Margaret Sanger, "Family Limitation, 9th ed.," 1919.
Published article. Source: Lawrence Lader Papers, Houghton Library, Harvard University. .
Pages 18-19 of this text were missing from the original; the text has been replaced with that of the 2nd English edition, which was based on the American 9th edition.
The need for information concerning birth control is more urgent today among the working women of America than it has ever been before.
The world war has awakened us to the realization that governments will continue to plunge nations into wars just so long as we, the mothers of men, make life cheap.
It is the big battalions of unwanted babies that make life so hard for the working woman and keep her in poverty and stress from generation to generation. Every mother feels the wrong that the State imposes upon her when it deprives her of information to prevent the bringing into the world of children she cannot feed or clothe or care for. She resents this with all the bitterness of her strength and will rejoice to find some information contained herein, to help the mothers of America free themselves from the burden of too-frequent pregnancies.
I have tried to give the knowledge of the best French and Dutch physicians translated into the simplest English, that all may easily understand.
There are various and numerous mechanical means of prevention which I have not mentioned here, mainly because I have not come into personal contact with those who have used them or could recommend them as entirely satisfactory.
I feel there is sufficient information given here, which, if followed, will prevent a woman from becoming pregnant unless she desires to do so.
If a woman is too indolent to wash and cleanse herself, and the man too selfish to consider the consequences of the act, then it will be difficult to find a preventive to keep the woman from becoming pregnant.
Of course, it is troublesome to get up to douche, it is also a nuisance to have to trouble about the date of the menstrual period. It seems inartistic and sordid to insert a pessary or a suppository in anticipation of the sexual act. But it is far more sordid to find yourself several years later burdened down with half a dozen unwanted children, helpless, starved, shoddily clothed, dragging at your skirt, yourself a dragged out shadow of the woman you once were.
Don't be over sentimental in this important phase of hygiene. The inevitable fact is that unless you prevent the male sperm from entering the womb, you are going to become pregnant. Women of the working class, especially wage workers, should not have more than two children at most. The average working man can support no more and the average working woman can take care of no more in decent fashion. It has been my experience that more children are not really wanted, but that the women are compelled to have them either from lack of foresight or through ignorance of the hygiene of preventing conception.
It is only the workers who are ignorant of the knowledge of how to prevent bringing children into the world to fill jails and hospitals, factories and mills, insane asylums and premature graves.
The working women can use direct action by refusing to supply the market with children to be exploited, by refusing to populate the earth with slaves.
It is also the one most direct method for you working women to help yourself today.
Pass on this information to your neighbor and comrade workers. Write out any of the following information which you are sure will help her, and pass it along where it is needed. Spread this important knowledge!
Every woman who is desirous of preventing conception will follow this advice: Don't wait to see if you do not menstruate (monthly sickness) but make it your duty to see that you do.
If you are due to be "sick" on the eighth of August, do not wait until the eighth to see, but begin as early as the fourth to take a good laxative for the bowels, and continue this each night until the eighth.
Women of intelligence who refuse to have children until they are ready for them, keep definite track of the date of their menstrual periods. A calendar should be kept, on which can be marked the date of the last menstruation, as well as the date when the next period should occur.
Women must learn to know their own bodies, and watch and know definitely how regular or irregular they are: if the period comes regularly every twenty-eight days (normal) or every thirty days as is in the case of many young girls.
Mark it accordingly on your private calendar; do not leave it to memory or guess work.
Only ignorance and indifference will cause one to be careless in this most important matter.
If a woman will give herself attention BEFORE the menstrual period arrives, she will almost never have any trouble, but if she neglects herself and waits to see if she "comes around," she is likely to have difficulty.
If a week has elapsed with no signs of the menstrual flow, then it is safe to assume conception has taken place.
Any attempt to interfere with the development of the fertilized ovum is called an abortion.
No one can doubt that there are times where an abortion is justifiable but they will become unnecessary when care is taken to prevent conception.
This is the only cure for abortions.
