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From 'left' to 'right' : a perspective on the role of the volunteers in family planning in the west and… Bishop, Mary F. 1971

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PROM "LEFT" TO  "RIGHT":  A P e r s p e c t i v e on t h e R o l e o f t h e V o l u n t e e r s i n F a m i l y P l a n n i n g i n t h e West and i n South A s i a  by Mary F. B i s h o p B.A.,  Queen's U n i v e r s i t y ,  1935  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF Master o f A r t s i n t h e Department of History  We a c c e p t t h i s t h e s i s as conforming t o the r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA MAY  1971  In p r e s e n t i n g an  this  thesis  advanced degree at  the  Library  I further for  shall  the  his  of  this  written  agree that  University  of  permission  representatives.  be  available  2., 6.  g r a n t e d by  gain  History  71  for  for extensive  permission.  The U n i v e r s i t y o f B r i t i s h V a n c o u v e r 8, Canada  British  the  It i s understood  thes,is f o r f i n a n c i a l  Department of  Date  f u l f i l m e n t of  make i t f r e e l y  s c h o l a r l y p u r p o s e s may  by  in p a r t i a l  Columbia  shall  requirements  Columbia,  Head o f my  be  I agree  r e f e r e n c e and copying of  that  not  the  that  Study.  this  thesis  Department  c o p y i n g or  for  or  publication  allowed without  my  ABSTRACT  This thesis i s an examination of the role of the volunteers i n the development of family planning programs i n the West and South A s i a , and of whether they have a continuing r o l e to play*  Through personal  experience,  interviews and correspondence with some of the leaders, through reports, other readings, and studies of motivation and the p r o v i s i o n of family planning services, the w r i t e r concludes that the volunteers played an indispensable part. Governments would not have introduced family planning programs i f voluntary organizations had not shown that they were needed and f e a s i b l e .  The volunteers l a i d the  groundwork not only f o r o f f i c i a l programs but f o r a v a r i e t y of careers i n family planning and related f i e l d s . have a continuing role to play as f r i e n d l y  They  critics^n  promotion, education, and innovative research, and to , make sure that b i r t h c o n t r o l , once considered to be f a r to the " L e f t " , becomes firmly entrenched as a Human "Right**,  TABLE OP CONTENTS Page ABSTRACT  i  NOTES ON TERMINOLOGY  i i i  LIST OP ABBREVIATIONS  v i  LIST OP TABLES  v i i  LIST OP ILLUSTRATIONS  viii  PREFACE  ix PART ONE 1  Introduction  F a m i l y P l a n n i n g Was Not New  Chapter  I  The S o c i a l Reformers: U n i t e d Kingdom . . .  20  Chapter  II  The S o c i a l Reformers: U n i t e d S t a t e s of America  45  Some Developments i n Europe and East A s i a  65  Chapter  III  PART TWO Chapter  IV  I n t e r n a t i o n a l Cross F e r t i l i z a t i o n  . . . .  79  PART THREE S o c i a l Reformers and Government i n South A s i a Chapter  V  Chapter  VI  Chapter  VII  Chapter V I I I  India  100  Ceylon  I67  Pakistan  205  Nepal  243 PART FOUR  Chapter  IX  Conclusions  252  Bibliography  263  Appendices  274  NOTES ON TERMINOLOGY  "When I_ use a word," Humpty Dumpty s a i d , i n r a t h e r a s c o r n f u l t o n e , " i t means j u s t what I choose i t t o mean - n e i t h e r more nor l e s s . " l As i n o t h e r f i e l d s , communication i n " f a m i l y p l a n n i n g i s sometimes d i f f i c u l t . involvement,  Depending on a t t i t u d e and degree o f  terms mean d i f f e r e n t t h i n g s t o d i f f e r e n t  people  For example, " B i r t h c o n t r o l " can mean methods o f p r e v e n t i n g "births o r may conjure up i d e a s o f t h e e m a n c i p a t i o n o f women or racism. " F a m i l y p l a n n i n g " can mean s p a c i n g o r l i m i t i n g p r e g n a n c i e s , t h e t r e a t m e n t o f i n f e r t i l i t y , o r some s o r t o f b u d g e t i n g o f f a m i l y income. " S t e r i l i z a t i o n " may mean t h e s i m p l e , v o l u n t a r y o p e r a t i o n on a man o r woman w h i c h g i v e s permanent freedom from t h e f e a r o f unwanted pregnancy w i t h o u t i m p a i r i n g s e x u a l performance; o r i t may arouse images o f e x p e r i m e n t s i n N a z i c o n c e n t r a t i o n camps, c a s t r a t i o n and t h e s t a t e o f b e i n g "no l o n g e r a man" o r "no l o n g e r a woman". " A b o r t i o n " may mean a m e d i c a l l y s a f e , l e g a l , back-up procedure f o r ignorance, rape, o r c o n t r a c e p t i v e f a i l u r e ; o r i t may mean a f o r b i d d e n s o l u t i o n , born o f v i c e , c a r r i e d o u t by a c r i m i n a l , i n w h i c h death i s a p o s s i b l e consequence, and t h e p r i o r r i g h t s o f the f o e t u s a r e i n c o n t r o v e r t i b l e . " P o p u l a t i o n c o n t r o l " o r " p o p u l a t i o n p l a n n i n g " may mean a v o l u n t a r y o r compulsory f a m i l y p l a n n i n g program w i t h h u m a n i t a r i a n i n t e n t , o r g e n o c i d e . H i s t o r i c a l l y , f a m i l y planning terminology response t o p u b l i c a t t i t u d e s .  In the nineteenth  evolved i n century  i n d i v i d u a l a d v o c a t e s o f s o c i a l r e f o r m throtigh b i r t h c o n t r o l  euphemistically c a l l e d contraceptives "preventive  checks".  L a t e r , when t h e y formed a v o l u n t a r y o r g a n i z a t i o n t h e y  called  i t a " M a l t h u s i a n l e a g u e " - even though Malthus opposed " p r e v e n t i v e checks", and regarded  continence  as t h e o n l y a c c e p t a b l e means o f c o n t r o l l i n g  o u t s i d e marriage fertility.  I n 1914 Margaret Sanger and a group o f s u p p o r t e r s i n Hew Y o r k c o i n e d t h e term " B i r t h C o n t r o l " t o s y m b o l i z e c h i l d " and t h e emancipation motherhood".  o f women from t h e "enslavement o f  I n t h e U n i t e d Kingdom, i n 1921,  i c i s m , Marie Stopes i n v e n t e d  a "wanted  to offset  crit-  "Constructive B i r t h Control".  A  l e s s f e m i n i s t , but also defensive term, r e l a t e d t o general concern o v e r low b i r t h r a t e s i n Europe and N o r t h A m e r i c a i n the 1930s, l e d t o t h e a d o p t i o n  i n B r i t a i n i n 1939 o f "Family  P l a n n i n g " a n d , i n t h e U n i t e d S t a t e s o f A m e r i c a , i n 19^2, o f "Planned P a r e n t h o o d " .  B o t h terms were i n t e n d e d t o i d e n t i f y  the movement more c l o s e l y w i t h t h e i d e a o f f a m i l y w e l l - b e i n g and freedom o f c h o i c e ; b u t n e i t h e r has ever meant u n l i m i t e d c h i l d - b e a r i n g , as i m p l i e d i n r e c e n t c r i t i c i s m s .  To-day,  "Family P l a n n i n g " i s a l s o t h e p o p u l a r term f o r v o l u n t a r y government programs. " B i r t h c o n t r o l " , "Family P l a n n i n g " , and " P o p u l a t i o n C o n t r o l " i n d i c a t e a l s o t h e s h i f t s i n o r i e n t a t i o n o f t h e movement, o v e r t h e y e a r s and as c i r c u m s t a n c e s  allowed - from  i n d i v i d u a l t o f a m i l y , t o n a t i o n a l , and i n t e r n a t i o n a l w e l l being. and  A few people d i s t i n g u i s h between "Family  Planning"  " P o p u l a t i o n C o n t r o l " as a p r i v a t e , v i s - a - v i s a p u b l i c  program, b u t no c o u n t r y has o f f i c i a l l y adopted t h e l a t t e r  designation.  Compulsion i s n o t contemplated  - f o r the present,  at l e a s t . Depending on t h e p o l i c y o f t h e o r g a n i z a t i o n o r g o v e r n ment, " B i r t h C o n t r o l " can mean m e c h a n i c a l , chemi'cal and b i o l o g i c a l methods o f p r e v e n t i n g c o n c e p t i o n , o r i t can a l s o embrace s t e r i l i z a t i o n and l e g a l l y i n d u c e d a b o r t i o n . L i k e t h e ' f a m i l y p l a n n e r s " , I s h a l l t r y t o use t h e terms " b i r t h c o n t r o l " , " f a m i l y p l a n n i n g " , "planned p a r e n t h o o d "  and  " p o p u l a t i o n c o n t r o l " i n t h e i r p e r m i s s i v e and i n t e r c h a n g e a b l e c o n n o t a t i o n s ; and t h a t , as Humpty Dumpty s a i d , i s what I choose i t t o mean.  L e w i s C a r r o l l , Through t h e L o o k i n g G l a s s , Modern L i b r a r y e d i t i o n , Hew Y o r k , c 1935, P« 214. x  G a r r e t H a r d i n , " M u l t i p l e Paths t o P o p u l a t i o n C o n t r o l , " F a m i l y P l a n n i n g P e r s p e c t i v e s , New Y o r k , June, 1970, p . 26. 2  LIST OP ABBREVIATIONS  AID, - o r USAID  -  U n i t e d S t a t e s Agency f o r I n t e r n a t i o n a l Development  PPA  -  Family Planning A s s o c i a t i o n  PPAC  -  F a m i l y P l a n n i n g A s s o c i a t i o n o f Ceylon  FPAI  -  Family Planning A s s o c i a t i o n of I n d i a  FPAN  -  Family Planning A s s o c i a t i o n o f Nepal  FPAP  -  Family Planning A s s o c i a t i o n o f P a k i s t a n  IPPF  -  I n t e r n a t i o n a l Planned P a r e n t h o o d  IUCD o r IUD  -  I n t r a u t e r i n e Contraceptive  LI'S  -  Lanka M a n i l a S a m i t i (Women's I n s t i t u t e  Federation  Device  o f Ceylon) NMB  -  Nieuw M a l t h u s i a a n s c h e n  Bond  PP-WP  -  Planned  SIDA  -  Swedish I n t e r n a t i o n a l Development Agency  WHO  -  World H e a l t h O r g a n i z a t i o n  UNESCO  -  TJNICEF  -  United Nations Educational, S c i e n t i f i c and C u l t u r a l O r g a n i z a t i o n U n i t e d N a t i o n s C h i l d r e n ' s Emergency Fund  Parenthood-World P o p u l a t i o n  (U.S.A.)  LIST OP TABLES Table I II III  Page Data on I n d i a n Government F a m i l y P l a n n i n g Program  152  F a m i l y P l a n n i n g Component o f N a t i o n a l Budget, India  157  B i r t h r a t e s per 1000, by "Race",  I95I-I96I,  182  Ceylon IV V VI  A t t e n d a n c e a t FPAC C l i n i c s  I83  B i r t h s p e r 1000 P o p u l a t i o n , C e y l o n , A l l Races and I n d i a n T a m i l Data on Ceylon Government F a m i l y P l a n n i n g  197 199  Program VII VIII IX X XI  Attendance a t FPAP C l i n i c s , 1964 and I967 Number o f A c c e p t o r s , P a k i s t a n Government Program, I965-I969 Data on P a k i s t a n Government F a m i l y P l a n n i n g Program Data on N e p a l Government F a m i l y P l a n n i n g Program Supplementary D a t a , South A s i a  . .  223 224 236 247 274  LIST OP ILLUSTRATIONS  Figure 1  Page L i v e B i r t h s i n Some Western C o u n t r i e s 1700-1958  2 3  Comparison o f S c a n d i n a v i a n and Japanese V i t a l Rates I 8 O O - I 9 6 O Population  o f I n d i a and P r o j e c t i o n ,  Population  o f C e y l o n and P r o j e c t i o n ,  1965-2000  4  1901-1993  5  . . . . . .  Demographic P a t t e r n s , Population 1900-2000  6 27 100  167  Ceylon and Sweden,  18-10-1960  6  .  185  of Pakistan  and P r o j e c t i o n , 205  PREFACE  Space r e s e a r c h and photographs o f E a r t h have h e l p e d many people t o r e a l i z e t h a t we l i v e on a f i n i t e p l a n e t , w i t h f i n i t e r e s o u r c e s , and l i t t l e  choice but t o l e a r n t o l i v e i n  harmony w i t h each o t h e r and w i t h o u r environment.  The i n -  f o r m a t i o n e x p l o s i o n o f t h e p a s t q u a r t e r c e n t u r y has a l s o made i t c l e a r t h a t many problems a r e common t o a l l c o u n t r i e s , a n d , g e n e r a l l y , d i f f e r o n l y i n degree.  One u n i v e r s a l c h a l l e n g e i s  p o p u l a t i o n g r o w t h and what t o do about i t . B e f o r e 1800, p o p u l a t i o n s were i n c r e a s i n g i n a l l count r i e s , b u t t h e r a t e was slowed by d e a t h from d i s e a s e , famine and war. I n t h e n i n e t e e n t h c e n t u r y , however, i n t h e i n d u s t r i a l i z i n g c o u n t r i e s o f Europe, h i g h e r s t a n d a r d s o f l i v i n g , more p o l i t i c a l s t a b i l i t y , and i m p r o v i n g h e a l t h s e r v i c e s b r o u g h t about a g r a d u a l d e c l i n e i n m o r t a l i t y .  A population "explosion"  would have o c c u r r e d t h e n , had i t n o t been f o r e m i g r a t i o n t o o t h e r temperate c l i m a t e s , t h e growing p r a c t i s e o f b i r t h t r o l , and economic expansion which was a b l e t o absorb o f t h e r e m a i n i n g growth.  con-  most  A t no time d i d t h e r a t e o f popu-  l a t i o n i n c r e a s e exceed 1 t o 1 . 5 p e r c e n t p e r y e a r , and i n t h e p a s t few decades, f o r example, growth r a t e s have d e c l i n e d t o around 0 . 5 i n t h e U n i t e d Kingdom, 0.8 i n Sweden, 1.0 i n t h e United States o f America,  and 1.1 p e r c e n t i n t h e N e t h e r l a n d s .  ( I n t h i s c e n t u r y , and f o r s i m i l a r r e a s o n s , Japan has a l s o  f o l l o w e d t h e same t r e n d t o an annual p o p u l a t i o n growth r a t e of 1.1 percent.)  Thus, t h e "demographic t r a n s i t i o n " from  h i g h b i r t h r a t e s and h i g h d e a t h r a t e s t o low b i r t h r a t e s and low d e a t h r a t e s i n t h e r i c h c o u n t r i e s came about g r a d u a l l y , over a p e r i o d o f a p p r o x i m a t e l y 1 5 0 y e a r s ; and, because a c c e s s to  n a t u r a l r e s o u r c e s i s s t i l l p o s s i b l e , p o p u l a t i o n growth i s  not y e t w i d e l y r e c o g n i z e d as a t h r e a t (even t h o u g h , i n s p i t e o f t h e s a f e t y v a l v e s mentioned, European s t o c k i n c r e a s e d t i m e s a t home, and f i v e t o seven t i m e s  abroad).  three  x  On t h e o t h e r hand, t h e t r a n s i t i o n i n t h e poor c o u n t r i e s o f A f r i c a , A s i a and l a t i n America d i d n o t b e g i n u n t i l World War I I . H e a l t h measures b r o u g h t epidemic  after  diseases i n  many o f them under c o n t r o l , famine r e l i e f became more s o p h i s t i c a t e d , and, though wars c o n t i n u e d t o k i l l p e o p l e ,  decimation  from t h i s cause was n o t s i g n i f i c a n t i n the o v e r - a l l m o r t a l i t y decline.  Because t h e m a j o r i t y were s t i l l engaged i n f a r m i n g ,  a g r i c u l t u r a l t r a d i t i o n s p r e v a i l e d , f e r t i l i t y remained h i g h , and p o p u l a t i o n growth r a t e s i n most A s i a n n a t i o n s shot upward. In  L a t i n A m e r i c a and A f r i c a , though m o r t a l i t y i s h i g h e r , popu-  l a t i o n g r o w t h r a t e s a l s o r o s e ; and now, on t h e t h r e e  "developing"  c o n t i n e n t s , t h e y range from more t h a n 2 t o n e a r l y k p e r c e n t p e r year.  2  I n a d d i t i o n t o growth i n t o t a l numbers, h i g h s u r v i v a l  r a t e s have caused imbalance countries.  