Testimony Before the United States Senate on Senate Bill 4436

Statement of Mrs. Margaret Sanger, National Chairman Committee on Federal Legislation for Birth Control

Mrs. Sanger: Mr. Chairman and gentlemen of the committee, this bill, S. 4436, directly affects the health, the future development and the happiness of 25,000,000 married women of child-bearing age in this country.

It further affects indirectly the health, happiness, and future welfare of 45,000,000 children in this country, of which 10,000,000 are said to be handicapped, according to the reports of 1,400 experts who came to this city at the call of President Hoover at the White House conference about a year ago.

At that conference President Hoover said:

"We approach all problems of childhood with affection. Theirs is the province of joy and good humor. They are the most wholesome part of the race, the sweetest, for they are fresher from the hands of God.

The fundamental purpose of this conference is to set forth an understanding of those safeguards which will assure to them health in mind and body. There are safeguards and services to be childhood which can be provided by the community, the State, or the Nation--all of which are beyond the reach of the individual present"

Let no one believe that these are questions which should not stir a nation; that they are below the dignity of statesmen or governments. If we could have but one generation of properly born, trained, educated, and healthy children, a thousand other problems of government would vanish. We would assure ourselves of healthier minds in more vigorous bodies to direct the energies of our Nation to yet greater heights of achievement. Moreover, one good community nurse will save a dozen future policemen.

Our problem falls into three groups: First, the protection and stimulation of the normal child; second, aid to the physically defective and handicappled child; third, the problems of the delinquent child.

Findings: Of 45,000,000 children in the United States more than 10,000,000 are handicapped thus:

• Improperly nourished: 6,000,000
• Defective speech: 1,000,000
• Weak or damanged hearts: 1,000,000
• Behavior problems: 675,000
• Mentally retarded: 450,000
• Tubercular: 382,000
• Impaired hearing: 342,000
• Totally deaf: 18,000
• Crippled: 300,000
• Partially blind: 50,000
• Wholly blind: 14,000
• Delinquent: 200,000
• Dependent: 500,000

And so on, to a total of at least 10,000,000 of deficients, more than 80 per cent of whom are not receiving necessary attention, though our knowledge and experience show that these deficiencies can be prevented and remedied to a high degree.

But that we be not discouraged, let us bear in mind that there are 35,000,000 reasonably normal, cheerful human electrons radiating joy and mischief and hope and faith.

And also, on the bright side, your reports show that we have 1,500,000 specially gifted children. There lies the future leadership of the Nation if we devote ourselves to their guidance.

It is not the delinquent child that is at the bar of judgement, but society itself. Industry must not rob our children of their rightful heritage. Any labor which stunts growth, either physical or mental, that limits education, that deprives children of the right of comradeship, of joy and play, is sapping the next generation.

Human progress marches only when children excel their parents.

Now, Mr. Chairman, you might say how does this bill affect handicapped children. It directly affects the handicapped children because as some of our experts here today will show the mothers of these handicapped children are needed for the care of these children.

Furthermore, according to these reports, it is stated that a large percentage of these children were handicapped from causes due to ignorance, poverty, and neglect.

Even the most optimistic of us will not claim that we are going to do away with poverty, ignorance, and neglect in the next few years, and yet these 1,400 experts did not emphasize that the parents of these 10,000,000 children should have the knowledge and means and instruction to prevent the coming of 10,000,000 more children, who may be handicapped from the same causes of poverty, ignorance, and neglect.

To me it is just a simple piece of common sense that people who can not take care of children to-day, because they are ignorant, or because they are too poor, or because they neglect them, certainly should not be encouraged to have more children.

In my own experience, both as the mother of three children, and as a trained nurse for many years in New York City, I came in contact with all kinds of people, representing the poor of all races, all creeds, and all religions.

I found that there are a certain number of people, perhaps we can say 20 per cent of our population today, who in spite of these laws have availed themselves of some kind of knowledge by which they have controlled the size of their families. Of the other 80 per cent, I found that about half are struggling to find something to control the size of their families, while the other half are those generally classed as unfit, mentally and physically, and include morons and mental defectives who usually come upon our social vista as permanent unemployable and dependants. It is for this other 40 per cent, you might say, or half of the 80 per cent, that we are talking to-day. It is these people that this bill will directly affect.

