BIRTH CONTROL
AND THE STATE
BIRTH CONTROL
AND THE STATE
A PLEA AND A FORECAST
BY
C. P. BLACKER
M.C., M.A., M.R.C.S., L.R.C.P.
[Illustration]
NEW YORK
E. P. DUTTON & COMPANY
681 FIFTH AVENUE
Copyright, 1926
By E. P. DUTTON & COMPANY
_All Rights Reserved_
PRINTED IN THE UNITED STATES OF AMERICA
FOREWORD
The pioneer battles on behalf of Birth Control, as everybody knows,
have been fought in this country by Dr Marie Stopes, who has largely
borne the brunt of that abuse which is meted out to all popular
exponents of ideas that do not harmonize with traditional morality. The
fact that Dr Stopes has been criticized, and at times attacked by the
medical profession (which until recently refused to acknowledge that
the subject of Contraception fell within its sphere) on the grounds
that she does not possess a medical degree, and the fact that she has
retaliated with vigour――and continues to do so in most of her public
utterances, have led to a breach between her and the more orthodox
elements of the profession, which to a certain extent, has impeded the
realization of her ultimate aim, namely the undertaking by the State of
the work she performs on a small scale in her privately-run clinique.
In what follows I have drawn attention to drawbacks attending the
dissemination of knowledge of Contraception by General Propaganda. I
have done so, however, fully realizing that this propaganda was, in
the first instance, necessary to override the barrier of prejudice
presented by orthodox morality, and equally realizing that if it had
not been for Dr Stopes and her propaganda this book would probably
never have been written. In its essential plea that advice on
Contraception, now obtainable only at private institutions, be made
generally available by the Ministry of Health at the centres under
its control, this book is at one with the wider aim expressed by Dr
Stopes in the words that commemorate the founding of her first private
clinique.
I know that in the past it has proved nearly impossible in a single
book to appeal effectively both to the general public, and to the
medical profession. Yet I have attempted to do that here. The task has
been made perhaps less difficult than usual by the fact that until
recently the subject of contraception has been completely ignored by
the medical profession, which as a whole seems to remain as uninformed
of its wider implication as does the general public. It will be found
that the book ends with a practical suggestion taking the form of an
appeal to the medical profession.
The substance of the first part of what follows originally appeared as
a series of articles in The Saturday Review, to which I am indebted for
permission to publish the book in its present form.
C. P. B.
BIRTH CONTROL AND THE STATE
A PLEA AND A FORECAST
Since the War, the subject of Birth Control has been widely discussed,
and much has been written about it. By some of its advocates it has
been extolled to the point where any criticism, however tentative,
is resentfully repudiated. By its enemies it has been represented as
a pernicious and unnatural practice leading to the degeneracy and,
ultimately, to the extinction of the race. So wholeheartedly felt, and
yet so profoundly opposed are these views, that it has been difficult
for the average person to find his bearings on any other basis than
that of his own sentiment.
It is clear that the implications of Birth Control, or, rather, what
is generally, though not logically understood by the term, of the
practice of contraception, are far reaching. It profoundly affects the
life of the individual; it reacts upon the internal economy of the
community; and it has a most important bearing upon the international
future of the country wherein it is practised. It is therefore
incumbent upon all serious students of contemporary world-problems to
realize clearly what is to be said on both sides, and to form thereon,
as far as lies in their power, an unbiassed opinion. This obligation
weighs especially heavily on medical men since, if the practice is to
be tolerated at all, it is by them that it should be administered and
controlled.
It is a general survey of this sort that is attempted here. The book
will begin with a consideration of the more important arguments that
have been advanced on each side. These will then be discussed, and
there will follow a conclusion as to the bearing of the practice upon
the future of civilization.
It will be convenient first to review the more serious arguments used
_against_ Birth Control, the problem being considered throughout both
as a world-problem and as one with a special significance for this
country. They fall into two distinct categories concerning (A) the Race
and (B) the Individual.
A. 1. The ‘military’ argument finds exponents among Nationalists, who
are convinced that the essential merit of a country lies in its powers
of offence and defence, or who are persuaded that future wars are, by
the constitution of human nature, inevitable, and that it is therefore
necessary for the country to which they belong to be fully equipped.
By such persons, Birth Control is opposed in so far as it would impair
their country’s man power.