Percentages  i n t h e age s t r u c t u r e s o f these  o f persons under f i f t e e n y e a r s now  v a r y from t h i r t y - f i v e t o more than f i f t y , i n c r e a s i n g the demand for  such b a s i c s e r v i c e s as f o o d , h o u s i n g , e d u c a t i o n , h e a l t h ,  V -X .., :  and t r a n s p o r t a t i o n , and d r a i n i n g o f f funds needed f o r o t h e r forms o f job c r e a t i o n and i n t e r n a t i o n a l t r a d e . dependency r a t i o s o b s t r u c t attempts  Such h i g h  t o r a i s e the standard o f  l i v i n g , and e a t up t h e b e n e f i t s o f each hard-won economic advance ? On a world-wide b a s i s , p o p u l a t i o n i s e s t i m a t e d t o be more than 3 * 3 b i l l i o n , i n c r e a s i n g a t 1 . 9 t o 2 p e r c e n t p e r y e a r , w i t h a p p r o x i m a t e l y 3 7 p e r c e n t under 1 5 y e a r s o f age. I f c u r r e n t c o n d i t i o n s p e r s i s t , i t i s expected t o double i n about 3 5 y e a r s , and t o r e a c h 1 1 b i l l i o n by 2 0 5 0 A.D.  The  p r o p o r t i o n o f y o u t h i n t h e w o r l d age s t r u c t u r e w i l l i n c r e a s e s t i l l further.  Even i f , from now o n , a l l c o u p l e s t r y t o r e -  s t r i c t f a m i l y s i z e t o two c h i l d r e n (replacement  level only),  s e v e r a l g e n e r a t i o n s w i l l pass b e f o r e a s t a t i o n a r y p o p u l a t i o n and a b a l a n c e d age s t r u c t u r e can be a c h i e v e d . t i m e , s o c i a l , economic and p o l i t i c a l  I n t h e mean-  problems a r e sure to  multiply. In t h e f a c e o f t h i s u n p l e a s a n t ing  awareness t h a t economic expansion  r e a l i t y , t h e r e i s growa l o n e cannot s o l v e t h e  p r o b l e m , and t h a t , growth r a t e s must be brought t o z e r o p e r y e a r , o r even t o a d e c l i n e , as soon as p o s s i b l e . ^ But t h e r e i s no agreement on t h e urgency o f t h e problem, o r on how t o go about a c h i e v i n g a s t a t i o n a r y p o p u l a t i o n . o n l y now b e g i n n i n g t o c o n s i d e r t h e q u e s t i o n . States, opinions vary.  Canadians a r e I n t h e "United  Paul E r l i c h , a b i o l o g i s t ,  . claims  t h a t zero p o p u l a t i o n growth (ZPG) i s e s s e n t i a l a t once, and t h a t compulsion  may have t o be u s e d .  G a r r e t t H a r d i n , a human  e c o l o g i s t , a l s o b e l i e v e s t h a t ZPG i s u r g e n t , b u t i s w i l l i n g t o see more e f f o r t put i n t o i m p r o v i n g the v o l u n t a r y before  resorting to force.  system  Prank N o t e s t e i n , a demographer,  a g r e e s t h a t t h e p o p u l a t i o n problem i s c e r t a i n l y u r g e n t , b u t says i t i s more so i n t h e d e v e l o p i n g others.  c o u n t r i e s than i n the  He r e g a r d s c o m p u l s i o n i n any c o u n t r y  as  unthinkable.  He argues t h a t i f b e t t e r i n c e n t i v e s and v o l u n t a r y were p r o v i d e d The  services  t h e poor i n a l l c o u n t r i e s , ZPG- would f o l l o w .  d e c l i n e would be g r a d u a l  enough, however, t o be u n l i k e l y 7  t o cause p a n i c r e a c t i o n i n f a v o u r o f i n c r e a s e J e a n n i e R o s o f f , o f P l a n n e d Parenthood-World  again.'  Population,  v i e w s such c r i s i s t h i n k i n g and argument as a waste o f t i m e . I t i s known t h a t i n a l l c o u n t r i e s some people have more c h i l d r e n t h a n t h e y want, and t h a t , i n t h e U n i t e d S t a t e s , f o r example, twenty t o f o r t y p e r c e n t o f p r e g n a n c i e s a r e unwanted. It  i s a l s o known t h a t most people a r e r e c e p t i v e t o t h e i d e a  of f e r t i l i t y  limitation.  I f unwanted p r e g n a n c i e s c o u l d be  p r e v e n t e d , much unhappiness f o r p a r e n t s and c h i l d r e n a l i k e would be a v o i d e d , and t h e p o p u l a t i o n a t t h e same t i m e .  Supporting  problem would be eased  N o t e s t e i n , Mrs. R o s o f f urges  g r e a t e r e f f o r t t o s a t i s f y known demands. programs, b e t t e r methods, .. opportunity  Better  b e t t e r education,  and more  f o r human f u l f i l m e n t a r e a t t a i n a b l e g o a l s .  As a m a t t e r o f f a c t , f o r c e d f e r t i l i t y possible.  voluntary  c o n t r o l i s im-  ITo government to-day would r i s k r e v o l u t i o n to t r y  i t and, i n any c a s e , t h e p e r s o n n e l t o c a r r y o u t such a p o l i c y are n o t a v a i l a b l e .  The o n l y s o l u t i o n i n t h e forseea.ble  future  i s t h e v o l u n t a r y system, and t h e o n l y way t o make i t r e a l l y e f f e c t i v e i s a combination  o f s o c i a l change, more a c t i v e  l e a d e r s h i p f r o m p u b l i c f i g u r e s , improved methods, and a v a i l a b i l i t y of b i r t h control.  I n any p l a n t o persuade people t o  adopt " f a m i l y p l a n n i n g " , m o t i v a t i o n and s e r v i c e s a r e c r u c i a l . What i n f l u e n c e s p e o p l e t o l i m i t t h e i r f e r t i l i t y ? 1965  In  Coale l i s t e d t h e d e c l i n e o f m o r t a l i t y , changes i n t h e  economic v a l u e o f c h i l d r e n i n an urban s o c i e t y , p r o h i b i t i o n o f c h i l d l a b o r , h i g h e r s t a t u s o f women, e d u c a t i o n , a t t i t u d e s t o r e l i g i o n , and t h e development o f s e c u l a r and r a t i o n a l t h i n k i n g as t h e i m p o r t a n t  factors.  n i n e t y percent o f c h i l d r e n attended  He a l s o n o t e d t h a t i f p r i m a r y s c h o o l , and a t  l e a s t 5 ° p e r c e n t o f t h e p o p u l a t i o n was u r b a n - d w e l l i n g , dec l i n e s would t a k e p l a c e i n any c a s e .  On the o t h e r hand,  France reduced i t s f e r t i l i t y b e f o r e any o f t h e s e f a c t o r s o b t a i n e d i n t h a t c o u n t r y , b u t England d i d n o t f o l l o w s u i t 9 u n t i l most o f them e x i s t e d .  N o t e s t e i n , K i r k and S e g a l a c -  cepted s i m i l a r c a t e g o r i e s l e a d i n g t o s o c i a l advancement, and added t h e breakdown o f t h e extended ( o r j o i n t ) f a m i l y system. But t h e y , t o o , agreed t h a t t h i s i s an o v e r s i m p l i f i c a t i o n o f the q u e s t i o n .  B e r e l s o n suggested t h a t f a m i l y w e l f a r e and  e d u c a t i o n a l o p p o r t u n i t i e s f o r t h e c h i l d r e n are" key f a c t o r s . I n any e v e n t , t h e p r a c t i c e o f c o n t r a c e p t i o n b e g i n s w i t h t h e "middle c l a s s e s " among whom m o t i v a t i o n i s h i g h , and access t o i n f o r m a t i o n and means i s r e l a t i v e l y easy.  l o w e r income  groups l a g b e h i n d , e i t h e r because t h e y a r e n o t i n t e r e s t e d , are unaware t h a t a c h o i c e i s p o s s i b l e , o r the means t o make  i t e f f e c t i v e i s not r e a d i l y a c c e s s i b l e . he concluded  T h e r e f o r e , i t may  t h a t , even when "birth c o n t r o l i s w i d e l y p r a c -  t i s e d , t h e r e i s no u n i v e r s a l p a t t e r n o f i n c e n t i v e s .  Declines  i n f e r t i l i t y occur because i n d i v i d u a l d e c i s i o n s a r e made f o r personal reasons.  I f more s o p h i s t i c a t e d methods a r e n o t  a v a i l a b l e , t h e attempt i s made t h r o u g h such f o l k methods as c o i t u s i n t e r r u p t u s ( w i t h d r a w a l o r "being c a r e f u l " ) , a b o r t i o n o r even i n f a n t i c i d e . p l a n n e r s i s another  induced  The i n f l u e n c e o f t h e f a m i l y  question.  T h i s s t u d y w i l l examine t h e r o l e o f t h e f a m i l y p l a n n e r s i n three s i g n i f i c a n t geographic  areas - the i n d u s t r i a l i z e d  c o u n t r i e s i n which t h e movement f i r s t developed;  the i n t e r -  n a t i o n a l a r e a , i n which i t grew, and South A s i a , t h e f i r s t modernizing  a r e a i n w h i c h e i t h e r a v o l u n t a r y o r a government  program was i n t r o d u c e d .  Two fundamental a s p e c t s - m o t i v a t i o n  ( l e a d e r s h i p , o p p o s i t i o n , a c c e p t a n c e ) and s e r v i c e s (programs and r e s u l t s ) ; and two rough time p e r i o d s - one l o n g  (from  1800 u n t i l World War I I ) , and t h e o t h e r s h o r t (from 1945 t o the end o f t h e 1960s) - w i l l p r o v i d e t h e framework f o r a s h i f t i n image from r a d i c a l " L e f t " t o "Human R i g h t " . I have drawn from p e r s o n a l e x p e r i e n c e as a v o l u n t e e r i n f a m i l y planning both i n a developing country  (Ceylon) and  i n Canada, on correspondence and i n t e r v i e w s w i t h some o f t h e l e a d e r s o f t h e v o l u n t a r y movement, annual r e p o r t s , proceedings,  speeches, p u b l i s h e d and u n p u b l i s h e d  supplementary r e s e a r c h .  conference  p a p e r s , and  I am i n d e b t e d  t o Hon.  James George, Canadian H i g h  Commissioner t o I n d i a , and h i s w i f e , C a r o l , f o r i n t r o d u c i n g me,  when t h e y were s t a t i o n e d i n C e y l o n , t o the  particularly,  Mrs. E. C.  volunteers:  ( S y l v i a ) Fernando, Honorary  o f the F a m i l y P l a n n i n g A s s o c i a t i o n (FPA)  o f Ceylon and a V i c e -  P r e s i d e n t o f the I n t e r n a t i o n a l P l a n n e d Parenthood ( I P P F ) ; Dr. and Mrs.  Secretary  Federation  ( M i s s ) S i v a Chinnatamby, FRCS, FRCOG; and  C. C. D e S i l v a .  Professor  For two y e a r s I served w i t h them i n  two weekly c l i n i c s (one i n a Colombo s o c i a l s e r v i c e o r g a n i z a t i o n and t h e o t h e r i n a suburban p u b l i c h o s p i t a l ) and as member of the E x e c u t i v e ciation.  Committee o f the F a m i l y P l a n n i n g  Asso-  Each has g i v e n me much i n f o r m a t i o n , b o t h i n c o n v e r -  s a t i o n and  correspondence.  P r o f . C.H.S. Jayewardene, co-  a u t h o r w i t h the l a t e P r o f . O.E.R. A b h a y a r a t n e , o f Trends i n C e y l o n ,  sent f u r t h e r i n f o r m a t i o n , and  some p o l i t i c a l comment.  Miss Ray Blaze' has  Fertility  Mr. L.O.  sent  McPhail  DeSilva  information  on the a t t i t u d e s of o t h e r v o l u n t a r y o r g a n i z a t i o n s i n Mr. J.R.  a  Ceylon.  (Colombo) and Mr. A l a n l a n g m u i r ( V a n c o u v e r ) ,  t h e n o f T. Ingledow and A s s o c i a t e s , a l s o sent r e l e v a n t C e y l o n government p u b l i c a t i o n s .  Mrs. W i l f r e d Graham, Vancouver,  k i n d l y s u p p l i e d background i n f o r m a t i o n on her  sister,  Dr. Mary Rutnam. Smt.  A v a b a i Wadia, ^ r e s i d e n t o f the F a m i l y  Planning  A s s o c i a t i o n o f I n d i a , Bombay, sent me numerous p u b l i s h e d r e p o r t s and p e r i o d i c a l s , as d i d Smt.  Dhanvanthi Rama Rau,  a l s o o f Bombay, f o u n d e r o f the FPA o f I n d i a ( F P A I ) ,  and  r e c e n t l y r e t i r e d as P r e s i d e n t o f t h e I n t e r n a t i o n a l P l a n n e d  Parenthood F e d e r a t i o n .  Dr. A l a n B. G i l r o y , P r i n c i p a l o f  the Ross I n s t i t u t e of T r o p i c a l H y g i e n e , I n d i a B r a n c h , J o r h a t , sent i n f o r m a t i o n and monthly r e p o r t s o f ITJD i n s e r t i o n s and s t e r i l i z a t i o n s i n the program b e i n g f i n a n c e d i n Assam and West B e n g a l by the I n d i a n Tea A s s o c i a t i o n . Richmond, B.C., Rajasthan,  Dr. M a r i a n B.  Hall,  f o r 23 y e a r s a m e d i c a l m i s s i o n a r y i n Ajmer,  and, so f a r as I know, the o n l y n o n - I n d i a n t o be  member of the n a t i o n a l c o u n c i l o f the F P A I , has a l l o w e d access to her papers.  The  a  me  C h r i s t i a n Medical A s s o c i a t i o n of  I n d i a has sent me r e p o r t s , and I have had h e l p f u l c o n v e r s a t i o n s w i t h Dr. Robert McClure of T o r o n t o , Dr. D a v i d o f Vernon, B.C.,  Kennedy  and Mrs. Wendy Marson of Ottawa, who  i n India with that organization.  Dean C.F.  worked  B e n t l e y , ,of the  U n i v e r s i t y o f A l b e r t a , passed on i n f o r m a t i o n on I n d i a , i n c l u d i n g speeches and a r t i c l e s by Dr. S, Chandrasekhar, when M i n i s t e r of State f o r Family P l a n n i n g , I n d i a . Hr. A.M.A. K a b i r , Dacca, S e n i o r V i c e - P r e s i d e n t , o f P a k i s t a n , has a l s o been v e r y h e l p f u l .  Dr. J.P.  FPA  Sharma,  P r e s i d e n t o f the FPA of N e p a l , Kathmandu, and Mrs. S h a n t i Rana, G e n e r a l S e c r e t a r y , sent i n f o r m a t i o n ; and Dr. (Mrs.) A t t i y a I n a y a t u l l a h , Honorary S e c r e t a r y , I n d i a n Ocean R e g i o n , I P P F , L a h o r e , gave her h e l p as w e l l .  Mr. George Cadbury, Chairman  o f the G o v e r n i n g Body, I P P F , and Mrs. Cadbury, o f O a k v i l l e , O n t a r i o , have g i v e n me two  i n t e r v i e w s , and Mrs. F r a n c i s D e n n i s ,  I n f o r m a t i o n O f f i c e r , I P P F , London, d e s e r v e s s p e c i a l thanks f o r her c o n t i n u i n g a s s i s t a n c e .  Thanks are a l s o due  to  Miss  B e r y l S u i t t e r s of the IPPF s t a f f f o r h i s t o r i c a l i n f o r m a t i o n .  M i s s Cassandra Kent, of the FPA The  (UK)  a l s o sent  information.  Swedish I n t e r n a t i o n a l Development Agency sent  r e p o r t s of SIDA programs i n South A s i a .  President Emeritus  F r a n k N o t e s t e i n , of the P o p u l a t i o n C o u n c i l and U n i v e r s i t y , t o o k time f o r a c o n v e r s a t i o n  Princeton  i n Vancouver i n  November, 1969> and Dr. N i c h o l a s W r i g h t , P o p u l a t i o n Adviser i n Ceylon,  sent i n f o r m a t i o n and  me  comments.  F r i e s e n , a l s o of the P o p u l a t i o n C o u n c i l , now  Council Dr. John  i n I r a n , sent  i n f o r m a t i o n on Muslim a t t i t u d e s t o f a m i l y p l a n n i n g .  Dr. John  E d l e f s e n , P o p u l a t i o n A d v i s e r t o the Colombo P l a n Bureau, Colombo, a l s o t o o k time t o t a l k t o me i n October,  in Victoria,  B.C.,  1969.  Mr. R i c h a r d Gamble, sonc o f the l a t e Dr. C l a r e n c e f o u n d e r o f the P a t h f i n d e r Fund, and p i o n e e r i n f a m i l y work i n S o u t h A s i a , was  a l s o h e l p f u l ; as were two  p l o y e e s of t h e Fund, t h e l a t e Mrs. V i c t o r i a , B.C.,  planning  former  em-  Margaret F. R o o t s , of  and Mrs. Edna McKinnon, o f Carmel, C a l i f o r n i a .  Miss Dorothy M a r t i n and M i s s Dorothy D u t t o n , o f UBC  Gamble,  l i b r a r y s t a f f were v e r y h e l p f u l .  