Birth Control

Revelations of the existence of a quietly functioning "birth control clinic" at the Fifth Ave. (Manhattan) office of the American Birth Control League, combined with the agitation over a clinic in Chicago (TIME, Dec. 3) and the anticipated clash over birth control in the 68th Congress have again placed in the foreground of public attention one of the most vexed and, from whatever standpoint considered, one of the most important of medico-social problems.

Legality. The U. S. is now the only civilized country, with the possible exception of Japan, which places absolute legal restrictions on the dissemination of information on methods of preventing conception. The present Federal legislation consists mainly of Section 211 of the Penal Code, enacted by Congress in the flurry of a closing session on March 3, 1873, at the instance of Anthony Comstock.-- It reads in part: "Every obscene, lewd or lascivious book, pamphlet ... or other publication of an indecent character, and every article . . . designed, adapted, or intended for preventing conception or producing abortion, or for any indecent or immoral use ... is hereby declared to be non-mailable matter. . . The penalty imposed for violation is a fine of not more than $5,000, imprisonment for not more than five years, or both. This and later Federal statutes, lumping all forms of contraceptive information indiscriminately with pornography and obscenity, prohibit the advertising, manufacturing and selling of, or interstate or foreign commerce in such articles or knowledge. The effect has been to limit their manufacture, sale and the giving of information to individual States. Nineteen States have clear and definite legislation essentially similar to the Federal statutes. Twenty-five other States have more ambiguous laws relating to "obscene, vulgar and indecent" objects or written matter of "immoral purpose." Four States--Georgia, New Hampshire, New Mexico, North Carolina-- have no legislation on birth control. One State--Connecticut--goes the limit, no exceptions, even to prohibiting the use of any "drug, medicinal article or instrument for the purpose of preventing conception."

In most States the action of the law depends on judicial interpretation. The recent decision of a Chicago court finds no provision in the Illinois law which would prevent the establishment of a clinic, while the New York statute specifically excepts from its prohibitions articles "used by physicians lawfully practicing, for the cure or prevention of disease.

It is this loophole which has made possible the operation of the present Fifth Avenue "clinic" by the American Birth Control League, Mrs. Sanger's organization. The clinic has been running since Jan. 1, 1923, and has advised 900 women gratis, during that period. It is in charge of Dr. Dorothy Bocker, formerly director of maternity and infant hygiene with the Georgia State Board of Health, surgeon of the U. S. Public Health Service, a graduate of Long Island College Hospital Medical College and an instructor in various universities. The experiment has been investigated by hundreds of social workers and physicians, and has proved its value, according to Mrs. Sanger. She appealed for $15,000 to extend the work to other centers at a luncheon attended by 500 prominent men and women. Cases have been referred to the clinic by many charities, hospitals, physicians, clergymen and others.

The patients were almost equally divided between Protestants, Catholics and Hebrews. Police interference has been threatened, but the legality of the clinic is not likely to be seriously challenged. The various birth control propaganda groups, however, are seeking much more .than the mere establishment of a few clinics. The Voluntary Parenthood League (Mrs. Mary Ware Dennett, Director) is making a concerted effort for the repeal of the sections of the Federal obscenity laws referring to contraceptive measures. In the short session of the last Congress a bill to accomplish this was introduced by Senator Cummins and Representative Kissel. Although many Congressmen, privately polled, approved the bill, it never reached the floor of the Houses, but died in the Senate Judiciary Committee. Senator Knute Nelson, the Chairman of that Committee and a strong opponent of the measure, has since died, as has Senator Dillingham, next in seniority. Senator Brandegee (of Connecticut), the new Chairman, has not declared himself, and whether the bill can muster a majority in the Committee and be reported out is uncertain. But it is certain to be introduced by Senator Cummins and to precipitate a nation-wide debate. Politically, of course, many legislators are afraid of the bill, fearing the effect on backward constituencies. The consistent opposition of the Roman Catholic Church to the birth control movement is well known.

Arguments Pro. The argument of the birth control propagandists is essentially as follows: The present law is unevenly enforced. The well- todo, educated part of the population, especially the professional groups, many of whom oppose any relaxation of the present restrictions, generally have access to such knowledge and are obviously limiting the number of their children. The birthrate of the United States, now about 22 per thousand population, as well as of all the more advanced countries, has declined steadily in the past half century since the agitation for birth control (starting in England with Robert Owen, Francis Place and the famous Bradlaugh-Besant trial) became widespread. It is well known that many physicians give information to their private patients. But the lower classes, economically and mentally, have been shut off from such sources. It is these classes, including the majority of immigrants, which have the largest families and contribute the largest share of paupers, defectives and diseased per- sons. Birth control information, if available to them, would improve the quality of the race by cutting off at its source the multiplication of the unfit or the unfortunate. Public clinics in the Netherlands and other countries, operating without Government opposition, have apparently had beneficial effect. Most advocates of birth control do not wish to remove all restrictions, but simply to make it legal for properly qualified persons, as physicians, public health officers or nurses, to give information to all married persons who desire it.

