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Part 1

BIRTH CONTROL AND THE STATE

A PLEA AND A FORECAST

BY C. P. BLACKER M.C., M.A., M.R.C.S., L.R.C.P.

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FOREWORD

The pioneer battles on behalf of Birth Control, as everybody knows, have been fought in this country by Dr Marie Stopes, who has largely borne the brunt of that abuse which is meted out to all popular exponents of ideas that do not harmonize with traditional morality. The fact that Dr Stopes has been criticized, and at times attacked by the medical profession (which until recently refused to acknowledge that the subject of Contraception fell within its sphere) on the grounds that she does not possess a medical degree, and the fact that she has retaliated with vigour――and continues to do so in most of her public utterances, have led to a breach between her and the more orthodox elements of the profession, which to a certain extent, has impeded the realization of her ultimate aim, namely the undertaking by the State of the work she performs on a small scale in her privately-run clinique.

In what follows I have drawn attention to drawbacks attending the dissemination of knowledge of Contraception by General Propaganda. I have done so, however, fully realizing that this propaganda was, in the first instance, necessary to override the barrier of prejudice presented by orthodox morality, and equally realizing that if it had not been for Dr Stopes and her propaganda this book would probably never have been written. In its essential plea that advice on Contraception, now obtainable only at private institutions, be made generally available by the Ministry of Health at the centres under its control, this book is at one with the wider aim expressed by Dr Stopes in the words that commemorate the founding of her first private clinique.

I know that in the past it has proved nearly impossible in a single book to appeal effectively both to the general public, and to the medical profession. Yet I have attempted to do that here. The task has been made perhaps less difficult than usual by the fact that until recently the subject of contraception has been completely ignored by the medical profession, which as a whole seems to remain as uninformed of its wider implication as does the general public. It will be found that the book ends with a practical suggestion taking the form of an appeal to the medical profession.

The substance of the first part of what follows originally appeared as a series of articles in The Saturday Review, to which I am indebted for permission to publish the book in its present form.

C. P. B.

BIRTH CONTROL AND THE STATE

A PLEA AND A FORECAST

Since the War, the subject of Birth Control has been widely discussed, and much has been written about it. By some of its advocates it has been extolled to the point where any criticism, however tentative, is resentfully repudiated. By its enemies it has been represented as a pernicious and unnatural practice leading to the degeneracy and, ultimately, to the extinction of the race. So wholeheartedly felt, and yet so profoundly opposed are these views, that it has been difficult for the average person to find his bearings on any other basis than that of his own sentiment.

It is clear that the implications of Birth Control, or, rather, what is generally, though not logically understood by the term, of the practice of contraception, are far reaching. It profoundly affects the life of the individual; it reacts upon the internal economy of the community; and it has a most important bearing upon the international future of the country wherein it is practised. It is therefore incumbent upon all serious students of contemporary world-problems to realize clearly what is to be said on both sides, and to form thereon, as far as lies in their power, an unbiassed opinion. This obligation weighs especially heavily on medical men since, if the practice is to be tolerated at all, it is by them that it should be administered and controlled.

It is a general survey of this sort that is attempted here. The book will begin with a consideration of the more important arguments that have been advanced on each side. These will then be discussed, and there will follow a conclusion as to the bearing of the practice upon the future of civilization.

It will be convenient first to review the more serious arguments used _against_ Birth Control, the problem being considered throughout both as a world-problem and as one with a special significance for this country. They fall into two distinct categories concerning (A) the Race and (B) the Individual.

A. 1. The ‘military’ argument finds exponents among Nationalists, who are convinced that the essential merit of a country lies in its powers of offence and defence, or who are persuaded that future wars are, by the constitution of human nature, inevitable, and that it is therefore necessary for the country to which they belong to be fully equipped. By such persons, Birth Control is opposed in so far as it would impair their country’s man power.

2. An argument allied to the above, yet one which must be distinguished carefully from it, deserves close scrutiny. It is to the effect that quite apart from military considerations the practice of Birth Control in a country is capable of acquiring in a short time such universality that the population may decrease, and eventually dwindle to proportions which would place that country, whatever its status, in a position of a second or third-rate power. From history the approximate generalization can be made that prolific races get the better of infertile races in the struggle, first for existence, and then at a later stage, for power. This generalization is likely to hold good in an economic sphere. Thus a graphic picture has been drawn of what will happen to England, in the matter of its population, if it follows in the wake of France. It will come to assume the proportions of an insignificant little island in the North Sea, the possessor, actually, of a mighty past, but in the present counting for nothing beside the densely peopled territories of Southern and Eastern Europe, Asia and America. Birth Control uncontrolled means race suicide.