Mr. Chairman, you asked Senator Hatfield a few questions that I wonder if I may cover. These parents, if they can afford to go to a private physician, if they have a family doctor, may get some kind of information as to the means of controlling the size of their families. It may not be the best advice, but nevertheless it is something, and it has enabled a certain percentage of our population to control the size of their families. Is it better than nothing, but the majority of women, those who are too poor to have a family physician, have to go to the hospitals and public institutions. They have to go to the dispensaries and to public wards to get their medical care and it is right here that this law operates. While a physician may in his private office do and say as he wishes; he may give some device and no one can ask him where he gets it; as soon as he is connected with an institution the situation is entirely changed. In the first place the hospital would have to order and pay for contraceptive supplies which he might prescribe. In the second place he would be accountable to the laws of the country for his action in that institution, and he can not thus jeopardize his own license nor the charter of the institution which operate legally under the State laws.

There is where this law operates, because the law, section 211, definitely forbids the transportation of articles or of information through the United States mails or common carriers. Unless every hospital has a manufacturing plant associated with it, or in the city where it is located, you will see that they must get their articles either from New York or Chicago or some large city where the articles are manufactured.

The tariff act, section 305, affects such articles coming in from other countries.

Many physicians do not know that there is a great deal of research going on in this particular field in England, in Oxford, and Cambridge, also the University of Edinburgh, Scotland. A great deal is being accomplished there because they are unhampered by restrictive laws and are free to do research, while we in this country are years behind in medical research in this particular field.

Senator Hastings: You do not happen to have a copy of that section 211?

Mrs. Sanger: I have, Mr. Chairman.

Senator Hastings: Were you going to put any part of that in the record?

Mrs. Sanger: I would like all of it to go in the record, with your permission, Mr. Chairman.

I have not only the statutes in question, but I have some of the legal opinions that have recently been given by the courts, both on the tariff act and also on section 211 as it affects the transportation of the articles in the mails, if you will permit these to go in.

Senator Hastings: As a matter of fact I was in error when I suggested to Senator Hatfield that this affected only the importation of articles. The most important thing is the modification of Section 211 of the Criminal Code.

Mrs. Sanger: Absolutely. This is the important thing, Mr. Chairman.

May I offer these?

Senator Hastings: We will put these in at the end of your remarks.

Mrs. Sanger: All right.

May I say again that the Federal law, section 211, makes no exception for physicians. It makes no exception for hospitals to get such supplies. It makes no exception for anyone. Any one convicted under this law is subjected to five years in prison and $5,000 fine.

In this country the laws of 47 States allow a physician to give contraceptive information in his practice. Some of them are limited.

In New York State he can only give information “for the cure and prevention of disease.” In New Jersey he can give it “for a just cause.” In 24 States the subject of contraception is not mentioned in their laws at all.

Senator Hastings: This law does not help there, does it?

Mrs. Sanger: It does by allowing them to transport the articles through the mails, also common carriers.

Senator Hastings: Yes; but of course these State laws remain in effect.

Mrs. Sanger: Absolutely; but there is only one State in the Union where giving of advice would be doubtful, and that is Mississippi. All the other States give a physician the right to give such information in his private practice provided he can get the things from the manufacturer. That is what our amendment provides for.

When this law was passed in 1873 there was very little known concerning the whole subject; certainly there was no real information concerning the medical and sociological importance of the practice of contraception. The subject of birth control or contraception was wrongly classed with indecency, obscenity, and abortion. The passage of this law in 1873 really closed the avenues of proper scientific information and research by the medical profession, medical schools, and medical universities in this country.

It has done untold harm to classify contraception in that category. It Is an insult to every decent married woman in the country who wants to bring up her family intelligently; it prevents her from applying the benefits of science to the cultivation of her children and the bringing up of her family; and, furthermore, to all intents and purposes it classifies every married woman in this country as a “child bearing conscript.” Unless a woman has some means of preventing conception and spacing her children, she is forced to bear children like an animal, and in fact animals are not allowed to breed in sickness and with diseased bodies as the women of this country are made to do to-day, as I will show you a little later on.

This bill is simple; it is conservative; it is constructive, because it simply allows the physician at a hospital, or licensed clinic, to receive such supplies and to give such information.

The passage of this bill would be the first attempt on the part of the Congress to place the responsibility of giving contraceptive instruction in the hands of the medical profession, where it rightly belongs.

It would be the first attempt on the part of Congress to give the medical profession the control of such knowledge, which we know is very promiscuously scattered about to-day. It would let physicians regulate the kind of devices used, and thus wipe out the present traffic in wrong and harmful devices. The poor mothers, the people who should have the information, are uninformed and are denied the proper kind of devices suitable to their own individual requirements.