2. An argument allied to the above, yet one which must be distinguished
carefully from it, deserves close scrutiny. It is to the effect that
quite apart from military considerations the practice of Birth Control
in a country is capable of acquiring in a short time such universality
that the population may decrease, and eventually dwindle to proportions
which would place that country, whatever its status, in a position of a
second or third-rate power. From history the approximate generalization
can be made that prolific races get the better of infertile races in
the struggle, first for existence, and then at a later stage, for
power. This generalization is likely to hold good in an economic
sphere. Thus a graphic picture has been drawn of what will happen to
England, in the matter of its population, if it follows in the wake
of France. It will come to assume the proportions of an insignificant
little island in the North Sea, the possessor, actually, of a mighty
past, but in the present counting for nothing beside the densely
peopled territories of Southern and Eastern Europe, Asia and America.
Birth Control uncontrolled means race suicide.
3. There is an ‘economic’ argument against Birth Control, which itself
takes two forms.
In the first place it is felt, in under-populated countries like New
Zealand, Australia, and perhaps to a less extent the United States,
that since it is desirable in the general interests that the population
should increase, it is to be preferred that this increase be effected
from native-born stock rather than through the process of accretion
by often undesirable aliens. Hence in most under-populated countries,
Birth Control is opposed.
In the second place it is probably felt (though probably not admitted)
by the Governments of those capitalistic countries confronted with
a labour problem, which are at the same time desirous of limiting
immigration, that the unrestricted multiplication of their working
classes, by causing a competition for wages, will create a cheap labour
market. It is highly unlikely that this view has much weight here,
though it may easily be otherwise in the United States, where the
labour problem is acute and where it is universally desired to limit
coloured immigration and immigration from South-Eastern Europe.
4. There is an argument against Birth Control, which has special
reference to the position of this country as the original founder of
a great Empire. Since most of the Dominions are still under-populated
and wish their numbers to increase, and since the increase of native
stock, even though fully encouraged, is unable to supply the demand for
labour, it is contended that Great Britain should always be able to
turn out a numerical surplus to send to the Dominions each year, which
in addition to satisfying a need for better-class immigrants would
serve to consolidate the racial and cultural bonds that keep the Empire
together.
B. The above arguments concern the race. The remainder which follow
refer primarily to the individual.
5. A ‘medical’ argument has been heard to the effect that the
actual practice of Birth Control or, more precisely, the use of
contraceptives, is inimical to health, being capable of causing both
local disease and more general constitutional disorders. Emotional
instability and various neuroses have been quoted as such products.
No woman making use of a contraceptive for the first time can escape
a feeling of revulsion at such a callous interference with a process
that above all others should be spontaneous and instinctive. No woman
can then fail to experience a sense of aversion from such a deliberate
thwarting of Nature’s most fundamental purpose.
6. Very potent also, is a ‘conventional’ objection which in practice
is often associated with the religious argument next to be considered,
though in reality it is distinguishable from it. On these grounds it
is felt that all that pertains to the province of sex is indecent,
disgusting, and unfit for discussion. The topic of Birth Control is
thus stigmatized as ‘immoral’ by many people of no deep religious
conviction.
7. The ‘religious’ objection nowadays finds its chief exponents among
the Japanese and Roman Catholics, though it is also strongly upheld by
many Anglicans and others. By the Japanese, Birth Control is condemned
on grounds that seem to be, partly at any rate, nationalistic. The
Japanese religion, intimately connected as it is with Ancestor Cult,
holds that it is the duty of every man to marry young, and to produce
the largest possible number of children, especially males, who may
carry on the tradition of the family and at the same time grow up into
soldiers capable of fighting for the Mikado in war. By the Japanese,
the Mikado is believed to be a Deity incarnate, not in the symbolical
sense in which some people have thought of the divine right of kings,
but in a real and vital sense, as ‘the occupant of a sacred throne
which was established at the time when the heavens and the earth
became separated.’ To die for him in war is the most supreme, the most
glorious duty. The objection to Birth Control here would thus seem
closely allied to the ‘military’ objection first advanced.
By Roman Catholics it is held to be a mortal sin to employ any chemical
or mechanical means to prevent conception, the only permissible form
of control being voluntary abstinence from each other on the part of
both parents. The abstinence of one parent against the will of the
other is also considered a mortal sin on the part of the refractory
parent. An exception to this rule is now made which permits parents
not desiring children to make use of a moment in the periodic life of
the mother during which conception is less likely to take place than
at other times――the so-called ‘safe’ period. It is, however, generally
agreed nowadays that the ‘safety’ pertaining to this period is in many
cases quite illusory and devoid of serious physiological or medical
basis. Opponents of the Roman Catholic Church have represented its
insistence on this prohibition as dictated by a desire to extend her
spiritual empire throughout the world, since obedience to it must
bring about a greater relative increase of believing Roman Catholics
than of adherents to other religious denominations tolerating Birth
Control. But its attitude would further appear to express a conviction
(manifested elsewhere in the insistence upon celibacy among Catholic
priests and in its systems of penances and abstinences) that sexual
indulgence is somehow incompatible with devotion to a purely spiritual
life, and when excessive produces a demoralizing effect upon human
nature, tending to make it weak, lazy, selfish and often vicious.
