CHAPTER XVI: WHY NOT BIRTH-CONTROL CLINICS IN AMERICA?<6>
THE absurd cruelty of permitting thousands of women each year to go
through abortions to prevent the aggravation of diseases for which they are under treatment
assuredly cannot be much longer ignored by the medical profession. Responsibility for
the inestimable damage done by the practice of permitting patients suffering from certain
ailments to become pregnant, because of their ignorance of contraceptives, when the physician
knows that if pregnancy goes to its full term it will hasten the disease and lead to
the patient's death, must in all fairness be laid at his door.
What these diseases are and what dangers are involved in pregnancy are
known to every practitioner of standing. Specialists have not been negligent in pointing
out the situation.
Eager to enhance or protect their reputations in the profession, they
continually call out to one another: "Don't let the patient bear a child ; don't
let pregnancy continue."
The warning has been sounded most often, perhaps, in the cases of tubercular
women. "In view of the fact that the tubercular process becomes exacerbated either
during pregnancy or after childbirth, most authorities recommend that abortion be induced
as a matter of routine in all tubercular women," says Dr. J. Whitridge Williams,
obstetrician-in-chief to the Johns Hopkins Hospital, in his treatise on Obstetrics.
Dr. Thomas Watts Eden, obstetrician and gynecologist to Charing Cross Hospital and member
of the staffs of other notable British hospitals, extends but does not complete the list
in this paragraph on page 652 of his Practical Obstetrics: "Certain of the
conditions enumerated form absolute indications for the induction of abortion. These
are nephritis, uncompensated valvular lesions of the heart, advanced tuberculosis, insanity,
irremediable malignant tumors, hydatidiform mole, uncontrollable uterine hemorrhage,
and acute hydramnios."
We know that abortion, when performed by skilled hands, under right
conditions, brings almost no danger to the life of the patient, and we also know that
particular diseases can be more easily combatted after such an abortion than during a
pregnancy allowed to come to full term. But why not adopt the easier, safer, less repulsive
course and prevent conception altogether? Why put these thousands of women who each year
undergo such abortions to the pain they entail and in whatever danger attends them?
Why continue to send home women to whom pregnancy is a grave danger
with the futile advice: "Now don't get this way again!" They are sent back
to husbands who have generations of passion and passion's claim to outlet. They are sent
back without being given information as to how to prevent the dangerous pregnancy and
are expected, presumably, to depend for their safety upon the husband's continence. The
wife and husband are thrown together to bring about once more the same condition. Back
comes the patient again in a few months to be aborted and told once more not to do it
again.
Does any physician believe that the picture is overdrawn? I have known
of many such
cases. A recent one that came under my observation was that of a woman
who suffered from a disease of the kidneys. Five times she was taken to a maternity hospital
in an ambulance after falling in offices or in the street. One of the foremost gynecologists
of America sent her out three times without giving her information as to the contraceptive
means which would have prevented a repetition of this experience.
Why does this situation exist? We do not question the good intent nor
the high purposes of these physicians. We know that they observe a high standard of ethics
and that they are working for the uplift of the race. But here is a situation that is
absurd ; hideously absurd. What is the matter?
Several factors contribute to this state of affairs. First, the subject
of contraception has been kept in the dark, even in medical colleges and in hospitals.
Abortion has been openly discussed as a necessity under certain conditions, but the subject
of contraception, as any physician will admit, has not yet been brought to the front.
It has escaped specialized attention in the laboratories and the research departments.
Thus there has been no professional stamp of approval by great bodies of experimenters.
The result is that the average physician has felt that contraceptive methods are not
yet established as certainties and has, for that reason, refused to direct their use.
Specialists are so busy with their own particular subjects and general
practitioners are so taken up with their daily routine that they cannot give to the problem
of contraception the attention it must have. Consultation rooms in charge of reputable
physicians who have specialized in contraception, assisted by registered nurses ; in
a word, clinics designed for this specialty, would meet this crying need. Such clinics
should deal with each woman individually, taking into account her particular disease,
her temperament, her mentality and her condition, both physical and economic. Their sole
function should be to prevent pregnancy. In accomplishing this purpose, a higher standard
of hygiene is attained. Not only would a burden be removed from the physician who sends
a woman to such a clinic, but there would be an improvement in the woman's general condition
which would in a number of ways reflect itself in benefit to her family.
All this for the diseased woman. But every argument that can be made
for preventive medicine can be made for birth-control clinics for the use of the woman
who has not yet lost her health. Sound and vigorous at the time of her marriage, she
could remain so if given advice as to by what means she could space her children and
limit their number. When she is not given such information, she is plunged blindly into
married life and a few years is likely to find her with a large family, herself diseased
and damaged, an unfit breeder of the unfit, and still ignorant!
What are the fruits of this woeful ignorance in which women have been
kept? First, a tremendous infant mortality ; hundreds of thousands of babies dying annually
of diseases which flourish in poverty and neglect.
Next, the rapid increase of the feebleminded, of criminal types and
of the pathetic victims of toil in the child-labor factories. Another result is the familiar
overcrowding of tenements, the forcing of the children into the street, the ensuing prostitution,
alcoholism and almost universal physical and moral unfitness.
Those abhorrent conditions point to a blunder upon the part of those
to whom we have entrusted the care of the health of the individual, the family and the
race. The medical profession, neglecting the principle involved in preventive medicine,
has permitted these conditions to come about. If they were unavoidable, we should have
to bear with them, but they are not unavoidable, as shown by facts and figures from other
countries where contraceptive information is available.