Senator Hastings: If you do not mind me interrupting you--

Mrs. Sanger: No.

Senator Hastings: It occurs to me paragraph numbered 3 might be a little uncertain “by any druggist in his legitimate prescription business.”

What is intended by that?

Mrs. Sanger: That the physician would prescribe certain devices, tested by research and experience in our clinics. The druggist should be able to supply these devices. We have found that contraceptives, to be properly safe and harmless, should be prescribed according to the individual requirements. just as eyeglasses must be individually fitted by oculists.

Senator Hastings: What I was interested in was whether it was intended that a person might apply to the druggist without going to the physician at all.

Mrs. Sanger: No. According to that I would understand that a person must have a physician's prescription.

Senator Hastings: I am anxious to find out what is your intent.

Mrs. Sanger: That is our intent, that it should be by prescription.

Senator Hastings: By prescription only?

Mrs. Sanger: Yes.

I do not wish to go into great detail concerning different methods and devices for contraception. However, there are certain articles, which are commonly used as contraceptives, but which may also be used for the cure and prevention of disease. These articles, according to a recent court decision may be legally transmitted through the United States mails. However, there are certain other articles which are used only for the prevention of conception, which are now excluded from the mails. These articles must be prescribed by a physician, and only after a thorough physical examination, so that the prescription varies with the individual. It is like any other medical advice, highly individual and adapted to the particular requirements of the patient. It is to such articles that we refer, and it is for these that the law must be changed.

Senator Hastings: There would be no objection to changing that to read “by any druggist upon a written prescription of a licensed physician”?

Mrs. Sanger: There would be no objection whatever.

Senator Hastings: I wanted to get your thought, so that after all what you are seeking here is all limited to physicians or medical colleges, which are really controlled by physicians.

Mrs. Sanger: Yes; they are already controlled by physicians. In many States the medical colleges are free to instruct their young graduates and physicians in this particular art, as they are instructed in other departments, but this has not generally been done up to the present time. There are comparatively few medical colleges that include a course in contraception in their regular curriculum.

I want to say in passing that where the laws allow a physician within the State to give information, some clinics have been established. Some of the social agencies and some of the forward-looking physicians are to-day struggling to solve their immediate problems, not only health problems, but social problems as well. The problem of unemployment, the whole question of congestion, is coming before them as never before. Birth control helps to solve some of these problems, but even where clinics are already in operation, it is difficult to obtain either the best information or supplies, under the present law. The proposed amendment would release the physician and make this information available, also, in public institutions such as clinics and hospitals.

Mr. Chairman, if I may digress for a moment, I want to go into an even broader aspect of the question.

Birth control is not a new idea. It is as old as nature itself. In fact, even in the period of savagery there was some means, some knowledge of controlling the numbrs in the tribes. It is only the methods that have changed.

Instead of infanticide and killing off the old and sick as has been done at various stages in the development of civilization, the only means of controlling the size of her family which is left to woman is abortion.

The number of abortions in this country is colossal, and we are convinced that only through a proper knowledge of contraception shall we do away with this abortion practice, one which is extremely detrimental to the health and happiness of women.

Let us now consider the two groups of people, those who practice birth control and those who do not. If you will look into every community, and every city and every town, you will see on the one hand small groups who have controlled the size of their families and on the other hand you will see a larger group who have not even been able to avail themselves of any information whatever. In the first group, we have the educated, cultured, well-to-do citizens; professors, doctors, lawyers, ministers, scientists, artisans, and skilled laborers. Here we find the spacing of children an adopted rule, the mother's health being the first consideration and the earning power of the father a close second. From this group come almost all of our social movements. Civilization is directly benefited and advanced through this low birth rate group. In the other large family group we have overcrowding, illiteracy, ignorance, slums, infant and maternal mortality, and child labor. Almost all our social problems are entrenched in this group and these conditions and their problems are perpetuated from generation to generation.

I, myself, have found that the mothers in both groups are equally desirous of bringing into the world only the number of children they can properly care for. I find that even women of the very lowest grade of intelligence are willing to avail themselves of information to prevent conception at any cost and at any trouble to themselves. I have, during the past several years, received over a million letters, the great majority of these letters coming from mothers and from women, especially in this second group. I should like to read a few of these letters which are rather typical of the conditions that prevail throughout the country--conditions that the passage of this bill would help:

Twenty nine years old, mother of nine children: "I am a Catholic 29 years old. I was married at 17 years of age and the first baby was born after 9 months 1 day. I have now been married 12 years have had 9 children. 6 are living and 3 are dead. I have had children every year since 1925. My husband is out of work now, so you see how hard it is to keep going and to pay one's debts and expenses for hospitals and doctors."

