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As the women’s rights movement gained momentum in the early 20th century, women's rights activists demanded not only the vote, but also equality in marriage, access to divorce, an end to the sexual double standard, the right to refuse sex from their husbands, and the right to control their reproduction. The birth control movement of the early 20th century emerged in tandem with this wide-ranging feminist agenda, and was easily adopted by the "New Woman" of the era.
As a young woman, Sanger worked as a nurse and encountered many women who became sick and died from illegal abortions. She hoped that one day there would be a “magic pill” that could prevent pregnancy. She recalled one instance, specifically, where the physician told a woman patient that she should not get pregnant again, less she
risk serious injury or death. When asked how to prevent pregnancy, the doctor recommended that she tell her husband to sleep on the roof. That woman later died from a botched abortion. Because of this instance, and other encounters with poor, often immigrant women who lacked legal access to contraceptives, Margaret Sanger decided to devote her life to this cause.
Sanger began to focus on spreading information about contraception to the masses--in direct violation of the Comstock Act. In 1914, Margaret Sanger began publishing ''The Woman Rebel'' after years of occasional articles in the ''New York Call''. She was radical in the sense that she urged the working class to stop supplying the market with children to be exploited, by refusing to populate the earth with expendable worker-slaves. She coined the term "birth control" in 1915 and soon established herself as the leader of this movement. When it seemed like she was going to be arrested for violating the Comstock Act, Sanger went abroad to England and France to learn more about birth control. When Sanger returned to the United States, she opened the first birth control clinic in New York in 1916.
Sanger was constantly embroiled in legal battles for violating the Comstock Act, nevertheless she maintained her clinic and began publishing the ''Birth Control Review''. In the very first issue, she, Frederick A. Blossom, and Elizabeth Stuyvesant stated their aims very clearly. As proponents of contraception, they believed that men and women alike needed to fight for the right of voluntary parenthood. She tried to work with doctors to lend legitimacy to her movement—which helped in the long run. After repeated legal battles, by 1918, there was a medical exception n the law that allowed physicians to offer contraceptive advice to married women for the cure and prevention of disease. With this loophole, Sanger promoted the establishment of birth control clinics across the country to be staffed by physicians who could legally provide contraceptive information and devices.
[[File:440px-MargaretSanger-Underwood.LOC.jpg|left|250px|Margaret Sanger, c. 1922.]]
In violating the Comstock Act, Sanger made public an understanding that some pregnancies were unwanted and that women should have the same sexual license as men.