3. There is an ‘economic’ argument against Birth Control, which itself takes two forms.

In the first place it is felt, in under-populated countries like New Zealand, Australia, and perhaps to a less extent the United States, that since it is desirable in the general interests that the population should increase, it is to be preferred that this increase be effected from native-born stock rather than through the process of accretion by often undesirable aliens. Hence in most under-populated countries, Birth Control is opposed.

In the second place it is probably felt (though probably not admitted) by the Governments of those capitalistic countries confronted with a labour problem, which are at the same time desirous of limiting immigration, that the unrestricted multiplication of their working classes, by causing a competition for wages, will create a cheap labour market. It is highly unlikely that this view has much weight here, though it may easily be otherwise in the United States, where the labour problem is acute and where it is universally desired to limit coloured immigration and immigration from South-Eastern Europe.

4. There is an argument against Birth Control, which has special reference to the position of this country as the original founder of a great Empire. Since most of the Dominions are still under-populated and wish their numbers to increase, and since the increase of native stock, even though fully encouraged, is unable to supply the demand for labour, it is contended that Great Britain should always be able to turn out a numerical surplus to send to the Dominions each year, which in addition to satisfying a need for better-class immigrants would serve to consolidate the racial and cultural bonds that keep the Empire together.

B. The above arguments concern the race. The remainder which follow refer primarily to the individual.

5. A ‘medical’ argument has been heard to the effect that the actual practice of Birth Control or, more precisely, the use of contraceptives, is inimical to health, being capable of causing both local disease and more general constitutional disorders. Emotional instability and various neuroses have been quoted as such products. No woman making use of a contraceptive for the first time can escape a feeling of revulsion at such a callous interference with a process that above all others should be spontaneous and instinctive. No woman can then fail to experience a sense of aversion from such a deliberate thwarting of Nature’s most fundamental purpose.

6. Very potent also, is a ‘conventional’ objection which in practice is often associated with the religious argument next to be considered, though in reality it is distinguishable from it. On these grounds it is felt that all that pertains to the province of sex is indecent, disgusting, and unfit for discussion. The topic of Birth Control is thus stigmatized as ‘immoral’ by many people of no deep religious conviction.

7. The ‘religious’ objection nowadays finds its chief exponents among the Japanese and Roman Catholics, though it is also strongly upheld by many Anglicans and others. By the Japanese, Birth Control is condemned on grounds that seem to be, partly at any rate, nationalistic. The Japanese religion, intimately connected as it is with Ancestor Cult, holds that it is the duty of every man to marry young, and to produce the largest possible number of children, especially males, who may carry on the tradition of the family and at the same time grow up into soldiers capable of fighting for the Mikado in war. By the Japanese, the Mikado is believed to be a Deity incarnate, not in the symbolical sense in which some people have thought of the divine right of kings, but in a real and vital sense, as ‘the occupant of a sacred throne which was established at the time when the heavens and the earth became separated.’ To die for him in war is the most supreme, the most glorious duty. The objection to Birth Control here would thus seem closely allied to the ‘military’ objection first advanced.

By Roman Catholics it is held to be a mortal sin to employ any chemical or mechanical means to prevent conception, the only permissible form of control being voluntary abstinence from each other on the part of both parents. The abstinence of one parent against the will of the other is also considered a mortal sin on the part of the refractory parent. An exception to this rule is now made which permits parents not desiring children to make use of a moment in the periodic life of the mother during which conception is less likely to take place than at other times――the so-called ‘safe’ period. It is, however, generally agreed nowadays that the ‘safety’ pertaining to this period is in many cases quite illusory and devoid of serious physiological or medical basis. Opponents of the Roman Catholic Church have represented its insistence on this prohibition as dictated by a desire to extend her spiritual empire throughout the world, since obedience to it must bring about a greater relative increase of believing Roman Catholics than of adherents to other religious denominations tolerating Birth Control. But its attitude would further appear to express a conviction (manifested elsewhere in the insistence upon celibacy among Catholic priests and in its systems of penances and abstinences) that sexual indulgence is somehow incompatible with devotion to a purely spiritual life, and when excessive produces a demoralizing effect upon human nature, tending to make it weak, lazy, selfish and often vicious. Probably the Catholic Church feels that the use of devices to prevent conception would abolish the necessity for salutary self-restraint, and would promote promiscuous and excessive indulgence. The effect of this prohibition is that most Catholics who are conscientious about not using contraceptives have large families. There are some, however, particularly in France, who do not take the prohibition very seriously.