Probably the Catholic Church feels that the use of devices to prevent
conception would abolish the necessity for salutary self-restraint,
and would promote promiscuous and excessive indulgence. The effect of
this prohibition is that most Catholics who are conscientious about
not using contraceptives have large families. There are some, however,
particularly in France, who do not take the prohibition very seriously.
At the bottom, however, of the religious objection, would appear to
lie the conviction that excessive sexual indulgence, dissociated
from the sequel of procreation and rendered possible by the use of
contraceptives, is morally harmful to the individual.
8. An objection of a pseudo-political nature is sometimes heard which
envisages a bureaucratic extension of Birth Control. The phrase is here
understood to imply a ‘National Control of Births’ and not a ‘Voluntary
Regulation of Births’, its more usual acceptance. Such a bureaucratic
interference in people’s private lives is held to constitute an
infringement of the liberty of the individual――in this case his
liberty to have as many children as he likes, when he likes. The
principle of individual liberty, the corner-stone of nineteenth century
Liberalism, still has a certain number of adherents.
9. The last outstanding argument is to the effect that the
popularization of Birth Control will lead to a general increase in
promiscuity, both among married and unmarried people. The temptation
to illicit indulgence would be made greater, the process of seducing
an innocent girl would be made easier, the ever-present lure of
prostitution to the underpaid girl worker would be made more difficult
to resist, if an assurance could be felt that the subsequent birth of
a child――hitherto a generally prevalent and effective deterrent――could
be prevented by the exercise of a popularly known technique. The
restraint imposed by fear may not be one of a high moral order, yet the
end which it serves is here, by common consent, socially desirable.
In face of the absence of any authoritative source of information on
Birth Control, and of the indifference of the medical profession with
regard to it, certain popular works on the subject have acquired an
immense vogue and have enjoyed an enormous sale. Though not intended
for this purpose, they are purchased and read extensively by young
persons in much the same spirit that improper literature in general is
read. Further, the sale to adults of these works containing as they do
a magnification and eulogy of the sexual act _per se_ (to be conceived,
expressly, apart from its normal biological sequel of child-birth as
a salutary and health-giving process), and containing also minute
instructions as to the technical use of contraceptives, has not been
confined to married persons. Such works have been held to inflame and
pervert the imagination of the young, and on pseudo-medical grounds,
to incite adults to promiscuity. It is to be noted, however, that the
above is an argument directed not so much against Birth Control itself
as against the method by which knowledge of it is communicated to the
public.
* * * * *
These appear to be the most important arguments currently advanced
against Birth Control.
It will be noted that several have been omitted from consideration.
The one based upon biblical condemnation is too futile to merit
restatement. The argument that contraception is ‘unnatural’ is equally
undeserving of repetition. The contention that it is anti-biological
will be discussed later.
* * * * *
Arguments on the other side will now be considered. They divide
themselves into three groups, which may arbitrarily be designated as
International, Social, and Individual arguments.
(_a_) _International._――The connexion between over-population and war is
nowadays fairly obvious and is particularly manifest in those countries
which are both industrially organized and consciously nationalist in
spirit. In the absence of these two conditions over-multiplication need
not be followed by war. India and China, for instance, are very densely
populated countries where over-multiplication frequently takes place.
This process does not, however, give rise to much danger of
international disturbance, in that both countries are, from the nature
of their organization, incapable of conducting war on modern lines, and
neither has a generally-felt, or a unifying national consciousness.
Excessive increase is here frequently checked by famines, which, though
causing incalculable suffering, do not readily generate wars.
Within recent years two countries have demonstrated the relation
between over-population and war, or the threat of war, namely Germany
and Japan.
In Germany before the war, where the ‘military’ objection to Birth
Control, first advanced, was prevalent, there existed an ethical code
by which German mothers were persuaded that they were fulfilling the
highest spiritual purpose of which their sex was capable by producing
male children destined to be soldiers, prepared to fight for their
country in a victorious war. It is now generally recognized here
that it was this attitude of mind, involving an expectation and a
glorification of war, associated with the distinctively German powers
of efficient organization centred in implicit obedience to the Kaiser,
which served to produce that exultant pride of power and aggressive
national consciousness which precipitated, if it did not actually
cause, the late war. The increase in the population of Germany was
advocated and extolled without regard to that country’s capacity to
support her swelling populations. To-day, though Birth Control is
largely practised by the upper and middle classes in Germany as
it is in this country, the old ideal still lingers on, and to it
is attributable that fear of Germany which, until recently, has so
conspicuously directed French policy since the Armistice.
