A Program of Contraceptive Research

The Birth Control Movement has two practical objectives. The first is to develop, through scientific research, the most healthful, sanitary, efficient, simple and inexpensive contraceptive methods. The second is to make it possible, through the education of public opinion and the liberalization of antiquated legislation, to convey the knowledge of those methods to all who need it.

This memorandum will deal with the problems of research only. I will briefly outline the need of a more extensive research program, and then I will indicate how in my opinion that program may best be carried out, and what it would probably cost.

The Need.

All Medical authorities agree that no completely satisfactory contraceptive methods have as yet been devised, and that the ultimate success of the Birth Control movement depends to a large extent on developing, through research, contraceptive methods that will be so simple, so safe, so convenient and so cheap that the popularization of their use among poor and ignorant people will be a comparatively easy matter. Research in this field would be of two sorts: laboratory work, and the collection, correlation and analysis of data.

Laboratory Work.

In this country the only individuals who, to my knowledge, are conducting laboratory work in this field are as follows:

Dr. Guyer and two of his colleagues, at the University of Wisconsin, who are conducting experiments in spermatoxins; Dr. Evans of the University of California, who is at work on the segregation of vitamin E, the elimination of which from the diet may possibly affect fertility, although but little is known about it as yet; Dr. Hooker of the Johns Hopkins University, who has done some experiments with the X-ray in relation to temporary sterilization, but has found that this method is too radical for human application; and Dr. Little, President of the University of Michigan, who has also done experiments with X-ray along the same line, and is positive that this method cannot safely be used.

These men are working independently of each other, and none of them is addressing himself primarily to the task of developing practical contraceptives for public use. For our purposes, therefore, there may be said to be no real laboratory research at present in this country, although it is possible that some of the work described above may ultimately yield practical results of the sort we desire.

So far as I know, there is also no real laboratory research in Europe in this field--with one important exception. At my instigation, Dr. F. A. E. Crew, chief of the Department of Zoology of Edinburgh University, and one of the leading European scientists, has opened a laboratory for contraceptive research, and has brought over from Germany as his assistant Dr. Weisner, a well-known associate of the great Steinach. They have mapped out a three-year program. They will experiment with various serums, glandular preparations, and other spermatoxins, using monkeys, guinea pigs and other animals, and extending their experiments over a number of generations. They are hopeful that many men and women now working in clinics in Scotland and London will co-operate with them in their experiments. Their program, which they have very carefully worked out, is budgeted to cost them approximately $10,000. a year for the three years. I have pledged myself to try to raise half that amount for them in this country.

Altogether this projected work of Dr. Crew and Dr. Weisner is, in my opinion, by all odds the most important research undertaking in our particular field anywhere in the world.

Collection, correlation and analysis of data.

Research along these lines is essential. At present there is no tabulated data on a large enough scale to be conclusive, that shows the actual results of the use of different contraceptives, their successes and failures and their social implications. Here and there scattered material of a limited sort has been published in this country; but as yet we are largely groping in the dark.

Fortunately there is available a volume of data in this country that I believe would prove of the highest importance if it were properly analyzed. I refer to the records of the Clinical Research Department of the American Birth Control League. I will give a brief history of this Department in order to explain the nature of these records.

The Department was organized in 1924 to give Birth Control information to mothers who applied for it, and who came within the provisions of the law, and to study contraceptive methods and related problems. Beginning with a staff of three, consisting of a physician, a Clinical secretary and a social worker, the staff now consists of four doctors (two each day), three nurses, a social worker, and (for Jewish and Polish mothers) an assistant social worker, and a secretary, and in addition, nine directors, of whom five are medical men and four are scientists, and all of whom are actively associated in directing the policies and research work of the Clinic.

Up to very recently the Clinic, which is located at 46 West 15th Street, New York City, has consisted of a large reception room, an adjacent smaller room which is used as a nursery and playground for children whose mothers are being examined, a room where the secretary interviews the patient and notes her history, a consultation room for the physician, and an examining and treatment room. Within the last few months we have added a new floor, which will give us another large reception room, two examining rooms, and an interview room. In spite of this expansion of space, and even if we can obtain the funds to add the necessary doctors, nurses and secretary, our facilities will still be overtaxed, for more and more mothers, many of them in desperate need, are coming to us, and frequently all our available appointments are filled up two weeks in advance. Last year we gave contraceptive advice to 4,521 women; this year the number will be much larger, as every month marks an increase. The figure above does not represent all of the women who applied, for many were turned away because they did not present a sufficient “health reason” to permit contraceptive information to be legally given.

