Part 2
The increase of humanitarianism in civilized countries has resulted in the creation of an enormous number of philanthropic institutions and charity organizations, through the channels of which much relief is brought to the impoverished classes. This spirit now makes it difficult for those endowed with a superfluity, or even a sufficiency of wealth, to contemplate with indifference the misery and degradation of less fortunately placed fellow human beings.
And lastly, since the entry to power of any given political party is conditioned by the acquisition by that party of a sufficient number of votes, given by a mainly proletarian electorate, it follows that politics are likely to be framed in such a way as to commend themselves to such an electorate. It would seem unfair to omit this fact from consideration, though it has been over-emphasized by a school of political cynics who deny the participation of humanitarian feelings in politics (outside the realm of speech-making), and who attribute to political expediency an excessive if not an exclusive rôle in improving the lot of the very poor.
In virtue, then, of these factors it would nowadays be very difficult for any individual, however worthless, actually to starve, and many people of defective stock and bad physique who, in the ordinary course of nature would perish, are now artificially kept alive to perpetuate their kind.
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The ‘economic’ factor tending to produce deterioration in the race, presupposes the dysgenic.
Among uncivilized peoples it is the biologically superior type which is most prolific. In advanced civilized countries, which are democratic in social organization, the reverse obtains. Thus among most primitive people, the Chief――_i.e._ the man with most courage, initiative, resourcefulness and power of leadership――enjoys the possession of most wives, and therefore produces most offspring. The analogue of the drunken unemployable of to-day would probably not be permitted to marry.
In England now, however, the drunken unemployable finds his nearest approach to an occupation in endowing his ill-fated wife with a stream of children, the regular succession of which is only eventually interrupted by the breakdown, age, or premature death of the wife, or by the death of the husband. And the only discouragement extended to such a man is forthcoming from the strictures passed upon him by his slum neighbours. None is forthcoming from the Government, and none from the hospital, which gratuitously delivers the wife of her children. In fact, information as to how she may arrest this devastating succession of children is deliberately withheld from her by nearly all hospitals, because it is felt that the condition of public opinion, upon which the hospitals largely depend for their finances, is averse from her being enlightened in this respect.
The organization for relief in this country is now so comprehensive and far-reaching that every necessity can be obtained gratis by those who cannot afford to pay for it. Thus the wife of the poor man is delivered of her children free of charge; the children are educated for nothing; if employment is not available for them at the time of leaving school, they are supplied with doles and relief free of obligation. And when they become senile, they are given old age pensions gratuitously. The funds necessary for the administration of these works are levied from the middle and upper classes, in rates and taxes.
Now the Englishman possesses a strong sentiment for institutions. A man who has himself received a certain kind of education, and who has been brought up according to a certain tradition, likes to provide the same education and the same tradition for his children. And if in the face of the increase in taxation, the rise in the cost of living, and the expenses of education, he cannot afford this, sooner than have children to whom he must deny what he considers a good start in life, he prefers to limit his family. This obtains of the man who suffers from a sense of obligation towards his children. The opposite holds good of the unemployed man at the other end of the social scale. He feels that he has sunk as low as is possible for him while still remaining out of prison. Insidiously his ambition and his self-respect become sapped by the soul-killing experience of finding himself a useless parasite upon the community. Frequently, as prison reports show, he takes to crime or drink. And slowly he is overcome by that sense of irresponsibility, of bitterness, of carelessness of the future, of improvident fatalism that takes possession of those living under continuously adverse circumstances.
It is a matter of indifference to him how many children are born to him since with each one his dole is increased. None of the restraints which enter into the longer view of the future held by the middle classes is felt by him. And so he goes ahead, and has as many children as time and the health of his wife (of which last he does not always show excessive consideration) will permit.
The following figures clearly illustrate this state of things. Whereas the number of children produced annually by a thousand teachers is 95, by Church of England ministers is 101, by doctors is 103, the average number produced by general labourers is 231. And among these general labourers it is the least desirable individuals――those, with least self-restraint, least foresight and with least consideration for their wives or the future of their children――who have largest families. And the undesirability may be of another kind. Mental defectives generally are very prolific. Girls of this condition, if left unwatched, are constantly becoming pregnant, there being apparently no shortage of men prepared to take advantage sexually of such unfortunate victims. It is to be noted that the economic situation following war is especially favourable to this discrepancy of fertility between classes. It would seem that the recent experience of the significance of war, the existing sense of social instability, the universal prevalence of unrest, hatred and international discord, make the more considerate parents feel that the world is not a very desirable place to bring children into. And this feeling is emphasized if they have to pay in taxation four times what they had to pay before, after which what money remains is worth about sixty-five per cent. of its previous value. But these considerations hardly affect the classes whose occupation is manual labour, or who have accustomed themselves to no occupation at all.