Seventeen children at 35: "I am 35 and the mother of 17 children, the last one not yet 2 months old, and I am in great hopes you can help me some way. Our net income during the winter has been $28 a month and out of that we have had to pay all our groceries, fuel, and clothes."

"I had the fond hope of becoming a teacher, but all I could do was six grades in public school, then out to work, fitted for nothing, so all I could do was housework at $1 a week. So I married, hoping to resume my studies at night school, but almost at once there was a pregnancy. Is it necessary to have my children grow up with no more hope or vision for their future than I've had? So many babies, never a time between them; why, one year I had one baby in January and twins the next December."

"I am pleading with you to help me some way."

Seven children at 30: "Will you please tell me about birth control? Our doctor refuses to tell us. I am 30 years old and have been married 11 years. My oldest child is 10 years old and I have 7 children and expect another baby next month. I had my last baby born dead last October. She was crippled and deformed. We are poor people trying to get along at $90 a month. Please help me."

Thirty-four years old; 12 pregnancies: "I am only 34 years old and have given birth to 12 children, only 3 of them living. They die so quickly after they are born, it seems they don't have strength to live long. My husband is a good hard-working man, but the best he ever made was $1.50, and never for long. We're poor people, Mrs. Sanger, and the coffins of the last two are not paid for yet. It's hard on a woman to see them go like that and I think if I did not have any for a while I could keep the three I've got and give them better than we ever had. Please help me. I'll be watching the postman, waiting for your answer. Please don't fail me."

Eight years in pregnancy for three children. Cruelty beyond belief! Nine little coffins. The United States Government would help her rear and breed pigs, cows, chickens, but makes laws to deprive mothers of knowledge to perfect and develop the human race.

A 75 per cent loss; sordid; a business man would shut up his shop. We are paying to-day for these laws of nearly 60 years ago. We are paying for them by the multiplication of the unfit, the diseased, the feeble-minded. We are paying for them in our high maternal mortality, in the hordes of death-doomed infants who never see their first birthday, in the widespread practice of abortions, in child labor, in the waste of mother power and creative energy. We are paying the cost in increasing billions and piling up huge debts for unborn generations to pay.

STATEMENT OF MRS. MARGARET SANGER--Continued

FRIDAY, MAY 20, 1932, Washington, D.C.

Mrs. Sanger: Mr Chairman, and gentlemen of the committee, in consideration of the time of the committee and their generosity in allowing us so much time to bring this discussion and subject before you, I will forego the impulse to answer and refute many of the personal accusations and charges that were made by the opposition in their testimony yesterday.

I just want to make this remark, that this committee, the persons in this work, and their character, their integrity, and their standing in the communities throughout the city, need no defense; and so I am going to continue this morning just on the merits and on the facts of the subject, as we have found them.

You will notice, Mr. Chairman, that while those who appeared against this bill gave some very representative opinions, they were mostly personal. They were not backed up by facts, and they were theories rather than practice.

For instance, Doctor Kelly, a noted physician, who has won a world-wide reputation in the field of medicine, appeared before you, not to talk about the merits of the bill, nor to give any evidence from a medical point of view at all, but to defend public morals; while Dr. John Ryan, a member of the Roman Catholic Church, came to theorize on economics and the population aspect of the whole question.

All of these opinions are interesting, and the discussions of the wider aspects of this bill are all right and good, but you will note there was no constructive policy offered in substitution for this bill. There was nothing constructive suggested as a means to do away with the various conditions to which they object that they claim are so prevalent in this country. As a matter of fact, the facts that were presented by the proponents of this bill were not refuted in any of the arguments or testimony, and when you sum it all up and weed out the personal opinions, you will find there was really no objection whatsoever made on the actual merits of this bill.

Not one person, in opposing the bill, claimed that a physician should not have the right to instruct patients as he saw fit; in fact, Canon Chase stated that no sensible person could oppose giving to trustworthy physicians freedom to do what is necessary to protect the life of a woman which would be endangered by another pregnancy, if her husband can not control himself.

I will take up some of the objections and try to answer them briefly. In the first place, our opponents claim that this bill will throw the mails wide open to the free and illicit distribution of contraceptive information. Their claim is ridiculous. The bill simply asks that a physician shall have the right to send and receive contraceptive information and supplies by the United States mails and common carriers, and also that such supplies and information may be sent to hospitals and licensed clinics.

