Letter to the Survey Magazine

From Mrs. Sanger

To The Editor:

The failure of an investigator for the Committee on Maternal Health to obtain medical "facts" concerning the practice of contraception in France, Holland, England and in New York city, has led Mrs. Gertrude Minturn Pinchot to express surprise (The Survey, March 15, 1925, p. 751) at "the scanty amount of exact information on the subject." The "surprises" of this "birth control" information are evidently based upon a misconception of the term "medical fact."

One basic "medical fact" has been overlooked or neglected by Mrs. Pinchot and the Committee on Maternal Health of which she is spokesman. This fact is that physiologically and hygienically contraception is feasible and practical; it may be as scientific as the ordinary technique of surgery and medical therapeutics. The accumulation and correlation of statistics will eventually support this fundamental medical fact, but the present scarcity of case-records which Mrs. Pinchot laments in no way confutes it. I have reason to believe that such records do exist; but even if they did not, no impartial investigation would be logically warranted to conclude upon such an assumption that practical education in contraception has been a failure. In France, according to Mrs. Pinchot, "more than sixty interviews with those who should know most demonstrated that the knowledge of it is underground, indefinite, and has never been gathered." Are we therefore to assume that the practice of birth control is not an accepted custom of the French people? We have no need of statistics or "medical facts" to convince us of French practice of contraception. Its acceptance has become so basic in the mores of France that even the present campaign for "repopulation" is tacitly based upon an acceptance of the conscious control of procreation, and the duty to vary this control from patriotic motives.

On the basis of the investigator's report from Holland, Mrs. Pinchot objects to the use of the word clinic to describe the birth control centers established there under the direction and instruction of the late Dr. Rutgers, founder of the Neo-Malthusian Band. For more than forty years, Dr. Rutgers trained women of the lower middle class by a few lessons and a reasonable pamphlet of instruction, as Mrs. Pinchot admits. The Band's printed report carries the names and addresses of three physicians, four midwives and forty-three "practitioners"--a total of fifty in all, from whom contraceptive instruction may be obtained. Because this work is independent of hospitals or medical supervision, Mrs. Pinchot erroneously assumes it to be negligible. As in all European countries, the practical Neo-Malthusian education has been a lay movement. The matter of contraception is looked upon as a matter of hygiene, prophylaxis and economics, and only in abnormal or pathological cases a matter for medical advice.

In this country, on the contrary, we have never underestimated the medical aspects of the problem. The American Birth Control League has sought the cooperation of the best medical thought, and has received a gratifying response. In establishing its clinical research department, the League deliberately refrained from the temptation of accumulating data of the type Mrs. Pinchot calls "dependable." The League realized the danger of jumping to satisfying conclusions upon such specialized records since the research was limited by the limitations of our laws to abnormal cases. Our aim has been experimental, tentative, pioneering, aiming to help the women who appeal to us, rather than to accumulate details which might lead to speciously "scientific" conclusions. Whatever our shortcomings, we have at least succeeded in breaking down the traditional apathy of the intellectually superior classes and in arousing the interest of an increasing number of sympathetic and understanding physicians. The cost of this venture has not been $26,000, as Mrs. Pinchot states, but approximately $16,000.

We agree that statistics and scientific analysis are important. We recognize that the cooperation of the medical profession is essential. We have never sought to usurp the function of the physician. As soon as the American medical profession signifies its desire to assume the burden of technical instruction, we shall be able to concentrate upon the educational and legislative aspects of this great problem. Patiently we await and shall warmly welcome such action. But let us not conclude erroneously, upon the limited evidence offered, that birth control is merely a medical problem. The whole social and spiritual destiny of the human race is bound up with it.

MARGARET SANGER
President of American Birth Control League, Inc., New York