Having reviewed the position as it exists in New Zealand, and having
set out what appear to be the main causes, it now remains to consider
possible preventive measures.
(1) THE RELIEF OF ECONOMIC STRESS.
In so far as hardships resulting from economic difficulties are
genuine, the Committee believes that there is a real call for and that
there are definite possibilities of relief by the State.
Two classes in particular call for most sympathetic consideration:--
(1) The wives of the unemployed, or of those precariously employed.
(2) The wives of those engaged in small farming, especially in the
dairy-farming districts of the North Island.
For such women we consider that much could be done by way of financial,
domestic, and obstetrical help.
_Financial Help._--In general terms all efforts at social betterment--the
reduction of unemployment, the improvement of wages and relief, the
reduction of taxation, direct and indirect, and the provision of better
housing conditions--should undoubtedly help to make conditions more
secure and more satisfactory for the rearing of larger families.
But further than this, we believe that really adequate financial
assistance _directly related to the encouragement of the family_
is urgently called for.
It is perfectly clear that general financial improvement does not,
itself, necessarily bring about larger families; limitation of the
family is probably more prevalent amongst those more fortunately
placed. What form this financial aid to the family should take requires
much consideration.
The assistance is required not merely at the time of confinement, but
also during the much longer period of the rearing and the education of
the family.
A general extension of the maternity allowance under any national
health scheme would afford some immediate financial assistance.
Income-tax exemption for children, however generous the scale, would
not benefit these badly circumstanced cases, for already they are below
the income-tax limit.
It would appear that further financial provision would have to take the
form of a direct children's allowance.
It is suggested that this might be put into effect by amending the
present Family Allowances Act to provide that--
(1) The amount be increased;
(2) The permissible income-level be increased;
(3) That, where given, the allowance be in respect of all the
children in the family; and
(4) That the age-limit of the children be increased to sixteen.
_Domestic Assistance._--Equally important is the provision of domestic
assistance, and here we are faced with a problem of the greatest
difficulty--a national problem which is affecting women in all walks of
life and of which this is but one aspect.
In many farming districts it is clear that lack of domestic help is a
greater burden to the harassed mother than even financial stringency.
Many admirable efforts are being made to give assistance in this
direction--in the country by the housekeeper plans of the Women's
Division of the Farmers' Union and other organizations, in the cities
by the Mothers Help Society and similar agencies.
Extension of such system is highly desirable, and the possibility of
their organization on a much larger scale with Government subsidy well
deserves consideration.
In many cases these efforts are limited as much by lack of personnel as
by lack of funds.
Alternatively, we suggest--
(1) That the Government should inaugurate and recruit a National
Domestic Service Corps of young women agreeable to enter the
domestic-service profession;
(2) That the recruits be guaranteed continuity of employment and
remuneration as long as their service was satisfactory;
(3) That they undergo whatever training is considered desirable at
technical school or otherwise;
(4) That they agree to perform service wherever required by the
Domestic Service Department, which Department shall ensure that the
living and working conditions are up to standard;
(5) That the service be made available to all women, and that first
consideration be given to expectant mothers, mothers convalescent
after childbirth, and mothers who have young families, and that the
service be either free or charged for according to the
circumstances of each case.
Again, realizing the fact that many of the considerations involved in
this question of domestic help are beyond the scope of this Committee,
we recommend that a full investigation should be made of the whole
matter.
_Obstetrical Aid._--As for obstetrical help, we believe that the
position is in the main adequate and good.
As far as the larger centres are concerned, no woman, however poor her
circumstances, need lack complete ante-natal supervision, for which no
charge is made, and proper confinement care, at most moderate cost, in
the St. Helens Hospitals or the various maternity annexes of the public
hospitals; where the mother is actually indigent, free provision is
available through the Hospital Boards or St. Helens Hospitals.
The country mother in certain districts is, however, much less well
placed, although the Health Department through its district nurses,
maternity annexes, and subsidized small country hospitals is trying to
meet the need.
We commend all possible efforts in this direction, and suggest that
transport difficulties as they affect the country mother be given
special consideration.
To a certain extent transport difficulties can be eliminated by making
more use of public hospitals nearest to the patient's residence, or of
private maternity hospitals subsidized by the Hospital Board of the
district.
