The Social and Individual Need of Birth Control

The Social and Individual Need of Birth Control

Berlin, GErmany"

Editor of Proceedings -- Mrs. Margaret Sanger

There is probably no other subject of equal importance which cuts so deeply into the foundations of social evolution as birth control. There is no other subject of equal importance that has been kept so long in equal obscurity, not only by the scientists but by the medical profession as well, yet none which has leapt so suddenly upon the horizon of international thought as this subject has done within the past ten years. George Bernard Shaw says that it is by far the most revolutionary discovery of the 19th Century.

The prominence of this subject has been brought forward, not only by the economic and social pressure of the age, but because it signifies a new moral standard, a new social and moral responsibility. It signifies a new responsibility of parents toward their children, of men and women toward the race. Birth control may be defined as the conscious control of the birth rate by scientific means that prevent the conception of human life.

Why, you may ask, is it necessary to control human life? Because the population of the world must from now on be controlled consciously and intelligently. It has previously been controlled by the forces of nature, such as by disease, pestilence, floods, famines and wars. These have been called “Nature’s checks”, and according to the Darwinian theory it is against these means that man has struggled, thereby strengthening and perfecting the human type.

With the development of science man consciously began to control the population by such means as infanticide and abortion. It is interesting to recall the fact that infanticide was the prevailing custom in Middle Europe in the greater latter part of the 18th Century, while all the punishments and tortures that were inflicted upon women for this crime did not avail, and it was not until knowledge and the technique of abortion became generally known that infanticide generally gradually went out of practice.

The same forces that underlie the practice of infanticide underlie the growing practice of abortion, not only in Central Europe, but throughout the civilized world today. And it is my belief that these practices will continue to increase unless knowledge to prevent conception is made accessible and available to all adult men and women.

Modern civilization is confronted with two problems: 1) that of the pressure of population upon the food supply of the world and, 2) that of reconciling humanitarian and democratic practices with race improvement. Modern and progressive scientists say that birth control is the solution of both. Lord Dawson, that distinguished English surgeon, who had the courage to take this question into the Church Congress of Bishops a few years ago, said that birth control was here and was here to stay, that the churches and other opponents might just as well try to sweep the ocean back with a broom as to forestall its development.

Let us look at this question more closely: if you look with an unprejudiced eye, you will realize that there are two groups of people in every country, the one group have practiced and continue to practice birth control. They have limited the number of children in the family according to the health of the mother, the income and earning capacity of the father, as well as the accepted social standards of life. We see in this group that perhaps only two or three children are born into the family over a long period of years. But we see also that the number of children born are usually, in the majority of cases, brought up to full maturity. It is from this group that there is the lowest infant mortality and the lowest maternal mortality. It is from this group that the children not only attend the best schools, but also enter the colleges and universities, and later fill some of the most lucrative positions in society.

On the other hand there is another group where birth control has not been practiced,--not because the parents do not desire the knowledge; not because the parents are less disciplined in their sexual habits than those in the other group; not because their desire to have innumerable children is any stronger than that of the parents in the first group, but simply because knowledge to prevent conception is in most cases denied them and is generally made inaccessible and difficult for their practice. It is in this group that mothers are over-burdened, not only with living children, but with the ordeal of pregnancies too frequent for their health and for human endurance. It is here that we find the highest percentage of infant and maternal mortality. It is here that we find more than 50% of the children born that are doomed to die before they reach their first year of age. It is in this group that we find over-crowding, slums, unemployment, lack of educational opportunities, child labour, disease and most of all of the social problems that confront our civilization today. It is in this group that the mothers are broken in health, spiritless, and their young lives turned to drudgery and toil before they arrive at full maturity. It is here that motherhood does not know its greatest joys nor ever comes into its full flowering.

It may be comforting to some of us to feel that some assistance is given to this group through legislative measures and philanthropic activities. But there is perhaps no country in the world where there has been greater philanthropic expenditure than that lavished on palliative measures in the United States. In 1923, $8 billion were expended on disease, defect, delinquency, and dependency. In 1924 this sum had increased to $9 billions, and in 1925 the sum had gone far beyond $9 billions the budget, and we have every reason to believe that within the next ten years this amount will be trebled and not just doubled, because such philanthropy makes it possible for individuals with transmissible disease, such as insanity and feeble-mindedness, not only to live themselves, but to perpetuate and to multiply their types and their ailments tenfold. These philanthropic activities can not be reconciled with racial improvement. They are dysgenic and anti-social in the long run. The feeble-minded and the insane are increasing far out of proportion to the normal increase and it is known that the feeble-minded mothers give birth to three times more children than the normal women in the same class.

If we take as an instance the problem of maternal mortality, and analyze it closely, we will see how important a part birth control (that is, prevention of conception), should take in this reprehensible condition. There are in the United States--I cannot speak for Germany--25,000 women who die each year from causes due to pregnancy. That means that every hour the clock strikes in the day or the night, two mothers pass out of life into the great beyond. These lives have been unnecessarily sacrificed, and deaths could have been avoided in seven cases out of ten by the prevention of conception.

We know further that the danger of the idea disease of tuberculosis is increased by pregnancy. We know that women suffering from heart and kidney diseases should not be allowed to become pregnant. We know that four women out of seven who have tuberculosis die, not from tuberculosis, but from pregnancy. This is criminal in the deepest sense of the word, for every mother who has any of these diseases and who consults a physician is always told that she must not become pregnant again. And under our laws in the United States, as well as the laws of England, a physician has the right to interrupt the pregnancy in such cases where the woman’s life is in danger. But after that she is sent back to her home, to her husband, to the same conditions, without accurate instruction of how to prevent pregnancy,--but, with a death sentence hanging over her head!! No woman can endure the continued strain of curettage, no matter how surgically performed. We also know that a woman is more receptive to pregnancy immediately after curettage, consequently it is most imperative that she should be protected.