Thus from a social point of view it is to be observed that quantitatively, in relation to the present resources of the country, England is at the present day considerably over-populated; and qualitatively that many persons of all classes possessing inferior physique are now artificially kept alive to perpetuate their stock, while at the same time those elements of the population who, by lack of intelligence or thrift or steadiness, or who by possession of other defects have been reduced to the lowest level of the social structure, to-day constitute the most fertile strain in the country.
(_c_) _Individual._――The argument has frequently been heard that it is desirable to communicate knowledge of Birth Control to the poorer classes in the interests of the mother and the children.
It is difficult to know what percentage of the unwanted children born in the poorer quarters of our large towns are conceived as the result of a culpable aggression on the part of the husband upon his wife――as when he returns home drunk on Saturday night and threatens her with physical violence if she refuses to submit to his conjugal rights――or as the result of an ignorance of Birth Control methods which are familiar to the more educated classes. Certain it is that a large percentage of the children born are unwanted, and equally certain that among the very poor ignorance of contraception is such as to appear incredible to those who have not had personal experience of it.
Thus in the Autumn of 1924 a group of seven externs, working in the district covered by Guy’s Hospital, made inquiries of the mothers whose confinements they attended as to whether the child just born had been wanted or not. The inquiries were made, when possible, on the tenth day, when the patients were last visited, in such a way that their answers were more likely to be favourably influenced by fondness for the child than unfavourably by recollection of the pains of labour. Furthermore, where any doubt existed, as for instance when a woman replied that she had not particularly desired the baby before it was born, but would not part with it for the world now, she was given the benefit of the doubt and the baby was counted as wanted. In all, inquiries were made in the case of seventy-eight children born. Out of these, forty-seven were definitely not wanted, and thirty-one wanted; and the writer can vouch for the fact that if these figures erred at all, they did so on the side of moderation. Thus, in at least one poor quarter of London, well over half of the children born were emphatically not wanted.
The hardships imposed on the mother by such conditions are sometimes very cruel. Numerous cases have been quoted by advocates of Birth Control in their propaganda which there is not space to reproduce here. The reader can, however, picture to himself the experience of a woman suffering from the sickness, shortness of breath, emotional instability, and deformity of pregnancy, having to maintain life in some squalid slum, house-keeping, cooking, cleaning and tending the children without change of air or scene and without holidays, up till the incidence of the final labour pains. And no sooner is a child born than the husband reasserts his “rights,” and the same dismal cycle repeats itself without prospect or hope of change, or of relief from a body that has ceased to know the easy freedom and self-forgetfulness of good health.
Indifference to the children appears. They are looked after out of a stern sense of duty. The native impulse of spontaneous maternal fondness is killed by the deadly routine, and when, as frequently happens, the child dies, after a few pangs of grief, an easy reconciliation (perhaps not without a deep-seated sense of inward gratitude), is made to what is acknowledged as the “Will of the Almighty.” Sometimes, the mother makes no secret of her relief. But no man who has come for any length of time in contact with these working-class mothers can fail to admire the patience, the stoicism and the grim fortitude with which they face their dreary lot.
Their ignorance of Birth Control, in face of the publicity the subject is now given in the Press, is almost incredible. The same quality of fatalism and resignation felt by the soldier in the war before the prospect of wounds or death, is still evinced by these women in the matter of child-birth. One frequently meets with a sentiment that “we must take what comes without grumbling,” that “what is fated must be,” and even that “we must not fly in the face of the Almighty.” There further exists a superstition that any object requiring internal adjustment, like a pessary, runs the risk of being lost in the woman’s inside.
A further aspect of the problem is the prevalence under the existing system of the practice of abortion. It is difficult, of course, to give any trustworthy figures in this connexion, since in many cases the fact that the mother has attempted to induce an abortion is not revealed to the medical man who attends her, or to the hospital authorities who take her in. The methods usually resorted to are of an amazing crudity. They vary from the pregnant mother jumping three or four times consecutively off a table on to the floor or throwing herself downstairs, to her swallowing large quantities of lead, ergot, quinine and other substances as well as nocuous doses of emetics, irritants and purgatives.