Medically, contraceptive methods are far from perfect. There is no known infallible means except complete abstinence from sex relations. But considerable research has been done which would be stimulated if the illegal aspect were removed. Improved methods may be looked for, and some commonly used, which are injurious to health, could be reduced. Likewise, abortions, estimated (though of course no reliable statistics are possible) at from 500,000 to 2,000,000 yearly in the U. S. would be reduced if preventive methods were more freely available.

Apart from the considerations of health and income, however, there is a growing demand among women for birth control to enable them to space the number of children they desire at such intervals as will make life more livable and make possible better care of the fewer children. An exhaustive scientific study of the sex life of 1,000 normal and well- educated married women, made by Dr. Katharine B. Davis, of the Bureau of Social Hygiene, revealed the fact that 74% used contraceptive methods themselves and gave their approval to them. Economic and health reasons, and desire for a satisfactory married life were about equally important as motives. The women who used contraceptives had an average of 1.93 children, while those who did not use them had 1.31.

Birth control propagandists are in the habit of imputing interested motives to their opponents, as that doctors fear loss of obstetrical patronage, clergymen want a plentiful supply of church members from the "lower classes," military men want "cannon fodder," politicians want voters, captains of industry want cheap labor, etc. "Foxes think large families among the rabbits highly commendable," writes Thomas Nixon Carver, Professor of Political Economy at Harvard.

Advocates. Prominent physicians who have been outspoken advocates of birth control include the late Abraham Jacobi (former President of the American Medical Association), S. Adolphus Knopf, William J. Robinson, A. L. Goldwater, Ira S. Wile, Donald R. Hooker, Reynold A. Spaeth, Lawrence Litchfield, Sir W. Arbuthnot Lane, Lord Dawson (King George's physician).

Other prominent professional and social leaders who have been active supporters of birth control are Herbert B. Swope, Frank I. Cobb, Arthur T. Vance, Heywood Broun, B. W. Huebsch, George Haven Putnam, Sinclair Lewis, Judges John Stelk, Benjamin B. Lindsey, William H. Wadhams, Mrs. Felix M. Warburg, Miss Jeannette Rankin, Lionel Sutro, Airs. Juliet B. Rublee, Winston Churchill, Mrs. Willard Straight, Mrs. Norman deR. Whitehouse, Mrs. C. C. Rumsey, Mrs. Amos R. E. Pinchot, Mrs. Julius Rosenwald.

Birth control has always been more or less closely associated with Malthusian doctrines of population, and many leading biologists and social scientists see in it the only practicable solution to the problem of subsistence, though most scientists are reserved in their support of the movement, and would stipulate certain eugenic safeguards. Among such thinkers might be mentioned Thomas Nixon Carver, Edward M. East, David Starr Jordan, G. Stanley Hall, Raymond Pearl, Franklin H. Giddings, Edward A. Ross, Irving Fisher, H. H. Goddard, Warner Fite, George H. Palmer, William P. Montague, Roswell H. Johnson, C C Little, Samuel J. Holmes, Henry Fairfield Osborn, Madison Grant, (Theodore) Lothrop Stoddard, Charles W. Eliot, Charles B. Davenport, Havelock Ellis, H. G. Wells, Arnold Bennett, George Bernard Shaw, Harold Cox, Leonard Darwin, Dean Inge.

Arguments Con. Opponents of birth control base their objections chiefly on the danger of widespread immorality if contraceptive information is freely available, especially to unmarried persons. The fear of pregnancy they believe to be the most effective check to promiscuity with the majority of people. Birth control is artificial, unnatural and an offense against the laws of God, in the same class with abortion and infanticide. On the medical side, there is also the fact that some methods are injurious to health.

Opponents. Prominent objectors to birth control are less vocal than in the past, but the late Theodore Roosevelt's protest against "race suicide" is well known. Many churchmen are outspoken against the movement, as, for instance, Archbishops Mundelein of Chicago and Hayes of New York, Dr. John Roach Straton and other Catholic and Fundamentalist leaders. Justice John Ford of New York, John S. Sumner of the Society for the Suppression of Vice, Commissioner of Accounts David Hirshfield of New York and Health Commissioner Herman N. Bundesen of Chicago are other leading opponents.

*Anthony Comstock was Secretary of the New York Society for the Suppression of Vice. He died in 1915.