.

                Leading gynecologists such as John Rock and John Irving at Harvard and Alan Guttmacher and Irv Cushner in Baltimore did the research and established the programs that led to voluntary contraceptive and sterilization services in Boston, Baltimore and then the rest of our country.

                Luella Klein, the first woman to be president of the American College of Obstetrics and Gynecology (and a professor of those subjects at Emory) was a quiet dreamer who influenced legislation on contraception in Georgia and nationally using her conciliatory, dignified, and evidence-based, approach to legislators.

                Gary Stewart was a Peace Corps volunteer in Malawi, author of Contraceptive Technology and developer of a remarkable Gold Star Program in Egypt that led to higher quality services.

                No one in the past 4 decades was a better advocate for women’s unique health care needs than Dr. Felicia Stewart. Prudent was one of her favorite words. She was a brilliant teacher, writer and clinician with a sense of humor that never let her or others around her down.

                Machiavelli-like cunning and politically savvy strategies have also contributed immensely to family planning efforts. Margaret Sanger once promised the mayor of Boston that she would not say a word if he would allow her to sit on the stage during an important public discussion of controversial contraceptive issues. He relented. She appeared on the dais with her mouth covered by a huge piece of duct tape. The muzzling of Margaret Sanger stole the show and was prominently featured in the New York Times coverage of the event.

                Alan Barnes at Hopkins saw many unmarried women wanting birth control pills. Marriage was required at that time in Maryland for a woman to be prescribed birth control pills. “Do you ever plan to marry?” he would ask college students.  They would reply “Of course, some day.” “Good” he would say with a twinkle in his eyes, “we will call this a premarital visit and you can have birth control pills”        Robin Hood-like redistribution of resources from wealthier and healthier sectors of the society to those less advantaged and less healthy is what public health is all about.  Title X, Medicaid and in many cases Medicare are all examples of this.  So are food distribution programs, many health insurance policies. Foundations and churches are other examples of modern day Robin Hood-like efforts to improve the health of the less advantaged citizens of our nation.

                Mullan concludes that all 3 personae, are important in public health and that, of the three, the initiatives most threatened now are the Robin Hood efforts. Our society is struggling mightily with this question: “How much should the wealthier and healthier be doing to assist the nation’s economically disadvantaged and less healthy citizens?”

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA