Wise Parenthood

Front matter

BY MARIE CARMICHAEL STOPES Doctor of Science, London; Doctor of Philosophy, Munich; Fellow of University College, London; Fellow of the Royal Society of Literature, and of the Linnean and Geological Societies, London

LONDON: G. P. PUTNAM'S SONS 24 BEDFORD STREET, STRAND, W.C.2

Introductory Note

THE rapid progress of the idea of birth regulation is one of the outstanding social phenomena of the time. But it cannot astonish the thoughtful, for the idea appeals almost irresistibly to the common sense and the conscience of civilised beings, and nothing save superstition and ignorance can impair or impede its triumph. Further, everybody knows that the vast majority of its instructed opponents practise in their private lives what they condemn for others. That birth regulation has disadvantages is arguable. Its disadvantages, however, are not those usually emphasised by its opponents. For example, no unprejudiced brain will contend that that which is so manifestly beneficent to the individual can be bad for the race. Nor have children hitherto been such a source of sorrow and disappointment to parents that the parental instinct is likely to be destroyed through the temptations of any device whatever. No! The disadvantages of birth regulation are mainly transient; they spring from an imperfect acquaintance with the methods of it; and they will pass. Millions and tens of millions of potential parents need advice about birth regulation. They cry out for sound advice, and they do not get it. They suffer, sometimes horribly, for want of sound advice. This book is a practical manual of birth regulation written by an unchallenged authority for the intimate use of potential parents.

ARNOLD BENNETT.

Author's Preface

THE origin of this book was an attempt to answer innumerable inquirers who, having read "Married Love" (first published in 1918), approached me desiring wholesome information on a subject of vital importance to themselves and to the race. Not only these individual inquirers, but the world at large, and even the medical profession, lacked a rational, scientific and critical consideration of the details concerning the methods for the control of conception, some of which are now so widely used. My book seemed urgently needed, because owing to this very lack of serious and scientific presentation, ill-informed and often debased instruction had been circulating freely.

And even the one British society then (1918) advocating control of conception, namely, the Malthusian League, distributed to inquirers an all too brief leaflet giving indiscriminate instructions, including, without sufficient critical examination or physiological caution, such methods as coitus interruptus, and advising douching (see p. 68). Some users observed for themselves that these methods are harmful; and the mistaken idea gained currency that these were representative methods, hence that "methods are harmful," and hence that the advocacy of birth control implies the advocacy of harmful methods. I am convinced by experience that much of the opposition to "methods" is due to the confusion thus created in prudish minds incapable of distinguishing between harmful methods and wholesome ones, yet vaguely aware that some methods are harmful.

In July, 1922, the above-named Society issued a revised leaflet (now a small pamphlet), re-written by Norman Haire, Esq., M.B., who follows the main thesis of my book, viz., that an internal rubber cap worn by the woman is the best contraceptive for general use. That he favours a different form of cap (the Dutch hemispherical type) is a minor, though not unimportant, point which will be dealt with in the following pages (see p. 49).

Owing to a variety of circumstances which have fostered ignorance and strengthened prejudice, the subject of the control of conception has not hitherto received that learned attention which its importance deserves; but for long there have been scattered in the medical and scientific journals and treatises, and in other and more intimately human records, facts based on more or less isolated experience which, once correlated, are sufficient at any rate to form a basis for the kind of critical consideration which is wanted. The ethical, the romantic, the physiological, the frankly practical and economic aspects, and the distantly ramifying results of the various methods, are all of vital importance and are essentially interwoven. Though one or the other may have received some attention, those who have pronounced their opinions for or against the control of conception have hitherto generally done so without specifying to which means they refer, and often without taking into consideration the conflicting needs of different aspects of the life of even one individual. Without making an elaborate treatise of this book, all these points have been borne in mind while writing it.

As is indicated in the title-page, the Fourteenth Edition has been revised, and certain changes which will I hope add to its usefulness, and a certain number of new passages, have been added. Since it was first written in 1918 it has had an enormous number of readers, many of whom have written to me confirming, and often illustrating from their own lives, the generalisations presented in its pages. Moreover, many of the readers have been medical men who have cordially endorsed its teaching.

Further practical knowledge has accrued concerning the subject of Contraception as a result of the founding of the pioneer Birth Control Clinic. To the Clinic have come many thousands of cases whose requirements have been investigated. In connection with public meetings and various private conferences, I have also had the advantage of discussions on the subject with numerous medical practitioners of different nationalities. Yet the main teachings of this book, as published in 1918, remain not only unshaken, but strengthened.

