CONCEPTION CONTROL AND ITS EFFECTS ON THE INDIVIDUAL AND THE NATION
by
FLORENCE E. BARRETT, C.B.E., M.D., M.S., B.Sc.
Consulting Obstetric and Gynæcological Surgeon to the Royal Free
Hospital. President of the Federation of Medical Women.
With a Foreword by His Grace the Archbishop of Canterbury.
1922
PREFACE
This small book has been written in response to many requests for some
statement regarding the individual and national effects of the
widespread practice of conception control.
It is not intended to give medical advice on the subject for, in my
judgment, that is best given to the individual by his or her medical
adviser, and will vary in different circumstances.
The question as to whether control of conception shall or shall not be
practised is a decision ethical and not medical in character when
husband and wife are healthy, and in the last resort will be decided
by the individual pair for themselves; but they will be wise to
discuss the question with their medical attendant in order to realise
all that is involved in their decision.
Space forbids anything like a full discussion of the national issues,
but that aspect of the subject demands quite as careful study as
personal needs or desires.
F.E.B.
31, DEVONSHIRE PLACE, W.1.
September, 1922.
FOREWORD
The Archbishop of Canterbury allows me to use the following letter as
a Foreword to this little book.
DEAR LADY BARRETT,
I have read with great interest the manuscript of your pamphlet. Very
many of us who have daily to do with the problems and perplexities of
our social life and to give counsel to the anxious or the penitent or
the perturbed will thank you for these clear and cogent chapters. To
arguments based on moral and religious principle you add the weight of
ripe experience and of technical scientific knowledge. Your words will
gain access to the commonsense of many who would perhaps regard the
opinions of clergy as likely to be prejudiced or uninformed. I am of
course not qualified to express an independent judgment upon the
medical or physiological aspects of this delicate problem, but I
desire on moral and religious as well as on social and national
grounds to support your general conclusions, and to express the hope
that your paper may have wide circulation among those who are giving
attention to what is becoming an urgent question in thousands of
English homes.
I am,
Yours very truly,
RANDALL CANTUAR.
LAMBETH PALACE, S.E.
3rd August, 1922.
CONTENTS
CHAPTER I
THE PROBLEM OF TO-DAY
CHAPTER II
THE DEMAND FOR KNOWLEDGE AND FROM WHOM TO OBTAIN IT
CHAPTER III
METHODS
CHAPTER IV
THE EFFECT OF WIDESPREAD CONCEPTION CONTROL ON NATIONAL EFFICIENCY
SUMMARY OF CONCLUSIONS
CHAPTER I
THE PROBLEM OF TO-DAY
In the late seventies of last century a pamphlet entitled _The Fruits
of Philosophy_ was republished by Mrs. Annie Besant and Mr. Charles
Bradlaugh, in their desire to mitigate the suffering of poor women who
were overburdened by work and further weakened by frequent
child-bearing. They resolved to face public obloquy and even legal
prosecution in order to bring to these women knowledge of how to
prevent conception, which, in their opinion, would give the relief
they so sorely needed. As is well known, the later pamphlet on the
same subject written by themselves was withdrawn from publication by
Mrs. Besant in 1886 on religious grounds.
During the last few years the idea of the need for conception control
has again become prominent, partly as a revolt against the bondage of
women in child-bearing, partly accentuated by the difficulties and
uncertainties of an adequate livelihood, and the desire to have a few
children well educated and cared for rather than many who shift more
or less for themselves.
But also the claim is made that marriage exists at least as much for
the fulfilment of happiness in union with the beloved as for the
procreation of children; and that it should be possible for a married
pair to have the fullest gratification without fear of children unless
they desire them.
Others, but these are extremists, go so far as to claim that apart
altogether from marriage vows, sexual intercourse should be the
experience of all, and that knowledge of how to avoid the birth of
illegitimate children should be given to all.