There is current among people an idea that conception can take place only at certain times of the month. For instance: ten days after the menstrual period, and four or five days before the next period. This is not to be relied upon at all, for it has been proven again and again that some women conceive at any time in the month. Do not depend upon this belief, for there is no scientific foundation for it. There is also the knowledge that nursing after childbirth prevents the return of the menstrual flow for several months and conception does not take place. It is well not to depend upon this too much, especially after the fifth month, for often a woman becomes pregnant again without having "seen anything" or without her realizing that she has become pregnant. She thus finds herself with one at the breast and another in the womb. Use some preventive.
Perhaps the commonest preventive excepting the use of the condom is "coitus interruptus" or withdrawal of the penis from the vagina shortly before the ejection of the semen. No one can doubt that this is a perfectly safe method; and it is not considered so dangerous to the man as some authorities have formerly viewed it, but it requires a man of the strongest willpower to be certain that he has withdrawn before any of the semen has been deposited in the vagina. It is very difficult to determine exactly whether this has been done. The greatest objection to this is the evil effect upon the woman's nervous condition. If she has not completed her desire, she is under a highly nervous tension, her whole being is perhaps on the verge of satisfaction. She is then left in this dissatisfied state. This does her injury. A mutual and satisfied sexual act is of great benefit to the average woman, the magnetism of it is health giving. When it is not desired on the part of the woman and she has no response, it should not take place. This is an act of prostitution and is degrading to the woman's finer sensibility, all the marriage certificates on earth to the contrary notwithstanding. Withdrawal on the part of the man should be substituted by some other means that does not injure the woman.
Although an antiseptic douche is an important factor in preventing conception, it should not be relied upon as a preventive measure in itself. A douche is a cleanser, but it is not of itself to be advised as a reliable method to prevent conception. When one understands how conception takes place, it can be seen at once that it is quite possible for a woman to be in a state of pregnancy before she leaves the bed, or before she can reach a douche, unless the womb has been previously covered with the rubber pessary, or by the ingredients of a suppository.
Nevertheless, every woman should learn to cleanse herself thoroughly, by means of the vaginal douche. Some women object to the use of the suppository because of its lubricant effect; this can be modified greatly by the use of a warm salt douche, taken just previously to inserting the suppository, cleansing the parts thoroughly of any secretions already there.
Cold water douches are not advised, as there is a tendency to chill and shock the nervous system. A warm or moderate douche is advised.
The use of warm soapsuds as a douche is used by women in France in the rural districts; just plain, common soap, as a cleansing douche after the act.
If you have bathing conveniences, go as quickly as possible to the bath room after the sexual act and prepare a douche. Lie down upon the back in the bath tub. Hang the filled douche bag high over the tub, and let the water flow freely into the vagina, to wash out the male sperm which was deposited during the act.
Do not be afraid to assist the cleansing by introducing the first finger with the tube and washing out the semen from the folds of the membrane. One can soon learn to tell by the feeling when it is sufficiently clean. It is said, that the French women are the most thorough douchers in the world, which helps greatly in keeping the organs in a clean and healthy condition, as well as preventing the male sperm from reaching the womb to mate with the ovum.
When there are no bath room conveniences -- a douche can be taken over the toilet or when that is impossible it can be taken over a vessel in a squatting position.
Following are some of the solutions to be used for the douche, which, when carefully used will kill the male sperm or prevent its entering the womb:
Lysol -- is a brown oily liquid which added to water forms a clear soapy solution.
One teaspoonful of lysol to 2 quarts of water (warm) makes a good solution for douching. Mix into a pitcher or vessel before placing it in the bag.
Bichloride -- Get the tablets blue or white from the druggist; the blue are less dangerous to have about because of the color. Always mix this solution thoroughly in a glass or pitcher before turning it into the bag. Never drop the tablet directly into the bag. One tablet to two quarts of water makes a sufficiently strong solution for preventive purposes.
Potassium Permanganate --This also makes a good solution, especially where there is a vaginal discharge. The special objection to this is that it stains the skin and clothing. This can be purchased in crystal form, and one-half teaspoonful dissolved in two quarts of water is the proper strength.
Salt solution -- Mix four tablespoons of table salt in one quart of warm or cold water and dissolve thoroughly. This is good and cheap.
Vinegar solution -- Many peasants in Europe use vinegar as an antiseptic almost exclusively. One glassful to two quarts of water is the strength usually desired. Cider vinegar is preferred. Douche afterward with clear water.