In Japan the connexion between numerical increase and a possible war is
now coming to be recognized here. Australia, New Zealand and the United
States are already definitely conscious of it. The Japanese religion,
based upon piety towards ancestors (to whom every man is bound to
perpetuate his family), and upon loyalty to the Mikado who, as Emperor
God, is held to be divine, imposes upon all faithful subjects the duty
of marrying young and of producing many children. This injunction
is again promulgated irrespective of the native resources of Japan,
and in the past has necessitated a considerable annual emigration
to other countries. The recent restrictions imposed by America upon
Japanese immigration, themselves prompted by motives common to most
English-speaking races, have led directly and inevitably to the
existing tension between America and Japan. As things stand at present,
it appears that this tension is likely to increase and may easily
eventuate in a war, in which there would be a greater probability
of our being involved than there was, initially, of America being
involved in the late war. Both the Americans and Japanese are sensitive
and proud people. After further tension has accumulated, a trivial
incident――the possible murder of an American official in Japan by some
irresponsible person――might lead to the despatch of a curtly-worded
note or to the formulation of an abrupt ultimatum out of which a second
world war might, like the last, suddenly flare up, to reduce modern
civilization to ruins and ashes.
Stress is laid on this particular aspect of the population problem
partly because it is felt that few nations now hold the desirable ideal
of adapting their numbers to their particular economic optimum, and
partly because it would seem that in face of this nationally encouraged
increase of population and of certain apparently unalterable race
antipathies, _no amount_ of international pacifism, or of condemnation
of violence, or of genuine humanitarian goodwill can prevent war.
Germany and Japan display the connexion between numerical increase
and wars most clearly to-day. It is possible that in the future other
nations may become conspicuous in this respect. Thus America, where
the teaching of contraception is illegal (in so far as anything is),
may, in another 50 or 100 years, develop an aggressive foreign policy.
And now that restrictions have been imposed on the entry of Italians
into America, it is conceivable that Italy may at some time discover an
Imperialist mission on the shores of the Mediterranean.
(_b_) _Social._――This aspect of Birth Control has been much discussed
and is concerned with the dimensions and quality of the population
of these islands. The argument, in the form in which it is usually
advanced, distinguishes a quantitative and a qualitative point of view,
the latter further possessing two aspects.
Quantitatively, it has been pointed out that in the last hundred years,
the increase in the population of this country has been excessive.
Because England was the pioneer of the Industrial Revolution, she
enjoyed initially an unprecedented national prosperity, unharassed by
competitors and with the world as her market. Though the conditions of
many of the early factory-workers were unquestionably appalling, the
wealth and economic importance of this country increased so rapidly
that she was enabled to support immensely greater numbers than at any
previous period of her history.
Thus in 1821 the population of England and Wales was just over 12
millions; in 1921 it had risen to nearly 38 millions. That is to say
that in a hundred years our population had more than trebled.
When, however, at the beginning of this century other countries began
to enter into competition with us, and to produce manufactured goods
on a large scale often underselling British goods, our hitherto
unchallenged industrial supremacy gradually commenced to suffer
eclipse. But our numbers have not adapted themselves to our diminished
power of employing labour thus created. On the contrary, the population
has continued steadily to increase, with the result that by slow
degrees the unemployment problem which, at present, looms so large on
our political horizon began insidiously to disclose itself. The present
formidable figure of nearly a million and a quarter of unemployed,
together with a large number of workers on short hours, testifies to
the fact that at the present time in relation to existing economic
conditions, this country seems to be over-populated.
* * * * *
From the point of view of quality it has been pointed out that there
are two factors which now tend to impoverish the race. They might
be distinguished and arbitrarily named as ‘Dysgenic’ and ‘Economic’
respectively.
The dysgenic factor may be propounded as follows: Though the Birth-rate
in England has fallen from 36 per 1000 in 1877 to 20 per 1000 or less
to-day, this decrease has not been accompanied by a decrease in the
population, since the Death-rate has dropped correspondingly. This has
taken place by reason of the complete suspension, if not the actual
reversal, in civilized countries to-day of the principle of Natural
Selection, operative amongst animals and primitive peoples.
There are three outstanding reasons to which this suspension is
attributable. They are the advances in sanitation and medical science,
the increase in humanitarianism, and the method of obtaining votes
which prevails in democratic countries.
