Margaret Sanger, "Human Conservation And Birth Control," March 3, 1938.

Typed speech. Source: Margaret Sanger Papers, Sophia Smith Collection , MSM S71:0977 .


Human Conservation And Birth Control

Margaret Sanger

In almost all of the conferences dealing with human conservation, maternal health, infant and maternal mortality, or population and the falling birth rate, conservation of the race through birth control is avoided or ignored. Speakers skirt the subject, delicately, and while it is in every one's mind and is discussed in the ante-rooms, and in private, at such conferences, it is not brought out into the open and given the place it deserves at these gatherings. It is a pleaser, therefore, to have the subject assigned me at this meeting. It is time -- in fact the time is long overdue -- that we should be frank and honest; that we should face the facts in this country and ask where the present policy -- if there be a policy -- of race conservation is leading us, so that we may plan to stem the tide of production of the unfit and try to turn it in the right direction.

In his address to the International Congress of Eugenics, 1932, Leonard Darwin said: "Racial deterioration is, I fully believe, taking place amongst us in such a way as to affect society as a whole; and if this be so, the cure should be as wide spread as the disease."

How can we define human conservation biologically? In olden times the race struggled toward a higher standard through the exercise of the law of the survival of the fittest. Only the strongest members of the race survived; it was a process of natural selection of those physically most fit. Inferior stocks were weeded out in the ruthless process; famine, pestilence and war assisting. Populations grew slowly under these checks, and intelligence was fostered as those not so physically strong had to learn how to protect themselves and develop arts and culture as well.

Then came the time when this balance was upset. Humanitarians, among civilized nations began their work to conquer disease, prolong life, reduce infant mortality and generally improve living conditions. Social services later became a business and the conservation of human life -- any life--a goal. There was no defined plan behind this program. It was motivated by sympathy and the desire to alleviate suffering. Laudable as was its purposes, emphasis was often not put on the proper objectives and the ultimate result has not tended to improve the race, but rather the reverse. Population increased rapidly, as natural checks were removed, but its quality of stamina, initiative and resistence did not increase proportionately. All over the world, where the subject is studies, we find biologists concerned over the fall in the level of intelligence, and the increase in the number of those of low I.Q. The figures of those men drafted for service in the World War in the United States, showed a level of about 12 years, mentally, and that in a nation with exceptionally high standards of living, and almost nationwide compulsory education.

All this is elementary and perhaps it is unnecessary to reiterate it, but we are here to deal with effects and hence, while searching for remedies for these effects, cannot ignore their causes.

Although the multiplication of the unfit is a world problem, we are here concerned with its impact on this country primarily.

Birth control, properly directed, is an implement of vast importance in conservation of the race: it is a basic need in any program of human betterment. But it has never been utilized in large scale planning and it is time to ask why.

The growth of population in the United States has been tremendously rapid, due both to natural fertility and immigration. The birth rate is now decreasing, and the increase slowing down, so that alarmists are already deep in gloom over the prospect of a stationary population in the not very distant future, though the increase still goes on. No one seems unduly alarmed about the quality of our population; the fears are all about decreasing quantity. We have millions of unemployed, many of them idle because they are unemployable except in boom times when almost any one can get a job. These people are providing a large proportion of the increase in both our social problems and our population today. At the recent conference on Better Care for Mothers and Babies, held in Washington, January 1938, the Surgeon General, Dr. Thomas Parran, stated that "approximately one million children are born each year in families on relief or with an annual income of less than $1,000.00."

These findings are backed by the studies of Dr. S.A. Stouffer of the University of Wisconsin, in the Journal of the American Statistical Association, September, 1934, showing that in 5,520 families on relief in Milwaukee, the rate of confinements, taking place nine months or more after the families went on relief, exceeded the non-relief families by 43%.

The late Edgar Sydenstricker and G. St. J. Perrott in another study of 8,000 families in 8 American cities (Milbank Mem. Quart. 12 April 1934) found that the birth rate had been highest during the depression in families without employment or with only part time work in 1932. The highest rate was in families who were poor in 1932 and continued poor in 1932. The rate was 66% higher than that of families in relatively comfortable circumstances. The birth rate of all those on relief was 54% higher than those not on relief. "High fertility," says Sydenstricker and Perrott, "was associated with inability to succeed in the severe competition for jobs, brought about by the depression." The high birth rate, they found, was largely in families who "could least afford, from any point of view, to assume this responsibility."

Popenoe & Williams, in an article, "Fecundity of Families Dependent on Public Charity",(American Journal of Sociology 40:214-220, September, 1934) found that in 504 families who prior to the depression were dependent on charity in Los Angeles County, California, the completed family averaged 5 children, of whom a third were born after the families became dependent. Over 80% of these families were being assisted by three or more social service welfare agencies."

The authors in questioning the possibility that such families may be producing children of superior quality point out that one must be optimistic indeed, to believe in such a possibility, if one may judge from intelligence levels in comparable groups elsewhere, which have been found uniformly below par.

The Charity Organization Society in New York in testing 451 representative children under its care found the median I.Q. 86. That of 821 children in Indianapolis was the same, while of 1,500 women admitted as charity obstetrical patients at Johns Hopkins Hospital, Baltimore, 39% o the whites and 70% of the negroes were found to have a mental age of 11 years or less. (Popenoe & Williams p. 220)

Prof. James H.S. Bossard, of the Department of Sociology, University of Pennsylvania, was quoted in 1935 (New York Times--January 25, 1935) as citing figures to show that the birth rate of families on relief was about 60% above that of families no on relief.

Any plan of human conservation would be supposed to build for human betterment--not to tear down; to encourage, not penalize those who are prudent and thrifty, while it encourages the reckless and improvident to breed.

Relief, by its ver nature is not conservation. It may serve a destructive purpose, first by keeping alive the most unfit and encouraging them by federal, state and local aid, to multiply their kind. Second: Relief cannot do more than try to patch up a bad situation. It serves to prolong conditions of poverty and misery. It provides just enough to keep from actual starvation those who live, normally, almost submerged.

But while keeping these people alive and fed it does something worse to them, mentally. It takes away the necessity that urges them forward in the endeavor to provide for themselves and their families. It destroys what little initiative they may have had before they went on relief. It supports the instincts of those who are always looking for the easy way, who love to follow the line of least resistance; the inefficient; the soft. It increases the unfit and decreases the fit.

The State is now placing a burden on the fit. Heavy taxation makes them keep their numbers down, but the unfit are relieved from the burden; the machinery of the State takes care of them at the expense of those who work and try to save for their children and old age.

People no longer have pride in taking care of themselves and their families. They assume the responsibility of parenthood carelessly, knowing that some one else will carry the burden for them it is not necessary now for them to make good. The sympathy which operated to take care of them has kept their bodies alive and fed, but has atrophied their spirits, and in so doing has dealt a heavy blow to the nation, for it was its spirit that drove it forward. There is not one of us here who does not remember -- and not so many years ago -- when there was nothing the average American would not do to avoid taking charity. Those days are gone. He does not take charity now, he goes on relief, and feels no shame about it often because charity is camouflaged now under this new name.

The Burden.

What efforts has this country made toward race conservation, and what agencies carry the load of the unfit?

Physical. Dr. Kingsbury will give you the picture of the cost of trying to keep the nation in health. Over 165,000 doctors; almost 6,500 hospitals; all kinds of public health agencies; nurses, dentists and others at an estimated cost of about 3 3/4 billions a year are part of the load. Dr. Huntington in "Tomorrow's Children" (p. 3) estimates that we spend 3 billion on education and possibly 2 billion on recreation for children, with another 2 billion on their health.

Much of this load is borne by all the people in taxes for public schools and state universities; in contributions for up-keep of hospitals and health agencies; in donations to Community Chests for every kind of activity, health and recreational. No one would grudge this money if it brought results. But we are constantly appalled by reading of the increase in crime--a large proportion of it by young criminals--by the low physical an mental standards of so many of our people. And if we ask why so little progress is made we are told that it is because we don't spend enough money--we need billions more if the needs are to be properly met.

In all this frantic struggle to get more money to take care of the hordes of the unfit, few voices have been heard asking why the people of this country should be asked to drag this increasingly heavy ball and chain forever; why something cannot be done to help these people keep themselves, thus relieving the burden on every one. Why spend so much money and effort on the effect, without going to the root of the matter and eliminating the cause? Why continue to put salve on a wound which never heals?

The nation's most precious asset is its children--provided that they are born of parents who can give them a fair physical and mental inheritance and can provide them with at least decent comfort.

At the White House Conference on Child Health and Protection in 1930, President Hoover said, "If we could have but one generation of properly born, trained, educated and healthy children, a thousand other problems of government would vanish."

Yet when these conferences are called together everything but birth control is weighed and considered--that topic is omitted.