At the bottom, however, of the religious objection, would appear to lie the conviction that excessive sexual indulgence, dissociated from the sequel of procreation and rendered possible by the use of contraceptives, is morally harmful to the individual.

8. An objection of a pseudo-political nature is sometimes heard which envisages a bureaucratic extension of Birth Control. The phrase is here understood to imply a ‘National Control of Births’ and not a ‘Voluntary Regulation of Births’, its more usual acceptance. Such a bureaucratic interference in people’s private lives is held to constitute an infringement of the liberty of the individual――in this case his liberty to have as many children as he likes, when he likes. The principle of individual liberty, the corner-stone of nineteenth century Liberalism, still has a certain number of adherents.

9. The last outstanding argument is to the effect that the popularization of Birth Control will lead to a general increase in promiscuity, both among married and unmarried people. The temptation to illicit indulgence would be made greater, the process of seducing an innocent girl would be made easier, the ever-present lure of prostitution to the underpaid girl worker would be made more difficult to resist, if an assurance could be felt that the subsequent birth of a child――hitherto a generally prevalent and effective deterrent――could be prevented by the exercise of a popularly known technique. The restraint imposed by fear may not be one of a high moral order, yet the end which it serves is here, by common consent, socially desirable. In face of the absence of any authoritative source of information on Birth Control, and of the indifference of the medical profession with regard to it, certain popular works on the subject have acquired an immense vogue and have enjoyed an enormous sale. Though not intended for this purpose, they are purchased and read extensively by young persons in much the same spirit that improper literature in general is read. Further, the sale to adults of these works containing as they do a magnification and eulogy of the sexual act _per se_ (to be conceived, expressly, apart from its normal biological sequel of child-birth as a salutary and health-giving process), and containing also minute instructions as to the technical use of contraceptives, has not been confined to married persons. Such works have been held to inflame and pervert the imagination of the young, and on pseudo-medical grounds, to incite adults to promiscuity. It is to be noted, however, that the above is an argument directed not so much against Birth Control itself as against the method by which knowledge of it is communicated to the public.

* * * * *

These appear to be the most important arguments currently advanced against Birth Control.

It will be noted that several have been omitted from consideration. The one based upon biblical condemnation is too futile to merit restatement. The argument that contraception is ‘unnatural’ is equally undeserving of repetition. The contention that it is anti-biological will be discussed later.

* * * * *

Arguments on the other side will now be considered. They divide themselves into three groups, which may arbitrarily be designated as International, Social, and Individual arguments.

(_a_) _International._――The connexion between over-population and war is nowadays fairly obvious and is particularly manifest in those countries which are both industrially organized and consciously nationalist in spirit. In the absence of these two conditions over-multiplication need not be followed by war. India and China, for instance, are very densely populated countries where over-multiplication frequently takes place. This process does not, however, give rise to much danger of international disturbance, in that both countries are, from the nature of their organization, incapable of conducting war on modern lines, and neither has a generally-felt, or a unifying national consciousness. Excessive increase is here frequently checked by famines, which, though causing incalculable suffering, do not readily generate wars.

Within recent years two countries have demonstrated the relation between over-population and war, or the threat of war, namely Germany and Japan.

In Germany before the war, where the ‘military’ objection to Birth Control, first advanced, was prevalent, there existed an ethical code by which German mothers were persuaded that they were fulfilling the highest spiritual purpose of which their sex was capable by producing male children destined to be soldiers, prepared to fight for their country in a victorious war. It is now generally recognized here that it was this attitude of mind, involving an expectation and a glorification of war, associated with the distinctively German powers of efficient organization centred in implicit obedience to the Kaiser, which served to produce that exultant pride of power and aggressive national consciousness which precipitated, if it did not actually cause, the late war. The increase in the population of Germany was advocated and extolled without regard to that country’s capacity to support her swelling populations. To-day, though Birth Control is largely practised by the upper and middle classes in Germany as it is in this country, the old ideal still lingers on, and to it is attributable that fear of Germany which, until recently, has so conspicuously directed French policy since the Armistice.