Inquiry and investigation have not resulted in the discovery of any method better for normal women than the use of the simple all-rubber cap described in the following pages. An improved form of greasy suppository to combine with it is now the reward of our work at the Clinic, and the fourteenth edition was the first to hand on to the public information about it (see p. 42). Research should be pursued, but it seems clear that no very revolutionary result in the field of simple contraceptive measures is imminent. Injections to produce temporary sterility, the use of X-rays, and other methods, suitable only for use by medical specialists, are those attracting attention in advanced circles, but they are not at present of any widespread practical use.

At the request of several distinguished medical men, some years ago I began to write a comprehensive manual on the subject, because none such exists in any language. This has now been completed, and is published by Messrs. Bale and Danielsson under the title "Contraception (Birth Control), Its Theory, History and Practice: A Manual for the Medical and Legal Professions." Educated readers who require more detailed information than the present small volume contains will find it useful and written in sufficiently non-technical language. Its perusal should answer many questions frequently asked.

In the preparation of the present small book I have been indebted to very many men and women who have voluntarily confided to me their personal experiences and needs, thus supplying me with invaluable facts. My thanks are due to the late Professor E. H. Starling, C.M.G., F.R.S., who, in 1919, while disclaiming any responsibility for this book, and even in various details definitely dissenting from my conclusions, read the early proof and gave me the benefit of his valuable opinions. The Rev. Sir James Marchant, K.B.E., F.R.S.Edin., and Dr. Mary Scharlieb, C.B.E., M.S., also very kindly read the proofs of an early edition, and I have benefited by their suggestions, although we disagree on fundamental principles.

Personal instruction about individual procedure will still be wanted by many, particularly where slightly abnormal formations or induced malformations render prevention diffi- cult; and I ardently believe that Clinics should be within reach of all, so that rightly trained midwives, nurses and doctors, of suitably sympathetic temperament, can be applied to personally for help.

Realising that this, like most books, will only be of use to the educated and more thoughtful people, and that it is of great racial urgency to bring this knowledge to the poorest and least literate section of the community, my husband Mr. H. V. Roe and I opened the first Birth Control Clinic in the British Empire in March, 1921, in a poor district in Holloway, London, N. For the convenience of its many visitors, in 1925 it was removed to more central quarters at 108, Whitfield Street, Tottenham Court Road, W.1. This Clinic is open daily without charge to all married persons, and has been used by great numbers of poor mothers as well as by members of the medical and nursing professions who desire the information and help I am always glad to give.

At the present date nearly ten thousand cases have come personally to the Clinic, and hundreds of thousands of applications by post from all parts of the world have been dealt with by sending practical advice, doctors' addresses, pamphlets and literature. Of those who have come for personal examination, and who have been helped, the first five thousand case sheets have been analysed and published in a little book at 2s. 6d. under the title of "The First Five Thousand," which those who are interested in the details of the Clinic work should find valuable reading.

On the day the Clinic was opened we framed and placed upon the wall the following:—

"THIS CLINIC IS FREE TO ALL, and is supported entirely by the two founders. Those who have benefited by its help are asked to hand on knowledge of its existence to others and help to create a public opinion which will force the Ministry of Health to include a similar service in Ante-Natal and Welfare Centres already supported by the Government in every district."

And it is gratifying indeed to feel that official representatives of all political parties, a great many independent Societies, and even the House of Lords itself by passing Lord Buckmaster's motion in 1926, show that they have rapidly come round to our way of thinking.

The new era which is now dawning should—must—be one in which the people are supplied with sound knowledge to meet their needs. Knowledge on many subjects which has been kept obscure to the past generation is reaching the public in garbled form. Only if those of scientific spirit who possess the nearest approach to truth which is at the time available will assist each other in spreading the truth, can the public be really helped and enlightened. For this reason, in 1921, I felt that it would be wise to knit together in a definite organisation some of the more public spirited of the many people who showed themselves alive to the significance of true and scientific sex-knowledge. The Society for Constructive Birth Control and Racial Progress was organised, and held its first general meeting in October, 1921. A list of its officers and some other particulars about it will be found in the flyleaf of this book. A sister Society in America, the Voluntary Parenthood League, has a heavier task than ours, as it has not merely to educate public opinion, but to effect a change of Federal Law before real practical work can be done in the States. All who care for true human progress should join one, or preferably both, of these Societies, for the English-speaking nations are so closely linked that in this matter they should cooperate.