the  My s u p e r v i s o r s i n the  Departments o f H i s t o r y and A n t h r o p o l o g y , P r o f s . P e t e r  Harnetty  and M i c h a e l Ames were p a t i e n t , h e l p f u l and l o n g s u f f e r i n g . a l l t h e s e and any o t h e r s i n a d v e r t e n t l y o m i t t e d , my thanks.  To  heartfelt  W i t h o u t t h e i r c o - o p e r a t i o n , t h i s study would not have  been p o s s i b l e .  FOOTNOTES  -  Preface  •'•Philip M. Hauser, "World P o p u l a t i o n Growth", P h i l i p M. Hauser, e d . , The P o p u l a t i o n Dilemma, 2nd e d . , Englewood C l i f f s , N.J., 1969, PP. 15-17; Frank W. N o t e s t e i n , Dudley K i r k and Sheldon S e g a l , "The Problem o f P o p u l a t i o n C o n t r o l " , I b i d . , p. 144; 1970 World P o p u l a t i o n Data S h e e t , The P o p u l a t i o n R e f e r e n c e Bureau, I n c . , Washington, D.C., A p r i l , 1970. 2  1 9 7 0 World P o p u l a t i o n Data S h e e t .  ^ A n s l e y J . C o a l e , " P o p u l a t i o n and Economic Development", Hauser, o p . c i t . , p. 84. ^1970 W o r l d P o p u l a t i o n Data S h e e t . A l s o Vancouver Sun. 3 J u l y 1970, c i t i n g AP d i s p a t c h from t h e U n i t e d N a t i o n s . 5 T . F r e j k a , " R e f l e c t i o n s on t h e Demographic C o n d i t i o n s Needed t o E s t a b l i s h a U.S. S t a t i o n a r y P o p u l a t i o n Growth'!, Population Studies. 1 9 6 8 , 22:379. 6 F r a n k l o r i m e r , " I s s u e s o f P o p u l a t i o n P o l i c y " , Hauser, o p . c i t . , p. 1 7 5 . 7 P a u l R. E r l i c h , The P o p u l a t i o n Bomb. New Y o r k , 1 9 6 8 , p. 8 1 , 83; G a r r e t t H a r d i n , " M u l t i p l e P a t h s t o P o p u l a t i o n C o n t r o l " , F a m i l y P l a n n i n g P e r s p e c t i v e s , New Y o r k , June, 1970, pp. 24-26; F r a n k W. . N o t e s t e i n , "Zero P o p u l a t i o n Growth: What I s I t ? " i b i d . , pp. 23-4. eannie R o s o f f , " C r i s i s T h i n k i n g : R h e t o r i c vs.. A c t i o n " , I b i d . , pp. 27-8; I . Bumpass and C.F. W e s t o f f , "The P e r f e c t C o n t r a c e p t i v e P o p u l a t i o n : E x t e n t and I m p l i c a t i o n s o f Unwanted F e r t i l i t y i n t h e U.S.", S c i e n c e i n p r e s s , c i t e d , i b i d , p. 28. 9 A n s l e y J . C o a l e , "The D e c l i n e o f F e r t i l i t y i n Europe", S . J . Behrman, L e s l i e C o r s a , J r . , and Ronald Freedman, e d s . , F e r t i l i t y and F a m i l y P l a n n i n g , Ann A r b o r , 1 9 6 9 , pp. 17-19. l°Frank W. N o t e s t e i n , Dudley K i r k , and Sheldon S e g a l , "The P r o b l e m o f P o p u l a t i o n C o n t r o l , Hauser, pp. 1 3 9 - 5 2 ; B e r n a r d B e r e l s o n , " F a m i l y P l a n n i n g Programs and P o p u l a t i o n C o n t r o l " , B e r n a r d B e r e l s o n , e d . , F a m i l y P l a n n i n g Programs: An I n t e r n a t i o n a l S u r v e y, New Y o r k , 1 9 6 9 , p. 297? A n s l e y J . C o a l e , " P o p u l a t i o n and Economic Development", Hauser, op.ci"fc., p. 6 0 .  PART  ONE  INTRODUCTION  " F a m i l y P l a n n i n g " Was  Not  New  Because o f the need t o compensate f o r p o p u l a t i o n l o s s e s caused by d i s e a s e , famine o r war, p r e - i n d u s t r i a l s o c i e t i e s i n many p a r t s o f the w o r l d v e n e r a t e d aged h i g h  birthratesP~  f e r t i l i t y and thus  B u t , when numbers threatened group  s u r v i v a l , o r i n d i v i d u a l i n t e r e s t s were at s t a k e , c o n t r o l was growth".  encour-  fertility  p r a c t i s e d , even t o o b t a i n "zero p o p u l a t i o n D i r e c t means, such as i n d u c e d a b o r t i o n , i n f a n t i -  c i d e , and the k i l l i n g  o r d e s e r t i o n o f the aged were, and  s t i l l a r e , commonplace i n some s o c i e t i e s . such as d e l a y e d marriage  I n d i r e c t means,  o r taboos r e l a t e d t o h e a l t h o r r e -  l i g i o n , have a l s o been u s e d .  I n a d d i t i o n , t h e r e have been  attempts t o p r e v e n t c o n c e p t i o n i t s e l f  - i n c l u d i n g such  magical  formulae as a n o i n t i n g the n a v e l w i t h s a l v e , s p i t t i n g t h r e e  3 t i m e s i n t o t h e mouth o f a f r o g , o r e a t i n g b e e s .  A relatively  e f f e c t i v e method, w i t h d r a w a l , has a l s o been u s e d , though  .  p r a c t i s e has v a r i e d from c o u n t r y t o c o u n t r y and from c l a s s to  class. From a n c i e n t t i m e s , t h r o u g h t r i a l and e r r o r , s e v e r a l  i n c r e a s i n g l y e f f i c i e n t means have been developed, but  these  were known o n l y t o t h e w e l l - t o - d o , and were m a i n l y f o r use "by women.  F o r example, E g y p t i a n p a p y r i , dated about 1 8 5 0 B.C.  and l a t e r , d e s c r i b e female methods, such as p e s s a r i e s made f r o m c r o c o d i l e o r e l e p h a n t dung, o r douching w i t h a combinat i o n o f honey and sodium c a r b o n a t e .  Tampons o f r o o t s o r  g r a s s , l i n t o r sponge soaked w i t h t a n n i c a c i d , gum a r a b i c (a component o f modern c o n t r a c e p t i v e j e l l i e s )  o r other  s o l u t i o n s were a l s o used.-* Some s o c i e t i e s used p o t i o n s s a i d t o induce but i n f o r m a t i o n on t h i s t o p i c i s s c a n t . r e p o r t s f o r t y - t w o medicines  sterility,  However, one study  t o be t a k e n by women, t h r e e t o  be t a k e n by b o t h men and women, and one t o be t a k e n b y men only.^  By t h e m i d - s i x t e e n t h c e n t u r y a male method, a p r o t o -  t y p e o f t h e modern condom ( a l i n e n v a r i e t y t o p r o t e c t t h e w e a r e r a g a i n s t s y p h i l i s ) had been added.''' The s k i n condom, f r o m membranous a n i m a l t i s s u e , a l s o made i t s appearance about t h i s time.  D e s c r i p t i o n s o f t h e d e v i c e a r e numerous i n seven-  t e e n t h and e i g h t e e n t h c e n t u r y European l i t e r a t u r e - i n t h e w r i t i n g s o f James B o s w e l l and Casanova, f o r example - b u t i t was  used more o f t e n t o p r e v e n t v e n e r e a l d i s e a s e than  I n d u s t r i a l i z a t i o n also played a p a r t . developed  conception.  When C h a r l e s Goodyear  h i s method o f v u l c a n i z i n g r u b b e r i n 1 8 3 9 > t h e r u b b e r  condom, and new rubber a p p l i a n c e s - c e r v i c a l caps and d i a phragms f o r women became p o s s i b l e . l a t e seventeenth  I n t h e meantime, i n t h e  c e n t u r y ( c 1 6 7 8 ) t h e Dutchman, Anthony van  Leeuwenhoek, had d i s c o v e r e d t h e n a t u r e o f spermatazoa, and i n s p i r e d a s u c c e s s i o n o f s t u d i e s t o f i n d a means o f  i m m o b i l i z i n g them.  T h i s l e d to the i n t r o d u c t i o n of f u r t h e r  female methods - v a g i n a l s u p p o s i t o r i e s and the modern  jellies,  Q  creams and foams.  I n 1929 the "rhythm" method was  and g i v e n q u a l i f i e d a p p r o v a l by t h e Roman C a t h o l i c  added, Church. ^ x  A f t e r World War I I , the p o p u l a t i o n e x p l o s i o n and i t s s o c i a l , economic and p o l i t i c a l i m p l i c a t i o n s added urgency t o r e s e a r c h ; and 'Western f a m i l y p l a n n e r s i n s p i r e d t h e d i s c o v e r y o f t h e modern o r a l c o n t r a c e p t i v e , and the r e v i v a l and i m p r o v e ment o f the i n t r a - u t e r i n e c o n t r a c e p t i v e d e v i c e (ITJCD, IUD o r "loop"). ' 1  1  B o t h male and female s t e r i l i z a t i o n have a l s o  become p o p u l a r , and a t t i t u d e s t o i n d u c e d a b o r t i o n a r e growing more l i b e r a l .  F o r a l l t h e i r e f f e c t i v e n e s s , a l l t h e s e methods  have d i s a d v a n t a g e s , and r e s e a r c h i n t o o t h e r s , such as i n j e c t i b l e s , i m p l a n t s and a b o r t i f a c i e n t s ( s u i t a b l e f o r mass use,.) c o n t i n u e s . There i s l i t t l e doubt t h a t the need i s u r g e n t , and t h a t a more a c c e p t a b l e s o l u t i o n w i l l be f o u n d . B u t , f o r the purposes o f t h i s s t u d y , the e v o l u t i o n o f modern f e r t i l i t y c o n t r o l t e c h n i q u e s and t h e i r worldwide use i s o n l y o f i n t e r e s t f o r i t s r e l a t i o n t o the h i s t o r y o f the b i r t h cont r o l "cause" w h i c h has developed o v e r the p a s t 170 y e a r s . T h i s movement was an attempt t o i n c r e a s e the use o f b i r t h c o n t r o l methods i n o r d e r t o h a s t e n v a r i o u s r e f o r m s such as improved w o r k i n g c l a s s wages and o f women.  I n each c o u n t r y i t had s i m i l a r  social .'" s t a t u s  characteristics,  b u t as f a r as i s known, i t a l l began i n those o f European stock.  E x c e p t f o r "Dr." Marie Stopes (an advocate of b i r t h  c o n t r o l i n t h e U n i t e d Kingdom from the 1920s u n t i l h e r d e a t h  i n 1958), t h e e a r l y l e a d e r s o f t h e movement i n t h a t c o u n t r y , the U n i t e d S t a t e s , and i n Western Europe, were f r e e t h i n k e r s . N e a r l y a l l came from "middle  c l a s s " "backgrounds.  Many had  e g a l i t a r i a n p o l i t i c a l v i e w s ; some were p a c i f i s t s ; and a l l were c o n v i n c e d , f o r one r e a s o n o r a n o t h e r , t h a t sex should be b r o u g h t out from under i t s " c l o a k o f s i n and shame".  A solution to  p o v e r t y , e q u a l r i g h t s f o r women, m a t e r n a l and c h i l d h e a l t h , and w o r l d peace were c u m u l a t i v e g o a l s , and reached  t h e i r peak,  a f t e r World War I I , i n support o f f a m i l y p l a n n i n g as a t o o l o f n a t i o n a l and i n t e r n a t i o n a l development, and f i n a l l y , a s a means o f c o n s e r v i n g r e s o u r c e s and t h e environment. o f promotion place.  Techniques  were adapted t o the concerns o f t h e time and  Many o f t h e b i r t h c o n t r o l v o l u n t e e r s i n t h e West  were a l s o a c t i v e i n campaigns f o r compulsory e d u c a t i o n , f r e e speech, freedom o f t h e p r e s s , u n i v e r s a l a d u l t f r a n c h i s e , l a n d r e f o r m , t h e a b o l i t i o n o f c h i l d l a b o r , and o t h e r s o c i a l measu r e s which a r e t a k e n f o r g r a n t e d t o d a y , b u t were r a d i c a l i d e a s when i n t r o d u c e d i n the n i n e t e e n t h and e a r l y t w e n t i e t h c e n t u r i e s . B i r t h c o n t r o l r e q u i r e d t h e longest b a t t l e (not y e t completely won),  and i t was fought f i r s t i n t h e U n i t e d Kingdom and t h e  United S t a t e s o f America. In t h e b e g i n n i n g , opponents were s c a t t e r e d , b u t t h e f a m i l y p l a n n e r s ' own peers were among them. would n o t s u p p o r t t h e i d e a .  Some f r e e t h i n k e r s  Some r a d i c a l s , some Trade  Union-  i s t s , and some C h a r t i s t s opposed i t , and, when t h e f e m i n i s t movement developed  i n the mid-nineteenth  m i l i t a n t s were d i v i d e d on t h e q u e s t i o n .  c e n t u r y , even these As t h e c e n t u r y  advanced, and t h e a d v o c a t e s o f b i r t h c o n t r o l became o r g a n i z e d , o p p o s i t i o n a l s o began t o c r y s t a l l i z e .  Hardin suggests that  t h e f o l l o w i n g q u o t a t i o n p r o b a b l y r e p r e s e n t s a f a i r l y common, i f n o t c o n s c i o u s , e x p r e s s i o n o f male a t t i t u d e s t o women, and hence, t o b i r t h c o n t r o l i n 1880. God made h i m s e l f t o be born o f a woman t o s a n c t i f y t h e v i r t u e o f endurance; l o v i n g s u b m i s s i o n i s an a t t r i b u t e o f a woman; men a r e l o g i c a l , b u t women, l a c k i n g t h i s q u a l i t y , have an i n t r i c a c y o f t h o u g h t . There a r e t h o s e who t h i n k women can be t a u g h t l o g i c ; t h i s i s a m i s t a k e . They can never, b y any power o f e d u c a t i o n a r r i v e a t t h e same mental s t a t u s as t h a t enjoyed by men .... Wifehood i s t h e crowning g l o r y o f a woman. I n i t she i s bound f o r a l l t i m e . To h e r husband she owes t h e d u t y o f u n q u a l i f i e d o b e d i e n c e . There i s no crime w h i c h a man can commit which j u s t i f i e s h i s w i f e i n l e a v i n g him o r a p p l y i n g f o r t h a t monstrous t h i n g , d i v o r c e . I t i s her duty t o s u b j e c t h e r s e l f t o h i m a l w a y s , and no crime t h a t he can commit can j u s t i f y h e r l a c k o f o b e d i ence. I f he be a bad o r w i c k e d man, she may g e n t l y r e m o n s t r a t e w i t h him, b u t r e f u s e him n e v e r . . . . I am t h e f a t h e r o f many c h i l dren and t h e r e a r e t h o s e who have v e n t u r e d t o p i t y me. "Keep your p i t y f o r y o u r s e l f , " I have r e p l i e d , "they n e v e r c o s t me a s i n g l e pang."15 I n a d d i t i o n t o t h e a t t i t u d e o f many i n d i v i d u a l s ,  several  m u t u a l l y dependent i n t e r e s t groups o b s t r u c t e d t h e movement.  CRUDE BIRTHRATES I N SOME INDUSTRIALIZED COUNTRIES  Sourcet  A.P.K. and K a t h e r i n e O r g a n s k i , " C h i l d r e n Become a n Economic L i a b i l i t y " , L o u i s e B. Young, ed., P o p u l a t i o n I n P e r s p e c t i v e , T o r o n t o , 1968, pb, p. 11-+.  S t a t e p o l i c y makers, b o t h b u r e a u c r a t i c and e l e c t e d , had a v e s t e d i n t e r e s t i n p o p u l a t i o n growth because o f t h e conv i c t i o n t h a t i t was synonymous w i t h i n t e r n a t i o n a l p o l i t i c a l muscle.  As l o n g as d e f e n c e , the waging o f war and t h e o c c u -  p a t i o n o f conquered t e r r i t o r i e s depended on l a r g e numbers o f men, i t was n a t u r a l t h a t governments s h o u l d f a v o r p r o - n a t a l i s t policies. ^ 1  B u t b i r t h r a t e s i n Europe and t h e U n i t e d  States  began t o d e c l i n e : i n France from about 1800, and, i n such c o u n t r i e s as B r i t a i n , Denmark, Norway, Sweden and t h e U n i t e d S t a t e s , from the 1 8 7 0 s . ^  By t h e 1930s t h e d e c l i n e was so  p e r s i s t e n t t h a t demographers began t o warn t h a t might b e g i n t o s h r i n k .  populations  F r y e r r e p o r t s a f r i n g e element who  added t o t h e g e n e r a l p a n i c by c l a i m i n g t h a t  contraception  would undermine t h e B r i t i s h Empire, a l l o w t h e y e l l o w and b l a c k r a c e s t o dominate, cause t h e d e g e n e r a t i o n the w o r l d o f geniuses  o f women and d e p r i v e  - an argument r e s u r r e c t e d from time t o  time by t h e opponents o f b i r t h c o n t r o l , and, l a t e l y , by t h o s e who oppose induced a b o r t i o n . was  Even though t o t a l  population  i n c r e a s i n g , laws a g a i n s t c o n t r a c e p t i o n were passed i n some  c o u n t r i e s , and p r o - n a t a l i s t measures such as f a m i l y and t a x b e n e f i t s were i n t r o d u c e d .  