We know that physicians do not prescribe by mail. Any physician that knows his business at all must have the patient before him, and must examine the patient to give her the best and most suitable contraceptive instruction and means for her individual case.

However, to do that he must first have up-to-date information himself, which we know in many cases is sadly lacking, because there has been no instruction in medical schools on the technique of contraception. Furthermore, information and advice alone are not sufficient. The physician must give some chemical or mechanical means to prevent conception, in order to protect the woman properly.

We know that physicians differ in their opinions regarding the subject. They differ because to a great extent they have not been taught in their medical schools. This is especially true of the older physicians, many of whom in the past have been taught much more on the technique of therapeutic abortions; they were not taught contraception at all, and you will find that it is these men who oppose our bill, because they simply are ignorant of the whole technique of contraception.

It was brought out that the American Medical Association had repudiated this bill. That is untrue. The American Medical Association at its annual convention in New Orleans last week, took no action on any bill. One must remember that the American Medical Association is composed of about 150,000 doctors, of which only about 9,000 would be really directly concerned with this question. These are the gynecologists and obstetricians, and that very group of gynecologists and obstetricians went on record a few years ago and gave the opinion that there should be no legislation curtailing the freedom of the physician in his lawful practice. Their resolution was offered as testimony in the early part of our proceedings.

I have here just an indication of what the medical profession feels. Here is a symposium, printed in the Medical Journal and Record in 1927. Two hundred and seventy-three doctors replied to the symposium, and of this number 248 were in favor of birth control, and proper legislation. Nineteen were against it. Two of them were unable to express an opinion. One thought contraceptive methods would bring abuses. One said that methods should be advised only after consultation with physicians and with the sanction of the United States Government and the Bible. One thought that this generation knows too much about such things, and the poor would not avail themselves of this information.

Another symposium appeared later in 1929, in the same Journal and Record. One hundred and eighteen doctors replied to the questionnaire. Of this number 99 said they were in favor of contraception. Four said they were not informed sufficiently to express an opinion. Fifteen were opposed.

I think that to a certain degree gives a brief indication, not a summary, but a cross section, of the general opinion of the medical profession.

I have also included in the record a list of medical societies and medical groups, a large number of which have indorsed this particular bill, the rest having indorsed the principles of contraception.

Dr. Gerry Morgan, as past president of the American Medical Association did not testify before you as a physician to discuss the merits of the bill but stated that he was here to speak on the “natural” laws of the universe.

One ex-president of the American Medical Association opposes this legislation while two others have fully supported it. The late Dr. Abraham Jacobi, former president of the American Medical Association, made a very excellent pronouncement on the whole subject some years ago, and was really the first one to bring this subject to the attention of the medical profession. A few years ago, Dr. William Allen Pusey in his statement accepting the presidency of the American Medical Association also held out squarely on the proper dissemination and regulation of contraceptive information by the medical profession.

Our opponents made the statement that the use of any contraceptive invariably had effect upon the pelvic organs and nervous system. That statement is an indication of the ignorance of some of the members of the medical profession.

We have in one clinic in New York City cared for and instructed over 28,000 women, whose records we have. A follow-up is made of these women. Social workers go into the homes. We have these actual facts, and within a very short period– we could present the data now, although it would be voluminous--a detailed report covering the first 10,000 of these cases is to be published.

We know it to be true that the great majority of these women have greatly benefited by this information, or rather by the rest they have had from pregnancy. Their health has improved. Their family conditions have improved. The whole happiness of the family has been increased. The children have been better cared for. In a very few cases, of course, there have been failures. These constitute, however, a very small percentage of the total, and in a very few instances women have resorted to abortions.

I would like, if I may, to offer for the record brief summaries of some of these cases to show you what their conditions are, the number of living children, and the number of dead children. Let me just read one.

An Italian woman, 29 years old on first visit (married at 15 years). She was diagnosed as a high-grade moron, with husband classified as mental case. Three children, youngest, an infant, two miscarriages, both due to overwork--five pregnancies in all. Clinical contraceptive advice has now been successful for four years. This family is able to carry on without help from social agencies because of the limitation of offspring.

We have a number of cases like this, Mr. Chairman, but I only read one for your information.

Senator Hastings: Do you want it put in the record?

Mrs. Sanger: I would like to if I may.

Senator Hastings: The committee will look at it to determine whether or not it should go in the record.

Senator Austin: I think those papers may go in the record.

(The papers referred to are as follows)