Certain general criticisms of the maternity services are elsewhere
discussed and certain recommendations are made.
It is in respect of overburdened and debilitated women of those classes
who are not in a position to obtain it privately that we have suggested
that the State might make provision for birth-control advice.
It is for such mothers especially that we have recommended the
establishment of birth-control clinics in connection with our public
hospitals.
We realize, however, that genuine economic hardship is not confined to
the unemployed, the wives of struggling farmers, and those on the
lowest wage-levels; relative to their own circumstances and
responsibilities, the difficulties of many women whose husbands are in
the lower-salaried groups, or in small businesses, for instance, are
just as anxious. For these we should also advocate the extension of the
maternity allowance and such further direct financial encouragement of
the family as can be devised.
Here, too, is the definite need for domestic help--possibly on a
subsidized plan.
Many of these women prefer to make their own private arrangements for
their confinements, and to enable them to do so we suggest that further
assistance might be given by the provision of more maternity hospitals
of the intermediate type, in which these mothers may have all adequate
facilities with the right of attendance by their own doctors. Here,
too, we believe that proper knowledge of child spacing is most
desirable, though we consider that this is a matter for private
arrangement.
(2) REMOVAL OF FEAR OF CHILDBIRTH.
It has been indicated that whereas the majority of witnesses expressed
the opinion that the fear of pregnancy and labour played little part in
the demand for abortion, and that the majority of women were satisfied
with the help and relief which they received at the time of their
confinement, yet there were some witnesses who held very strongly that
inadequate pain relief and lack of sympathetic understanding of the
individual on the part of the attendants were factors of considerable
importance.
We believe that these complaints are, as far as the maternity services
in general are concerned, entirely unjustified.
Taken as a whole, there is probably a more general use of
pain-relieving measures in New Zealand to-day than anywhere else in the
world.
Nevertheless, while commending what has already been done, we trust
that every endeavour will be made by the Health Department, the doctors
of the Dominion, and those responsible for the management of our
maternity hospitals to do everything possible to extend these
pain-relieving measures within the limits of safety, and to encourage
that sympathetic consideration of the individual which is so desirable.
While deprecating certain attacks which have been made on the St.
Helens Hospitals, and appreciating the fact that there are other
considerations involved besides the relieving of pain, we feel sure
that the Health Department will investigate the possibility of
improving the services rendered by these Hospitals by the introduction
of resident medical officers.
We agree with one witness who expressed the opinion that too much had
been done in the past in the way of publishing the risks of maternity.
We feel that there are real grounds for confidence in the obstetrical
services of the Dominion and that any fear of pregnancy which does
exist would be largely removed if the public were made aware that New
Zealand now has a very low death-rate in actual childbirth, that relief
in labour is largely used, and that further developments in this
direction are continually being investigated.
(3) CONTROL OF ABORTION AMONGST THE UNMARRIED.
The evidence before the Committee indicates that, while this is not the
major problem, it is, nevertheless, an important one.
Obviously, the main cause is a looseness of the moral standard, and the
remedy must be educational.
It is not the province, nor is it within the capacity of this
Committee, to make detailed recommendations on this matter, but we
would urge upon all those concerned--the educational authorities,
religious bodies, the various youth movements and women's
organisations, and individual parents--the importance of enlightened
education of the young in the matter of sex problems.
One factor of great importance we believe to be the widespread use of
contraceptives amongst the unmarried.
It might, at first thought, seem likely that the use of contraceptives,
however reprehensible, would tend to diminish the incidence of
abortion.
But we believe that actually this is not the case: there is reason to
think that many young women, relying on undependable methods of
prevention, are tempted, and then, finding themselves in misfortune,
resort to some method of abortion.
It is our opinion that not only is immorality encouraged by the
indiscriminate sale of contraceptives, but, indirectly, criminal
abortion has increased amongst the young.
For these reasons above all we are convinced that there should be a
determined effort to suppress the indiscriminate sale of
contraceptives.
While realizing the great practical difficulties, we believe that much
could be done.
In particular, we believe that some effective measures could be devised
to control the distribution of that type of contraceptive which is
mainly used in these circumstances.
We recommend the consideration of the licensing of the importation of
certain contraceptive goods.