allowances  Due t o government p r o p a -  ganda i n Germany and I t a l y t h e b i r t h r a t e s i n t h o s e  countries  responded f o r a s h o r t t i m e , b u t t h e l o n g term s l i p p a g e i n Europe and i n many c o u n t r i e s o f European s t o c k ( i n c l u d i n g 18 Canada) has c o n t i n u e d . A n o t h e r i n t e r e s t group t o oppose b i r t h c o n t r o l f o r many y e a r s was t h e b u s i n e s s  community, and i n t h i s i t r e c e i v e d  government s u p p o r t .  Commercial e n t e r p r i s e s u p p o r t e d  n a t a l i s t p o l i c i e s on the b a s i s t h a t "More b a b i e s business".  T h i s c u l t had  mean more  i t s roots i n nineteenth  a t t i t u d e s t o l a b o r and wages on b o t h s i d e s of the  century Atlantic.  A growing p o p u l a t i o n would keep l a b o r c o s t s low and the demand f o r goods.  pro-  increase  Whoever p r o f i t e d from cheap l a b o r  was  p r e p a r e d t o r e s i s t t o the l a s t d i t c h any promotion o f b i r t h 19  control information.  The  t w e n t i e t h century  industrial  e x p a n s i o n d i d not d i f f e r i n i t s t e n e t s , even though the " b i o l o g i c a l C a s s a n d r a s " were w a r n i n g as e a r l y as the and  kOs  that overpopulation  was  a t hand.  1930s  As per c a p i t a i n -  come i n the l i t e r a t e w o r l d i n c r e a s e d , the l a t t e r were accused o f a t t a c k i n g the " r e l i g i o n of p r o g r e s s " , t o n o t i c e what was  and ho one t o o k t i m e  happening e l s e w h e r e .  S i n c e World War  I I the a t t i t u d e has p e r s i s t e d .  Nathan  K e y f i t z , a Canadian born demographer t e a c h i n g a t the U n i v e r s i t y o f C a l i f o r n i a , B e r k e l e y , has i d e n t i f i e d urban landowners, m a n u f a c t u r e r s , c h u r c h e s , and  developers,  the a d v e r t i s i n g 21  media as the contemporary promoters o f the f e r t i l i t y  cult.  Now,in a d d i t i o n t o the b i o l o g i s t s and a "reformed" breed o f demographers, a number o f e c o l o g i s t s , e c o n o m i s t s , s o c i o l o g i s t s , and o t h e r p r o f e s s i o n a l s i n f i e l d s r e l a t e d t o  population,  have added t h e i r v o i c e s t o h i s p r o t e s t about u n b r i d l e d popul a t i o n i n c r e a s e and  consumption.  R o b e r t S. McNamara, P r e s i d e n t  o f the World Bank, a l s o has spoken out a g a i n s t i t , f i r s t 1969«  2 2  in  C o n f i d e n c e i n i n c r e a s e d consumption i s d i m i n i s h i n g  because o f the i n f l u e n c e o f l e s s m a t e r i a l i s t i c p h i l o s o p h i e s ,  q u e s t i o n s about t h e m e r i t s o f t e c h n o l o g y , and t h e f a c t s o f e n v i r o n m e n t a l damage. Q u e s t i o n i n g i s now widespread circles  i n occidental religious  a l s o , but t h i s d i d not b e g i n to g a i n s t r e n g t h u n t i l  the 1 9 6 0 s .  However, r e l i g i o u s o p p o s i t i o n t o b i r t h  had i t s o r i g i n s i n a n c i e n t t i m e s .  Fertility  control  c u l t s were normal  i n p r i m i t i v e s o c i e t i e s , and a p p a r e n t l y the major r e l i g i o n s to  had  s t r u g g l e a g a i n s t the i n f l u e n c e s o f f e r t i l i t y gods and god-  desses.  T h i s produced  a c l a s h between the need f o r s u r v i v a l  and i n c l i n a t i o n s toward l i c e n s e .  The  strongest opposition to  b i r t h c o n t r o l had i t s o r i g i n s i n t h i s c o n f l i c t and  asceticism  became m e r i t o r i o u s . R i c h a r d M. F a g l e y , a demographer, and a u t h o r o f a s t u d y on b e h a l f o f the World C o u n c i l o f  Churches,  e x p l a i n e d t h a t t h e O l d Testament i n j u n c t i o n , "Be F r u i t f u l M u l t i p l y " c o n j u r e d up a p i c t u r e o f an abundant P r e s e r v a t i o n o f the f a m i l y name was f e r t i l i t y , and, i f a man  and  society.^  another f a c t o r  encouraging  d i e d w i t h o u t progeny, i t was h i s  b r o t h e r ' s duty t o marry t h e widow and beget c h i l d r e n f o r t h i s purpose.  Onan would n o t conform, and used w i t h d r a w a l t o evade Oh,  his  o b l i g a t i o n t o impregnate  Tamar.  A c o n t r o v e r s y has s i n c e  raged (among C h r i s t i a n s ) over whether the L o r d s l e w Onan f o r the a c t o f w i t h d r a w a l i t s e l f , or f o r r e f u s i n g t o p e r f o r m h i s Levirate duty. ^ 2  r a c e remained,  Although the o b l i g a t i o n to perpetuate the  c o n t r a c e p t i o n must have been p e r m i s s i b l e l a t e r  i n J e w i s h h i s t o r y f o r t h e Talmud, w r i t t e n between the and s i x t h c e n t u r y A.D.,  second  recommended c o i t u s i n t e r r u p t u s , a  v a g i n a l sponge, o r a d r i n k s a i d t o induce s t e r i l i t y .  About  230 A.D. t h e r e was an argument o v e r man's duty t o ensure p e r p e t u a t i o n o f t h e r a c e , so t h e onus was p l a c e d on women t o use 27  the sponge, i f d e s i r e d . '  The J e w i s h E n c y c l o p a e d i a  that u r b a n i z a t i o n induced the adoption  indicates  of a two-child f a m i l y  norm, a p a t t e r n s t i l l o b s e r v e d by many Jews i n Europe, t h e 28 U n i t e d S t a t e s and Canada.  I n the "Princeton Study", Family  Growth i n M e t r o p o l i t a n A m e r i c a , i t was shown t h a t Jews i n t h e U n i t e d S t a t e s today a r e b e t t e r c o n t r a c e p t o r s and Roman C a t h o l i c s . ^ 2  than P r o t e s t a n t s  Though c o n t r a c e p t i o n was p e r m i t t e d a t  f i r s t i n C h r i s t i a n i t y , Greco-Roman l i c e n s e , i n w h i c h t h e wors h i p o f Venus f i g u r e d , was a f a c t o r i n a change o f a t t i t u d e . - ^ ' To p r e v e n t m o r a l breakdown, a t t h e end o f t h e f o u r t h c e n t u r y A.D., S t . A u g u s t i n e h e l d t h a t every c o n j u g a l a c t was for  t h e purpose o f p r o c r e a t i o n .  T h i s t e a c h i n g was r e i n f o r c e d  i n t h e t h i r t e e n t h c e n t u r y by S t . Thomas Aquinas i n h i s • g r e a t work, Summa T h e o l o g i c a .  Almost e v e r y a s p e c t o f A r i s t o t e l i a n  p h i l o s o p h y was adopted except t h e p r i n c i p l e o f b i r t h c o n t r o l . St.  Thomas h e l d t h a t b i r t h c o n t r o l was a g a i n s t n a t u r e  and, i n  an age o f f a m i n e , d i s e a s e and war, i t was a l o g i c a l r u l i n g . S i n c e t h a t time C h r i s t i a n s have debated whether Aquinas was condemning t h e common p r a c t i s e o f a b o r t i o n and i n f a n t i c i d e , o r whether he was r u l i n g o u t c o n t r a c e p t i v e p r a c t i c e s . - ^ " I n any  e v e n t , h i s views have s u r v i v e d and, u n t i l a f t e r World War  I , on t h e ground t h a t s m a l l f a m i l i e s were s e l f i s h and r e d u c e d i n d u s t r i a l p r o d u c t i o n , t h e y were u p h e l d by P r o t e s t a n t as w e l l as Roman C a t h o l i c Churches. One o f t h e f i r s t o f t h e P r o t e s t a n t Churches t o waver  was t h e Church o f England i n 1 9 3 0 a n d , by t h e 1 9 6 0 s , a p p r o v a l was extended by most o f t h e o t h e r s as w e l l .  overt Although  approving  t h e rhythm method i n 1 9 3 0 , Roman C a t h o l i c p r e l a t e s  maintained  a more o r l e s s u n i t e d o p p o s i t i o n t o " a r t i f i c i a l "  means u n t i l t h e 1 9 6 0 s .  I t was suggested t h a t b i r t h c o n t r o l  would cause grave p h y s i c a l d i s o r d e r s , f i b r o i d tumors, ity,  i n f i d e l i t y , s e p a r a t i o n and d i v o r c e .  steril-  A m a r r i e d woman who 32  p r a c t i s e d c o n t r a c e p t i o n was no b e t t e r than a p r o s t i t u t e . Today Roman C a t h o l i c churchmen a r e n o t unanimous, and, n o t o n l y a r e many C a t h o l i c s p r a c t i s i n g a r t i f i c i a l b i r t h c o n t r o l , but d i s a p p r o v a l has n o t been s t r o n g enough t o p r e v e n t t h e i n t r o d u c t i o n o f modern b i r t h c o n t r o l programs i n some C a t h o l i c  33 nations. B i r t h c o n t r o l has been i n t r o d u c e d a l s o t o t r y t o combat t h e u n u s u a l l y h i g h induced a b o r t i o n r a t e s and "uncon-  34 scious i n f a n t i c i d e " , a r e s u l t of parental neglect.  In  C h i l e , f o r example, t h e i l l e g a l a b o r t i o n r a t e i s e s t i m a t e d t o be one t o two l i v e b i r t h s , and i n Uruguay and Honduras, one t o t h r e e , and one t o f o u r l i v e b i r t h s , r e s p e c t i v e l y . M a r x i s t s , who were once r i g i d l y opposed t o b i r t h c o n t r o l , i n b o t h "West" and " E a s t " , have l a t e l y been a m b i v a l e n t about it.  Some a d h e r e n t s c l a i m t h a t " s u r p l u s l a b o r " i s c h a r a c t e r i s -  t i c o f c a p i t a l i s m and i m p e r i a l i s t e x p l o i t a t i o n , and t h a t t h e i d e a l s t a t e s h o u l d be a b l e t o absorb i n c r e a s i n g p o p u l a t i o n t h r o u g h economic growth i n b o t h a g r i c u l t u r e and i n d u s t r y . them, a b i g p o p u l a t i o n i s a p o l i t i c a l a s s e t .  To  Nevertheless,  a  r e c e n t assessment o f M a r x i s t o p i n i o n shows t h a t , i n t h e USSR, a t l e a s t , Marx, E n g e l s , and l e n i n a r e now c o n s i d e r e d  t o have  f a v o r e d b i r t h c o n t r o l when n e c e s s a r y , state.  even i n t h e " s o c i a l i s t "  Government p o l i c i e s a r e s a i d t o be based on t h e c o n -  cept t h a t women must have t h e c h o i c e r e g a r d i n g m a t e r n i t y , and that contraception i s preferable to abortion. i n o t h e r a c t i v i t i e s i s a l s o needed. to-day f o r developing  Their labor  B i r t h c o n t r o l i s recommended  c o u n t r i e s as an a i d t o economic growth  and t o r a i s e t h e s t a n d a r d o f l i v i n g .  In fact  contraception  i s a v a i l a b l e i n such M a r x i s t c o u n t r i e s as B u l g a r i a , C h i n a , Cuba, C z e c h o s l o v a k i a , Hungary, t h e USSR, and Y u g o s l a v i a . Induced a b o r t i o n i s a v a i l a b l e i n some. A n o t h e r group o p p o s i n g b i r t h c o n t r o l has been t h e medical p r o f e s s i o n .  I d o l i z e d as h e a l e r s , d o c t o r s o f t h e  n i n e t e e n t h and t w e n t i e t h c e n t u r i e s i n the West used H i p p o c r a t e s , o f t h e f o u r t h c e n t u r y B.C., as t h e guide t o e t h i c a l p r a c t i c e , and t o o k p r i d e i n t h e t r a d i t i o n o f s e r v i c e e s t a b l i s h e d by such p h y s i c i a n s as Soranos o f Ephesus (second g y n a e c o l o g i s t ) , and A v i c e n n a ,  century  the t e n t h century ( i s l a m i c )  d o c t o r whose t e a c h i n g s were i n f l u e n t i a l i n Europe d u r i n g the Middle Ages and a f t e r . ... I w i l l use t r e a t m e n t t o h e l p t h e s i c k a c c o r d i n g t o my a b i l i t y and judgement, b u t n e v e r w i t h a v i e w t o i n j u r y and w r o n g d o i n g . I w i l l keep pure and h o l y b o t h my l i f e and my a r t . I n whatsoever houses I e n t e r , I w i l l e n t e r t o h e l p t h e s i c k , and I w i l l a b s t a i n from a l l i n t e n t i o n a l wrongdoing and harm....37 These l e a d e r s o f t h e p r o f e s s i o n i n t h e i r t i m e s t o o k i t f o r g r a n t e d t h a t b i r t h c o n t r o l would be p r a c t i s e d , and d i s c u s s e d v a r i o u s methods i n t h e i r w r i t i n g s . However, a f t e r Summa T h e o l o g i c a , t h e r e was d i s c r e e t s i l e n c e among Western t r a i n e d  d o c t o r s on s u c h m a t t e r s . 19th  and  20th  W i t h v e r y few e x c e p t i o n s  c e n t u r i e s ) , the s i l e n c e was  maintained  ( i n the f o r seven  hundred y e a r s . U n t i l the 1 9 6 0 s l i t t l e or no i n s t r u c t i o n was  given i n  l e c t u r e s or demonstrations i n medical schools or c o l l e g e s anywhere i n t h e w o r l d , and no i n f o r m a t i o n on t h e  sociological  a s p e c t s o f f e r t i l i t y , human s e x u a l i t y o r p o p u l a t i o n dynamics was  imparted.-^  F r y e r n o t e s t h a t m e d i c a l men  gave the  fol-  lowing excuses f o r t h e i r l a c k of i n t e r e s t i n the s u b j e c t : b i r t h c o n t r o l endangers v i r i l i t y , i s conducive t o a d u l t e r y , d e s t r o y s the "glamour" o f m a r r i a g e ,  i s a danger t o h e a l t h ,  l e a d s t o l u n a c y , has a s t e r i l i z i n g e f f e c t , o r i s tantamount 39 to  masturbation•  '  A n o t h e r problem was  a g y n a e c o l o g i c a l conference  f r a n k l y admitted  i n Budapest i n September,  at  19&9,  when the d o c t o r s agreed t h a t d i f f i c u l t y a l s o a r o s e over t r a d i t i o n a l r i v a l r y between p r a c t i t i o n e r s o f c u r a t i v e medicine t h o s e whose s p e c i a l t y ^ was The  preventive  and  medicine.  r e l u c t a n c e o f the m e d i c a l p r o f e s s i o n t o t a k e a l e a d  i n t h e promotion o f b i r t h c o n t r o l was  summed up by Dr.  Alan  Guttmacher, P r e s i d e n t o f the U n i t e d S t a t e s v o l u n t a r y o r g a n i z a t i o n , P l a n n e d Parenthood-World P o p u l a t i o n , as f o l l o w s : D e d i c a t i o n t o the p r e s e r v a t i o n o f l i f e a t a l l c o s t s , t o  "doing  no harm", t o a d e s i r e f o r p o p u l a r i t y , t o m e d i c a l p o l i t i c s , t o a r e l u c t a n c e t o p l a y God,  and l a s t l y , because o f a l l b o d i l y  s y s t e m s , the r e p r o d u c t i v e t r a c t i s unique i n t h a t " i t i s the o n l y one w h i c h f a s c i n a t e s S t a t e and  Church."  H o s p i t a l s f o l l o w e d the d o c t o r s ' l e a d i n r e f u s i n g t o g i v e c o n t r a c e p t i v e care - i n few Y o r k , f o r example, u n t i l  Ik  1958.  D r . Guttmacher a t t r i b u t e d t h e r e c e n t s o f t e n i n g o f a t -  t i t u d e s t o t h e f a c t t h a t , s t i l l h e s i t a n t i n the matter of f a m i l y p l a n n i n g , , t h e World H e a l t h O r g a n i z a t i o n had agreed t o d e f i n e h e a l t h as a human r i g h t , and a s t a t e o f "complete p h y s i c a l , m e n t a l and s o c i a l w e l l - b e i n g " and n o t m e r e l y t h e absence o f d i s e a s e o r i n f i r m i t y . In 1 9 5 9 i n the" U n i t e d S t a t e s , t h e American P u b l i c H e a l t h A s s o c i a t i o n passed a r e s o l u t i o n i n f a v o u r o f f a m i l y p l a n n i n g * The American C o l l e g e o f O b s t e t r i c i a n s and G y n a e c o l o g i s t s  fol-  lowed s u i t i n 1 9 6 3 J and t h e American M e d i c a l A s s o c i a t i o n i t s e l f did  so i n 1 9 6 4 b u t , even t o - d a y , few d o c t o r s w i l l speak o u t as  individuals i n i t s fsvor.  