The discussion of this subject has taken place under the title of
Birth Control, but the control or regulation of births is not really
the point under discussion. A very big factor in the diminution of
births comes under the heading of abortions, whether voluntary or
through conditions which might be remedied. That subject is not
touched upon in this paper, but only methods which avoid conception,
which is, of course, a very different subject from the larger one of
avoiding births.
At first sight it might seem a comparatively simple thing, in view of
the knowledge which already exists of the physiological processes
involved in conception, to advise a method which shall prevent
conception at will without harmful effect upon man or woman and yet
leave intercourse unimpaired. But even at first sight it is obvious
that whatever knowledge may be available, and whatever methods may be
devised, it would not be easy to convey this knowledge rightly to the
individual it is hoped to benefit without doing harm to others.
Further thought shows that the national problems involved are so
important and far reaching in effects that they might well arrest the
attention of the most careless advocate of indiscriminate conception
control.
This is a subject, therefore, which requires careful consideration
from the point of view of the individual, of public morality, and of
national welfare--and the more closely it is studied the more apparent
are the far reaching issues involved. It is improbable that the
practice of using contraceptives will continue for even a generation
without revealing the harmful effects which must to some extent ensue.
In the whole discussion of this subject it is important to keep in
mind that the physical is only one aspect of the sex relation.
In the evolution which sex has shared with all else, the psychic side
appears even in the higher animals. In them the desire is not for mere
indiscriminate physical satisfaction, but the element of choice comes
in, a factor which sometimes upsets the plans of breeders. In man this
aspect of the relation is all important. The higher side of sex, or
what we may call the psychical secondary sex characters, seem to
extend through the whole range of mental and spiritual activities.
Because of this there is freshness of contact in mental and spiritual
intercourse between men and women which differs somewhat from that
between individuals of the same sex, and very much of the joy of life
springs from the impact of these differing yet completing selves the
one upon the other.
Where the whole being enters into the union of the sexes the complete
joy of marriage is realised, the characteristic of which is that it
does not fade, but becomes ever deeper and more fully realised, a sure
indication that the highest pleasure of sex union is only attained
when it consummates a love which involves mutual sympathy and
consideration. Physical union alone produces dissatisfaction the more
quickly in proportion as it is physical only; on the other hand, when
all parts of the nature find their counterpart in another, the joy of
such intercourse pervades the whole life, and frequent repetition of
physical intercourse is not essential to its highest development.
This is well known to all true lovers who have for varied reasons
exercised some voluntary self-control in regard to the physical side
of sex in marriage, either in deference of the one to the desire of
the other, or to avoid too frequent child-bearing, or in special
seasons such as Lent.
On the other hand it has been observed by most people that many
marriages which seem to promise well, quickly lose even to the eye of
the outsider all the romance of the days of courtship. Is not too
frequent physical indulgence sometimes the cause?
Even the time of courtship is spoiled by unrestrained demonstration of
affection, and the beauty of the higher side of love is apt to lose
its delicate bloom by over accentuation of the physical in marriage;
husband and wife sadly admit to themselves that disillusionment has
come--the real truth being that in seeking only physical satisfaction
in each other, their eyes have become blinded to those higher
qualities which each glimpsed in the other during the happier days of
courtship, and the "road of the loving hearts," which they hoped to
tread through life, has been missed because they have forgotten that
"man is a spirit and doth not live by bread alone."
To many the introduction of this aspect of the question may seem
beside the mark. For them the practical question in a world of sense
is how to avoid having children when for any reason they are not
wanted, and yet leave unimpaired facilities for married life. It is
true the problem is not always stated so bluntly. The uses of
contraceptives are explained, together with a recommendation for
moderation in physical intercourse; but as will be shewn below, if
such moderation is really practised, it is possible to live a natural
married life such as renders unnecessary the use of artificial
contraceptives with all their attendant evils and yet limit the size
of the family.