Frequently the woman practises local violence upon herself, or engages the services of a professional abortionist, a class more numerous than is generally supposed. Such a person, after practising his art, is in the habit of instructing the woman as soon as she feels the pain or notices any haemorrhage, to report herself to a medical man or present herself at a hospital where she is taken in as an ordinary case of threatened abortion. The responsibility for what may subsequently happen to the woman is thus effectively removed from the abortionist’s shoulders, it being in the interest of everyone concerned to preserve silence as to the part he has played.
The damage done to the health of many poor women by such practices is enormous, and might largely be avoided by a judicious instruction in Birth Control.
When the effects of all this upon the children are considered, it is at once found that the question of Birth Control is intimately connected with the housing problem. The overcrowding in large slum families is notorious. At an early age the day is passed by these children in the street, where, filthy and untended, they receive little by way of notice from their elders except hard words or blows. Their nights are spent packed, in a fetid atmosphere, several together in the same bed from which they may witness their parents in sexual intercourse, sometimes their mother in labour, and where they are free to indulge in what, later in life, would be called incestuous practices with one another. The writer has on more than one occasion attended a woman in confinement while several children were watching her from a bed in the same room, there being, in the urgency of the situation, no time to dispose of them and nowhere immediately available to send them.
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Substantially this is what has been said on each side of this complex question.
Before proceeding to discuss the arguments heretofore propounded, it is necessary to emphasize the fact that from the technical point of view _a really satisfactory contraceptive does not yet exist_.
The chief disadvantage attaching to the contraceptive used by the man is that it is quite impossible to induce the type of individual whose procreation we would wish to restrict to use any contraceptive at all.
The child is usually begotten by such a parent when he is drunk, and everyone who has had experience of the conditions prevailing in bad slums will know that it is futile to expect to achieve anything along these lines through the man. The problem must be met through the woman who, unlike the man, has to put up with the discomfort and the pain of repeated pregnancies, and has to shoulder the main burden of large families. Were it not for this elementary human fact all attempts to teach Birth Control to the very poor and destitute would fail completely.
Essentially, contraceptives which the woman can use are of two sorts, and involve two principles――namely, a mechanical or occlusive, and a chemical or spermicidal principle.
The objections to the first are two, namely that they are far from being fool-proof, and that unless sanctioned by a doctor their use can be followed by serious harm. It will be clear to any medical man that for a patient suffering from gonorrhœal cervicitis, or indeed from any condition involving a chronic cervical discharge, the use of an occlusive pessary may lead to disastrous consequences. The broadcasting of promiscuous advice as to the utilization of these objects in the absence of an examination by a competent medical man or woman is therefore to be strongly condemned.
The drawback, to all existing spermicidal suppositories is simply their uncertainty, though they are as nearly fool-proof as anything of the kind can be. It is possible that by further research a suppository, physically harmless but of certain action may be discovered, in which case, from its practical and sociological aspect, the problem of birth control will be greatly simplified. It remains, however, a little doubtful whether the chemical principle, however actively spermicidal, will ever dispense with the necessity of some occlusive device. But this is a sphere in which later research may prove of great value, and nothing but a tentative statement is now possible. The statement may, however, be made that if there is one method of Birth Control as to whose harmfulness there is little room for doubt, it is the method of coitus interruptus. In both sexes it gives rise to a condition of chronic anxiety which, nowadays, is far from uncommon. In the absence of local disease any of the above methods of contraception is preferable to this one.
The effectiveness of those women’s contraceptives now in vogue is difficult to estimate. There is little doubt that an unduly high estimation of their success has been formed in certain quarters, based on the assumption that in cases of failure, the working woman will promptly report the event to the centre where the contraceptive was obtained. The writer is persuaded that this is often a mistaken assumption, and that many cases of failure pass in consequence unnoted. There is also difficulty in knowing whether the instructions in the adjustment of the occlusive pessary have been adequately followed out. This process is not always easy, and as has been said above, is far from fool-proof.
The arguments above advanced will now be considered in their relation to (_a_) the Individual and (_b_) the Race.
(_a_) _The Individual._――The arguments relating to the individual are divisible into those applicable to (1) married, and (2) unmarried persons.