The l i b e r a l i s e d a t t i t u d e s o f t h e  m e d i c a l a s s o c i a t i o n s t o a b o r t i o n and s t e r i l i s a t i o n i n t h e U n i t e d Kingdom, t h e U n i t e d S t a t e s and Canada i s o f a d d i t i o n a l i n t e r e s t b u t few d o c t o r s as i n d i v i d u a l s w i l l speak o u t i n •fB e s e v m a t t e r s * Not s u r p r i s i n g l y , e d u c a t i o n and t h e law have tended also to r e f l e c t the opinions o f the o p p o s i t i o n . 1850s  Prom t h e  i n t h e U n i t e d Kingdom t h e s e i n t e r a c t i n g and m u t u a l l y  s u p p o r t i n g i n t e r e s t groups t r a n s l a t e d t h e i r o p p o s i t i o n i n t o laws f o r b i d d i n g blasphemy, o b s c e n i t y , and a b o r t i o n , w h i l e , from t h e 1 8 6 0 s i n t h e U n i t e d S t a t e s t h e proponents o f b i r t h c o n t r o l were p r o s e c u t e d  and j a i l e d f o r "pornography".  In the  l a s t quarter o f the nineteenth century, the United States F e d e r a l P o s t a l R e g u l a t i o n s were amended t o f o r b i d t h e d i s s e m i n a t i o n o f i n f o r m a t i o n about c o n t r a c e p t i o n , and many S t a t e s followed suit with similar l e g i s l a t i o n .  Laws a g a i n s t b i r t h  c o n t r o l were a l s o passed i n Europe, a t d i f f e r e n t t i m e s . "Malthusian" Associations  Leagues, and, l a t e r , F a m i l y  Planning  t o promote t h e i d e a as a t o o l o f s o c i a l r e f o r m  were formed i n c o u n t r i e s o f European s t o c k , h u t i t was n o t u n t i l t h e 1 9 5 0 s t h a t t h e y o r p r o f e s s i o n a l s i n t h e f i e l d had much i m p a c t .  Then t h e i r governments began t o a c c e p t i n t h e o r y  t h a t f a m i l y p l a n n i n g was a needed p u b l i c s e r v i c e , b u t were s l o w t o a c t a t home, and o b s t r u c t e d  h e l p f o r d e v e l o p i n g coun-  t r i e s u n t i l the l a t e 1 9 6 0 s . I n s p i t e o f t h e o p p o s i t i o n , and perhaps u n r e l a t e d t o the a c t i v i t i e s o f t h e F a m i l y P l a n n i n g b i r t h r a t e s showed t h a t c o n t r a c e p t i o n  Associations, declining was b e i n g p r a c t i s e d  widely  by t h e middle and upper income groups i n Western c o u n t r i e s by i n d i v i d u a l choice.  What w i l l happen t o "Western" b i r t h r a t e s  i n f u t u r e i s now thought t o depend on e d u c a t i o n ,  economic  c o n d i t i o n s , c h i l d b e a r i n g i n t e n t i o n s , and t h e s i z e o f t h e reproductive  age group.  But most w e s t e r n governments a r e  s t i l l r e l u c t a n t t o develop population  p o l i c i e s and t a k e  p o s i t i v e a c t i o n t o i n f l u e n c e knowledge, a t t i t u d e s and p r a c t i c e , and t h e v o l u n t e e r s  a r e s t i l l a t t e m p t i n g t o persuade them 4l t o do s o , b u t t o b u i l d i t on i n d i v i d u a l c h o i c e •  FOOTNOTES  -  Introduction  i R i c h a r d M. F a g l e y , "Parenthood and World R e l i g i o n s " , The P o p u l a t i o n E x p l o s i o n and C h r i s t i a n R e s p o n s i b i l i t y " , O x f o r d , I 9 6 0 , p. 9 5 . Norman E. Himes, M e d i c a l H i s t o r y o f B a l t i m o r e , 1 9 6 3 , p. 79. 2  Contraception,  ^ P e t e r F r y e r / The B i r t h C o n t r o l l e r s . London, 1 9 6 5 , pb, p. 2 0 - 1 . The H i s t o r y o f Contraceptives", I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d F e d e r a t i o n , London, I 9 6 7 , P» 14. **John P e e l & Malcolm P o t t s , Textbook o f C o n t r a c e p t i v e Practice. Cambridge, 1 9 6 9 , pb., pp. 4 9 - 5 1 ; Clyde V. K i s e r , ed. " P a n e l D i s c u s s i o n on the Comparative A c c e p t a b i l i t y o f D i f f e r e n t Methods o f C o n t r a c e p t i o n " , R e s e a r c h i n F a m i l y P l a n n i n g , P r i n c e t o n , 1 9 6 2 , pp. 3 8 0 - 8 1 ; M e d i c a l men used to d i s a p p r o v e o f t h i s method, but t h e r e i s no e v i d e n c e t h a t i t i s h a r m f u l , and i t i s now accepted as f a i r l y r e l i a b l e f o r those s k i l f u l enough t o use i t . I t has a l w a y s been p o p u l a r i n Europe and t h e U n i t e d S t a t e s , and a l s o among educated c l a s s e s i n A s i a . ^Himes, o p . c i t . , pp. 3 , 4 ;  I P P F , o p . c i t . , p.  2.  ^K. N d e t i , " A t t i t u d e s o f the R u r a l P o p u l a t i o n t o the C l i n i c S e r v i c e s , " The R o l e o f F a m i l y P l a n n i n g i n A f r i c a n Development, London, 1 9 6 8 , p p . 4 7 - 8 ; B.E. F i n c h and Hugh Green, C o n t r a c e p t i o n Through the Ages, S p r i n g f i e l d , 1 9 6 4 , pp. 1 0 5 - 0 8 . 7  H i m e s , O p . C i t . , p.  186. 31-5.  F r y e r , O p . C i t . , pp. 9iPPP, 1 0  O p . C i t . , pp.  18-19.  P e e l & P o t t s , O p . C i t . , pp.  80-1.  ^ I b i d . , p. 1 2 9 . The l a t t e r was f i r s t i n t r o d u c e d by Grafenburg i n Germany and H a i r e i n B r i t a i n i n t h e 1 9 2 0 s , b u t was condemned by the m e d i c a l p r o f e s s i o n a t t h a t t i m e . ^Marie Stopes was n o t a m e d i c a l d o c t o r . i n Botany from a German u n i v e r s i t y .  PhD.  She h e l d a  F r y e r , O p . C i t . , p. 1 1 , 248; C P . B l a c k e r , "Family P l a n n i n g and E u g e n i c Movements i n t h e M i d - T w e n t i e t h C e n t u r y " , The E u g e n i c s Review. J a n u a r y , 1 9 5 6 , 47, 4 , p. 2 2 5 . 1 3  ^ F r y e r , O p . C i t . , pp.  88-96.  "'"-'The Rev. W i l l i a m John Knox l i t t l e , "On Woman's P l a c e i n N a t u r e " , G a r r e t t H a r d i n , ed., P o p u l a t i o n , E v o l u t i o n and B i r t h C o n t r o l , San F r a n c i s c o , 1964, pb. pp. ±97-8. " ^ L i n c o l n H. and A l i c e T a y l o r Bay, Too Many A m e r i c a n s , B o s t o n , 1964, pp. 188-89; J . J . S p e n g l e r , "The Economics o f P o p u l a t i o n Growth", S t u a r t Mudd, ed., The P o p u l a t i o n C r i s i s and the Use o f World R e s o u r c e s , B l o o m i n g t o n , 1964, pp. 7 3 - 9 3 ; A.F.K. and K a t h e r i n e O r g a n s k i , P o p u l a t i o n and World Power, New Y o r k , I 9 6 I , p. 1 7 ; P h i l i p Hauser. P o p u l a t i o n and World P o l i t i e s . G l e n c o e , 1958, pp. 1 9 3 - 2 1 3 .  17  'A.F.K. and K a t h e r i n e O r g a n s k i , " C h i l d r e n Become an., Economic L i a b i l i t y , L o u i s e B. Young, ed., P o p u l a t i o n i n P e r s p e c t i v e , New Y o r k , 1968, p. 114; Kings±ey -uavis, " P o p u l a t i o n " , i b i d , p. 1 1 9 , 127. 18 P e t e r F r y e r , o p . c i t . , p. 2 9 4 ; Vancouver Sun, 5 J u l y 1969, p. 6 . 19 ^ L i n c o l n H. and A l i c e T a y l o r Bay, o p . c i t . , pp. 1 4 7 - 5 3 ; J . Mayone S t y c o s , "Problems o f F e r t i l i t y C o n t r o l i n UnderDeveloped A r e a s " S t u a r t Mudd, ed., o p . c i t . , p. 9 6 ; A r t h u r W. C a l h o u n , A S o c i a l H i s t o r y o f the American F a m i l y . V o l . 3 , From I863 to 1919, New Y o r k , 1919 ( i 9 6 0 ) p. 1 3 6 . 20  G a r r e t t H a r d i n , "Cassandra Gets a H e a r i n g " , G a r r e t t H a r d i n , ed., o p . c i t . , pp. 39-40. 21 Nathan K e y f i t z , " P o p u l a t i o n and S o c i e t y " . I n t e r n a t i o n a l J o u r n a l , V o l . x x i v , No. 3 , Summer, 1 9 6 9 , p. 145. P a u l R. E h r l i c h , The P o p u l a t i o n Bomb. New Y o r k , 1 9 6 8 , p. 149; J . J . S p e n g l e r , " I m p l i c a t i o n s o f P o p u l a t i o n Change f o r B u s i n e s s " , Commercial, F i n a n c i a l C h r o n i c l e , Aug. 11, 1966, UBC M i c r o f i l m R 3 0 1 0 , I 9 6 6 - 6 7 , p. 3 , 26-27. " I t i s h i g h t i m e , t h e r e f o r e , t h a t b u s i n e s s cease l o o k i n g a t the s t o r k as a b i r d o f good omen.", p. 27; R o b e r t S. McNamara, A d d r e s s t o the U n i v e r s i t y o f N o t r e Dame, N o t r e Dame, I n d i a n a , 1 May, 1969, IBRD, Washington, p. 1 0 - 1 1 . S 2  ^ H a r d i n , o p . c i t . , p. 180; R i c h a r d M. F a g l e y , The P o p u l a t i o n E x p l o s i o n and C h r i s t i a n R e s p o n s i b i l i t y , New Y o r k , I 9 6 0 , p. 115. 24 Genesis 3 8 . 5 H i m e s , o p . c i t . , pp. 6 9 - 7 0 . By 330 B.C., P a l e s t i n e was o v e r p o p u l a t e d , and, a t the t i m e o f t h e J e w i s h m i g r a t i o n , l a r g e f a m i l i e s were no l o n g e r an a s s e t . Polygamy was abandoned, and a two c h i l d f a m i l y became a c c e p t a b l e . 2  2  ^ A c c o r d i n g t o Marie S t o p e s , t h e Roman C a t h o l i c c h u r c h d e l i b e r a t e l y confused c o n t r a c e p t i o n w i t h "Onanism"; and some opponents a l s o i n t e r p r e t e d "Onanism" as m a s t u r b a t i o n . Marie S t o p e s , C o n t r a c e p t i o n , London, 1 9 2 3 , p. 6 9 , f n . ' P a g l e y , o p . c i t . , p. 1 2 1 . C D  27  'Himes, o p . c i t . , pp. 7 7 - 7 8 .  D a v i d M. Peldman, B i r t h C o n t r o l i n J e w i s h l a w , New Y o r k , 1 9 6 8 , p . 3 0 4 . 2 8  9 F a g l e y , o p . c i t . , p. 1 2 1 ; Clyde V. K i s e r , "Summary o f P o p u l a t i o n S t u d y " , o p . c i t . , pp. 1 8 5 - 1 9 2 . 2  3°Fagley, o p . c i t . , p p . 95-96. 31 :Imes, o p . c i t . , p p . 9 3 , 9 7 - 9 8 ; H  F r y e r , o p . c i t . , pp. 2 0 - 2 1  3 A l v a h W. S u l l o w a y , " B i r t h C o n t r o l and C a t h o l i c D o c t r i n e " , H a r d i n , e d . , o p . c i t . , p . 238. 2  3-^1970 World P o p u l a t i o n Data S h e e t . P o p u l a t i o n R e f e r e n c e B u r e a u , Washington, D.C., 1 9 7 0 ; D o r o t h y Nortman, P o p u l a t i o n and F a m i l y P l a n n i n g Programs: A F a c t b o o k , R e p o r t s on Popul a t i o n / F a m i l y P l a n n i n g , P o p u l a t i o n C o u n c i l , New Y o r k , J u l y 1 9 7 0 . pp. 3 3 - 3 4 . I n L a t i n America, since 1966, governments have approved, and sometimes a s s i s t e d , " , , u n i v e r s i t y , o r u n i v e r s i t y - o r g a n i z e d s e r v i c e s i n twelve S p a n i s h - s p e a k i n g c o u n t r i e s where t h e h i g h e s t p o p u l a t i o n g r o w t h r a t e s i n t h e w o r l d e x i s t - a c o n t i n e n t a l average o f 2 . 9 p e r c e n t p e r annum and a d o u b l i n g time o f 24 y e a r s . "The S o c i a l Consequences o f P o p u l a t i o n Growth", P o p u l a t i o n R e f e r e n c e B u r e a u , S e l e c t i o n No. 3 0 , Washington, D.C., O c t o b e r , I 9 6 9 . J  3-'Family P l a n n i n g i n F i v e C o n t i n e n t s , I P P F , London, A p r i l , 1970, pp. 1 5 , 2 1 , 1 8 . 3 I b i d . , pp. 1 1 - 3 1 ? USSR: Views on P o p u l a t i o n / F a m i l y Planning, Studies i n Family Planning, Population C o u n c i l , New Y o r k , J a n u a r y , 1 9 7 0 , p. 4 9 . 6  -^John B a r t l e t t , F a m i l i a r Q u o t a t i o n s , B o s t o n , 1955» P» 2 1 . 3 8 c h r i s t o p h e r T i e t z e e t a l , "Teaching o f F e r t i l i t y R e g u l a t i o n i n M e d i c a l S c h o o l s , Survey i n t h e U n i t e d S t a t e s and Canada, 1 9 6 4 . " JAMA. A p . 4 , 1 9 6 6 , V o l . I 9 6 , pp. 20-24j Donald T. R i c e , " A s i a n i - e d i c a l C o l l e g e s and F e r t i l i t y C o n t r o l " , JAMA, 6 May, 1 9 6 8 , V o l . 204, # 5 6 , p. 1 0 6 ; v  Dr. J o r g e V i l l e r e a l , D i r e c t o r o f P o p u l a t i o n , Pan American F e d e r a t i o n o f A s s o c i a t i o n s o f M e d i c a l S c h o o l s , Bogota, " M e d i c a l l e a d e r s h i p : A C o n t r i b u t i o n t o a Country's Economic Development", F a m i l y P l a n n i n g and N a t i o n a l D e v e l opment, P r o c . SE A s i a and O c e a n i a R e g i o n , IPPF, J u n e , 1 9 6 9 , Bandung, London, 19&9, PP» 51-f>7; Dr. G u i l l e r m o A d r i a s o l a , School of P u b l i c Health, U n i v e r s i t y of C h i l e , " I n t e g r a t i o n o f F a m i l y P l a n n i n g i n t o M e d i c a l C u r r i c u l a " , I b i d . , pp. 1 8 5 - 1 9 2 . 3 9 l r y e r , o p . c i t . , pp.  144,201,274,276,294,3*0.  ^OAlan Guttmacher, "The R e s p o n s i b i l i t y o f t h e P u b l i c H e a l t h and M e d i c a l P r o f e s s i o n s " , P r o c . 8 t h I n t e r n a t i o n a l C o n f e r e n c e , I P P F , S a n t i a g o , 1 9 6 7 , London, 1967, pp. 208^09. ^ L i n c o l n H. Day, "The American F e r t i l i t y S t u a r t Mudd, ed., O p . C i t . , pp. 2 3 1 - 3 8 .  Cult",  CHAPTER  I  The S o c i a l Reformers: The U n i t e d Kingdom  I t has always needed a devoted band of p i o n e e r s t o i n t r o d u c e the i d e a , t o brave uninformed o p p o s i t i o n , and t o e s t a b l i s h the f i r s t s e r v i c e s . T i m i d i t y i s too o f t e n the most prominent q u a l i t y o f p o l i t i c i a n s and c i v i l s e r v a n t s , and the courage o f v o l u n t e e r s has had t o show them t h a t t h e y had no need t o f e a r . The demand i s l a t e n t l y p r e s e n t i n e v e r y c o u n t r y from the o r d i n a r y p e o p l e . . . . The s t o r y o f b i r t h c o n t r o l as a t o o l o f s o c i a l r e f o r m began i n t h e l a s t decade o f the e i g h t e e n t h c e n t u r y when Marquis de Condorcet, a F r e n c h p h i l o s o p h e r , wrote o f the i d e a l s t a t e i n w h i c h a l l p a s s i o n would e v e n t u a l l y dwindle away; and W i l l i a m Godwin, an E n g l i s h m a t e r i a l i s t , b e l i e v i n g p o v e r t y was  caused by s o c i a l i n e q u i t i e s , urged man t o make 2  g r e a t e r use o f h i s c a p a c i t y f o r s e l f - d e t e r m i n a t i o n and r e a s o n . Such views aroused c o n s i d e r a b l e c o n t r o v e r s y . Among those  who  a t t a c k e d them was an A n g l i c a n c l e r g y m a n , Reverend Thomas M a l t h u s , who  l a t e r became p r o f e s s o r o f p o l i t i c a l economy a t the E a s t  I n d i a Company's t r a i n i n g college,Haileybury»  H i s Essays on  The P r i n c i p l e o f P o p u l a t i o n as I t A f f e c t s the F u t u r e Improvement o f Mankind sought t o demonstrate t h a t the achievement o f the i d e a l s t a t e would always be o b s t r u c t e d by the tendency o f p o p u l a t i o n t o p r e s s upon the means o f s u b s i s t e n c e .  Between  1798  and 1826  Malthus r e v i s e d h i s o r i g i n a l essay f i v e  h u t h i s i d e a s remained t h e same. follows:  They may  times,  he summarized as  P o p u l a t i o n i n c r e a s e s i n a g e o m e t r i c r a t i o , whereas  subsistence increases only i n arithmetic r a t i o . l a t i o n not s u b j e c t t o c e r t a i n checks, the means of s u b s i s t e n c e .  