Infant mortality is even more deplorable. While we have reduced the infant death rate in the United States within the past ten years, it could have been reduced far quicker and with less cost in suffering and energy had instruction been given to the parents of the children who die. We have 250,000 infants who die each year before they reach one year of age. It is said that 90% of these die from causes due to poverty and neglect. We know, and the most optimistic of us would not contend that either poverty or neglect will be eradicated from the world next year; and yet we allow the same 250,000 mothers and 250,000 fathers of these children to bring into the world the next year another 250,000 children to die of poverty and neglect. It is true that we are lavish with free milk stations, free food, free medical supplies, free dental attention, free everything in the material sense of the word, but not in the one essential thing that would enable these parents to help themselves and to stand on their own feet and better their condition and to make face independently their future.

Birth control information (that is, methods of the prevention of conception), could help many of these parents to solve the problems of infant mortality themselves. Children who die under one year do so from various causes, but it is generally recognized by specialists that three underlying causes are important factors in the infant death rate:

• 1) too frequent pregnancies that of the mother whose children are born in full term but so close together that the mother does not have an opportunity to give adequate care to a child with feeble inheritance.
• 2) too frequent pregnancies which in many cases are interrupted, leaving the mother in a feeble state of health, also lowering her resistance and vitality when she eventually carries a child to full term.
• 3) the condition of women desiring to interrupt the pregnancy through drugs, and oftly deadly injurious abortifacients, becoming discouraged by the failure of the drug and then carrying the pregnancy to full term. Research now in progress is demonstrating the fact that many of these children were endangered in the womb of the mother through these harmful attempts at abortion and consequently came into the world with lessened vitality and, in many cases, with weakened organs.

One could go on analyzing in this way every social problem existing today, but these cases are sufficient to illustrate the necessity for fundamental application of knowledge rather than palliative measures.

I wish there were time to dwell upon the subject of child labour, for there is nothing that so wrings my heart and makes me feel the importance of fighting on until the end of time, for this cause, when I see little children forced into fields and factories and workshops to spend their childhood days. I sometimes wish that the venerable societies for the prevention of cruelty to children could prevent the cruelty of children being born in conditions that make cruelty inevitable. If we could prevent the cruelty of children being born in disease and misery, immorality and poverty, we would, within a generation, re-make the world.

In advocating the practice of birth control, that is, the prevention of conception, I do not say that all parents should be compelled to limit their families, but I do maintain that there are certain conditions when, for the benefit of children that might be born as well as in consideration of future generations, that no children should be born at all. There are some cases where sterilization should be applied as the solution of this problem, but in the great majority of needy cases contraception could very well be practiced. I maintain that birth control must be practiced,--

• 1) wherever there is a transmissible disease in either the father or the mother;
• 2) wherever the woman is suffering from any of the temporary diseases, such as tuberculosis, heart or kidney diseases;
• 3) wherever the children that are already born are sub-normal;
• 4) in order that there may be two to three years between the births of children, that the mother may have rest from her labour, a rest and a period to enjoy her new baby, and a period to prepare for the coming of the next child;
• 5) if marriage takes place during the adolescent period, or before the 23rd year, and the woman should wait until that age before she becomes a mother;
• 6) until parents are economically able to provide for them decently and to give them the opportunities to develop their potentialities;
• 7) at least one year, and if possible two years should transpire after marriage so as to cement and strengthen the relationship of love between the man and the woman before a child comes into being.

The form method of control must depend upon the individual case. We who have studied this subject in its entirety for the past ten years recognize that there are three groups of practices: 1) abstinence, or continence, where coitus does not take place at all; 2) sterilization, which does not mean castration, but is applied to the man or woman through surgery or irridation--this of course renders a permanent condition of sterility which may not always be in normal cases is seldom advisable; 3) the temporary application of chemical or mechanical means to prevent conception.

There is a good deal of research going on in America and in England in regard to these three methods. I myself have been director of a Birth Control Clinic in New York City for the past five years where we have had about 6,000 cases to whom we have given either chemical or mechanical appliances and instruction as to their use. We have three physicians in charge, as well as three nurses and a social worker who goes into the homes to follow up the cases to see if perfect satisfaction is given and, if not, to report back to the Clinic what is the cause. I am pleased to say that while the methods that are available for our use today are by no means perfect, nevertheless in our last report we can say that we have had not more than 2% of failures when the instruction given has been followed.

In New York City, while we have only one clinic and we are studying the science of methods, in Chicago there are five clinics under the direction of Dr. Yarrow, and in California there are two clinics, one in conjunction with the Stanford University Hospital. In England there are 22 Clinics run under private auspices, and the women of England are now waging a fight on the Government to allow contraceptive advice and instruction to be given at the maternal and infant welfare centers. The House of Lords has already passed a resolution that this should be done, and now the women plan to bring a motion before the House of Commons and have this instruction available in every Health Center as woman’s normal and natural right. I am strongly in favour of this information being given by the medical profession, in their public and private practice, but I especially recommend that until such time as the methods are perfected that special Clinics be established where this information is given, not only as a corollary of diseases, but for economic and social reasons as a special means of ascertaining facts and data whereby the methods may be eventually more perfected.

Briefly, this is the case for Birth Control in its individual and social aspect. It is my belief that woman must free herself from the forces which have made them her child-bearing machines throughout the ages. She must choose the time to be a mother or not to be a mother, as she sees fit. Women, through knowledge of Birth control, will not only free themselves, but will also free the children from social conditions which otherwise will remain inevitable. As they free themselves and their children, then can they come go forward with men , toward that greatest of all goals--the emancipation of the human race.