WHY NOT BIRTH-CONTROL CLINICS IN AMERICA
[Footnote: This chapter, in substance, and largely in language,
appeared under the present title in the March, 1920, issue of American
Medicine (New York) and is incorporated in this book by courtesy of
that publication.]
The absurd cruelty of permitting thousands of women each year to go
through abortions to prevent the aggravation of diseases for which
they are under treatment assuredly cannot be much longer ignored by
the medical profession. Responsibility for the inestimable damage done
by the practice of permitting patients suffering from certain ailments
to become pregnant, because of their ignorance of contraceptives, when
the physician knows that if pregnancy goes to its full term it will
hasten the disease and lead to the patient's death, must in all
fairness be laid at his door.
What these diseases are and what dangers are involved in pregnancy are
known to every practitioner of standing. Specialists have not been
negligent in pointing out the situation. Eager to enhance or protect
their reputations in the profession, they continually call out to one
another: "Don't let the patient bear a child--don't let pregnancy
continue."
The warning has been sounded most often, perhaps, in the cases of
tubercular women. "In view of the fact that the tubercular process
becomes exacerbated either during pregnancy or after childbirth, most
authorities recommend that abortion be induced as a matter of routine
in all tubercular women," says Dr. J. Whitridge Williams,
obstetrician-in-chief to the Johns Hopkins Hospital, in his treatise
on _Obstetrics_. Dr. Thomas Watts Eden, obstetrician and gynecologist
to Charing Cross Hospital and member of the staffs of other notable
British hospitals, extends but does not complete the list in this
paragraph on page 652 of his _Practical Obstetrics_: "Certain of the
conditions enumerated form absolute indications for the induction of
abortion. These are nephritis, uncompensated valvular lesions of the
heart, advanced tuberculosis, insanity, irremediable malignant tumors,
hydatidiform mole, uncontrollable uterine hemorrhage, and acute
hydramnios."
We know that abortion, when performed by skilled hands, under right
conditions, brings almost no danger to the life of the patient, and we
also know that particular diseases can be more easily combatted after
such an abortion than during a pregnancy allowed to come to full term.
But why not adopt the easier, safer, less repulsive course and prevent
conception altogether? Why put these thousands of women who each year
undergo such abortions to the pain they entail and in whatever danger
attends them?
Why continue to send home women to whom pregnancy is a grave danger
with the futile advice: "Now don't get this way again!" They are sent
back to husbands who have generations of passion and passion's claim
to outlet. They are sent back without being given information as to
how to prevent the dangerous pregnancy and are expected, presumably,
to depend for their safety upon the husband's continence. The wife and
husband are thrown together to bring about once more the same
condition. Back comes the patient again in a few months to be aborted
and told once more not to do it again.
Does any physician believe that the picture is overdrawn? I have known
of many such cases. A recent one that came under my observation was
that of a woman who suffered from a disease of the kidneys. Five times
she was taken to a maternity hospital in an ambulance after falling in
offices or in the street. One of the foremost gynecologists of America
sent her out three times without giving her information as to the
contraceptive means which would have prevented a repetition of this
experience.
Why does this situation exist? We do not question the good intent nor
the high purposes of these physicians. We know that they observe a
high standard of ethics and that they are working for the uplift of
the race. But here is a situation that is absurd--hideously absurd.
What is the matter?
Several factors contribute to this state of affairs. First, the
subject of contraception has been kept in the dark, even in medical
colleges and in hospitals. Abortion has been openly discussed as a
necessity under certain conditions, but the subject of contraception,
as any physician will admit, has not yet been brought to the front. It
has escaped specialized attention in the laboratories and the research
departments. Thus there has been no professional stamp of approval by
great bodies of experimenters. The result is that the average
physician has felt that contraceptive methods are not yet established
as certainties and has, for that reason, refused to direct _their
use_.
Specialists are so busy with their own particular subjects and general
practitioners are so taken up with their daily routine that they
cannot give to the problem of contraception the attention it must
have. Consultation rooms in charge of reputable physicians who have
specialized in contraception, assisted by registered nurses--in a
word, clinics designed for this specialty, would meet this crying
need. Such clinics should deal with each woman individually, taking
into account her particular disease, her temperament, her mentality
and her condition, both physical and economic. Their sole function
should be to prevent pregnancy. In accomplishing this purpose, a
higher standard of hygiene is attained. Not only would a burden be
removed from the physician who sends a woman to such a clinic, but
there would be an improvement in the woman's general condition which
would in a number of ways reflect itself in benefit to her family.
All this for the diseased woman. But every argument that can be made
for preventive medicine can be made for birth-control clinics for the
use of the woman who has not yet lost her health. Sound and vigorous
at the time of her marriage, she could remain so if given advice as to
by what means she could space her children and limit their number.
When she is not given such information, she is plunged blindly into
married life and a few years is likely to find her with a large
family, herself diseased and damaged, an unfit breeder of the unfit,
and still ignorant!
What are the fruits of this woeful ignorance in which women have been
kept? First, a tremendous infant mortality--hundreds of thousands of
babies dying annually of diseases which flourish in poverty and
neglect.
Next, the rapid increase of the feebleminded, of criminal types and of
the pathetic victims of toil in the child-labor factories. Another
result is the familiar overcrowding of tenements, the forcing of the
children into the street, the ensuing prostitution, alcoholism and
almost universal physical and moral unfitness.
