For nearly 10 years, the letters with the fashionable letterhead from the most stylish of addresses - Madison Avenue in New York City - arrived on the desk of George Lawrence, the head of the N.C. Maternal Health League.

The letters were filled with plans to ignite a birth-control revolution in the state, and with triumph when those plans succeeded.

"We were delighted to hear of the new developments in North Carolina which will mean that your birth control work will go forward quickly and with such splendid backing," read a letter from a member of the American Birth Control League to the head of the N.C. Maternal League. "What a perfect place to have a birth control information given out - in connection with prenatal clinics! You and your committee are indeed to be congratulated."

The first state-sponsored birth-control clinics in the country opened here in 1938. They were lauded as proof of the state's progressive policies, as was the decision to make abortion legal here in 1968, five years before the U.S. Supreme Court legalized abortion for the country.

But in between the two movements, another one existed, based on the idea that the state - instead of the individual - was better suited to make reproductive choices.

The eugenics movement helped put the decision about who should have children into the hands of the five members of the Eugenics Board of North Carolina. About 7,600 people were sterilized in the state from 1929 through 1974 - many of them poor black women who were pressured into making such a decision.

But before the eugenic sterilization program took off in the late 1940s and '50s, North Carolina was admired for its birth-control movement, which was praised in national magazines and used as a model for other states.

"No spot in North Carolina is more than 50 miles from a state-sponsored birth-control clinic. First to promote birth control officially, the state is going at the job in earnest," said an article in The Atlantic Monthly in October 1939.

But that movement ran counter to the ideas that the eugenics movement was founded on. The birth-control movement began in part because of the maternal health problems in North Carolina in the early part of the 20th century.

The state had one of the worst infant-mortality rates in the country. About 66 babies died out of every 1,000 born - well above the national average of 54 deaths for every 1,000 births. Mothers were also at high risk.

In 1930, the state had a population of about 3.5 million people.

There were 832 pregnancy-related deaths for every 100,000 live births in North Carolina in 1930. Currently the rate is about 12 deaths for every 100,000 live births.

Officials blamed the high death rates on such basic problems as bad hygiene, poverty and lack of prenatal care.

People hoped that birth control could combat some of these problems.

"To improve conditions so that dirt, poverty and disease will disappear is the ideal solution. But that will take time. Birth control offers immediate help," read The Atlantic Monthly article.

The women who asked for help were usually those who had given birth every year for several years and had no other way of preventing more pregnancies.

"I am married and 22 years old. Have been married 3 yrs. and have 2 babies. We love our babies very much, but we feel we are not able to care for any more. My husband makes a living salary but that is all.… I had never heard of birth control clinics before. You don't know how relieved my mind will be when I learn the sweetest secret of married life and my dear friend it will mean the happiness of my home I'm always afraid and it makes my husband ill and cross," wrote Mrs. C.J. Blackman in an undated letter.

But after 1940, little was written or said about the clinics. Instead, the state focused on its eugenic sterilization program.

It is not clear from the documents preserved in the state archives why the birth-control movement received so little attention while the eugenics movement took over. But even at its beginning, the state birth-control movement struggled with too many demands and not enough money.

"Following the announcement of the availability of the consultant services, the difficulty has been to meet the requests from local health officers," said an article in the American Journal of Public Health in October 1938.

• The biennial reports from the Eugenics Board of North Carolina and its handbook will be available online beginning Monday at the State Library Web site: http://statelibrary.dcr.state.nc.us

• Victims and their families who want to get involved withthe committee on the state's sterilization program can call Care-Line, an information and referral service of the N.C. Department of Health and Human Services, at (800) 662-7030.

• Danielle Deaver can be reached at 727-7279 or at ddeaver@wsjournal.com

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