With respect to each mother interviewed (including some of those turned away) a history chart is filled out by the secretary, giving among other things her social history (nationality and religion; husband’s occupation, health, income and habits; her own income, education, intelligence, and so forth) habits; her sex history (age at first pregnancy, number of years married, of children living and dead, of miscarriages and whether accidental, therapeutic or self-induced, the character of her labors, whether contraceptives used and how long, etc., etc.) And her physical condition (including pelvic measurements, etc.)

Each patient is requested to return at the end of six weeks to report her results with the prescribed method, and to be re-examined. Further reports are requested at internals of three months. The social worker and her assistant carefully follows up the return visits of the cases, and whenever possible home visits are made to delinquent patients in an effort to be of further assistance to them and to obtain fuller information as to the results of the advice and methods prescribed.

From all of this follow-up work, we obtain detailed information, which is noted on the charts, as to the relative successes and failures of the various sorts of contraceptives which we prescribe, the effects of their use on the patients’ health and home conditions, and the reasons for their abandonment (husband’s objections, inconvenience, improvement in health, etc.) in those cases where they have ceased to be used.

We now have over ten thousand of these individual history charts, each one of which is a mine of information, and all of which, taken together, if properly correlated and analyzed, would be of inestimable social and scientific value. With our already over-taxed staff we have had neither the time nor the funds to make the necessary analysis. A superficial examination of the charts reveals the significant fact that almost as many Catholic mothers have applied to us as Jewish or Protestant, that over 70% of the families represented earn less than $50. per week, that frequently those with the least incomes have the largest number of children, and that the number of induced abortions among the poorer class of mothers with large families is enormous. In the year 1925, for instance, out of a group of less than 2,000 women, 1,434 induced abortions were admitted, varying from one to as many as forty abortions in one particular case. When we consider that women generally are afraid and reluctant to admit the occurrence of induced abortions, the total given above undoubtedly underestimates the actual number.

But these are only a few of the things we need to know. We need to know the relative efficiency of the various contraceptive methods, and the effects of their use on health, sex relations, and economic status; the relation of the infant death rate to the number of children and of pregnancies; the relation of births and of infant deaths to the size of the family income; the frequency of induced abortions related to economic status, number of children and other factors; the sex history and physical condition of women in relation to the number of their pregnancies, size of their families and so on; the attitudes of husbands to various contraceptive methods and to what extent the husband’s occupation, personal habits, religion, etc. are factors in determining the wife’s condition. These and kindred matters must be made known we can advance much further. I am convinced that a thorough and intelligent analysis of our charts is the most immediately practical step that can be taken in Birth Control research, for I know of no other body of information that contains such important and illuminating personal and social details.

I believe that the proposed analysis, when published, would not only advance the whole science of Birth Control, but would have other indirect results of almost equal importance: (1) It should stimulate the formation of other Clinics. The American Birth Control LeagueAfter long and arduous effort, has succeeded in getting Clinics have been organized in Los Angeles, Baltimore, Detroit, Chicago and Cleveland, but Their number is still pitifully small and they mark only the beginning of our attempt to have the problems adequately dealt with throughout the country. I believe that the publication of our findings would be of enormous educative value, especially among sociological and medical groups whose support is so necessary to the advance of the movement. (2) It would assist us materially, I think, in making our legislative campaigns more effective, because we would be able to point to a body of facts so large and so striking that no one could explain it away. (3) It would almost certainly lead to a more detailed, careful and uniform system of data-taking and fact-finding on the part of similar clinics and even on the part of doctors. (4) By showing the relative faults and merits of different contraceptives, it would stimulate and guide laboratory research.

The employment of a properly trained secretary to do this work under our supervision, the cost of stenographic assistance, and the publication of the final results, would in my opinion require approximately $5,000 and would probably take from eight to ten months to complete.

Meanwhile the work of the Clinic must be continued and expanded, both for humanitarian reasons and for the added light that it will throw on our problems. I have mentioned the new rooms that we have very recently added to our Clinic. To make the proper use of this new space we shall need two more nurses, four more doctors, and one more secretary. Our present operating costs and our costs as they would be with the expanded staff are as follows:

• Item:
• Rent. Present cost per month: $200. Cost per month with expanded staff: $200.
  
• Medical service (Now consisting of four doctors, alternating two a day at $5.00 a day, or $60. per week). Present cost per month: 250 Present cost per month: 250. Cost per month with expanded staff: 250.
  
• Add Four more doctors (On same schedule). Cost per month with expanded staff: 250.
  
