Access to birth control was highly restricted in turn-of-the-century America. Not only was it difficult to obtain contraceptive devices, but the 1873 Comstock Law prohibited the distribution even of literature about birth control, deeming such materials "obscene."

Goldman first became convinced that birth control was essential to women's sexual and economic freedom in the 1890s, when she worked as a nurse and midwife among poor immigrant workers on New York's Lower East Side. There she saw first-hand the suffering of poor women who, unable to support the children they already had, often resorted to dangerous, self-induced abortions. She began to take direct action in the 1910s, smuggling contraceptive devices into the United States, lecturing frequently on "the right of the child not to be born" and demanding that women's bodies be freed from the coercion of the government.

Although Margaret Sanger is often considered the pioneer of the birth control movement, it was Goldman who brought the young activist into the struggle. The two women parted ways only when Sanger shifted her focus to the single, pragmatic goal of winning the legal right to distribute birth control information. Goldman, by contrast, believed that the law that denied women access to birth control information was symptomatic of general social, political and economic injustice and always insisted that the issue be viewed as part of a broader struggle.

At least twice, Goldman was arrested and charged with violating the Comstock Law. She managed to turn one trial in 1916 into a national forum on birth control, successfully attracting many writers, artists, intellectuals and progressives to her cause. Despite the support, Goldman was sentenced to a fine of $100 or 15 days in the workhouse. She chose the workhouse.