I have daily evidence that already this little book is of use all the world over, and I hope it may help to improve our race, and to check the spread of nervous and other injuries sadly prevalent as a result of ignorant attempts to obtain that wise and health-giving control of parenthood which all who think must crave.

While it is far from being an exhaustive treatise, and while it is deliberately written in non-technical and clear English, it was the first scientific and critical consideration of the practical aspects of the subject which, as Lord Dawson said at the Church Congress, in October, 1921, "has come to stay."

I should like to take this opportunity of urging young couples who truly love, to have all the children to whom they can give health and beauty, even if by doing so they sacrifice their personal luxuries.

M. C. S.

1927.

Chapter 1

"I think, dearest Uncle, you cannot really wish me to be the Mamma d'une nombreuse famille, for I think you will see the great inconvenience a large family would be to us all, and particularly to the country, independent of the hardship and inconvenience to myself. Men never think, at least seldom think, what a hard task it is for us women to go through this very often."—Queen Victoria in a letter to the King of the Belgians, January 15, 1841.

A FAMILY of healthy happy children should be the joy of every pair of married lovers. To-day more than ever the course of duty and delight coincide for those who have health and love in their homes. For to-day as never before the world needs the products of sound and beautiful love, and though these range from the intangible aroma of peace and happiness which a rightly wedded pair radiate, through an infinite variety of spiritual and physical results, the most vital and the most potentially valuable to the community are the children.

Whatever theory of the transmission of characteristics scientists may ultimately adopt, there can be little doubt in the minds of rational people that heredity does tell, and that children who descend from a double line of healthy and intelligent parents are better equipped to face whatever difficulties in their environment may later arise than are children from unsound stock. As Sir James Barr said in the British Medical Journal, 1918: "There is no equality in nature among children nor among adults, and if there is to be a much-needed improvement in the race, we must breed from the physically, morally and intellectually fit."

Nevertheless, the happiness which children should be in a home depends less on a conscious sense of civic virtue (though that may be a factor), than on an acute and warm personal feeling of the parents towards each other. Every man who finds beauty and goodness in his wife must feel a keen desire to repeat that beauty and goodness throughout all time, and every woman who has picked her mate freely, and because she thought him a knight among men, must long to see his characteristics reproduced, so that the world should not lose the imprint of his splendour when the inevitable happens and he has to pass. Indeed, one may almost take it as an axiom when dealing with true love that the pair do feel thus towards each other, and consequently desire children, unless they are aware that either is stricken by some inherent weakness or disease which might reappear in the child. Then they must refrain from parenthood out of a sense of duty and pity towards the unborn.

Nature herself provided that men and women should delight in meeting. Given a loving married pair in normal health, and unsophisticated in any way, there is seldom any lack of children around them after they have been wedded for some years. This is what is still described as the "natural" condition of affairs, and in these days of sophistication in so-called "civilisation," some reformers urge a return to Nature and an unregulated birth-rate.

If, however, the course of "nature" is allowed to run unguided, babies come in general too quickly for the resources of most, and particularly of city-dwelling, families, and the parents as well as the children consequently suffer. Wise parents therefore guide nature, and control the conception of the desired children so as to space them in the way best adjusted to what health, wealth, and happiness they have to give. The object of this book is to tell prospective parents how best to do this, and to hand on to them in a concise form what help science can give on this vital subject.

This is not an attempt to present complete arguments to show the racial and national necessity for the Control of Conception: various aspects of this theme have been presented by others.

Recently valuable expositions of the supreme importance to humanity of a wise use of the control of conception have been made from many different points of view and by various distinguished people. Doubtless much more remains to be said, for there are many who are still ignorant, and consequently prejudiced against the greatest of the steps humanity can take next in its evolution; but this is not the place to deal with the wider aspects of the subject.

That a large proportion of intelligent and thoughtful married couples are practising at the present moment some method or other of the control of conception is beyond dispute. In Lord Dawson of Penn's speech before the Church Congress at Birmingham in 1921 he said: "I will put forward with confidence the view that birth control is here to stay. It is an established fact, and for good or evil has to be accepted. Although the extent of its application can be and is being modified, no denunciations will abolish it." The question before us, therefore, is not whether or no some knowledge of contraceptives should be allowed; it is already established. General dissatisfaction with most of the methods used is however prevalent; and this dissatisfaction is not being alleviated, because there is also a widespread ignorance of satisfactory methods, even on the part of medical practitioners. Numbers of people who are practising and have been practising the control of conception by various means for years, are in urgent need of a better method than any known to them. The following pages are written for them.