Cold water douche -- This will sometimes remove the semen quite effectively without the aid of an antiseptic. But as the semen can hide itself away in the wrinkled lining of the vaginal cavity, the cold water will only impede its progress for a time. As soon as the warmth of the body revives its activity, the semen continues on its journey to meet the ovum.
Every woman should possess a good two quart rubber douche bag called fountain syringe. Hang it high enough to insure a steady direct flow.
Bulb syringes, such as the whirling spray syringes, have been found satisfactory by many women for the purpose of injecting antiseptic solutions. Directions with syringe.
Some women use the douche before the sexual act as a preventive. If this is done, any astringent such as boric acid, alum, citric acid, hydrochlorate of quinine used in the solution will do. Only a pint of solution is needed for this purpose, following the act a larger douche is used as a cleanser. This can also be done with the regular antiseptic douche.
There is little doubt that a thorough douching of the genital passage with an antiseptic solution performed by skilled hands immediately after the sexual act would destroy the male sperm, and nothing else would be necessary. But there is always the possibility that the sperm has entered the womb before the solution can reach it.
It is safer therefore to prevent the possibility of the contact of the semen and the ovum, by the interposition of a wall between them. One of the best is the condom or rubber "cot."
These are made of soft tissues which envelope the male organ (penis) completely and serve to catch the semen at the time of the act. In this way the sperm does not enter the vagina.
The condoms are obtainable at all drug stores at various prices. There are some of skin gut and some of rubber tissue. These are seamless, thin and elastic and yet tough; if properly adjusted will not break. Fear of breaking is the main objection to their use. If space has not been allowed for expansion of the penis, at the time the semen is expelled, the tissue is likely split and the sperm finds its way into the uterus. The woman becomes pregnant without being conscious of it. If on the other hand care is given to the adjustment of the condom, not fitting it too close, it will act as one of the best protectors against both conception and venereal disease. Care must be exercised in withdrawing the penis after the act, not to allow the condom to peel off, thereby allowing the semen to pass into the vagina.
It is desirable to discard the condom after it has been used once. But as this is not always done, care must be taken to wash the condom in an antiseptic solution before drying it and placing it away for further use.
The condom is one of the most commonly known preventives in the United States. It has another value quite apart from prevention in decreasing the tendency in the male to arrive at the climax in the sexual act before the female.
There are few men and women so perfectly mated that the climax of the act is reached together. It is usual for the male to arrive at this stage earlier than the female, with the consequence that he is further incapacitated to satisfy her desire for some time after. During this time the woman is in a highly nervous condition, and it is the opinion of the best medical authorities that a continuous condition of this unsatisfied state brings on or causes disease of her generative organs, besides giving her a perfect horror and repulsion for the sexual act.
Thousands of well meaning men ask the advice of physicians as to the cause of the sexual coldness and indifference of their wives. Nine times out of ten it is the fault of the man, who through ignorance and selfishness and inconsiderateness, has satisfied his own desire and promptly gone off to sleep. The woman in self defense has learned to protect herself from the long hours of sleepless nights and nervous tension by refusing to become interested.
The condom will often help in this difficulty. There are many girls who have had no education on this subject, no idea of the physiology of the act, who upon any contact of the semen have a disgust and repulsion, from which it takes some time to recover. Much depends upon the education of the girl, but more depends upon the attitude of the man toward the relation.
Another form of prevention is the pessary (see cut). This is one of the most common preventive articles used in France as well as among the women of the middle and upper class in America. At one time the cost of these ranged up to seven dollars, as they were imported into this country from France. Today they are manufactured in this country, and may be had from two dollars up.
They come in three sizes -- large, medium and small.
It is well to get the medium size, as the small ones are only for very small boned women and easily get out of place.
In my estimation a well fitted pessary is one of the surest methods of preventing conception. I have known hundreds of women who have used it for years with the most satisfactory results. The trouble is women are afraid of their own bodies, and are of course ignorant of their physical construction. They are silly in thinking the pessary can go up too far, or that it could get lost, etc., etc., and therefore discard it. It can not only get into the womb, neither can it get lost. The only thing it can do is to come out. And even that will give warning by the discomfort of the bulky feeling it causes, when it is out of place.