The Children's Bureau was created after the first White House Conference was called in 1912 by Theodore Roosevelt. the Second Conference called by Woodrow Wilson in 1929 reviewed the same old problems, and said that many things ought to be done about them; but birth control was not mentioned.

The Third Conference, called by Herbert Hoover in 1930, made the recommendation, through a sub-committee on obstetric training, that medical students should be taught the technique of contraception and medical indications therefore, but birth control was not discussed at the sessions.

The latest conference on Better Care for Mothers and Babies, held under the auspices of the Children's Bureau in January, 1938, was addressed by the Surgeon General, Dr. Thomas Parran, who informed it that, "One-third of the population here is ill-fed, ill-housed, ill-clothed and ill-provided with opportunity for life and health." He stressed the fact that the relationship between poverty and disease had long been known, and said that "illness among persons on relief is 68% higher than among those in comfortable circumstances; chronic illness 87% higher,"--these figures probably being taken from the recent National Health Survey under the Division of Public Health.

Dr. Parran then went on to consider the question of maternal mortality. "The 12,544 mothers who died as a result of conditions of pregnancy and child-birth in 1935, do not represent the whole of the loss from child-bearing. In the past it seems clear that we have underestimated the size and scope of the problem, for there were more than 60,000 babies who died 2 weeks after birth; there were 77,119 recorded still-births. In other words, there occur inthe country each year, more than 150,000 deaths -- 60% of which are needlessly lost because of the mismanagement of the child-bearing function." He went on, "Approximately one million children are born each year to families on relief or with an annual income of less than $1,000.00. Here are found the highest death rates of mothers and infants; Here the least, and the least good, medical care."

Yet not a voice was raised to ask why this crime was permitted, why there mothers and babies were sacrificed; why no one gave these families any advice on contraception!

What form of race conservation is this? Not that many American men were killed in the World War, but we mourn them unceasingly, because they were young and they were sacrificed. Night and day a sentry guards the tomb of the Unknown Soldier at Arlington--the symbol of our sorrow for the holocaust of war. But who mourns these mothers, or tries to prevent the yearly repetition of their deaths by making it possible for them to have a breathing spell between the births of their children?

In only one tabulated report on maternal mortality, by Dr. Helen MacMurchy of Canada, have I see "Exhaustion after repeated pregnancies", listed as a cause of death of the mother.

But the nation loses more than the mothers. There are the babies. Figures on infant mortality in this country have been incomplete until the last few years, because all of the states had not come into the birth registration area. Still-birth registration is even now most unsatisfactory, and the American Committee on Maternal Welfare, under Dr. Fred Adair, is endeavoring to have a uniform blank adopted for such registrations, for until this is done all vital statistics are skewed by this unknown factor.

We do know, however, that infant mortality in the United States is inexcusably high and that some of its underlying causes should be attacked. In 1926,Robert Morse Woodbury, in "Infant Mortality and Its Causes", said,--"Perhaps first in the underlying causes of these infant deaths--was lack of health and physical vitality in the mother during pregnancy. Infants whose mothers died within one year following confinement had a mortality rate 4 times as high as that for other infants. Where the mother died one month after confinement 6 in every 10 of the babies died before the end of the first year. Infants whose mothers had tuberculosis had a mortality 2 1/2 times as high as that among other infants."

Woodbury's figures showed that lack of spacing of birth affected the death rate unfavorably; that the rate when births were at one year intervals was 146.7, dropping to 98.6 within two year intervals and to 86.5 when children were born three years apart.

Low family income was another unfavorable factor. Where earnings were less than $450.00 a year, infant death rate was 166.9. When they rose to $1,250.00 and over, the rate dropped to 59.1, and where there was no income it shot up to 210.9.

The larger families, where the family income per capita fell with each additional child, the death rate was heavy. Woodbury's figures show that where earnings were less than $50.00 per capita each year the infant death rate was 215.9.

Each survey of maternal mortality lists induced abortion as one of the major causes of this loss of life to the nation. From 1/4 to 1/3 of the mothers died from this cause. Statistics show that they are usually young married women, who leave families of small children behind them. They induce abortion because they have reached the end of the rope. In many cases they cannot feed the children behind them. They induce abortion because they have reached the end of the rope. In many cases they cannot feed the children they have and another is something they cannot face. Government investigations of this problem are now in progress in Great Britain and New Zealand. It is a growing evil all over the world. Repressive laws do not stamp it out. The trade flourishes because the poor, who should have the best contraceptive advice do not get it, and the cheap abortionist or midwife "helps them out" when an undesired pregnancy exists. There is money in it for the unscrupulous men, sometimes physicians, who either operate alone, at high prices for those who can afford to pay, or form an "abortion ring" such as was uncovered on the West Coast about a year ago, when one of its victims died.