(1) It is to be noted that some of the contentions advanced on each side apply to the different phases of the married life of the woman.
Thus the revulsion of feeling against the use of contraceptives is experienced chiefly by the woman who has had either no children or few children. On the other hand, the woman who has the greatest need for a knowledge of Birth Control is the one who has had many children and desiring no more would probably feel little or no aversion from taking precautions against conceiving them. It appears to the writer that there is no adequate objection to communicating to such a multiparous mother this much needed information.
The difficulty in the case of the newly-married woman is of another type. The discrepancy between the ages at which human beings reach sexual maturity and at which they find themselves capable of maintaining a family, raises a number of exceedingly difficult problems. Seeing that the sexual requirements of man constitute a factor varying very greatly from individual to individual, and to a large extent depending, as is now realized, upon a very complex balance of glandular functions, it is more difficult than most popular moralists seem to realize to lay down general rules applicable impartially to every body.
Questions such as the following are raised: Can it reasonably be expected of _every_ man to live ten or more years of his sexually adult life in complete continence? If not, is it better for him to marry young and probably unequipped to support children, having remained continent till that time, or to marry later, probably better equipped financially to become a father, yet having had promiscuous experience of women before marriage? And if he does marry young, can he be expected to remain continent in his married life till he and his wife feel that they can satisfactorily maintain a family? If he finds he cannot do this, should he proceed to have children whom he cannot properly support, or is it better for the couple to overcome their dislike of contraceptives――a feeling which it is idle for advocates of Birth Control to ignore――and thus avoid having children till they are wanted? These are a few of the general questions which are raised in this connexion to which no comprehensive answer can possibly be given.
Much controversy has revolved round the question of the desirability of self-control as a means of regulating births, and of its universal practicability. It is here contended that where possible this is immeasurably the best means of regulating births. At the same time, it is futile to advance a counsel of such perfection and difficulty that a highly probable failure to observe it will be followed by socially disastrous results. Everyone would acknowledge that the Medical Officer of a military unit who refused to instruct the soldiers under his supervision in the precautions they should take against contracting venereal disease, on the high moral grounds that they should never expose themselves to such risk, would be carrying his idealism to socially harmful lengths. Yet it is a much more difficult task for two people in love with each other and living together in the intimacies of married life to exercise continuous self-denial over long periods extending to years, than it is for the soldier to abstain from occasional promiscuity. In both cases it is clear that the correct course is to start by putting the case for restraint as clearly and forcibly as possible, and then to explain what steps must be taken in the event of that restraint proving too great a task. In the Army and Navy such appeals, when tactfully made, have met with a response which justifies the view that, within limits, more can be done in this way than might be supposed. As a general rule, then, it would appear desirable that contraceptives should be used as little as possible, especially in the early years of married life.
It also seems to the writer that in the case of normal married people, too much has been made of the demoralizing effect of the ‘excessiveness’ of that indulgence which is supposed to be permitted by the practice of contraception and which forms the basis of the ‘moral’ objection advanced in this country. This argument frequently emanates from ecclesiastical sources, where knowledge of the sexual aspect of human nature as well as of the technical side of contraception is apt to be restricted and biassed. In effect, the man who is sufficiently provident and considerate of his wife to encourage the necessary precautions (which――a point too often ignored by prejudiced critics――from the immediately selfish point of view both parties would far sooner forego), is not the kind of man to indulge in reprehensible excesses. Actually, demoralization seems rather to be produced in those men who insist on gratifying themselves regardless of their means, or of the welfare of the children they so abundantly procreate, or of the feelings and health of their wives.
(2) The case of unmarried persons clearly falls into a different category. There can be little doubt that the publicity given to the subject of Birth Control has kindled the imagination of many young people and led to various transgressions. The requirement here is to discover a method by which at the same time this publicity may be diminished and information made selectively more available. Both these results could be achieved if the subject were taken up by the Ministry of Health, and facilities created for the appropriate giving of knowledge thereon by responsible qualified persons. By such means the particular advice suited to each individual case could be privately given, precisely where it is required, and steps might be taken to stop the journalistic broadcasting of information and discussion which has brought the subject into such discredit.
The effects of this measure would be comparable to the arrest of the literature upon the subject of venereal diseases, and to the reduction of their incidence that has been brought about by the institution of special departments for the treatment of these diseases in the large towns.