Were popu-  i t would expand beyond  In f a c t , given a t o t a l population  o f one b i l l i o n , i t would m u l t i p l y by 256 s u b s i s t e n c e would o n l y m u l t i p l y by 9»  i n 200 y e a r s , whereas The  l o n g term cheek  i s want of f o o d , but s h o r t term checks are m o r a l r e s t r a i n t ( a degree o f a s c e t i c i s m t h r o u g h s e x u a l r e s t r a i n t marriage,  outside  and l a t e m a r r i a g e ) , v i c e ( p r o s t i t u t i o n and  forms of s e l f - g r a t i f i c a t i o n ) , and m i s e r y disease),  (war, famine  other and  I n s p i t e o f these checks, p o p u l a t i o n growth con-  's  t i n u e s , and the poor are the c h i e f v i c t i m s .  Malthus  claimed  t h a t , i n s t e a d of h e l p i n g t o r e l i e v e p o v e r t y , the Poor Laws ( i n s t i t u t e d i n the s e v e n t e e n t h aggravating  it.  c e n t u r y and s i n c e amended) were  Because the low income p o p u l a t i o n was  encour-  aged t o i n c r e a s e i n number, " p r o v i s i o n s " per c a p i t a were reduced.  Some o f those who  would be f o r c e d to a p p l y .  were not y e t on s o c i a l a s s i s t a n c e P r i c e s o f p r o v i s i o n s were r i s i n g ,  but t h e r e a l p r i c e of l a b o r was o f f r u g a l i t y , and t h e r e was purposes.  The  d e c l i n i n g . There was  a lack  i n c r e a s e d spending f o r u s e l e s s  French R e v o l u t i o n had  indeed improved the  c o n d i t i o n o f the poor i n t h a t c o u n t r y by g i v i n g them a g r e a t e r share of l a n d and the b e n e f i t s of p r o d u c t i o n , b u t t h i s had  been  accompanied by a d i m i n i s h e d p r o p o r t i o n o f b i r t h s , g r e a t e r i n d u s t r y , g r e a t e r s e l f - r e l i a n c e and an i n c l i n a t i o n t o s a v e .  I f i t be taught t h a t a l l who a r e born have a r i g h t t o s u p p o r t on the l a n d , whatever be t h e i r number, and t h a t t h e r e i s no o c c a s i o n to e x e r c i s e any prudence i n the a f f a i r of m a r r i a g e so as t o check t h i s number, the temptat i o n s , a c c o r d i n g t o a l l the known p r i n c i p l e s of human n a t u r e , w i l l i n e v i t a b l y be y i e l d e d t o , and more and more w i l l g r a d u a l l y become dependent on p a r i s h a s s i s t a n c e . There cannot t h e r e f o r e be a g r e a t e r i n c o n s i s t e n c y and c o n t r a d i c t i o n than t h a t those who m a i n t a i n t h e s e d o c t r i n e s r e s p e c t i n g the poor should s t i l l complain o f the number o f p a u p e r s . Such d o c t r i n e s and a crowd o f paupers a r e u n a v o i d a b l y u n i t e d ; and i t i s u t t e r l y beyond the power o f any r e v o l u t i o n o r change of government t o s e p a r a t e them.... 0  M a l t h u s s t a t e d a l s o t h a t the o n l y s o l u t i o n was r a i s e the b u y i n g power o f the poor by and r e d u c i n g i n wages.  to  controlling prices  the l a b o r s u p p l y , t h u s b r i n g i n g about a r i s e  I f the r i c h r e a l l y wanted t o see the  condition 7  o f t h e poor improve, t h e y must a c c e p t an end t o cheap l a b o r . A s t a t i o n a r y p o p u l a t i o n was  d e s i r a b l e , f o r i t would b r i n g  about a b a l a n c e between s u p p l y and  demand.  were needed, i n c e n t i v e s c o u l d be i n t r o d u c e d . have been the n i n e t e e n t h  Then, i f growth ( T h i s must  c e n t u r y v e r s i o n o f Zero  Population  Growth!) By r e d u c i n g  the l a b o r s u p p l y , Malthus meant  the r a t e o f n a t u r a l i n c r e a s e , and  reducing  s t a t e d that t h i s could  be brought about by m o r a l r e s t r a i n t .  only  He d i d not f a v o r b i r t h  c o n t r o l by any o t h e r means. When t h i s r e s t r a i n t produces v i c e , the e v i l s w h i c h f o l l o w a r e but too c o n s p i c u o u s . A promiscuous i n t e r course t o s u c h a degree as t o p r e v e n t  the b i r t h o f c h i l d r e n seems t o l o w e r , i n the most roe rice d manner, the d i g n i t y o f human n a t u r e . I t cannot be w i t h o u t i t s e f f e c t on men, and n o t h i n g can be more obvious than i t s tendency t o degrade the female c h a r a c t e r , and t o d e s t r o y ' a l l i t s most amiable and d i s t i n g u i s h i n g c h a r a c t e r i s t i c s ...° Malthus i s b e i n g r e - r e a d t o - d a y w i t h growing In  interest.  the l i g h t o f progress-in food p r o d u c t i o n , t e c h n o l o g y ,  and  s t u d i e s o f t h e f a c t o r s a f f e c t i n g human f e r t i l i t y , a number o f p e o p l e b e l i e v e he was wrong.  On the o t h e r hand, perhaps h i s  t h e o r y has been proven t r u e f o r d e v e l o p i n g c o u n t r i e s a l r e a d y , and, i f t o t a l r e s o u r c e s a r e l i m i t e d , f o r the r e s t o f the w o r l d as w e l l .  H i s s u g g e s t i o n t h a t p o v e r t y c o u l d be s o l v e d  by s e l f - h e l p and l i m i t a t i o n o f f e r t i l i t y may have been b o t h r e a l i s t i c and u s e f u l .  I t i s b e i n g t r i e d to-day i n some p l a c e s .  R i g h t or wrong, Malthus d i d p o s t u l a t e a r e l a t i o n s h i p between p o p u l a t i o n and f o o d , and i n s p i r e d c o n t i n u i n g s t u d i e s o f popul a t i o n change and the development o f the s c i e n c e o f demography. The  essays made enemies i n more than one  camp.  The  U t o p i a n s were upset by t h e argument t h a t t h e i r i d e a l  was  unattainable•  advocacy  Business i n t e r e s t s resented Malthus's  o f h i g h e r wages f o r l a b o r , and used h i s comment t h a t t h e r e would always be p r o p r i e t o r s and l o b o r e r s t o j u s t i f y i n a c t i o n to  improve t h e l o t o f t h e l a t t e r •  The U t i l i t a r i a n s ,  who  agreed w i t h many o f h i s i d e a s i n p r i n c i p l e , saw no hope o f h e l p i n g the w o r k i n g c l a s s t o reduce f e r t i l i t y t h r o u g h ceticism.  I t was  as-  from the U t i l i t a r i a n group t h a t the f o r e -  r u n n e r s o f t h e f a m i l y p l a n n i n g movement a r o s e , and, when t h e y  formed o r g a n i z a t i o n s i n the l a t e n i n e t e e n t h and e a r l y twent i e t h c e n t u r i e s , many o f them were so audacious as t o  call  t h e m s e l v e s , " M a l t h u s i a n " o r "Neo-Malthusian Leagues".  Nothing  a s s o c i a t e d p o p u l a t i o n growth w i t h human m i s e r y so r e a d i l y , as did  t h e name o f M a l t h u s , h u t , c o n s i d e r i n g h i s v i e w s on c o n t r a -  c e p t i o n , n o t h i n g was a b i g g e r sham. The proponents o f U t i l i t a r i a n i s m , Jeremy Bentham, James M i l l and Joseph Townshend, argued t h a t , i f the l o t o f the w o r k i n g c l a s s e s c o u l d be improved t h r o u g h a r e d u c t i o n i n t h e i r numbers, t h e y s h o u l d have c o n t r a c e p t i o n . The f i r s t o f the a c t i v e s u p p o r t e r s o f the i d e a , and a c l o s e f r i e n d o f M i l l , was F r a n c i s P l a c e , a s e l f - e d u c a t e d t a i l o r who  had known p o v e r t y  b u t was becoming s u c c e s s f u l i n b u s i n e s s and p o l i t i c s .  Urging  the needs o f the w o r k i n g c l a s s e s , and o f women w i t h p h y s i c a l weaknesses, P l a c e wrote I l l u s t r a t i o n s and P r o o f s o f t h e P r i n c i p l e o f P o p u l a t i o n , i n w h i c h he condemned M a l t h u s ' s 10 "moral r e s t r a i n t " as i m p r a c t i c a l .  H a n d b i l l s were d i s t r i -  b u t e d i n 1822 i n w o r k i n g c l a s s d i s t r i c t s i n London and the industrial north.  They were a d d r e s s e d "to the m a r r i e d o f  b o t h s e x e s " i n b o t h " g e n t e e l l i f e " and "among t h e w o r k i n g p e o p l e " , and suggested t h a t , by l i m i t i n g the number o f  chil-  d r e n , the workers would e n j o y r i s i n g wages and have more t i m e for  r e c r e a t i o n and the m o r a l and r e l i g i o u s i n s t r u c t i o n o f t h e i r  offspring.  Through w i t h d r a w a l and the sponge, workers c o u l d  make e a r l y m a r r i a g e s , and p r o s t i t u t i o n and debauchery be r e d u c e d .  P l a c e ' s opponents c a l l e d h i s h a n d b i l l s  and s a i d t h e y would have the o p p o s i t e e f f e c t .  would "diabolical"  But no  action  was  taken t o s i l e n c e Mm,  and he had  the support  of other  11  U t i l i t a r i a n s as w e l l . for  John S t u a r t M i l l summed up the case  b i r t h c o n t r o l i n 1823, By c h e c k i n g p o p u l a t i o n , no p a i n i s i n f l i c t e d , no a l a r m e x c i t e d , no s e c u r i t y i n f r i n g e d . I t cannot t h e r e f o r e , on any p r i n c i p l e s , be termed immoral; and ... i f i t tends t o e l e v a t e the w o r k i n g p e o p l e from p o v e r t y and i g n o r a n c e t o a f f l u e n c e and i n s t r u c t i o n , I am compelled t o -, r e g a r d i t as h i g h l y m o r a l and v i r t u o u s .  ?  As an exponent o f b i r t h c o n t r o l , P l a c e was  f o l l o w e d by  R i c h a r d C a r l i l e , a f r e e t h i n k i n g p u b l i s h e r who,  besides  con-  t i n u i n g t h e campaign f o r c o n t r a c e p t i o n f o r the p o o r , a l s o f o u g h t a l o n g b a t t l e f o r the freedom of the p r e s s .  Together  w i t h m e d i c a l a r t i c l e s on o t h e r t o p i c s , he p u b l i s h e d E v e r y Woman's Book, a pamphlet w h i c h a d v o c a t e d the sponge, the condom and w i t h d r a w a l .  So f a r as i s known, however, n e i t h e r  P l a c e nor C a r l i l e had any e f f e c t on the w o r k i n g c l a s s b i r t h r a t e ; and o v e r t i n t e r e s t i n b i r t h c o n t r o l waned a f t e r passage o f the Reform B i l l and t h e new P o o r Law  o f 1834  (which  placed  s o c i a l w e l f a r e payments under the s u p e r v i s i o n o f the n a t i o n a l government).  I t i s d o u b t f u l a l s o i f c o n t r a c e p t i o n was  used  a t t h a t time t o any g r e a t e x t e n t by any income group i n B r i t a i n , but i n one v e r y h i g h p l a c e t h e r e was cern.  I n 1841  p e r s o n a l con-  the young Queen V i c t o r i a wrote t o her  the K i n g of the B e l g i a n s , I t h i n k , d e a r e s t U n c l e , you cannot r e a l l y w i s h me t o be the "Mama d'une nombreuse f a m i l l e " , f o r I t h i n k you w i l l see w i t h me the g r e a t i n c o n v e n i e n c e a l a r g e f a m i l y would be t o us a l l , and p a r t i c u l a r l y t o  uncle,  the c o u n t r y , independent o f t h e h a r d s h i p and i n c o n v e n i e n c e t o m y s e l f ; men n e v e r t h i n k , a t l e a s t seldom t h i n k what a h a r d t a s k i t i s f o r us^women t o go t h r o u g h t h i s very o f t e n . 1  5  N e v e r t h e l e s s t h e Queen became r e s i g n e d t o t h e "hard t a s k " n i n e times i n l e s s than seventeen  years.  I n F r a n c e , however, where i n t e l l e c t u a l r a d i c a l i s m and s o p h i s t i c a t i o n were a l r e a d y w e l l e s t a b l i s h e d , w i t h d r a w a l and the sponge were much i n vogue.  The b i r t h r a t e had f a l l e n  f r o m 38.5 p e r 1000 i n 1771-75 t o 3 1 . 3 i n 1816 (and was t o d e c l i n e t o 25.4 b y 1871-1880).  What W i l l i a m Ranger c a l l e d  " d i s g u i s e d i n f a n t i c i d e " was a l s o v e r y common - b a b i e s  turned  over t o a n c i e n t crones o r f o u n d l i n g h o s p i t a l s , p a c i f i e d w i t h g i n and d y i n g o f n e g l e c t , o r p e r i s h i n g i n t h e care o f peasant women i n t h e c o u n t r y s i d e . 14 i n t h i s way.  More than one t h i r d o f b a b i e s d i e d  From 1846 e m i g r a t i o n from Western Europe a l s o  reduced t h e p o p u l a t i o n growth r a t e .  Agitation for birth  c o n t r o l i n c r e a s e d , a b o r t i o n became commonplace, t h e age o f marriage r o s e , and, i n p u r s u i t o f h i g h e r s o c i a l and economic 15 s t a t u s , f a m i l y s i z e shrank.  SCANDINAVIA AND JAPANi COMPARISON OP VITAL RATES  1800  1820  1840  1860  1880  1900  1920  1940  1960  Figure 2. Birth and death rates for Denmark, Norway, and Sweden combined (black lines and dales) are compared with Japanese rates (gray lines and dates) of 50 years later. Japan has been passing through a population change similar to that which occurred earlier in Scandinavia."Area between respective birth-rate curves (solid lines) and death-rate curves (broken lines) shows natural increase, or population growth that would have occurred without migration. In past few years both Japanese rates have dropped extremely rapidly. #  I l l u s t r a t e s the d i f f e r e n c e between a spontaneous and a n induced d e c l i n e i n p o p u l a t i o n growth r a t e s . Source*  K i n g s l e y D a v i s , " P o p u l a t i o n " , L o u i s e B. Young, e d . , P o p u l a t i o n i n P e r s p e c t i v e . T o r o n t o , 1968, pb, p. 119.  I n t h e U n i t e d Kingdom, i n 1854, a f t e r a time l a p s e o f t w e n t y y e a r s , t h e e f f o r t s o f P l a c e and C a r l i l e were r e v i v e d when D r . George D r y s d a l e w r o t e , anonymously, a hook c a l l e d P h y s i c a l , S e x u a l and N a t u r a l R e l i g i o n .  I t was p u b l i s h e d by  Edward T r u e l o v e , a f r e e t h i n k i n g f o l l o w e r o f R o b e r t  Owen,  S c o t t i s h s o c i a l r e f o r m e r and p i o n e e r i n t h e c o - o p e r a t i v e movement.  L a t e r e d i t i o n s were c a l l e d Elements o f S o c i a l  Science, and, i n the P l a c e t r a d i t i o n , favoured c o n t r a c e p t i o n and sex e d u c a t i o n as a means o f r a i s i n g wage r a t e s .  Drysdale  went f u r t h e r , however, i n h o l d i n g t h a t mankind s u f f e r e d f r o m the i n t e r r e l a t e d e v i l s o f p o v e r t y , p r o s t i t u t i o n and c e l i b a c y , and i n s i s t e d t h a t b i r t h c o n t r o l was t h e cure f o r a l l t h r e e . M a r r i a g e s h o u l d n o t be c o n s i d e r e d t h e p r e r e q u i s i t e f o r i n t e r course a n d , i f women would take t h e r e s p o n s i b i l i t y f o r a v o i d i n g pregnancy, by u s i n g t h e sponge, men c o u l d have f u l l enjoyment o f "the v e n e r e a l a c t " .  Drysdale a l s o included f r a n k d i s c u s -  s i o n o f a l l methods o f b i r t h r e g u l a t i o n - from p r o l o n g e d l a c t a t i o n t o induced a b o r t i o n - v e r y d o u b t f u l t o v e r y He wrote a r t i c l e s on N e o - M a l t h u s i a n i s m Charles Bradlaugh's  certain.  (birth control) f o r  N a t i o n a l Reformer, and, i n t h e e a r l y  1860s, f o u n d e d , w i t h B r a d l a u g h , a s h o r t - l i v e d League t o promote c o n t r a c e p t i o n . ^ 1  Malthusian  Whether o r n o t D r y s d a l e * s  f r e e l o v e p h i l o s o p h y was t h e cause, t h e B r i t i s h government passed t h e Obscene P u b l i c a t i o n s A c t i n 1857* b e f o r e a n o t h e r uproar over f a m i l y l i m i t a t i o n  I t was n o t l o n g occurred.  I n 1868, L o r d Amberley, son o f L o r d J o h n , and f a t h e r o f B e r t r a n d R u s s e l l , a t a meeting on o v e r - p o p u l a t i o n and p u b l i c  h e a l t h , o r g a n i z e d by the London D i a l e c t i c a l S o c i e t y , the hope t h a t b i r t h c o n t r o l methods would improve. and  expressed The  s o c i e t y promoted o v e r - p o p u l a t i o n , he s a i d , and he  sure t h a t , i f women had families.  He was  clergy was  a say, t h e y would not f a v o r l a r g e  a t t a c k e d from many q u a r t e r s , i n c l u d i n g the  m e d i c a l p r e s s , and the f u r o r e l a s t e d f o r more t h a n a y e a r , 17 g i v i n g the i s s u e i n c r e a s e d p u b l i c i t y . of P l a c e , the campaign was g r e a t e r p u b l i c row was Dedicated i s s u e , and,  But, from the days  more o r l e s s d e s u l t o r y u n t i l a  r a i s e d by B r a d l a u g h h i m s e l f .  t o p r o m o t i n g f r e e p u b l i c d i s c u s s i o n of  s p e c i f i c a l l y , such causes as compulsory  any  education,  l a n d r e f o r m , the s e p a r a t i o n o f church and s t a t e , r e p u b l i c a n i s m , and the a b o l i t i o n of h e r e d i t a r y peerages - as a f r e e t h i n k e r , B r a d l a u g h a l s o a t t a c k e d c o n v e n t i o n a l r e l i g i o n , and, i n p a r t i c u l a r , the swearing s t r u g g l e he was  o f o a t h s on t h e B i b l e .  A f t e r a long  e l e c t e d t o the House of Commons where he  c o n s i d e r a b l e r e s p e c t , though l i t t l e a p p r o b a t i o n , r a d i c a l views. prosecuted  and  for his  V/hen a B r i s t o l b o o k s e l l e r and p u b l i s h e r j a i l e d f o r s e l l i n g an i l l u s t r a t e d  ( b e l i e v e d t o have i n c l u d e d drawings o f the  won  was  edition  reproductive  organs) o f F r u i t s of P h i l o s o p h y , a book on b i r t h c o n t r o l by D r . C h a r l e s Knowlton o f the U n i t e d S t a t e s , B r a d l a u g h t h a t t h i s was an i m p o r t a n t  decided  another instance i n which f r e e d i s c u s s i o n of s u b j e c t had been o b s t r u c t e d .  f r e e speech must be p u r s u e d .  The  p r i n c i p l e of  Forming the F r e e t h o u g h t P u b l i s h -  i n g Company w i t h Mrs. Annie Besant (another s o c i a l  reformer  and a f e m i n i s t ) he p u b l i s h e d the same pamphlet - t h i s time  w i t h n o t e s "by Dr. D r y s d a l e .  Next, Bradlaugh n o t i f i e d  p o l i c e t h a t he i n t e n d e d t o s e l l i t , and where. Mrs. Besant were charged w i t h o b s c e n i t y . c i r c u l a t i o n s i n c e 1832  the  He. and  Though the book's  had averaged o n l y a thousand c o p i e s  a y e a r , i n t h e t h r e e months between t h e i r a r r e s t i n 1877 t h e i r t r i a l , 1 2 5 , 0 0 0 c o p i e s were s o l d .  and  The two were c o n v i c t e d  o f p u b l i s h i n g "an obscene l i b e l c a l c u l a t e d t o d e s t r o y o r c o r r u p t the morals o f the p e o p l e " but t h e i r defense was  summed  up as f o l l o w s : No b e t t e r book can be p u b l i s h e d , f o r d o c t o r s w i l l not w r i t e , and p u b l i s h e r s w i l l not s e l l , a work w h i c h may b r i n g them w i t h i n the w a l l s o f a g a o l . I t was f o r the sake of f r e e d i s c u s s i o n t h a t we p u b l i s h e d the a s s a i l e d pamphlet, and t o make the way p o s s i b l e f o r o t h e r s d e a l i n g w i t h the same t o p i c , t h a t we r i s k e d the p e n a l t y w h i c h has f a l l e n upon u s . . . . Once more a cause has t r i umphed by t h e f a l l of i t s defenders ... and has g a i n e d a h e a r i n g from the dock t h a t i t would never have won from the p l a t f o r m .... ... T h i s b a t t l e w i l l end, as e v e r y o t h e r such b a t t l e has ended, i n the t r i u m p h o f a Free P r e s s .... 1 ° On a t e c h n i c a l i t y , B r a d l a u g h and Mrs. Besant won and a t once p u b l i s h e d a new  an a p p e a l ,  pamphlet, w r i t t e n by Mrs.  Besant,  The Law o f P o p u l a t i o n : I t s Consequences and i t s B e a r i n g Upon Human Conduct and M o r a l s .  In i t she d i s c u s s e d t h e popu-  l a t i o n problem i n I n d i a and i n I r e l a n d , and the  humanitarian  reasons f o r making b i r t h c o n t r o l knowledge a v a i l a b l e t o a l l . She d e s c r i b e d v a r i o u s methods - rhythm, w i t h d r a w a l , douche, baudruche (condom) and the sponge, and warned a g a i n s t r e l i a n c e  on l a c t a t i o n . s a r y and  She  favored  a b o r t i o n o n l y i f a b s o l u t e l y neees  concluded, Thus has t h e c e f f o r t t o o b t a i n s o c i a l r e f o r m gone hand i n hand w i t h t h a t f o r p o l i t i c a l and r e l i g i o u s freedom; the v i c t o r s i n t h e l a t t e r have been the s o l d i e r s i n the former. Discussion on the p o p u l a t i o n q u e s t i o n i s not y e t s a f e ; l e g a l p e n a l t y t h r e a t e n s those who advocate t h e r e s t r i c t i o n of b i r t h i n s t e a d of the d e s t r u c t i o n of l i f e ; .... V/e work f o r the redemption of the p o o r , f o r the s a l v a t i o n of the w r e t c h e d ; the cause of the people i s the s a c r e d e s t o f a l l c a u s e s , and i s the one which i s the most c e r t a i n t o t r i u m p h , however sharp may be the s t r u g g l e f o r the victory. 9 x  T h i s p u b l i c a t i o n enjoyed phenomenal s a l e s (200,000 i n s i x y e a r s ) even as f a r away as New f u r t h e r l e g a l a c t i o n was 20 Kingdom.  South Wales; but  t a k e n t o s u p p r e s s i t i n the  no United  Mrs. Besant and B r a d l a u g h were f r e q u e n t l y a t -  t a c k e d , however, f o r c o n t r i b u t i n g t o " s e x u a l o r g i e s s o c i a l degradation" who  copies  because i t was  and  assumed t h a t f r e e t h i n k e r s  would approve D r y s d a l e ' s t h e o r i e s of f r e e l o v e must be  w h o l l y depraved.  But, t h e y had p r a i s e d D r y s d a l e f o r h i s  courage, not f o r h i s p h i l o s o p h y .  R e a l l y s i g n i f i c a n t was  the  f a c t t h a t t h e d i s t r i b u t i o n of b i r t h c o n t r o l knowledge was more or l e s s unimpeded i n the U n i t e d I n 1877 w i t h Dr. C H .  o r 1878 Drysdale,  the M a l t h u s i a n  Kingdom. league was  revived,  younger b r o t h e r of the a u t h o r o f  E l e m e n t s , as p r e s i d e n t , and Annie B e s a n t as s e c r e t a r y . younger D r y s d a l e ' s w i f e , Dr. A l i c e V i c k e r y , f i r s t woman d o c t o r , and  now  Edward T r u e l o v e were among the members.  The  Dr. H.A. A l l b u t t , a d e r m a t o l o g i s t , 21 j o i n e d i n 1880.  L i k e t h e U t i l i t a r i a n s , w i t h whom some were  a f f i l i a t e d , these "Malthusians" against poverty.  f r e e t h i n k e r and r e p u b l i c a n ,  saw themselves as c r u s a d e r s  House-to-house canvasses o f w o r k i n g c l a s s  a r e a s were conducted, and a monthly j o u r n a l i s s u e d . Malthusian  The  became v e r y p o p u l a r and a t t r a c t e d new members.  B u t , due t o t h e i n f l u e n c e o f Mme H e l e n a B e t r o v n a B l a v a t s k y , l e a d e r o f t h e T h e o s o p h i s t movement, Mrs. Besant l e f t thought and t h e M a l t h u s i a n  League.  Free-  Instead o f contraception,  she adopted t h e view t h a t t h e s e x u a l i n s t i n c t must be c o n t r o l led,  and t h a t i t s i n d u l g e n c e s h o u l d be r e s t r i c t e d t o t h e 22  perpetuation  of the race.  I n 1928,  however, she a t t e n d e d  a d i n n e r h e l d i n London i n honour o f t h e f i f t i e t h  anniversary  o f the famous B r a d l a u g h - B e s a n t t r i a l , and i n d i c a t e d t h a t she had  amended h e r c o n v i c t i o n s once more.  Wow, she s a i d , she  f e l t she had been r i g h t t o f o l l o w Madame B l a v a t s k y ' s  views,  and t h a t s e l f c o n t r o l was e s s e n t i a l ; b u t b i r t h c o n t r o l must be promoted f o r m a t e r i a l r e a s o n s .  J  By t h i s time o p p o s i t i o n was b e g i n n i n g  to c r y s t a l l i z e ,  but t h e e f f o r t s o f the i n t e r e s t groups t o p u t an end t o t h i s t h r e a t were o n l y p a r t i a l l y s u c c e s s f u l . As has been n o t e d , i n t h e 1870s t h e B r i t i s h b i r t h r a t e commenced a more o r l e s s s t e a d y d e c l i n e w h i c h has c o n t i n u e d t o 2k  t h i s day.  The f i r s t t o c o n t r o l t h e i r f e r t i l i t y were b u s i n e s s 25  and p r o f e s s i o n a l f a m i l i e s . ^ drawal popular. married l a t e r .  Methods were i m p r o v i n g and w i t h -  From t h e 1870s, t h e middle c l a s s e s a l s o I t i s p o s s i b l e , too, that the small family  and  " l a d y " w i f e had become a s t a t u s symbol and means o f s o c i a l 26  upgrading.  D.V. G l a s s suggests t h a t w o r k i n g c l a s s  couples  who wished t o upgrade themselves d i d n o t r e a l l y a c c e p t  birth  c o n t r o l u n t i l i t was o b v i o u s t h a t i t had been adopted by t h e h i g h e r income g r o u p s ; b u t , once t h e s t y l e was s e t , t h e y  fol-  lowed s u i t . ' ' ' 2  The  i n t e r e s t groups c o n t i n u e d t h e i r o v e r t o p p o s i t i o n ,  however, and, when, i n 1 8 8 7 D r . A l l b u t t p u b l i s h e d The W i f e ' s 1  Handbook - w h i c h i n c l u d e d h y g i e n e , p r e - n a t a l and baby c a r e , t h e m e d i c a l p r o f e s s i o n forbade him t h e r i g h t t o p r a c t i s e . A p p a r e n t l y t h e G e n e r a l M e d i c a l C o u n c i l was n o t o n l y  confusing 28 contraception w i t h obscenity, but also with abortion. The movement i t s e l f c o n t i n u e d t o be accused o f i m m o r a l i t y and a t h e i s m , b u t i t found new support f r o m a n o t h e r c o n t r o v e r s i a l  body, t h e E u g e n i c s S o c i e t y f o r R a c i a l Q u a l i t y , founded i n 1883  by S i r F r a n c i s G a l t o n . ^ 2  The Fabian S o c i e t y , a S o c i a l i s t  o r g a n i z a t i o n l e d by George -Bernard Shaw, S i d n e y and B e a t r i c e Webb and o t h e r s , a l s o s u p p o r t e d  it. 30 " N e o - M a l t h u s i a n " had been c o i n e d .  By t h i s t i m e , t h e t e r m , However, t h e d e c l i n i n g  b i r t h r a t e t o o k on a new a s p e c t . Alarmed by what t h e y c o n s i d e r e d a t h r e a t o f underp o p u l a t i o n , t h e A n g l i c a n b i s h o p s , a t t h e Lambeth Conference o f 1908, condemned c o n t r a c e p t i o n and c a s t i g a t e d d o c t o r s who p r o v i d e d i n f o r m a t i o n o r f i t t e d p a t i e n t s w i t h t h e Dutch c a p , otherwise  known as t h e Mensinga diaphragm,  ( I t was i n v e n t e d  i n t h e 1870s by D r . W i l l i a m Mensinga o f F l e n s b u r g , and, by 31 1908, was a v e r y p o p u l a r method). But t h e i r w a r n i n g s went  unheeded.  I r o n i c a l l y enough, t h e B r i t i s h Census o f 1911  showed t h a t clergymen, d o c t o r s and t e a c h e r s had t h e s m a l l e s t f a m i l i e s - t h r e e o c c u p a t i o n a l groups o v e r t l y opposed t o b i r t h 32 c o n t r o l , b u t , a p p a r e n t l y , t h e most e f f e c t i v e p r a c t i t i o n e r s . I n B r i t a i n , i l l e g a l l y induced  a b o r t i o n was p r e v a l e n t ,  and, n o t o n l y dangerous a p p l i a n c e s , b u t dangerous a b o r t i f a c i e n t s were b e i n g promoted by p h a r m a c i s t s , 33 b a r b e r s , and market t r a d e r s .  herbalists,  Misunderstanding  and m i s i n f o r -  mation about t h e r e a l n a t u r e and purpose o f b i r t h c o n t r o l had become so w i d e s p r e a d t h a t D r . C.V. D r y s d a l e , P r e s i d e n t o f t h e M a l t h u s i a n League, (son o f D r . C.R. D r y s d a l e , an e a r l i e r p r e s i d e n t and nephew o f D r . George D r y s d a l e , a u t h o r o f Elements o f S o c i a l S c i e n c e ) d e c i d e d  i n 1913 t o h o l d p u b l i c  meetings t o c l e a r up some o f t h e c o n f u s i o n .  He a l s o  circu-  l a t e d l e a f l e t s , p a r t i c u l a r l y i n working class d i s t r i c t s , w h i c h i n c l u d e d i n f o r m a t i o n on c o n t r a c e p t i o n and a l s o about infertility.  Not l o n g a f t e r w a r d s M a r i e S t o p e s , a second  woman advocate o f sex e d u c a t i o n and c o n t r a c e p t i o n appeared on t h e s c e n e . Her o r i e n t a t i o n , though i n p a r t s o c i a l and e u g e n i c , was m a i n l y h u m a n i t a r i a n and p e r s o n a l . B i r t h c o n t r o l was f o r h e r a means o f f r e e i n g women from the bondage o f numerous and unwanted p r e g n a n c i e s ; hence h e r o u t l o o k was a l s o f e m i n i s t and l i b e r t a r i a n . 3 ^ Mrs. S t o p e s , a b o t a n i s t who had earned a PhD. i n a German U n i v e r s i t y , and whose uncomsummated m a r r i a g e had been a n n u l l e d i n 1916,  d e c i d e d t o p u b l i s h a book on s e x and mar-  r i a g e so t h a t o t h e r s c o u l d be h e l p e d  t o u n d e r s t a n d t h e i r own  problems.  P u b l i c a t i o n was f i n a n c e d by H.V. Roe, one o f t h e  f o u n d e r s o f Avro A i r c r a f t , whom she l a t e r m a r r i e d .  Though i t  gave few d e t a i l s about t h e s u b j e c t , M a r r i e d Love caused an international sensation.  Her r e a d e r s demanded more p r e c i s e  i n f o r m a t i o n , so D r . Stopes o b l i g e d w i t h Wise P a r e n t h o o d , i n w h i c h she d e s c r i b e d v a r i o u s methods o f i n t e r c o u r s e and b i r t h c o n t r o l , i n d i c a t i n g h e r p a r t i a l i t y f o r t h e c e r v i c a l cap.  The  l a t t e r p u b l i c a t i o n was v e r y c o n t r o v e r s i a l , and even s u p p o r t e r s o f b i r t h c o n t r o l f e l t t h a t i t was t o o f r a n k and t o o r e a d i l y a v a i l a b l e t o s c h o o l boys and g i r l s . B e l i e v i n g t h a t she had d i v i n e i n s p i r a t i o n , i n 1920, Dr. Stopes attempted t o persuade t h e Lambeth Conference o f t h a t y e a r t o approve c o n t r a c e p t i o n .  