It is incredible that organized medicine does not know that these evils exist, (a canker inside the profession in spite of Hippocratic oaths) and do something about it; but no one stirs. It is encouraging, however, that more and more in these surveys of maternal death following abortion the point is stressed that had these women been given proper contraceptive information many of them need not have died, and recommendation made that such instruction be made available, so that in the future, lives may be saved.

And so we go to the same weary round. The White House Conference of 1930 found that, out of 45 million children, 6 million were improperly nourished, 1 million had defective speech; 3 million impaired hearing, 1 million weak or damaged hearts; 675,000 behavior problems; 450,000 mentally retarded; 382,000 tuberculous; 300,000 crippled. It was recommended that something be done to alleviate these conditions. And sothey started to patch and tinker and repair the damage.

But the same flood of defective children went on pouring out in the same old way. No one ever dreamed of stopping that leak. And another conference was held in 1938. Its Findings Committee, "after reviewing the information placed before it", announced (its figures slightly at variance with the Surgeon General's who spoke at it that "14,000 women die each year in this country from causes connected with childbirth, leaving at least 35,000 children motherless; more than 75,000 infants are still-born, and more than 69,000 die during the first month of life." They say that the maternal mortality rate has not been appreciably reduced here in years; that the still-birth rate has remained unchanged and that from one-half to two-thirds of these maternal deaths are preventable. They go on to state that approximately 840,000 or more than one-third of al the births in the United States "occur each year in families on relief or with incomes (including home produce) of $750. a year."

They then make recommendations. The nearest they dare get to birth control is to say that "preconceptional and premarital care will help to safeguard the mother from possible later disaster."

The usual recommendations of adequate pre- and postlated care; medical, dental and nursing care during pregnancy, and labor; periodic examination by a pediatrical hospitalization, etc., etc., were made. And then came the inevitable demand for larger funds, under the Social Security Act, to finance these needs.

Has it never occurred to our present charitable and relief agencies that they are really not relieving our social problems, but are aggravating them? What have our government agencies really done to conserve the best in human kind? In animal industry the poor stock is not allowed to breed; in gardens the weeds are kept down. The Government sends all kinds of literature through its numerous departments to inform farmers and livestock breeders as to how they can improve produce--by nurturing the good and eliminating the bad stock.

But when it comes to human beings these same agencies prefer to patch and tinker rather than to prevent or eliminate. They are dominated by the fear of religious intolerance, with its dogmatic cruelty. It is this same intolerance (and let us be frank about it) that prevents all discussion at these National Conferences of the one thing which would help most in human conservation--birth control.

You cannot build a good house without a strong foundation, and the foundations of this nation are being sapped. While alarmists are shaking their heads over the declining birth rate, we had in 1935 (Huntington--"Children of Tomorrow") 90,000 feeble-minded and epileptics in institutions alone, with 2 million, estimated, in the population. Few state laws forbid the marriage of such persons. There were 324,000 insane in institutions and 184,000 criminals, confined, but constantly paroled to commit more crimes. There were 650,000 persons committed to jail each year. The cost of all this is staggering; it runs into many billions annually. In addition there were about 5 million who failed to go above the 4th grade in school and about 5 3/4 millions of that age in the United States.

These are not reassuring figures, but if we do not really attack the problem intelligently, the totals will be worse in another generation. This is the size of the problem. What is being done about it? No government agency dares to suggest a nation-wide program of birth control, but such a program must ultimately be adopted or our national level of intelligence will continue to sink.

Private enterprise and philanthropy have always blazed the trail in human conservation. It was a lay group that inaugurated the battle against tuberculosis and which has successfully fought that disease and greatly lowered its incidence. So with cancer. Lay groups raised funds for research in this field. Lay groups carried the burden of charity for years, until in 1932, the Government took it over and the relief program began.

We are now facing a situation where more and more of our citizens are expecting and demanding that they and their children be taken care of indefinitely--possibly for life. this load is assuming such proportions that the nation will not be able to carry it unless the annual increment of relief babies is checked, and unless those not on relief but living on the bare subsistence level are given instruction.

It may be said that they do not want such help, but my experience of years tell a different story. Over a million mothers have written to me begging for information on family limitation and their letters would convince any one -- except a religious fanatic, that here is a great and agonizing need that is not being filled.