In Holland, for instance, where the information concerning contraceptives
has been accessible to the people, through clinics and pamphlets, since 1881, the general
death rate and the infant mortality rate have fallen until they are the lowest in Europe.
Amsterdam and The Hague have the lowest infant mortality rates of any cities in the world.
It is good to know that the first of the birth-control clinics of Holland
followed shortly after a thorough and enthusiastic discussion of the subject at an international
medical congress in Amsterdam in 1878. The Dutch Neo-Malthusian League was founded in
1881. The first birth-control clinic in the world was opened in 1885 by Dr. Aletta Jacobs
in Amsterdam. So great were the results obtained that there has been a remarkable increase
in the wealth, stamina, stature and longevity of the people, as well as a gradual increase
in the population.
These clinics must not be confused with the white enameled rooms which
we associate with the term in America. They are ordinary offices with the necessary equipment,
or rooms in the homes of the nurses, fitted out for the work. They are places for consultation
and examination, opened by specially trained nurses who have been instructed by Dr. J.
Rutgers, of The Hague, secretary of the Neo-Malthusian League, who has devoted his life
to this work. There have been more than fifty nurses trained specially for this work
by Dr. Rutgers. As a nurse completes her course of training, she establishes herself
in a community and her place of consultation is called a clinic.
The general results of this service are best judged by tables included
in the Annual Summary of Marriages, Births and Deaths in England, Wales, Etc., for
1912.<7>
In Amsterdam, the birth rate dropped from 37.1 for the period of 1881-85
to 24.7 for 1906 and 23.3 in 1912. During the same periods, the death rate fell from
25.1 to 13.1, and in 1912 to 11.2. Infant mortality for the same period fell from 203
for each thousand living births to 90, and in 1912 to 64. Illegitimate fertility also
decreased. Results in other cities, as shown by the table at the end of this chapter,
are exactly similar.
In the Australian Commonwealth, where birth control is taken as a matter
of course, and information concerning contraceptives is available to the masses, the
births were so well distributed in 1915 that while the birth rate was 27.3, there was
a general death rate of only 10.7. New Zealand, which is also one of the typical birth-control
countries, had a birth rate of 25.3 and a general death rate of only 9.1 for the same
year. These figures are in marked and happy contrast with those for the birth registration
of the United States, where the reports for 1916 show a birth rate of 24.8 but an infant
death rate of 14.7. A similar comparison may be made with the German Empire in 1913,
where there was a birth rate of 27.5 in 1913 and a mortality rate of 15. In these countries,
birth-control information is not so generally within the reach of the masses and, consequently,
the largest percentage of births come to that class least able to bring children to full
maturity, as indicated in the mortality rates.
In conclusion, I am going to make a statement which may at first seem
exaggerated, but which is, nevertheless, carefully considered. The effort toward racial
progress that is being made today by the medical profession, by social workers, by the
various charitable and philanthropic organizations and by state institutions for the
physically and mentally unfit, is practically wasted. All these forces are in a very
emphatic sense marking time. They will continue to mark time until the medical profession
recognizes the fact that the ever increasing tide of the unfit is overwhelming all that
these agencies are doing for society. They will continue to mark time until they get
at the source of these destructive conditions and apply a fundamental remedy. That remedy
is birth control.
[*]Amsterdam
[Malthusian (Birth Control) League started 1881; Dr. Aletta Jacobs gave advice to poor
women, 1885]:
|
|
1881-85 |
1906-10 |
1912 |
|
|
Birth rate |
37.1 |
27.7 |
23.3 |
per 1,000 of population |
|
Death rate |
25.1 |
13.1 |
11.2 |
per 1,000 of population |
|
INFANTILE MORTALITY: Deaths in first year |
203 |
90 |
64 |
per thousand living births |
|
The Hague [now headquarters of the Neo-Malthusian (Birth Control) League]: |
1881-85 |
1906-10 |
1912 |
|
|
Birth rate |
38.7 |
27.5 |
23.6 |
per 1,000 of population |
|
Death rate |
23.3 |
13.2 |
10.9 |
per 1,000 of population |
|
INFANTILE MORTALITY: Deaths in first year |
214 |
99 |
66 |
per thousand living births |
|
Rotterdam: |
1881-85 |
1906-10 |
1912 |
|
|
Birth rate |
37.4 |
32.0 |
29.0 |
per 1,000 of population |
|
Death rate |
24.2 |
13.4 |
11.3 |
per 1,000 of population |
|
INFANTILE MORTALITY: Deaths in first year |
209 |
105 |
79 |
per thousand living births |
Fertility and Illegitimacy Rates:
|
|
1880-2 |
1890-2 |
1900-2 |
|
|
Legitimate fertility |
306.4 |
296.5 |
252.7 |
(Legitimate births per Legitimate fertility per 1,000 married women ages
15-45) |
|
Illegitimate fertility |
16.1 |
16.3 |
11.3 |
(Illegitimate births per Illegitimate fertility per 1,000 married women
ages 15-45) |
|
The Hague: |
1880-2 |
1890-2 |
1900-2 |
|
Legitimate fertility |
346.5 |
303.9 |
255.0 |
|
Illegitimate fertility |
13.4 |
13.6 |
7.7 |
|
Rotterdam: |
1880-2 |
1890-2 |
1900-2 |
|
Legitimate fertility |
331.4 |
312.0 |
299.0 |
|
Illegitimate fertility |
17.4 |
16.5 |
13.1 |
<--warning - avertissement | <--index | -->next chapter
<6> This chapter, in
substance, and largely in language, appeared under the present title in the March, 1920,
issue of American Medicine (New York) and is incorporated in this book by courtesy
of that publication.