If this book gets into the hands of some who have not given the subject of the control of conception adequate thought they should read the books mentioned on pp. 83–84. This short list is only representative of a few of the more important aspects of the subject; but if a serious student is not yet convinced by them and will follow up and read all the other works referred to in them, he will then at any rate have a fair idea of the essentials of the subject and can form his own opinions.

What we are here concerned with is the fact that contraceptive methods of all sorts are now so widely used that it is high time serious attention should be devoted to the subject. People should not be employing anything less satisfactory than the best now obtainable; but, unless they are given the best, they will assuredly use some less desirable means.

I will give a quotation from one of our most ardent social reformers. The Rev. Sir J. Marchant, Secretary of the Birth Rate Commission and Director of the National Council of Public Morals, in his book, "Birth Rate and Empire," says as follows (pp. 144–146):

If, then, the volitional control of births within the married state has become a normal proceeding, if it is fast losing its apparent indelicacy, if it is spoken about without raising vicious passions, if it is becoming the "correct thing" to do … we must give up the futile attempt to keep young people in the dark and the assumption that they are ignorant of notorious facts. We cannot, if we would, stop the spread of sexual knowledge; and, if we could do so, we should only make matters infinitely worse. This is the second decade of the twentieth century, not the early Victorian period. … It is, then, no longer a question of knowing or not knowing. We have to disabuse our middle-aged minds of that fond delusion. Our young people know more than we did when we began our married lives, and sometimes as much as we know ourselves, even now. So that we need not continue to shake our few remaining hairs in simulating feelings of surprise and horror. It might have been better for us if we had been more enlightened. And if our discussion of this problem is to be of any real use, we must at the outset reconcile ourselves to the facts that the birth-rate is voluntarily controlled, that brides and bridegrooms know how it is done, and many will certainly do it. Certain persons who instruct us in these matters may hold up their pious hands and whiten their frightened faces as they cry out in the public squares against "this vice," but they only make themselves ridiculous. Their influence in stemming the tide is nearly nil.

The Rev. Sir J. Marchant says, "Brides and bridegrooms know how it is done." That is true. They know some, perhaps several, ways of securing voluntary instead of involuntary parenthood, but very few have precise and satisfactory knowledge of, or understand the reasons against, many of the methods which are recommended to them either by medical men or by friends who, as ignorant as they themselves, have been in the habit of using methods described as "harmless," simply because they do no gross and obvious injury.

Many things are reckoned "harmless" which are nevertheless far from satisfactory. Let me take an illustration from another aspect of our lives. Every medical man would consider doses of a half-teaspoonful of ammoniated quinine as not only harmless but beneficial to a patient suffering from influenza. Nevertheless, some even in normal health find that a few such doses upset the digestion for several weeks. It is true that in an influenza epidemic it may be more important to order quinine than to think about people's digestions, and in this sense quinine is not only "harmless" but beneficial. There are many parallels to this in the use of various kinds of preventives which are described as "harmless."

It is amazing that medical and physiological science should have so neglected research on this most vital subject, and that a more perfect procedure should not yet have been devised: it is perhaps more amazing that the reactions and results of the methods now widely used should not have been thoroughly studied and understood. The methods which I have to suggest are not yet the ideal, but they are much simpler, more healthful and less disillusioning than those most in vogue before this book was written. I am glad to think it has materially changed current practice.

After giving the details necessary for the comprehension and employment of the best methods which I can recommend, I shall mention one or two others of those in general use, with reasons why I think them inadvisable save in very special circumstances. The large number of other and still less satisfactory means employed will not be touched upon at all, as this is not a monographic dissertation, but an attempt to be helpful by presenting, if not the ideal, at any rate the good in place of the less good or actually bad.