Program

What can we do about it? What plan will cover it? Only a national, coordinated service. We have now in this country about 384 birth control clinics for a population of millions of women of child bearing age. The majority of these are financed by lay committees; a few are run by state or local public health agencies; all are under medical direction.

To say that this handful of centers is filling the need is ridiculous. They are a drop in an ocean. There should be thousands of clinics, easily accessible, with less rigid requirements and financed by the Government as part of its public health service.

But even if every organized health center had such service it would still not be enough. The clinics almost invariably advise one method. This method entails a medical examination and technical knowledge. In rural areas such clinics often cannot be set up. Not only are no trained physicians available, but the women live too far away to be able to travel in for aid; so it must be taken to them, as obstetric service is taken to them by the frontier nurses in many states.

Simple methods have been discovered, to fit the needs of these women; something which will not require a doctor's examination but which will not require a doctor's examination but which a nurse can advise under a doctor's prescription. Simple methods may not be 100% effective, but what therapy in any disease can claim that? Such methods will be better than nothing-- They will reduce the number of the unwanted and the unfit.

All obstructive laws should be so clarified and recorded that nowhere in this country should there be a shadow of doubt as to the doctor's legal right to advise patients where pregnancy is contraindicated.

Discovery of even simpler, effective methods entails research. Millions have been spent in research in other fields, but only a few thousands in this. Well directed liberally financed research is an essential part of this program.

For those mothers--and there will always be such--who are too dull-witted, to careless or too inert to use even simple methods, under direction, sterilization is indicated. I shall not go into this field extensively, for it is covered by another paper on the program, but the last available figures from the Human Betterment Foundation show that to date of January 1, 1937, only 25,403 persons had been sterilized in state institutions in the United States. Of these 10,674 were men and 14,729 women. Twenty-eight states have laws governing institutional inmates, but these figures include 42 cases operated on in New York before the law there was declared unconstitutional in 1918. Of the total number sterilized 11,484 or over 45% were in California institutions. There is no way of estimating the number of women sterilized in hospitals, where it is often routine procedure in cases where the mother-s life would be endangered by another pregnancy; nor can we estimate the number of men in our population who have had a voluntary vasectomy, for various reasons, though communications from individual physicians indicate that this number is increasing, particularly among professional men.

Contrary to common belief it is not illegal in most states for a physician to sterilize a patient on request. In such cases written consent should be obtained from wife or husband as a safeguard for the doctor.

Operation on the male may be an office procedure and is accompanied by little risk. Operation on the woman is a major surgical procedure in most cases, but perfection of the operation by the vaginal route, or by Xray in cases where an artificial menopause will not too greatly unbalance the woman's system, may obviate the risks to the mothers of the future.

Again, however, we must stress the fact that in a national program for human conservation institutional and voluntary sterilization are not enough; they do not reach those elements at large in the population whose children are a menace to the national health and well-being.

Reports in medical journals state that the indications laid down in the German law are being carefully observed. These are gongenital feeble-mindedness; schizophrenia, circular insanity; heredity epilepsy; hereditary chorea (Huntington's)' hereditary blindness or deafness; grave hereditary bodily deformity and chronic alcoholism.

Surely everyone will agree that the children of parents so afflicted are no contribution to the nation for even if they do not inherit these defects they are children of parents so handicapped that life will give them little, owing to their necessarily bad environment.

There are 1,700 special courts and 27 higher courts in Germany to review the cases certified for sterilization there. The rights of the individual could be equally well safeguarded here, but in no case should the rights of society, or which he or she is a member, be disregarded.

Dean Inge--The Gloomy Dean--in his "Gleanings from a Note Book" has said: "Don't be a pioneer. It is the early Christian that is gotten by the lion. The safest mountain paths are those trodden by mules and asses. Follow them."

In their anxiety to follow this advice, many nations are throwing away their heritage; discarding the best to take care of the worst elements of society. If we have not intelligence to adopt the program outlined above because it is a step toward human conservation, let us adopt it in consideration for the mothers who have borne the crushing load of our neglect through the centuries. If we have no sympathy for the mothers, whose normal duty has been considered childbearing, regardless of physical or economic conditions, let us adopt it in pity for the children--those innocent sufferers born into a world they never made -- thrown out handicapped to struggle for subsistence in a society so organized that only the strong can get ahead--but eventually revenging themselves on this society by forming the social problem group which costs us billions annually.

But let us thing straight and think fast, for the years are rolling by while we drift without a real or practical program for race conservation.


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Copyright 2003. Margaret Sanger Project


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