Before inserting pessary inject into cap a small amount of boric ointment. This will act as a cement to help seal the mouth of the womb for the time being and thus doubly insures prevention.
In inserting the pessary it is well to get into a position which will make the entrance easy. One foot resting on a low chair opens the parts considerably, also a squatting position brings the uterus lower and makes the fitting of the pessary easier. Do not use vaseline or oils on rubber, it decays it. Glycerine or soap rubbed on its surface makes it smooth enough to slip easily into place.
After the pessary has been placed into the vagina deeply, it can be fitted well over the neck of the womb. One can feel it is fitted by pressing the finger around the soft part of the pessary, which should completely cover the mouth of the womb.
If you do not feel the mouth of the womb through the rubber then the pessary is not on right. It should be moved backward a little or forward until the mouth can be felt covered. If you still cannot feel it then remove and use some other preventive. The uterus may be turned or tipped back so far that a pessary could not reach the cervix.
If it is properly adjusted there will be no discomfort, the man will be unconscious that anything is used, and no germ or semen can enter the womb.
It is not always necessary to take a douche until the following morning, but it is always SAFER to douche immediately after the act. Take part or about a quart of an antiseptic douche BEFORE the pessary is removed; after removing it continue the douche and cleanse thoroughly.
Wash the pessary in clear cold water, dry well and place away in the box. One should last two years, if cared for.
I consider the use of the pessary as one of the most convenient, as well as the cheapest and the safest method of prevention. Any nurse or doctor will teach one how to adjust it; then women can teach each other.
It is not advisable to wear the pessary all the time.
Take it out after using, and wear it only when needed.
A little experience will teach one that to place it is a simple matter.
There is the so-called "wishbone pessary," recently much in favor by physicians. It is made of gold and platinum, or gold and silver. It is necessary that it be purchased and inserted by a physician. It can be worn constantly; no douching is necessary.
Better results are obtained when the pessary is removed and cleansed every two or three months. A physician must do this also.
Sponges can also be had at the drug store. They have a tape attached to them to be conveniently removed. They should be soaked in an antiseptic solution for a few minutes before coitus and then introduced into the vagina far up as they can be placed. Some physicians have recommended the use of the cotton plug, instead of the sponge, to be soaked in a solution of three per cent carbolic and glycerine, before the act. The male sperm is destroyed by the weakest solution of carbolic acid. Some of the peasants in Europe use the cotton plug soaked in vinegar for the same purpose and find it satisfactory. In this country a boric acid solution has been used for the same purpose and with satisfactory results. Of course this requires a saturated solution, as, for instance, one teaspoonful of the powder to a cup of water stirred until dissolved.
Sponges and plugs can be recommended as perfectly safe, if followed by an antiseptic douche before the removal of the plug or sponge, thus preventing the sperm from entering the womb. The problem is: to kill the male sperm upon entering the vagina, or to wash it out or to kill it directly afterwards. A weak solution of alum may also be used for cotton plugs and sponges, also carbolated vaseline on plugs.
Get one fully as large as the fist -- boil it for ten minutes. Before using it dip in water and vinegar half and half and squeeze out partly, then push it up as far as it will go, pack it tight around the mouth of the womb so that it covers completely. Douche thoroughly after its removal.
One of the cheapest methods of birth control is the use of a large sponge.
Suppositories are becoming more generally used in U.S.A. than any other method of prevention.
These may be found at any reliable pharmacy. The majority of them are made from cocoa butter or gelatine, which makes it necessary that they be deposited in the vagina several minutes before the act, in order for them to melt. Special ingredients negate the effect of the male seed.
Get your druggist to make up any of the following:
Acid citric, 6 grains
Acid boracic, 1 dram
Cocoa butter, 90 grains
Another suppository found reliable is:
Boric acid, 10 grains
Salicylic acid, 2 grains
Quinine bisulphate, 3 grains
Cocoa butter, 60 grains
A simple recipe which anybody an easily make is as follows:
1 ounce cocoa butter
60 grains quinine
Melt the cocoa butter, mix the quinine with it, and form into suppositories by letting mixture harden into cake and then cutting it up into ten pieces.