A few fortunate people who really understand their own physiology, or by happy instinct have chanced upon the right use of their bodies and have been in the habit of practising satisfactory methods, may say or think that such simple and direct instruction as follows is not needed. I have, however, overwhelming evidence and experience that ignorance is rife even in the very places where knowledge might be expected to hold sway. For some time past, scarcely a day has gone by without my receiving letter after letter from people who have long been married, from people who have consulted physicians, from people who have tried many experiments, and who are yet ignorant of any really satisfactory means of achieving what they have been perforce achieving in unsatisfactory ways. I once asked a medical woman who had had a practice for fifteen years what method she would advise: she knew of no method whatever. A well-known doctor in London, who for twenty years had had a general and important family practice, asked me if I could tell him of any method other than the sheath, which was the only one he knew, as his patients were inquiring and he did not know what to tell them. Many married couples, who are even told by the doctor that for the wife to have another child would be fatal, are at the same time not told any rational method of prevention. With variations depending on the temperament of the writer, I get appeals one after the other saying: "We have asked our doctor, but he tells us nothing which is of any use. We have therefore to go on using this, that, or the other method, which we feel to be unsatisfactory, because we do not know what else to do." In the pages which follow they will find an account of the physiological reactions of various methods and will thus be able to use the means best suited to their own circumstances.

Some churchmen recommend and some demand "absolute continence," save when a child is desired as a result of union. Where the mated pair are young, normal, and in love, such advice is not only impracticable, it is detrimental. Under such conditions a rigid and enforced abstinence, even where it is not directly injurious to health, may yet have as harmful effects as incontinence. The capacities and requirements of people vary greatly, and no universal rule can apply to all. Other clerics and ascetic-minded laymen sometimes disguise (perhaps even deceiving themselves) "absolute continence" under the more popular term of "self-control," which has a noble sound, and is liable, by credulous audiences, to be applauded. But "self-control" will not limit the numbers of the family unless it is so extensive that its correct description is "total abstinence extended over years," and this, as most medical men now agree, is not conducive to the physical well-being, or the mental harmony of a home composed of normal, strong and healthy young people, however suitable it may be for those ageing or of weak vitality. On the one side "absolute continence," and on the other an easy self-indulgence, are in married life equally to be condemned. In either of these two quagmires disasters lie in great variety. The narrow and safe path between them is a wise, reasoned and controlled use of the most intimate and sacred functions of the body.

Though for general guidance the suggestion which I have made, particularly in Chapter V of "Married Love," may be of service, yet each pair must find out for themselves the point where self-control becomes an object in itself and detrimental to health and vitality, and where on the other hand the expression of love begins to slide into a too facile indulgence.

My object is not to make sex-experience a danger-free indulgence, but to raise the sense of responsibility, the standard of self-control and knowledge which goes with maturity, and consequently the ultimate health and happiness of those who mate. It should be understood by the man, who is in general the more active partner, that he has to consider not only himself but his mate, and that the only right rule in marriage is that which gives the greatest sum total of health and happiness to the two concerned, for the benefit of the nation and the race. To achieve this, most men will have to exercise a fine self-control, truly ennobling and strengthening both to mind and body.

A knowledge of the means of prevention of conception may co-exist with low standards of living and personal hygiene, but even then such knowledge may save the next generation the misery of being hurled into wretched con- ditions, and may save the community the cost of maintaining anti-social lives.

Some, who would otherwise welcome the spread of knowledge on this important subject, fear an increase of promiscuous relations as a result. It appears, however, that the type of person who desires to lead an irregular life has long had access to sufficient information to satisfy such requirements, while the virtuous mother has been helpless in her ignorance of how to control her motherhood in the interests of her children. Daily experience at the Birth Control Clinic bears this out in a convincing manner. Hundreds of worn and wretchedly over-burdened mothers have applied for the help given by knowledge, but not a couple of flighty young people. The latter can get crude information from their companions.

Those who would debar the personally selfish from the knowledge of such methods of control, forget that it is just by those who do not trouble to prevent evils that the worst and most disastrous attempts are made to overtake the evils they themselves originated. I do not wish in this book to speak of the prevalence and horror of the poor and ignorant woman's attempts at early abortions: the story would be too heartrending, and is out of place in this little book, which is one of help and guidance.

Destructive of the health of both mother and child are the frantic efforts of women "caught," prematurely after a birth, or too frequently in their lives, by undesired motherhood. The desolating effects of abortion and attempted abortion can only be exterminated by a sound knowledge of the control of conception. In this my message coincides with that of all the Churches in condemning utterly the taking of even an embryonic life.

Alas that so many ignorant women do not realise the difference between the control of conception and abortion, and for want of knowledge of the former are ruining their health and pouring money into the pockets of unscrupulous firms which sell "pills."

Chapter 2

"All turns on what we say is included under divine law. If it is de jure divino, then there is no power to modify it; but if any portion is not, then there is power."

DOES divine law condemn scientific methods of controlling conception?