The advances in sanitation and medical science made in the last 60
years have resulted in an enormous reduction of infant mortality in
large towns, and also in an average prolongation of life. Epidemics
of smallpox, cholera, typhus, diphtheria, scarlet fever, etc., which
took such a heavy toll in the past, are now effectively controlled by
the existing system of isolation hospitals, and of efficient public
health supervision. To-day it is possible for the medical student to
traverse his six laborious years of training without seeing a single
case of typhoid fever――a disease which in the times of his elders
used to be one of the commonplaces of a hospital. These improvements
in sanitation, the progress made in aseptic surgery, in prophylactic
medicine, and in the general treatment of disease, have been largely
responsible for the lowering of the death-rate already mentioned.
The increase of humanitarianism in civilized countries has resulted in
the creation of an enormous number of philanthropic institutions and
charity organizations, through the channels of which much relief is
brought to the impoverished classes. This spirit now makes it difficult
for those endowed with a superfluity, or even a sufficiency of wealth,
to contemplate with indifference the misery and degradation of less
fortunately placed fellow human beings.
And lastly, since the entry to power of any given political party
is conditioned by the acquisition by that party of a sufficient
number of votes, given by a mainly proletarian electorate, it follows
that politics are likely to be framed in such a way as to commend
themselves to such an electorate. It would seem unfair to omit this
fact from consideration, though it has been over-emphasized by a school
of political cynics who deny the participation of humanitarian feelings
in politics (outside the realm of speech-making), and who attribute to
political expediency an excessive if not an exclusive rôle in improving
the lot of the very poor.
In virtue, then, of these factors it would nowadays be very difficult
for any individual, however worthless, actually to starve, and many
people of defective stock and bad physique who, in the ordinary course
of nature would perish, are now artificially kept alive to perpetuate
their kind.
* * * * *
The ‘economic’ factor tending to produce deterioration in the race,
presupposes the dysgenic.
Among uncivilized peoples it is the biologically superior type which is
most prolific. In advanced civilized countries, which are democratic
in social organization, the reverse obtains. Thus among most primitive
people, the Chief――_i.e._ the man with most courage, initiative,
resourcefulness and power of leadership――enjoys the possession of most
wives, and therefore produces most offspring. The analogue of the
drunken unemployable of to-day would probably not be permitted to marry.
In England now, however, the drunken unemployable finds his nearest
approach to an occupation in endowing his ill-fated wife with a stream
of children, the regular succession of which is only eventually
interrupted by the breakdown, age, or premature death of the wife, or
by the death of the husband. And the only discouragement extended to
such a man is forthcoming from the strictures passed upon him by his
slum neighbours. None is forthcoming from the Government, and none from
the hospital, which gratuitously delivers the wife of her children. In
fact, information as to how she may arrest this devastating succession
of children is deliberately withheld from her by nearly all hospitals,
because it is felt that the condition of public opinion, upon which the
hospitals largely depend for their finances, is averse from her being
enlightened in this respect.
The organization for relief in this country is now so comprehensive and
far-reaching that every necessity can be obtained gratis by those who
cannot afford to pay for it. Thus the wife of the poor man is delivered
of her children free of charge; the children are educated for nothing;
if employment is not available for them at the time of leaving school,
they are supplied with doles and relief free of obligation. And when
they become senile, they are given old age pensions gratuitously. The
funds necessary for the administration of these works are levied from
the middle and upper classes, in rates and taxes.
Now the Englishman possesses a strong sentiment for institutions. A man
who has himself received a certain kind of education, and who has been
brought up according to a certain tradition, likes to provide the same
education and the same tradition for his children. And if in the face
of the increase in taxation, the rise in the cost of living, and the
expenses of education, he cannot afford this, sooner than have children
to whom he must deny what he considers a good start in life, he prefers
to limit his family. This obtains of the man who suffers from a sense
of obligation towards his children. The opposite holds good of the
unemployed man at the other end of the social scale. He feels that he
has sunk as low as is possible for him while still remaining out of
prison. Insidiously his ambition and his self-respect become sapped by
the soul-killing experience of finding himself a useless parasite upon
the community. Frequently, as prison reports show, he takes to crime
or drink. And slowly he is overcome by that sense of irresponsibility,
of bitterness, of carelessness of the future, of improvident fatalism
that takes possession of those living under continuously adverse
circumstances.
It is a matter of indifference to him how many children are born to him
since with each one his dole is increased. None of the restraints which
enter into the longer view of the future held by the middle classes is
felt by him. And so he goes ahead, and has as many children as time and
the health of his wife (of which last he does not always show excessive
consideration) will permit.