In Japan the connexion between numerical increase and a possible war is now coming to be recognized here. Australia, New Zealand and the United States are already definitely conscious of it. The Japanese religion, based upon piety towards ancestors (to whom every man is bound to perpetuate his family), and upon loyalty to the Mikado who, as Emperor God, is held to be divine, imposes upon all faithful subjects the duty of marrying young and of producing many children. This injunction is again promulgated irrespective of the native resources of Japan, and in the past has necessitated a considerable annual emigration to other countries. The recent restrictions imposed by America upon Japanese immigration, themselves prompted by motives common to most English-speaking races, have led directly and inevitably to the existing tension between America and Japan. As things stand at present, it appears that this tension is likely to increase and may easily eventuate in a war, in which there would be a greater probability of our being involved than there was, initially, of America being involved in the late war. Both the Americans and Japanese are sensitive and proud people. After further tension has accumulated, a trivial incident――the possible murder of an American official in Japan by some irresponsible person――might lead to the despatch of a curtly-worded note or to the formulation of an abrupt ultimatum out of which a second world war might, like the last, suddenly flare up, to reduce modern civilization to ruins and ashes.

Stress is laid on this particular aspect of the population problem partly because it is felt that few nations now hold the desirable ideal of adapting their numbers to their particular economic optimum, and partly because it would seem that in face of this nationally encouraged increase of population and of certain apparently unalterable race antipathies, _no amount_ of international pacifism, or of condemnation of violence, or of genuine humanitarian goodwill can prevent war.

Germany and Japan display the connexion between numerical increase and wars most clearly to-day. It is possible that in the future other nations may become conspicuous in this respect. Thus America, where the teaching of contraception is illegal (in so far as anything is), may, in another 50 or 100 years, develop an aggressive foreign policy. And now that restrictions have been imposed on the entry of Italians into America, it is conceivable that Italy may at some time discover an Imperialist mission on the shores of the Mediterranean.

(_b_) _Social._――This aspect of Birth Control has been much discussed and is concerned with the dimensions and quality of the population of these islands. The argument, in the form in which it is usually advanced, distinguishes a quantitative and a qualitative point of view, the latter further possessing two aspects.

Quantitatively, it has been pointed out that in the last hundred years, the increase in the population of this country has been excessive. Because England was the pioneer of the Industrial Revolution, she enjoyed initially an unprecedented national prosperity, unharassed by competitors and with the world as her market. Though the conditions of many of the early factory-workers were unquestionably appalling, the wealth and economic importance of this country increased so rapidly that she was enabled to support immensely greater numbers than at any previous period of her history.

Thus in 1821 the population of England and Wales was just over 12 millions; in 1921 it had risen to nearly 38 millions. That is to say that in a hundred years our population had more than trebled.

When, however, at the beginning of this century other countries began to enter into competition with us, and to produce manufactured goods on a large scale often underselling British goods, our hitherto unchallenged industrial supremacy gradually commenced to suffer eclipse. But our numbers have not adapted themselves to our diminished power of employing labour thus created. On the contrary, the population has continued steadily to increase, with the result that by slow degrees the unemployment problem which, at present, looms so large on our political horizon began insidiously to disclose itself. The present formidable figure of nearly a million and a quarter of unemployed, together with a large number of workers on short hours, testifies to the fact that at the present time in relation to existing economic conditions, this country seems to be over-populated.

* * * * *

From the point of view of quality it has been pointed out that there are two factors which now tend to impoverish the race. They might be distinguished and arbitrarily named as ‘Dysgenic’ and ‘Economic’ respectively.

The dysgenic factor may be propounded as follows: Though the Birth-rate in England has fallen from 36 per 1000 in 1877 to 20 per 1000 or less to-day, this decrease has not been accompanied by a decrease in the population, since the Death-rate has dropped correspondingly. This has taken place by reason of the complete suspension, if not the actual reversal, in civilized countries to-day of the principle of Natural Selection, operative amongst animals and primitive peoples.

There are three outstanding reasons to which this suspension is attributable. They are the advances in sanitation and medical science, the increase in humanitarianism, and the method of obtaining votes which prevails in democratic countries.

The advances in sanitation and medical science made in the last 60 years have resulted in an enormous reduction of infant mortality in large towns, and also in an average prolongation of life. Epidemics of smallpox, cholera, typhus, diphtheria, scarlet fever, etc., which took such a heavy toll in the past, are now effectively controlled by the existing system of isolation hospitals, and of efficient public health supervision. To-day it is possible for the medical student to traverse his six laborious years of training without seeing a single case of typhoid fever――a disease which in the times of his elders used to be one of the commonplaces of a hospital. These improvements in sanitation, the progress made in aseptic surgery, in prophylactic medicine, and in the general treatment of disease, have been largely responsible for the lowering of the death-rate already mentioned.