We urge that the sale or distribution of contraceptives should be
restricted entirely to registered practising chemists, doctors,
hospital departments or clinics, and that their sale by other persons
should be illegal and subject to severe penalty.
Evidence placed before the Committee showed that, a profit up to 300
per cent. was being made on contraceptive appliances.
We recommend that the restriction on the advertisement of
contraceptives should be more rigidly enforced, and particularly that
the promiscuous advertisement and sale of contraceptives by "mail
order" agencies should be made illegal.
We recommend that it should be made unlawful to supply contraceptives
to young persons.
Difficulties and possibilities of evasion are of course obvious, but,
nevertheless, similar restrictions have been applied with at least some
measure of success in other directions.
We would also appeal to the Pharmaceutical Society and to the
individual chemists, since the responsibility rests so largely with
them, to co-operate most earnestly in this matter.
With regard to abortifacients, the recommendations we later make apply
with even greater force to unmarried women.
Several witnesses, speaking on behalf of women's organizations,
advocated the introduction of women police for the guidance and
protection of the young in places of public resort.
Reference to the effect of alcohol on moral restraint has already been
made.
The second big consideration is the care of the unmarried woman who is
in trouble.
It has been suggested that if there were a more tolerant attitude
towards such girls many who now resort to abortion would be prepared to
go forward and face the future.
As one witness stated:--
"She should be treated with the greatest tenderness. Usually she is
more sinned against than sinning; but she carries all the blame
which belongs not only to the man but also to society, which has
been guilty of supine acquiescence in the surrender of standards of
moral conduct.
"She has to give birth to a child which has the rights of every
unborn infant; and she has to re-establish herself in the
community.... It is terribly difficult for them afterwards with the
child, and they need all the help they can get. It seems to me that
some of them must go in sheer dread to the abortionist. My definite
opinion is that something more needs to be done."
In all fairness to the many fine organizations which are helping these
girls, the Committee is satisfied that there is no lack of tolerance,
sympathy, and helpfulness with them.
If fault there is, it is in the attitude of the general public to this
matter.
Some criticism has been directed at the St. Helens Hospitals because
they are not freely open to unmarried women, but it is only right that
the position should be made clear.
The actual position is that, in the majority of cases, the St. Helens
Hospitals, which can only offer accommodation to an expectant mother
for the period of her confinement, are _not suitable_ for dealing
with single women, who require protection and care before and after
their confinements as well.
There are, throughout the country, many admirable institutions which
are equipped to give this service.
Discussion before this Committee has, however, made it clear that where
an unmarried mother can make adequate private arrangements for the care
of herself and her infant after confinement, the St. Helens Hospitals
are prepared to take her for the actual confinement period.
In regard to the maternity homes which deal with unmarried women, there
has also been some criticism of the usual regulations in these homes
which call for a period of residence in the home both before and,
especially, after confinement.
It should be pointed out, however, that this is a wise and humane
provision, entirely in the interests of the mothers and their babies;
it ensures for the mother that very period of convalescence which other
witnesses have so strongly advocated under other circumstances, it
gives the baby protection in the most difficult early months, and it
allows the helpers in the home an opportunity to make provision for the
baby's future.
Here, again, where the mother is able to make adequate provision for
herself and her infant, these regulations are certainly relaxed in some
of the homes concerned, and we would commend this practice in suitable
cases to those responsible for the management of all these homes.
Regarding the obstetrical care given to the unmarried mothers in these
homes, the evidence given indicates clearly that it is of a standard
equal to that in our other maternity hospitals.
Indeed, whereas the risks of childbirth amongst unmarried mothers the
world over is notoriously high, amongst the women who place themselves
in the care of these homes in New Zealand the maternal mortality and
the infant mortality are both exceedingly low.
In the homes of which the members of the Committee have personal
knowledge the same ante-natal care (indeed, since these patients are
resident in the home and under close observation, more complete care)
is given and the same methods of pain relief are used.
It is only right that these reassuring facts should be made public.
Regarding the provision for the children in these cases, while we are
satisfied that the State and the various organisations responsible for
their care deal with them in a kindly and sympathetic manner, we agree
that every effort should be made to give them a fair prospect in life,
to avoid any stigma, and to keep secret their misfortune.