The following figures clearly illustrate this state of things. Whereas
the number of children produced annually by a thousand teachers is 95,
by Church of England ministers is 101, by doctors is 103, the average
number produced by general labourers is 231. And among these general
labourers it is the least desirable individuals――those, with least
self-restraint, least foresight and with least consideration for their
wives or the future of their children――who have largest families. And
the undesirability may be of another kind. Mental defectives generally
are very prolific. Girls of this condition, if left unwatched, are
constantly becoming pregnant, there being apparently no shortage of
men prepared to take advantage sexually of such unfortunate victims.
It is to be noted that the economic situation following war is
especially favourable to this discrepancy of fertility between classes.
It would seem that the recent experience of the significance of war,
the existing sense of social instability, the universal prevalence of
unrest, hatred and international discord, make the more considerate
parents feel that the world is not a very desirable place to bring
children into. And this feeling is emphasized if they have to pay in
taxation four times what they had to pay before, after which what
money remains is worth about sixty-five per cent. of its previous
value. But these considerations hardly affect the classes whose
occupation is manual labour, or who have accustomed themselves to no
occupation at all.
Thus from a social point of view it is to be observed that
quantitatively, in relation to the present resources of the country,
England is at the present day considerably over-populated; and
qualitatively that many persons of all classes possessing inferior
physique are now artificially kept alive to perpetuate their stock,
while at the same time those elements of the population who, by lack
of intelligence or thrift or steadiness, or who by possession of other
defects have been reduced to the lowest level of the social structure,
to-day constitute the most fertile strain in the country.
(_c_) _Individual._――The argument has frequently been heard that it
is desirable to communicate knowledge of Birth Control to the poorer
classes in the interests of the mother and the children.
It is difficult to know what percentage of the unwanted children born
in the poorer quarters of our large towns are conceived as the result
of a culpable aggression on the part of the husband upon his wife――as
when he returns home drunk on Saturday night and threatens her with
physical violence if she refuses to submit to his conjugal rights――or
as the result of an ignorance of Birth Control methods which are
familiar to the more educated classes. Certain it is that a large
percentage of the children born are unwanted, and equally certain that
among the very poor ignorance of contraception is such as to appear
incredible to those who have not had personal experience of it.
Thus in the Autumn of 1924 a group of seven externs, working in the
district covered by Guy’s Hospital, made inquiries of the mothers
whose confinements they attended as to whether the child just born
had been wanted or not. The inquiries were made, when possible, on
the tenth day, when the patients were last visited, in such a way
that their answers were more likely to be favourably influenced by
fondness for the child than unfavourably by recollection of the pains
of labour. Furthermore, where any doubt existed, as for instance when
a woman replied that she had not particularly desired the baby before
it was born, but would not part with it for the world now, she was
given the benefit of the doubt and the baby was counted as wanted. In
all, inquiries were made in the case of seventy-eight children born.
Out of these, forty-seven were definitely not wanted, and thirty-one
wanted; and the writer can vouch for the fact that if these figures
erred at all, they did so on the side of moderation. Thus, in at least
one poor quarter of London, well over half of the children born were
emphatically not wanted.
The hardships imposed on the mother by such conditions are sometimes
very cruel. Numerous cases have been quoted by advocates of Birth
Control in their propaganda which there is not space to reproduce
here. The reader can, however, picture to himself the experience of
a woman suffering from the sickness, shortness of breath, emotional
instability, and deformity of pregnancy, having to maintain life in
some squalid slum, house-keeping, cooking, cleaning and tending the
children without change of air or scene and without holidays, up till
the incidence of the final labour pains. And no sooner is a child born
than the husband reasserts his “rights,” and the same dismal cycle
repeats itself without prospect or hope of change, or of relief from a
body that has ceased to know the easy freedom and self-forgetfulness of
good health.
Indifference to the children appears. They are looked after out of
a stern sense of duty. The native impulse of spontaneous maternal
fondness is killed by the deadly routine, and when, as frequently
happens, the child dies, after a few pangs of grief, an easy
reconciliation (perhaps not without a deep-seated sense of inward
gratitude), is made to what is acknowledged as the “Will of the
Almighty.” Sometimes, the mother makes no secret of her relief. But
no man who has come for any length of time in contact with these
working-class mothers can fail to admire the patience, the stoicism and
the grim fortitude with which they face their dreary lot.
Their ignorance of Birth Control, in face of the publicity the subject
is now given in the Press, is almost incredible. The same quality of
fatalism and resignation felt by the soldier in the war before the
prospect of wounds or death, is still evinced by these women in the
matter of child-birth. One frequently meets with a sentiment that
“we must take what comes without grumbling,” that “what is fated must
be,” and even that “we must not fly in the face of the Almighty.”
There further exists a superstition that any object requiring internal
adjustment, like a pessary, runs the risk of being lost in the woman’s
inside.
