I know that some social conservatives despise Mrs. Sanger. One of her organizations evolved into Planned Parenthood, which is hated primarily because it gives women access to abortions and secondarily because it gives unmarried women access to contraception. In reaction, some have portrayed Sanger as a eugenicist of near Nazi ferocity, eager to improve the race through selective breeding, sterilization and murder of the unfit. They accuse her of aiming to exterminate people of color. They attribute her widespread support among African American leaders to a diabolical campaign of duplicity.
It’s hard to imagine anyone quite so powerful as the monster they depict, particularly if the supposed villain is a diminutive woman in an era when women did not have the vote and were barred from most influential occupations. Indeed, much of the book is a record of the obstacles Sanger faced as she struggled to help disadvantaged women learn how to space their children and produce fewer of them. She had frequent run-ins with Catholic prelates, of course. Time and again the police raided her headquarters, destroyed her property, terrorized her clients, and hauled her off to jail. Courts usually ruled against her. Congress repeatedly refused to consider bills favoring the distribution of information about contraception.
Yet nothing could stop the hundreds of thousands of women who wrote to her begging for help, and nothing could stop Sanger from attempting to provide it.
On “one stifling mid-July day of 1912,” Sanger, a public health nurse who worked in New York’s slums, had had an epiphany. A truck driver, Jake Sachs, had called a doctor to help his 28-year-old wife, who was dying of septicemia following a self-induced abortion. The young couple already had three children, and the wife was convinced they could afford no more. The doctor sent for Sanger, and for two weeks the two of them worked to save Mrs. Sachs. At the end she pulled through, but the doctor warned that another pregnancy would kill her.
“I know, doctor,” she replied timidly, “but,” and she hesitated as though it took all her courage to say it, “what can I do to prevent it?”Three months later, Jake Sachs again called Mrs. Sanger, who again rushed to their apartment. Mrs. Sachs died within ten minutes of her arrival. That night, Sanger paced for hours through city streets.
The doctor was a kindly man, and he had worked hard to save her, but such incidents had become so familiar to him that he had long since lost whatever delicacy he might once have had. He laughed good-naturedly. “You want to have your cake and eat it too, do you? Well, it can’t be done.”
Then picking up his hat and bag to depart he said, “Tell Jake to sleep on the roof.” 
When I finally arrived home and let myself quietly in, all the household was sleeping. I looked out my window and down upon the dimly lighted city. Its pains and griefs crowded in upon me, a moving picture rolled before my eyes with photographic clearness: women writhing in travail to bring forth little babies; the babies themselves naked and hungry, wrapped in newspapers to keep them from the cold; six-year-old children with pinched, pale, wrinkled faces, old in concentrated wretchedness, pushed into gray and fetid cellars, crouching on stone floors, their small scrawny hands scuttling through rags, making lamp shades, artificial flowers; white coffins, black coffins, coffins, coffins interminably passing in never-ending succession. The scenes piled one upon another on another. I could bear it no longer.In 1912, contraception was illegal. Doctors could not dispense contraceptive devices to women (though apparently they were allowed to give men condoms to prevent STDs). The Comstock law prohibited even speaking or writing about contraception. Somehow the rich knew how to get around those laws; their families tended to be of modest size. The poor, however, had no idea how to space their children or limit their number. As a result, many desperately poor women gave birth 12, 15, even 18 times, if they lived so long. The majority of immigrant and working-class children died before reaching adulthood, and the survivors were often malnourished, sickly, uneducated, and often brain damaged as well.
… I went to bed, knowing that no matter what it might cost, I was finished with palliatives and superficial cures; I was resolved to seek out the root of evil, to do something to change the destiny of mothers whose miseries were as vast as the sky. 
Today Americans rightly protest the cruel treatment of dogs in puppy mills. A mere hundred years ago, many urban Americans lived in conditions that were just as bad. And almost nobody dared to tell women that they didn’t have to have a baby every year, that they could limit their children to a number they could support. Nobody dared to provide them with devices that would enable them to have fewer births, but also fewer deaths and more surviving children. Almost nobody, that is, but Margaret Sanger and the people who worked with her.
Her story is more than a history of birth control in America. Much of it reads like a vivid travel memoir: Sanger visited many countries and recorded her observations and impressions. It is also a fascinating social history of the now almost-forgotten lifestyles and mores of the early 20th century. Besides, the book is fun to read: Sanger is a clever writer. She describes one newly married couple, for example, as having “little but love, faith, and hope to save them from charity.” Here is her one-sentence characterization of a lawyer she consulted: “The seeds of social service had been planted in him; his legal training only temporarily slowed down their growth.”
So what about Sanger’s supposed secret schemes of race purification? I found no evidence of them in this book. Some of her supporters were indeed eugenicists – people who thought that the mentally and morally unfit should be sterilized. That view was quite common until at least mid-20th century (my own evangelical parents said similar things) and Sanger probably shared it, but it was not her primary concern. The way she wanted to purify the race was to allow people to choose the number of children they bore, so that they could adequately feed, clothe, and educate their families. Then, she believed, far fewer children would be sickly, far fewer mothers would die in childbirth, and far more children would live to adulthood. In this way, she thought, the human race would become stronger.
Interestingly, some of Sanger’s views are at odds with the views of many Planned Parenthood advocates today. In October of 1916, she opened a birth control clinic in Brooklyn. Women were admitted in groups to learn how to plan their families.
To each group, [she writes,] we explained simply what contraception was; that abortion was the wrong way – no matter how early it was performed it was taking life; that contraception was the better way, the safer way – it took a little time, a little trouble, but was well worth while in the long run, because life had not yet begun. Her pro-life views conflicted with those of a prominent German gynecologist she interviewed in 1920. When she opined that abortion was a ridiculous substitute for contraception,
the doctor rose, his chest sticking out; he buttoned his coat, bowed formally, and inquired, “Where did you say you came from?”Margaret Sanger was, I believe, pro-life. She was also pro-choice. People on both sides of today’s culture war have a lot to thank her for.
“New York City.”
“Are you sure you are not from France or Belgium?”
“Nobody who has the welfare of Germany at heart could talk to me as you have this morning. Only enemies could come here to give such information [about contraception] to our women.”
I wished he would sit down; he made me nervous. But I went on. “Why is it such an act of enmity to advocate contraceptives rather than abortions? Abortions, as you know yourself, may be quite dangerous, whereas reliable contraceptives are harmless. Why do you oppose them?”
To my horror he replied, “We will never give over the control of our numbers to the women themselves. What, let them control the future of the human race? With abortions it is in our hands; we make the decisions, and they must come to us.”
That was not the tone of this doctor alone but also that of most of his confrères. 
It’s easy for us older folks to complain that the world is going to hell. Whenever I get in a curmudgeonly mood, the surest cure is to watch an old movie or read an old book and notice how people lived and how women were regarded back then. Sanger’s autobiography made me profoundly grateful to live in an era when women are, comparatively speaking, respected; when most children – even of the poor – survive to adulthood; and when the Constitutionally guaranteed right to free speech is taken for granted.