It has been suggested by one witness that the privacy of an unmarried
mother's affairs has been interfered with the present regulations
regarding the notification of births. Under the Child Welfare Act as it
at present operates there is a duty on the Registrar to inform the
Child Welfare Department of every birth, and the register is also open
to the Plunket Society for purposes of following up.
Good as the intention of these provisions is in the interests
of the babies, the assertion has been made that in certain cases the
knowledge of this lack of secrecy has deterred women from allowing
their pregnancies to continue, and has constrained them to seek
abortion.
The Committee is not prepared to comment on this complaint, but would
suggest that it be investigated, and that, if there is any
justification in it, the regulations be amended so that, while fully
protecting the child, full secrecy is maintained.
(4) TO MEET CHANGES IN SOCIAL OUTLOOK.
The Committee has concluded that, beyond the economic and domestic
considerations already discussed, there are many changes in modern
social outlook which are operating in the direction of family
limitation, and which, in many cases, lead to the practice of abortion.
Can anything be done to prevent the occurrence of abortion resulting
from these tendencies in modern life?
Concerning birth-control the realities of the position must be faced.
There can be no doubt that there is a widespread uncontrolled and
ill-instructed use of contraceptives.
As one witness put it, "New Zealand is saturated with birth-control."
Owing to this extensive half-knowledge there is in many cases an
entirely unwarranted dependence on their reliability to the exclusion
of any measure of self-discipline whatever.
The Committee is under no illusion in this matter.
With this attitude prevailing in the community and provided with such a
weapon--even though it is likely to explode in their own hands--women
will continue to limit their families. No social legislation, however
generous, will prevent it, nor, as far as the Committee can see, will
legal prohibitions do much to restrict it.
Two lines of action are suggested:--
(1) To direct the knowledge of birth-control through more
responsible channels, where, while the methods advised would be
more reliable, the responsibilities and privileges of motherhood,
the advisability of self-discipline in certain directions, and
other aspects of the question could be discussed.
It is this view which has led the Committee to the recommendations it
has made in the discussion of birth-control.
(2) To appeal to the womanhood of New Zealand in so far as selfish
and unworthy motives have entered into our family life, to consider
the grave physical and moral dangers, not to speak of the dangers
of race suicide which are involved.
We can but urge all those who have to do with the education of our
youth and the moulding of women's opinion to give these matters earnest
consideration, and the Committee is of the opinion that it is necessary
to develop the education of young people in biology and physiology in
our primary and secondary schools as a foundation for a more rational
and wholesome outlook on sex matters.
(5) CONTRACEPTION.
The practice of contraception is a debatable question, and one on which
the most varied evidence has been given.
Witnesses opposed this practice, some on moral grounds, some with the
plea for a greater natural increase in the population of New Zealand.
Others again, particularly the representatives of women's
organizations, advocated the establishment of clinics for the general
instruction of married women in the practice of reliable methods of
contraception. They expressed the opinion, and some of them supported
their opinions with sound argument and overseas experience, that the
instruction of the mothers of New Zealand in the practice of
child-spacing rather than resulting in a diminution of the birth-rate
might well cause an increase in the size of many families, for, in
addition to enabling mothers to plan their families, such clinics also
specialize in propaganda calculated to awaken women to an appreciation
of the privileges and responsibilities of motherhood.
The Committee agrees that the possession of reliable contraceptive
knowledge by the married women of New Zealand would tend to augment
rather than to diminish further the natural rate of increase of our
population, for an additional factor to those given above lies in the
large amount of sterility which follows induced abortion, that most
unsatisfactory of all forms of birth-control.
The evidence laid before the Committee shows that in New Zealand every
year thousands of women imperil, and indeed negate, their future
prospects of motherhood by submitting to the induction of abortion.
It has been shown that abortion is a delayed, dangerous, and
unsatisfactory form of birth-control, and it can quite logically be
argued that if a reliable and simple method of contraception was known
to all married people the abortion problem would assume very small
proportions.
This is, to a large extent, true, but it must not be forgotten that
both abortion and contraception have various aspects, and that apart
from other objections there are practical difficulties which are not
easily surmounted. There is no known contraceptive which is simple,
inexpensive, and 100 per cent. reliable for the thoughtless, the
careless, and the stupid.
Contraception may be considered under three headings:--
(1) The practice of contraception extramaritially, which only needs
to be mentioned to be deprecated.