A further aspect of the problem is the prevalence under the existing
system of the practice of abortion. It is difficult, of course, to give
any trustworthy figures in this connexion, since in many cases the fact
that the mother has attempted to induce an abortion is not revealed
to the medical man who attends her, or to the hospital authorities
who take her in. The methods usually resorted to are of an amazing
crudity. They vary from the pregnant mother jumping three or four
times consecutively off a table on to the floor or throwing herself
downstairs, to her swallowing large quantities of lead, ergot, quinine
and other substances as well as nocuous doses of emetics, irritants and
purgatives.
Frequently the woman practises local violence upon herself, or engages
the services of a professional abortionist, a class more numerous than
is generally supposed. Such a person, after practising his art, is in
the habit of instructing the woman as soon as she feels the pain or
notices any haemorrhage, to report herself to a medical man or present
herself at a hospital where she is taken in as an ordinary case of
threatened abortion. The responsibility for what may subsequently
happen to the woman is thus effectively removed from the abortionist’s
shoulders, it being in the interest of everyone concerned to preserve
silence as to the part he has played.
The damage done to the health of many poor women by such practices is
enormous, and might largely be avoided by a judicious instruction in
Birth Control.
When the effects of all this upon the children are considered, it is at
once found that the question of Birth Control is intimately connected
with the housing problem. The overcrowding in large slum families is
notorious. At an early age the day is passed by these children in
the street, where, filthy and untended, they receive little by way
of notice from their elders except hard words or blows. Their nights
are spent packed, in a fetid atmosphere, several together in the same
bed from which they may witness their parents in sexual intercourse,
sometimes their mother in labour, and where they are free to indulge
in what, later in life, would be called incestuous practices with one
another. The writer has on more than one occasion attended a woman in
confinement while several children were watching her from a bed in the
same room, there being, in the urgency of the situation, no time to
dispose of them and nowhere immediately available to send them.
* * * * *
Substantially this is what has been said on each side of this complex
question.
Before proceeding to discuss the arguments heretofore propounded, it is
necessary to emphasize the fact that from the technical point of view
_a really satisfactory contraceptive does not yet exist_.
The chief disadvantage attaching to the contraceptive used by the man
is that it is quite impossible to induce the type of individual whose
procreation we would wish to restrict to use any contraceptive at all.
The child is usually begotten by such a parent when he is drunk, and
everyone who has had experience of the conditions prevailing in bad
slums will know that it is futile to expect to achieve anything along
these lines through the man. The problem must be met through the
woman who, unlike the man, has to put up with the discomfort and the
pain of repeated pregnancies, and has to shoulder the main burden of
large families. Were it not for this elementary human fact all attempts
to teach Birth Control to the very poor and destitute would fail
completely.
Essentially, contraceptives which the woman can use are of two sorts,
and involve two principles――namely, a mechanical or occlusive, and a
chemical or spermicidal principle.
The objections to the first are two, namely that they are far from
being fool-proof, and that unless sanctioned by a doctor their use can
be followed by serious harm. It will be clear to any medical man that
for a patient suffering from gonorrhœal cervicitis, or indeed from
any condition involving a chronic cervical discharge, the use of an
occlusive pessary may lead to disastrous consequences. The broadcasting
of promiscuous advice as to the utilization of these objects in the
absence of an examination by a competent medical man or woman is
therefore to be strongly condemned.
The drawback, to all existing spermicidal suppositories is simply their
uncertainty, though they are as nearly fool-proof as anything of the
kind can be. It is possible that by further research a suppository,
physically harmless but of certain action may be discovered, in which
case, from its practical and sociological aspect, the problem of birth
control will be greatly simplified. It remains, however, a little
doubtful whether the chemical principle, however actively spermicidal,
will ever dispense with the necessity of some occlusive device. But
this is a sphere in which later research may prove of great value,
and nothing but a tentative statement is now possible. The statement
may, however, be made that if there is one method of Birth Control as
to whose harmfulness there is little room for doubt, it is the method
of coitus interruptus. In both sexes it gives rise to a condition
of chronic anxiety which, nowadays, is far from uncommon. In the
absence of local disease any of the above methods of contraception is
preferable to this one.
The effectiveness of those women’s contraceptives now in vogue is
difficult to estimate. There is little doubt that an unduly high
estimation of their success has been formed in certain quarters,
based on the assumption that in cases of failure, the working woman
will promptly report the event to the centre where the contraceptive
was obtained. The writer is persuaded that this is often a mistaken
assumption, and that many cases of failure pass in consequence unnoted.
There is also difficulty in knowing whether the instructions in the
adjustment of the occlusive pessary have been adequately followed out.