• Three nurses ($150. per month). 450. Cost per month with expanded staff: 450.
  
• Item: Add two more nurses. Cost per month with expanded staff: 300.
  
• Item: Secretary. Present cost per month: 100. Cost per month with expanded staff: 100.
  
• Item: Add another secretary. Cost per month with expanded staff: 100.
  
• Item: Telephone (approximate). Present cost per month: 15. Cost per month with expanded staff: 15.
  
• Item: Increased telephone service (estimated). Cost per month with expanded staff: 15.
  
• Item: Cleaning. Present cost per month: 25. Cost per month with expanded staff: 25.
  
• Item: Additional cleaning (estimated). Cost per month with additional staff: 25.
  
• Item: Social Worker. Present cost per month: 150. Cost per month with expanded staff: 150.
  
• Item: Add another social worker. Cost per month with expanded staff: 150.
  
• Item: Assistant Social Worker (For Jewish and Polish). Present cost per month: 50. Cost per month with expanded staff: 50.
  
• Item: Contraceptive materials (approximate). Present cost per month: 500. Cost per month with expanded staff: 500.
  
• Item: Additional materials (estimated). Cost per month with expanded staff: 500.
  
• Present cost per month: $1,740. Cost per month with expanded staff: $3,080.
  
• Annual Cost. Present cost per month: $20,880. Cost per month with expanded staff: $36,960.
  
• INCREASE: Present cost per month: 16,080
  
• Present cost per month: $36,960. Cost per month with expanded staff: $36,960
  

* Contraceptive materials are sold to patients who can afford them at cost. In many instances the patients cannot afford them and we give them to them. Some patients are able to pay a nominal charge for medical service, and the figure of $500. a month represents the approximate cost of contraceptives less the amounts received from patients in payment thereof and in payment for medical services.

Thus we shall have to add approximately $16,000. more to our annual budget in order to finance the expansion of our facilities. This expense is absolutely necessary unless we are to turn away daily an ever-increasing number of crushed and tragic figures who come to us for the knowledge that is life to them. But, as I have said, the growth of the Clinic is equally significant from the point of view of continued and broadening research, and as it grows and develops two additional things happen:

(1) it becomes ever more important as a model for the organization of other Clinics in other localities, and (2) more and more it attracts the interest and affects the opinion of the medical profession. The Clinic has become increasingly a centre to which physicians from this country and Europe are coming for observation and for instruction in modern contraceptive technique, in which respect the Clinic is helping to supplement the teachings of the medical schools, which pay but scant, if any, attention to the problems of contraception. I do not think I exaggerate when I say that the Clinic is the greatest single stimulus in this country to the awakening of medical opinion and the greatest single source of contraceptive information for the profession. The influence and value of the Clinic along these lines is bound to grow as the Clinic grows and as it plays more and more a significant part in the community.

Conclusion.

The most immediately practical and fruitful steps in contraceptive research that I can think of are, as I have tried to show:

1. In laboratory research, the program of Dr. Crew and his assistant, Dr. Weisner, at the Edinburgh University. This is to cost $10,000 a year for three years. I wish to secure for them in this country half of that amount, or $5,000 a year for three years.

1. In fact-finding research, the correlation and analysis of the more than 10,000 personal record charts of the Clinical Research Department of The American Birth Control League. This work, including publication of the results, would cost approximately $5,000 and could be completed, I believe, in eight to ten months.

2. In general research (combining elements of both laboratory and factual research) the program of the Clinic--which, in addition to its value as an organ of research, ministers daily to the needs of suffering and ignorant mothers and also acts as an enormous stimulus in the spread of the Birth Control movement. I have shown that the Clinic’s program of increased usefulness will require, over and above its present budget, some $16,000 a year, the funds for which are not yet in sight.

Believing as I do that hap-hazard, uncontrolled parentage leads directly and inevitably to poverty, over-crowding, delinquency, defectiveness, child labor, infant mortality, international friction and war, and believing further that the development of more perfect contraceptive methods and the better understanding of the various problems of Birth Control are necessary if these evils are to be stamped out, I hope that the program I have outlined in the foregoing pages may be carried out, and that the funds necessary thereto may be furnished. I shall only be too glad to give further details with respect to any of the matters discussed above, and I wish also to add that at any time desired the Clinical Research Department of the American Birth Control League can be separately incorporated, so as to dissociate a legal entity from the League. I refer to this because of the possibility that a donor who was primarily interested in research or medical work might prefer to give to a legal entity whose activities were restricted within these limits.