(2) The practice of contraception by married people irrespective of
their circumstances.
Evidence was given by responsible and representative women in support
of a mother's right to say when she will bear her children, and
although we agree that this privilege might well be conceded her, we
are of the opinion that it is not the function of the State to
undertake the dissemination of the knowledge and give the practical
instruction necessary to enable the general adoption of this principle.
This general instruction can well be left to the medical profession,
who should also undertake the responsibility of impressing the
privileges of motherhood upon young women seeking such advice.
In recommending that such general instruction should be left to the
medical practitioners, we are cognizant of the fact that many members
of that profession are at a loss to know what methods of contraception
can be reliably recommended to lay persons.
A sub-committee of the Obstetrical Society, consisting of members who
have made a special study of this problem, has been set up, and the
presentation of their report will doubtless clarify the position in the
minds of the medical profession.
(3) The practice of contraception by married women who, in the
opinion of their medical attendant, should have temporary or
permanent freedom from the fact or fear of pregnancy.
Not only are there cases in which severe illness exists making further
pregnancies dangerous, but there is also a heterogenous group including
all gradations of health and economic reasons.
Here we have the mother with health undermined and reserve vitality
reduced to a minimum by the strain of bearing and rearing a large
family. She approaches the menopausal stresses with anxiety and
apprehension, having done her duty to family and race, often having
lived an exemplary self-sacrificing life, the intolerable contemplation
of a late pregnancy drives her to desperate measures often for the
first time in her life.
Again, there is the relatively young, tired, anaemic, debilitated
mother, with a number of young children born at very close intervals,
often denied even a half-holiday, let alone an adequate one, unable to
afford suitable domestic assistance, often with poor housing or
domestic arrangements, and completely exhausted with the incessant
round of cleaning, cooking, and the strain of the inevitable
fretfulness of a number of young children.
The Committee is of the opinion that it is the State's duty to ensure
that mothers within this group should obtain the respite that the
health of themselves and their present and future families demands.
The economic aspects of these problems are dealt with in our general
recommendations, but we also recommend that departments should be
established, preferably in conjunction with the out-patients'
departments of our public hospitals, whither medical practitioners
could refer for instruction and equipment with contraceptive appliances
mothers who in their opinion should be assured of temporary or
permanent freedom from child-bearing.
It might be desirable that the certifying doctor's recommendation
should be endorsed by the officer in charge of the department before
admission, but that is a practical point which could be discussed at a
later date with members of the Obstetrical Society and medical
profession.
Though the Committee discounts the exaggerated statements that have
been made at intervals about the sale of contraceptives to juveniles,
and though no first-hand information on such matters was laid before
the Committee, yet we are of the opinion that the sale of
contraceptives to young persons should be prohibited.
(6) THE CONTROL OF THE ADVERTISEMENT AND SALE OF ABORTIFACIENT DRUGS
AND APPLIANCES.
The Committee recommends the advertising and sale (except by doctor's
prescription) of drugs euphemistically described as for the "correction
of women's ailments" or "correction of irregularities" should be
forbidded. For their alleged purpose of correcting functional menstrual
irregularities they have no value; as abortifacients though usually
ineffective their unrestricted sale should be forbidden. As stated
previously, "their only value is as a lucrative source of gain to those
people who, knowing their inefficiency, yet exploit the distress of
certain women by selling them." An example of this exploitation was
obtained by the Committee. The drugs were advertised as "corrective
pills, ordinary strength, 7s. 6d.; extra strong, 12s. 6d.; special
strength, 20s." A supply of the last was obtained, and analysis showed
that they consisted of (1) a capsule containing about 12 drops of oil
of savin, value about 6d., dangerous to health but usually useless for
the purpose sold; (2) 9 tablets of quinine, worth about 4s., and quite
ineffective; (3) 24 iron and aloes pills, worth about 6d., and equally
ineffective. The gross profit on this 2s. worth of rubbish was at least
900 per cent. If it is possible to legislate to stop such fraudulent
exploitation of people we recommend that it be done.
The Committee also recommends that the sale of surgical instruments
which can be used for the purpose of procuring abortions, such as
catheters, Bougies, and sea-tangle tents, be prohibited, except on the
prescription of a medical practitioner, and that if possible their
importation be placed under control.