This process is not always easy, and as has been said above, is far
from fool-proof.
The arguments above advanced will now be considered in their relation
to (_a_) the Individual and (_b_) the Race.
(_a_) _The Individual._――The arguments relating to the individual are
divisible into those applicable to (1) married, and (2) unmarried
persons.
(1) It is to be noted that some of the contentions advanced on each
side apply to the different phases of the married life of the woman.
Thus the revulsion of feeling against the use of contraceptives is
experienced chiefly by the woman who has had either no children or few
children. On the other hand, the woman who has the greatest need for
a knowledge of Birth Control is the one who has had many children and
desiring no more would probably feel little or no aversion from taking
precautions against conceiving them. It appears to the writer that
there is no adequate objection to communicating to such a multiparous
mother this much needed information.
The difficulty in the case of the newly-married woman is of another
type. The discrepancy between the ages at which human beings
reach sexual maturity and at which they find themselves capable
of maintaining a family, raises a number of exceedingly difficult
problems. Seeing that the sexual requirements of man constitute a
factor varying very greatly from individual to individual, and to
a large extent depending, as is now realized, upon a very complex
balance of glandular functions, it is more difficult than most popular
moralists seem to realize to lay down general rules applicable
impartially to every body.
Questions such as the following are raised: Can it reasonably be
expected of _every_ man to live ten or more years of his sexually
adult life in complete continence? If not, is it better for him to
marry young and probably unequipped to support children, having
remained continent till that time, or to marry later, probably better
equipped financially to become a father, yet having had promiscuous
experience of women before marriage? And if he does marry young, can
he be expected to remain continent in his married life till he and his
wife feel that they can satisfactorily maintain a family? If he finds
he cannot do this, should he proceed to have children whom he cannot
properly support, or is it better for the couple to overcome their
dislike of contraceptives――a feeling which it is idle for advocates of
Birth Control to ignore――and thus avoid having children till they are
wanted? These are a few of the general questions which are raised in
this connexion to which no comprehensive answer can possibly be given.
Much controversy has revolved round the question of the desirability
of self-control as a means of regulating births, and of its universal
practicability. It is here contended that where possible this is
immeasurably the best means of regulating births. At the same time, it
is futile to advance a counsel of such perfection and difficulty that
a highly probable failure to observe it will be followed by socially
disastrous results. Everyone would acknowledge that the Medical Officer
of a military unit who refused to instruct the soldiers under his
supervision in the precautions they should take against contracting
venereal disease, on the high moral grounds that they should never
expose themselves to such risk, would be carrying his idealism to
socially harmful lengths. Yet it is a much more difficult task for two
people in love with each other and living together in the intimacies
of married life to exercise continuous self-denial over long periods
extending to years, than it is for the soldier to abstain from
occasional promiscuity. In both cases it is clear that the correct
course is to start by putting the case for restraint as clearly and
forcibly as possible, and then to explain what steps must be taken
in the event of that restraint proving too great a task. In the Army
and Navy such appeals, when tactfully made, have met with a response
which justifies the view that, within limits, more can be done in this
way than might be supposed. As a general rule, then, it would appear
desirable that contraceptives should be used as little as possible,
especially in the early years of married life.
It also seems to the writer that in the case of normal married
people, too much has been made of the demoralizing effect of the
‘excessiveness’ of that indulgence which is supposed to be permitted by
the practice of contraception and which forms the basis of the ‘moral’
objection advanced in this country. This argument frequently emanates
from ecclesiastical sources, where knowledge of the sexual aspect
of human nature as well as of the technical side of contraception
is apt to be restricted and biassed. In effect, the man who is
sufficiently provident and considerate of his wife to encourage the
necessary precautions (which――a point too often ignored by prejudiced
critics――from the immediately selfish point of view both parties would
far sooner forego), is not the kind of man to indulge in reprehensible
excesses. Actually, demoralization seems rather to be produced in those
men who insist on gratifying themselves regardless of their means, or
of the welfare of the children they so abundantly procreate, or of the
feelings and health of their wives.
(2) The case of unmarried persons clearly falls into a different
category. There can be little doubt that the publicity given to the
subject of Birth Control has kindled the imagination of many young
people and led to various transgressions. The requirement here is to
discover a method by which at the same time this publicity may be
diminished and information made selectively more available. Both
these results could be achieved if the subject were taken up by the
Ministry of Health, and facilities created for the appropriate giving
of knowledge thereon by responsible qualified persons. By such means
the particular advice suited to each individual case could be privately
given, precisely where it is required, and steps might be taken to stop
the journalistic broadcasting of information and discussion which has
brought the subject into such discredit.