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Appendix II
Medical Aspects of Contraception

Since the above was written, there has appeared a book entitled Medical Aspects of Contraception, published by Messrs. Hopkinson in the late autumn of 1927, on which we feel we must make a few comments. It consists of the Report of the Medical Committee appointed by the National Council of Public Morals in connection with the investigations of the National Birth Rate Commission; and, although its conclusions do nothing to modify the views expressed in the preceding pages, there is much in the volume which offers very useful and authoritative confirmation of conclusions at which we have already arrived. The Committee, which consisted of the most distinguished gynæcologists and medical experts of the day, considered only the medical aspects of contraception, and heard only medical witnesses, and among the conclusions at which it arrived there is much that cannot be too widely known.
        It is impossible to call attention to everything that is of value to us in this Report, but the reader who has carefully noted the arguments and data collected in the preceding pages will be interested in a few excerpts.
        Before recording their conclusions, the Committee called attention to the following "sources of error"

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which they say "appear to vitiate much that has been written" on the subject of Birth Control:—

        "In normal experience of married life, the average intervals of child-bearing are much longer than is commonly supposed; and the facts do not bear out the impression that might be gathered from much of the writing on the subject." 1
        "In the ordinary married life of the young, usually an interval of about two years elapses between births, and after the age of thirty this interval usually increases. This has been the experience of large communities before modern 'birth control' was known. Hence to speak of an 'avalanche of babies' as almost inevitable unless special preventive measures are taken, is inaccurate and misleading. The above statements represent average experience. There are, no doubt, many cases of too rapid child-bearing in which special advice is desirable.
        "In view of the above facts, the Committee have little doubt that contraceptives are frequently employed when, if they were not employed, conception would not occur." 2

        On the question of giving information about contraceptive methods, the Committee says:—

"We are of opinion that no impediment should be placed in the way of those married couples who desire information as to contraceptives when this is needed for medical reasons or because of excessive child-bearing or poverty." 3

        (We demur in regard to the last condition for reasons already stated above. See Chapter III. For poverty must not be a pretext for eliminating or reducing good stocks among the working classes. Obviously some other remedy must be found. And if pressure and struggle were reduced by the progressive elimination of unsound stocks, it would not be necessary to re-

        1 Report, p. 3.
        2 Ibid., p. 4.
        3 Ibid., p. 13

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commend contraceptives to desirable couples among the poor.)
        Regarding the giving of information about contraceptive methods, the Committee says:—

"In this matter the welfare of the family, and especially of the children, should determine the common practice; and this welfare is not secured when there is only one child, or when too long intervals elapse between the birth of children." 1

        Concerning the widespread propaganda of the birth-controllers, the Committee says:—

"We view with anxiety the undiscriminating publicity now being given by some persons to the subject of birth-control . . . some of the current publications on this subject we regard as a public bane, especially to young unmarried people." 2

        To the general conclusions of the Committee, certain members add special memoranda, and among the more interesting of these is that written by Sir Arthur Newsholme and Professor Leonard Hill. In it they say that, although they are in general agreement with the Report, and have signed it, they wish to make three statements modifying their adherence to it. These three statements are, in our opinion, of the utmost importance:—

        "(A) We are convinced that even greater stress than is suggested in the Report may be laid on what appears to be the exaggeration as to the frequency with which control of conception in married life is called for in the interest of the family, or for health's sake. 3

        1 Report, p. 13. See Chapters V and VI above.
        2 Ibid., p. 13, See various passages above, but particularly Chapter VIII.
        3 Ibid., p. 19. See various passages above, especially Appendix I.

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        "(B) Although we concur in the statement that little evidence has been adduced of physical mischief caused by contraceptives, we are not satisfied that they are harmless. Evidence on such a subject is difficult to obtain, and absence of evidence cannot be accepted as conclusive proof of harmlessness. 1
        "(C) We desire to place our opinion on record, and to protest against the unjustifiably dogmatic assertions often made as to the effect of contraception, practised to its present extent, in producing a stock which is intrinsically poor in its hereditary qualities. These assertions arise out of the greater fertility among poorer sections of the population, who are assumed to be inferior in inherited qualities; but . . . these assertions must . . . be classed as Non-Proven. Given better conditions than those now existing for the children of the poorer sections of the population, their alleged relative inferiority may, in our opinion, be found to be non-existent." 2

        It is impossible in a few paragraphs to give an adequate impression of the valuable contents of this Report. It should be read as a whole, together with the evidence of the experts, and their cross-examination by the Committee. As an example of sober and impartial investigation it is a rare exception in the literature of Birth Control, and deserves to be widely read by all who are anxious to settle their point of view on this very vexed question.

        1 Report, p. 19. See pp. 26 and 162 above.
        2 Ibid. See Chapter III above.



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