Those abhorrent conditions point to a blunder upon the part of those
to whom we have entrusted the care of the health of the individual,
the family and the race. The medical profession, neglecting the
principle involved in preventive medicine, has permitted these
conditions to come about. If they were unavoidable, we should have to
bear with them, but they are not unavoidable, as shown by facts and
figures from other countries where contraceptive information is
available.
In Holland, for instance, where the information concerning
contraceptives has been accessible to the people, through clinics and
pamphlets, since 1881, the general death rate and the infant mortality
rate have fallen until they are the lowest in Europe. Amsterdam and
The Hague have the lowest infant mortality rates of any cities in the
world.
It is good to know that the first of the birth-control clinics of
Holland followed shortly after a thorough and enthusiastic discussion
of the subject at an international medical congress in Amsterdam in
1878. The Dutch Neo-Malthusian League was founded in 1881. The first
birth-control clinic in the world was opened in 1885 by Dr. Aletta
Jacobs in Amsterdam. So great were the results obtained that there has
been a remarkable increase in the wealth, stamina, stature and
longevity of the people, as well as a gradual increase in the
population.
These clinics must not be confused with the white enameled rooms which
we associate with the term in America. They are ordinary offices with
the necessary equipment, or rooms in the homes of the nurses, fitted
out for the work. They are places for consultation and examination,
opened by specially trained nurses who have been instructed by Dr. J.
Rutgers, of The Hague, secretary of the Neo-Malthusian League, who has
devoted his life to this work. There have been more than fifty nurses
trained specially for this work by Dr. Rutgers. As a nurse completes
her course of training, she establishes herself in a community and her
place of consultation is called a clinic.
The general results of this service are best judged by tables included
in the _Annual Summary of Marriages, Births and Deaths in England,
Wales, Etc., for 1912_. [Footnote: (See table on page 208.)]
In Amsterdam, the birth rate dropped from 37.1 for the period of
1881-85 to 24.7 for 1906 and 23.3 in 1912. During the same periods, the
death rate fell from 25.1 to 13.1, and in 1912 to 11.2. Infant
mortality for the same period fell from 203 for each thousand living
births to 90, and in 1912 to 64. Illegitimate fertility also
decreased. Results in other cities, as shown by the table at the end
of this chapter, are exactly similar.
In the Australian Commonwealth, where birth control is taken as a
matter of course, and information concerning contraceptives is
available to the masses, the births were so well distributed in 1915
that while the birth rate was 27.3, there was an infant death rate of
only 10.7. New Zealand, which is also one of the typical birth-control
countries, had a birth rate of 25.3 and an infant death rate of only
9.1 for the same year. These figures are in marked and happy contrast
with those for the birth registration of the United States, where the
reports for 1916 show a birth rate of 24.8, but an infant death rate
of 14.7. A similar comparison may be made with the German Empire in
1913, where there was a birth rate of 27.5 in 1913 and an infant
mortality rate of 15. In these countries, birth control information is
not so generally within the reach of the masses and, consequently, the
largest percentage of births come to that class least able to bring
children to full maturity, as indicated in the infant mortality rates.
In conclusion, I am going to make a statement which may at first seem
exaggerated, but which is, nevertheless, carefully considered. The
effort toward racial progress that is being made to-day by the medical
profession, by social workers, by the various charitable and
philanthropic organizations and by state institutions for the
physically and mentally unfit, is practically wasted. All these forces
are in a very emphatic sense marking time. They will continue to mark
time until the medical profession recognizes the fact that the ever
increasing tide of the unfit is overwhelming all that these agencies
are doing for society. They will continue to mark time until they get
at the source of these destructive conditions and apply a fundamental
remedy. That remedy is birth control.
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[Footnote: Amsterdam [Malthusian (Birth Control) League started 1881;
Dr. Aletta Jacobs gave advice to poor women, 1885]:
1881-85 1906-10 1912
Birth rate......... 37.1 27.7 23.3 per 1,000 of population
Death rate......... 25.1 13.1 11.2 per 1,000 of population
INFANTILE MORTALITY:
Deaths in first
year................ 203 90 64 per thousand living births
The Hague [now headquarters of the Neo-Malthusian (Birth Control) League]:
1881-85 1906-10 1912
Birth rate........... 38.7 27.5 23.6 per 1,000 of population
Death rate........... 23.3 13.2 10.9 per 1,000 of population
INFANTILE MORTALITY:
Deaths in first
year................. 214 99 66 per thousand living births
These figures are the lowest in the whole list of death rates and
infantile mortalities in the summary of births and deaths in cities in
this report.
Rotterdam:
1881-85 1906-10 1912
Birth rate.......... 37.4 32.0 29.0 per 1,000 of population
Death rate.......... 24.2 13.4 11.3 per 1,000 of population
INFANTILE MORTALITY:
Deaths in first
year................ 209 105 79 per thousand living births
Fertility and Illegitimacy Rates:
1880-2 1890-2 1900-2 (Legitimate births per
1,000 married women
Legitimate fertility.. 306.4 296.5 252.7 aged 15 to 45.)
1880-2 1890-2 1900-2 (Illegitimate births per
1,000 unmarried women,
Illegitimate fertility..16.1 16.3 11.3 aged 15 to 45.)
The Hague:
1880-2 1890-2 1900-2
Legitimate fertility.... 346.5 303.9 255.0
Illegitimate fertility... 13.4 13.6 7.7
Rotterdam:
1880-2 1890-2 1900-2
Legitimate fertility.... 331.4 312.0 299.0
Illegitimate fertility... 17.4 16.5 13.1]