But it is necessary to consider more carefully the claim made to-day
that contraceptives are both necessary and harmless, and that public
propaganda on the subject is desirable.
There are several different groups for whom relief is claimed:--
1. Women who are suffering from chronic or from temporary ill-health
are frequently not in a condition to bear the strain of child-bearing,
and indeed it may become a real danger to their future health, either
mental or physical.
2. There are cases of inherited disease, mental or physical, which
ought to prohibit child-bearing.
3. There are over-worked women whose daily work, added to
child-bearing, destroys their health and vitality. These people are
found not only among the so-called working classes; the same
conditions with somewhat different types of strain are found in wives
of professional men with very slender incomes.
4. Some parents wish to "space" their children, that greater attention
may be given to each, or they wish to limit the number of their family
on account of financial and other difficulties.
With these and other considerations in view, the widespread teaching
of methods of preventing conception is advocated because it is
claimed:--
(a) That except for general propaganda, the greatest sufferers, viz.,
poor women with constantly recurring pregnancies, would otherwise
never learn of any method of relief.
(b) That many young people who for various reasons, such as housing or
financial difficulties or inherited disease, feel themselves unable to
have a family, would if such knowledge were available marry much
earlier, and their natural desires would be satisfied, while apart
from marriage they might resort to promiscuous intercourse.
(c) That homes where the growing difficulties and strain of a
continually increasing family are leading to estrangement between
husband and wife, are restored to happiness when saved from the
difficult choice between continence, which they have never trained
themselves to practice, or many children with which they cannot cope.
There are, however, serious fallacies in these contentions.
The propagandists of conception control appear to take it for granted
that after preventive measures in early youth, children may be
conceived at will whenever they are desired; and, moreover, it is
assumed that apart from such precautions every woman will conceive
annually and will continue to do so until 10-12 children have been
born.
Neither of these suppositions is supported by facts. On the contrary,
there are large numbers of married couples who would give anything to
have children, but have postponed it until circumstances should seem
quite desirable, and then, to their grief, no children are given to
them. It is very unfair to teach people that they may safely postpone
the natural tendency to bear children in youth and rely upon having
them later in life. Probably gynæcologists are consulted more often by
women who desire children but do not have them, than by those who
wish to avoid having them--the truth being that the tendency among
people in comfortable surroundings is towards relative sterility
rather than towards excessive fertility.
Those who are interested in this aspect of the question will find the
facts admirably set forth in Mr. Pell's book on _The Law of Births and
Deaths_, being a study of the variation in the degree of animal
fertility under the influence of environment.
He finds that the all-important factor which determines fertility is
the amount of nervous energy of the organism, and that nervous energy
is produced or modified by three specially influential factors, viz.,
Food, both quantity and quality; Climate, hot or cold--moist or dry;
and, lastly, all those varied conditions which make for greater or
lesser mental and physical activity.
Fertility, broadly speaking, varies in inverse proportion to the
degree of nervous energy or what we may call vitality.
Conditions, therefore, which lower the general vitality below the
normal produce abnormal fertility. This excessive child-bearing under
present conditions still further lowers the standard of life and the
health of the mother, hence a vicious circle is set up, the only
escape from which will come by such consideration of the laws of
health relating to work, housing, food and recreation as shall ensure
the maximum of vitality to the workers. This is the true method of
conception control.
There comes a point in the development of nervous energy which is
productive of sterility. It is true that principles based on so many
varying factors will necessarily appear to fail in individual cases.
Environment with its influence on the nervous energy of the individual
will be modified by the inherited tendency of that individual towards
fertility or the reverse. We find, therefore, isolated cases of large
families among the well-to-do and small families among those whose
vitality is below the normal, but if the general principle is true we
should expect to find a larger number of _sterile_ marriages among the
well-to-do than among those whose lives are more full of hardship, and
this undoubtedly is the case.