1. What is the best preventive?
There is no one preventive to be recommended for everyone in every case. There are good and harmless preventives, any one of which can be made safe, according to the intelligence applied in using them.
I would advise the use of a recommended suppository for the first few months in the case of a bride, until the parts are in a condition where a pessary may be inserted and worn with comfort. Sometimes it is advisable to use suppositories during the early months of marriage, using the pessary only after children have been born.
2. Is a douche necessary after the use of the suppository?
To be certain of good results, I would advise a douche as soon as convenient.
3. Are any of these methods recommended injurious to the health of the man or woman?
The only method which physicians claim may be injurious to one or both is the continued practice of withdrawal. This method is not generally recommended, though it is practiced largely in France and England.
4. Which method is safest?
All are safe if you use care and intelligence in applying them.
5. Which the least troublesome?
The pessary can be recommended as the least troublesome, as after it is inserted it may be left to cover the cervix until the next day.
6. Is there a safe period?
There is no absolutely safe period between the menstrual periods where intercourse can take place without pregnancy occurring, at least not for all women. Some women claim this period exists in themselves, but unless you know this positively I would not advise a woman to depend upon it.
7. How soon after menstruation ceases should intercourse occur?
This should be left, as in all cases, to the natural desire of the woman.
8. Does nursing a baby prevent pregnancy?
It is claimed that pregnancy does not so easily occur during the nursing period, especially during the first three or four months. There are many women, however, who have conceived, immediately giving birth to another baby eleven months after the other. I would not advise depending upon this at all. Use some preventive at once and control intelligently the time for the next baby's arrival, instead of leaving it to chance.
9. Does fear of pregnancy affect the child?
Fear affects everything. We do not yet know the effect upon the human race which the fear of pregnancy has caused.
10. Is it harmful to take drugs during the first few weeks after menstruation has stopped?
It is considered especially harmful, not only to the mother, but to the child in cases where the drugs have not the desired effect. It stands to reason that a drug which is powerful enough to eject the fertilized ovum out of the uterus must have power to affect other organs. We often find children wetting the bed up to a late age, as well as suffering from other organic weaknesses, which may be traced back to the mother's frantic attempt to "come around."
11. Should the woman or the man take the precautions?
Either or both, but preferably the woman. The methods to be used by the man -- withdrawal and the condom -- have their objections for many people. While it is true that the employment of either of these methods lessen the trouble for the woman, they also deprive her of that great sacred closeness or spiritual union which the full play of magnetism gives when not checked by fear, as in withdrawal, or interfered with, as in the use of the condom. Some sensitive men object to the use of these methods, as also do many women. It is for each couple to decide. Many men prefer to use the condom in consideration of the woman, to lessen her trouble in douching.
12. Should a woman have joy in the union?
13. Why does she not?
Either because her mind is occupied with fear of the results, or because of the awkwardness and ignorance of the man.
14. Can this be overcome?
Yes; first, by using a contraceptive which gives confidence so there shall be freedom from fear of pregnancy; second, by making the husband understand that a greater love and joy is created in the relation when the union is consummated only when the woman desires it naturally.
I have given in the foregoing pages the most commonly known means of prevention. Personally I recommend every poor woman who has had at least one child to use a well fitted pessary and learn to adjust it.
Birth control, or family limitation, has been recommended by some of the leading physicians of the United States and Europe. The movement can no longer be set back by setting up the false cry of "obscenity." It has already been incorporated into the private moral code of millions of the most influential families in every civilized country. It will shortly win full acceptation and sanction by public morality as well.
In cases of women suffering from serious ailments, such as Bright's disease, heart disease, insanities, melancholia, idiocy, consumption, and syphilis, all a physician is allowed to do is to tide these women through their pregnancies if possible. Even though the life of the woman is positively endangered, he cannot relieve her without calling a colleague in consultation. Therefore, the mortality of mothers suffering from these diseases and their infants is very high, and premature births common.
To conserve the lives of these mothers and to prevent the birth of diseased or defective children are factors emphasizing the crying need of a sound and sane educational campaign for birth control.
Copyright 2003. Margaret Sanger Project