This aspect of the problem is deserving of careful study. The desire
for children in so many homes where every advantage could be given,
may be gratified when more knowledge of how wisely to modify the
environment of the rich is within our grasp.
It may be that the more simple life among those who have much will
give to them the prize of children which they covet more than things
which wealth can buy.
But let us return for a moment to the false expectation that children
will come to all unless prevented.
The results of this assumption are really serious. They involve the
training of large numbers of people in unnatural practices, which in
many cases are unnecessary, even if they were desirable. They rob many
families of the children who would have been the delight of their
parents through middle and later life.
Moreover, it is obvious that advice which may be quite necessary in
cases of ill-health or special conditions, may be fundamentally wrong
to give broadcast to all individuals, for apart from the fact that
when given to all it is largely unnecessary, there are other serious
objections, as follows:--
1. A public opinion at the present time is being gradually produced
which takes it for granted that as a matter of good form young people
should not have children for a few years after marriage, and it is
becoming a common practice to start married life with sordid and
unnatural preparations for a natural act; yet many of these young
people, men and women alike, are most anxious to have children, and
only seek to know how to prevent them because they believe it to be
"the thing to do."
One or two illustrations which have come to my personal knowledge will
perhaps show the kind of idea which is conveyed to the mind of young
people by books and speeches on this subject, though such results may
not have been desired by the authors or speakers.
A young bride came to her mother on returning from her honeymoon and
said, "Mother, how long must we wait before having children--is it
really necessary to prevent them for a year or two? We are both dying
to have babies."
A young couple on the eve of marriage consulted a gynæcologist
regarding the question of using the cap pessary to prevent the
possibility of having children for a few years.
The bride, who was greatly distressed, produced the pessary which she
had purchased, and said she could not possibly use it; her fiancé,
however, had been advised that she could, and ought to do so, hence
the first serious dispute had arisen between them, clouding the
future.
She was told by her doctor that it was quite impossible for her, and
this fully satisfied the future husband.
The next point was if this method were impossible what should be used.
They were a splendid young couple, with ample means to support a
family, and the doctor naturally asked--"But for what purpose do you
need any methods to prevent children at all?" They hesitated and
looked at each other, and then said--"I don't know, but we thought it
was the thing to do."
They left with the whole nightmare put aside, determined not to spoil
the perfect consummation of their happiness.
Many similar cases might be quoted where young people, without any
considered motive, are acting in accordance with the vogue of the
moment.
2. The use of contraceptives does not encourage self-control, yet the
cultivation of self-control is a far higher gain to the individual and
the nation than any apparent advantages obtained by its abandonment.
By no means unimportant is the influence that wide diffusion of the
knowledge of how to prevent conception would have in causing more
irregular unions and greater promiscuity in sex relations. The effect
of this would not only loosen, rather than strengthen, the marriage
tie, but would inevitably lead to an extension of venereal disease.
Many people seem to think that contraceptives prevent venereal disease
at the same time that they prevent conception. But this is not so. The
use of methods of prevention by women is no protection to them from
infection.
3. We have, moreover, to take a wider view, and consider who will
receive and act upon the advice given, and hence what the result will
be on the differential birth-rate of the community.
It is quite obvious that the educated classes can most easily follow
instructions which result in protection from conception, and since
such knowledge most easily circulates among the more highly endowed
classes, it has been claimed that it is important to make efforts to
let the knowledge be so widespread that it may reach all. The result,
however, could only be that the practice of conception control would
spread throughout the upper, middle and more intelligent of the
working classes, and this would involve a very serious reduction in
the births of those who furnish the leaders and efficient workers in
all branches of life, and in those only.
For the birth-rate amongst the least intelligent, least efficient and
the mentally deficient will be unaffected. It must be apparent that
after a very few generations of such weeding out of the best, with the
continuous multiplication of the worst type of citizen, the general
standard of efficiency, enterprise and executive skill of the nation
would be seriously impaired. Such, briefly stated, is the problem
before the public at the present time.