Her p r i v a t e l e t t e r t o  each o f t h e b i s h o p s was s t u d i o u s l y i g n o r e d . B u t t h e o p p o s i t i o n l o s t ground when L o r d Dawson o f Penn, p h y s i c i a n t o K i n g Georve V, e l e c t r i f i e d a l a y congress i n Birmingham the n e x t year by s u p p o r t i n g b i r t h c o n t r o l .  H i s stand was backed by  Dean Inge ("The Gloomy Dean") o f S t . P a u l ' s C a t h e d r a l .  As  t h e r e was new concern f o r m a t e r n a l and c h i l d h e a l t h , and f e m i n i s m was growing s t r o n g e r , b o t h t h e c l e r g y and d o c t o r s began t o r e l e n t . I n 1921 D r . Stopes and h e r husband opened t h e " f i r s t b i r t h c o n t r o l c l i n i c i n t h e B r i t i s h Empire" i n I s l i n g t o n , where a n u r s e f i t t e d women w i t h c e r v i c a l caps (known a l s o a s "check" o r " o c c l u s i v e " p e s s a r i e s ) .  As t h e c l i n i c was i n a  m o b i l e v a n , i t c o u l d a l s o be c a l l e d t h e " f i r s t m o b i l e i n the world.  clinic"  Acceptance was handicapped by t h e a t h e i s m o f  most o f h e r p r e d e c e s s o r s , and by t h e advocacy o f f r e e l o v e by some o f h e r r i v a l s ( H a v e l o c k E l l i s and H.G. W e l l s , f o r example), so Mrs. Stopes o r g a n i z e d t h e S o c i e t y f o r C o n s t r u c t i v e B i r t h C o n t r o l and R a c i a l P r o g r e s s , a p p e a l i n g f o r members on the grounds o f s o c i a l b e t t e r m e n t ,  eugenic improvement o f t h e  r a c e and as a p r e v e n t i v e o f war. I n h e r P r e s i d e n t i a l Address to t h e S o c i e t y , she s t a t e d t h a t o p p o s i t i o n had a r i s e n because p e o p l e a s s o c i a t e d b i r t h c o n t r o l w i t h t h e r a d i c a l i s m and f r e e t h i n k i n g o f C h a r l e s B r a d l a u g h and A n n i e B e s a n t , b u t t h a t h e r s u p p o r t e r s were r e a l l y n o t r a d i c a l a t a l l .  In fact,  their  c h i e f aim was t o h e l p space p r e g n a n c i e s , i n t h e i n t e r e s t s o f the i n d i v i d u a l mother, and o f t h e r a c e .  Dutiful  Christians  c o u l d now d i s c u s s i t , f o r t h e f a c t s were i n n o c e n t enough.  In  h e r book, C o n t r a c e p t i o n Mrs. Stopes a l s o accused t h e Roman C a t h o l i c s o f d e l i b e r a t e l y c o n f u s i n g "Onanism" w i t h b i r t h control. A few months a f t e r h e r I s l i n g t o n c l i n i c was opened, the M a l t h u s i a n league s t a r t e d a c l i n i c a t Walworth, u s i n g the Dutch cap (diaphragm) - evidence o f disagreement between the two over whether t h e c e r v i c a l cap was s u p e r i o r t o t h e Dutch cap, and, a l s o , whether l a y p e r s o n n e l s h o u l d be a l l o w e d to  f i t these d e v i c e s .  There was a l s o argument over w h i c h t y p e 36  o f c h e m i c a l c o n t r a c e p t i v e s h o u l d be u s e d .  To encourage  s e r v i c e s w h i c h would be s t a f f e d by m e d i c a l p r a c t i t i o n e r s , i n 1924  t h e M a l t h u s i a n league o r g a n i z e d t h e S o c i e t y f o r t h e P r o -  v i s i o n of B i r t h Control C l i n i c s .  As they were a b l e t o o v e r -  come p a t i e n t shyness more r e a d i l y than men, women d o c t o r s  were i n g r e a t demand, and  t r a i n i n g c o u r s e s f o r b o t h were s e t  37  up by Dr. Norman R a i r e .  As numerous u n r e l i a b l e methods o f  c o n t r a c e p t i o n were s t i l l b e i n g s o l d , and, as t h e r e was  lack  o f s c i e n t i f i c knowledge about the s u b j e c t , the S o c i e t y a l s o s u p p o r t e d i n 1927  the o r g a n i z a t i o n o f the B i r t h C o n t r o l I n -  v e s t i g a t i o n Committee, the membership o f w h i c h added g r e a t l y 38  t o the p r e s t i g e of the movement.  I t became a j o i n t A n g l o -  American endeavor i n v o l v i n g a l s o the U n i t e d S t a t e s N a t i o n a l Committee on M a t e r n a l H e a l t h ; and, because of the Comstock Law  (see page 47)  the work was  done i n B r i t a i n .  Outgrowths  o f the B i r t h C o n t r o l I n v e s t i g a t i o n Committee were the Popul a t i o n I n v e s t i g a t i o n Committee i n t h e U n i t e d Kingdom and  the  39  P o p u l a t i o n C o u n c i l i n the U n i t e d I n 1927 p a v i n g the way  the M a l t h u s i a n  States.  League decided  f o r the f o r m a t i o n , i n 1 9 3 0 ,  B i r t h Control Council.  to d i s s o l v e ,  of the N a t i o n a l  S i r Thomas H o r d e r , p h y s i c i a n - i n -  o r d i n a r y t o H.R.H., the P r i n c e o f Wales, p r e s i d e d , and members i n c l u d e d P.R.  Browne, P r o f e s s o r o f O b s t e t r i c  other Medicine,  London U n i v e r s i t y ; J . Maynard Keynes; P r o f e s s o r H a r o l d L a s k i ; B e r t r a n d R u s s e l l ; H.G. (Although  W e l l s ; C.V.  Drysdale  and  Marie S t o p e s .  she proposed the r e s o l u t i o n which b r o u g h t the  z a t i o n i n t o b e i n g , she r e s i g n e d i n 1 9 3 3 ) . needs of the unemployed, and the p r e s s u r e and t h i n k e r s , i n J u l y , 1 9 3 0 ,  organi-  I n response t o  the  of s o c i a l i s t w r i t e r s  the M i n i s t r y of H e a l t h i s s u e d a  memorandum a u t h o r i z i n g b i r t h c o n t r o l s e r v i c e s f o r p u r e l y p l a n n i n g u n t i l 1967 when the F a m i l y P l a n n i n g A c t was p a s s e d ) . m e d i c a l r e a s o n s (the o n l y government c o n c e s s i o n t o f a m i l y  The  members o f t h e C o u n c i l were d i s a p p o i n t e d when l o c a l  H e a l t h A u t h o r i t i e s d i d n o t t a k e up t h e c h a l l e n g e .  The f o l -  l o w i n g y e a r t h e name o f t h e C o u n c i l was changed t o N a t i o n a l B i r t h C o n t r o l A s s o c i a t i o n , and, i n 1938, t h e B i r t h C o n t r o l I n v e s t i g a t i o n Committee, t h e Workers' B i r t h C o n t r o l Group, the S o c i e t y f o r t h e P r o v i s i o n o f B i r t h C o n t r o l C l i n i c s , and the B i r t h C o n t r o l I n f o r m a t i o n Centre to  (see p. 82 ) amalgamated  form t h e F a m i l y P l a n n i n g A s s o c i a t i o n .  This o r g a n i z a t i o n  came i n t o o f f i c i a l e x i s t e n c e i n May, 1939» and was loaned 41 p r e m i s e s by t h e Eugenics  Society.  Opposition t o a l l t h i s a c t i v i t y centred mainly i n the League o f N a t i o n a l L i f e , o r g a n i z e d b y Roman and A n g l o - C a t h o l i c s , w i t h a few o t h e r r e l i g i o u s e l e m e n t s . opposing  c o n t r a c e p t i o n were advanced.  Numerous r e a s o n s f o r Cysts and tumors would  r e s u l t , n o t t o mention " M a l t h u s i a n U t e r u s " - an a i l m e n t o f d i r e p r o p o r t i o n s on t h e i n s i d e , i t was s a i d , w h i c h produced 42 "an a n x i o u s , drawn e x p r e s s i o n " on t h e o u t s i d e .  Birthrates  were l o w , i n any case, and t h e r e were a c c u s a t i o n s t h a t t h e f a m i l y p l a n n e r s were encouraging  race  suicide.  At Marie Stopes's s u g g e s t i o n , t h e f a m i l y p l a n n e r s d e c i d e d i t would be w i s e t o i n c o r p o r a t e i n t o t h e i r program marriage  guidance and p r e - m a r i t a l c o u n s e l l i n g , t h e d i a g n o s i s  and t r e a t m e n t eugenics.  o f i n f e r t i l i t y as w e l l as c o u n s e l l i n g i n  The g o a l o f m a t e r n a l and c h i l d w e l f a r e c o u l d em-  brace t h i s s e r v i c e .  I n a d d i t i o n , " f a m i l y p l a n n i n g " was  adopted as a comprehensive term w h i c h would be l e s s c o n t r o 43 v e r s i a l and more d e s c r i p t i v e than " b i r t h c o n t r o l " . Some  support  f o r v o l u n t a r y s t e r i l i z a t i o n was a l s o d e v e l o p i n g i n  the 1 9 3 0 s , h u t as was p r e v i o u s l y n o t e d , experiments i n Germany d u r i n g World War I I made t h e i d e a u n p o p u l a r f o r some years  afterward. Even f o r o r d i n a r y b i r t h c o n t r o l s e r v i c e s , a problem  arose f o r t h e F a m i l y P l a n n i n g A s s o c i a t i o n because so few d o c t o r s knew a n y t h i n g about c o n t r a c e p t i o n .  I t was  necessary  f o r them t o r e f e r p a t i e n t s t o t h e v o l u n t a r y c l i n i c s , and, i n cases where p a t i e n t s v i s i t e d the c l i n i c s w i t h o u t  referral,  the c l i n i c d o c t o r s were f o r c e d t o b r e a k a r u l e o f m e d i c a l e t h i c s - t h a t no-one would t r e a t a n o t h e r d o c t o r ' s p a t i e n t except i n an emergency, o r when he r e q u e s t e d The  such a c t i o n .  problem was p a r t i c u l a r l y d i f f i c u l t f o r women d o c t o r s who  were i n p r a c t i c e on s u f f r a n e e i n any case.  Inasmuch as t h e  l o c a l B r i t i s h Medical A s s o c i a t i o n branch u s u a l l y  disapproved  o f f a m i l y p l a n n i n g , a l l d o c t o r s who worked f o r t h e v o l u n t a r y c l i n i c s p l a c e d themselves i n j e o p a r d y .  I f , as sometimes  happened, l a y committees s e t c l i n i c p o l i c i e s w i t h o u t t a t i o n with t h e i r doctors, further complications  consul44  arose.  The B r i t i s h government would n o t concede t h e n e c e s s i t y t o i n c l u d e f a m i l y p l a n n i n g s e r v i c e s as a r o u t i n e i n o r d i n a r y maternal  and c h i l d h e a l t h u n i t s , b u t d i d agree t o a s s i s t  l o c a l H e a l t h A u t h o r i t i e s , and t h e F a m i l y P l a n n i n g A s s o c i a t i o n grew r a p i d l y , u s i n g t h e premises o f t h e l a t t e r .  The L o c a l  H e a l t h A u t h o r i t i e s a l s o p r o v i d e d some f i n a n c i a l h e l p . I 9 6 7 , when t h e government accepted  By  more r e s p o n s i b i l i t y , t h e  FPA was o p e r a t i n g more t h a n 900 c l i n i c s , over 90 p e r c e n t  housed i n L o c a l H e a l t h A u t h o r i t y , M a t e r n a l and C h i l d H e a l t h Centres, or h o s p i t a l premises.  A p a r t from m e d i c a l o f f i c e r s  and n u r s e s , t h e c l i n i c s a r e s t i l l r u n m a i n l y "by v o l u n t e e r s who s e r v e as r e c e p t i o n i s t s , i n t e r v i e w e r s and s u p p l y c l e r k s . The L o c a l H e a l t h A u t h o r i t i e s a r e now a l l o w e d t o s e t up f a m i l y p l a n n i n g s e r v i c e s t h e m s e l v e s , b u t , because some o f t h e members of  t h e o l d i n t e r e s t groups i n o p p o s i t i o n a r e s t i l l  influential  in  some c a s e s , t h e government does n o t push them.  The m a j o r i t y  of  L.H.A.s s t i l l p r e f e r t o l e a v e i t t o t h e FPA, and p r o v i d e  f i n a n c i a l support. to  I n a d d i t i o n t o making s e r v i c e s a v a i l a b l e  m a r r i e d c o u p l e s , t h e FPA now a c c e p t s s i n g l e women and,  b e s i d e s c o n v e n t i o n a l methods o f c o n t r a c e p t i o n , a c c e p t s t h e u s e f u l n e s s o f a b o r t i o n as a back-up f o r a c c i d e n t o r i g n o r a n c e . The F a m i l y P l a n n i n g A s s o c i a t i o n c o n t i n u e s t o t r a i n m e d i c a l and 46 paramedical personnel. I n c r e a s e d government s e r v i c e s v i a area h e a l t h a u t h o r i t i e s are being considered, but a c t i o n i s 47  unlikely for several years. In in  summary, l e a d e r s h i p i n t h e f a m i l y p l a n n i n g movement  t h e U n i t e d Kingdom came from t h e educated  classes.'  Motives  were numerous and v a r i e d , b u t a l l were d i r e c t e d t o s o c i a l r e f o r m o f one s o r t o r a n o t h e r .  Opposition c r y s t a l l i z e d i n the  p o l i t i c a l , commercial, r e l i g i o u s and m e d i c a l a r e n a s , b u t a c ceptance by t h e g e n e r a l p u b l i c was growing as t h e needs o f t h e s o c i e t y changed.  The v o l u n t e e r s h a s t e n e d  t h i s process  through  t h e i r p u b l i c p r o m o t i o n , b u t , t o t h e end o f 1969» p o l i t i c a l supp o r t was s t i l l h e s i t a n t .  The F a m i l y P l a n n i n g A s s o c i a t i o n was  very h e l p f u l i n the early financing of the I n t e r n a t i o n a l  P l a n n e d P a r e n t h o o d F e d e r a t i o n , b u t , b e f o r e c o n s i d e r i n g the o r i g i n and development o f t h a t o r g a n i z a t i o n , i t i s n e c e s s a r y t o l o o k a t t h e p a r a l l e l development o f t h e movement, a l s o as a means o f s o c i a l r e f o r m , i n t h e U n i t e d S t a t e s o f 48 America.  FOOTNOTES  -  Chapter  I  G-eorge Cadbury, "The R o l e o f t h e I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d F e d e r a t i o n " , S t u a r t Mudd, ed., The P o p u l a t i o n C r i s i s and t h e Use o f World R e s o u r c e s , The Hague, 1 9 6 4 , p. 369 x  James A l f r e d F i e l d , " B e g i n n i n g o f t h e B i r t h C o n t r o l Movement," E s s a y s on P o p u l a t i o n . C h i c a g o , 1 9 3 1 , p . 2 5 8 . 2  3 l b i d » , "The M a l t h u s i a n C o n t r o v e r s y " , p. 1 5 . ( M a l t h u s ' s mathematics have s i n c e been q u e s t i o n e d . ) ^Thomas R. M a l t h u s , Essay on t h e P r i n c i p l e o f P o p u l a t i o n as I t A f f e c t s t h e F u t u r e Improvement o f Mankind, 5 t h e d . , V o l . 1 , Book 1 , Chapter 1 , (John Murray) London, 1 8 1 7 , P. 3 ^ . ^ I b i d . , Chapter I I , p. 2 5 . Ibid., p. 6 9 . 6  (J.M. Dent) London, 1 8 1 6 , V o l . I I , Chapter V I I ,  I b i d . . (John Murray) London, 1 8 1 7 , V o l . I l l , pp. 111-114. 7  8  9  Ibid., Vol. I l l ,  Chapter I I I ,  Chapter I V , pp. 1 1 5 - 1 1 7 .  I b i d . , V o l . 1 , Book 1 ,  Chapter I I , p . 2 0 .  ^ J o h n P e e l & Malcolm P o t t s , Textbook o f C o n t r a c e p t i v e P r a c t i c e , Cambridge, 1 9 6 9 , P» 2» P l a c e was l a t e r a c t i v e i n t h e f i g h t t o r e p e a l t h e Combination Laws, and f o r t h e Reform B i l l o f 1 8 3 2 I x  ± x  H i m e s , o p . c i t . , pp. 2 1 3 - 1 7 ;  P r y e r , o p . c i t . , p. 82.  » A . M . " (John S t u a r t M i l l ) i n The B l a c k Dwarf, 27 November 1 8 2 3 ; No. 22^ page 7 5 6 , c i t e d F r y e r , p. 8 9 . 12  l^The L e t t e r s o f Queen V i c t o r i a : A S e l e c t i o n o f Her M a j e s t y ' s Correspondence Between t h e Y e a r s 1 8 3 7 and 1861, A r t h u r C h r i s t o p h e r Bacon and V i s c o u n t E s h e r , e d s . V o l . I , London, 1 9 0 7 , p. 3 2 1 . 14 W i l l i a m L. L a n g e r , " D i s g u i s e d I n f a n t i c i d e " , G a r r e t t H a r d i n , ed., P o p u l a t i o n , E v o l u t i o n and B i r t h C o n t r o l , 1969,  pb, p p . 1 9 4 - 9 6 .  F r y e r , o p . c i t . , pp. 3 ^ - 5 , 41. See a l s o K i n g s l e y D a v i s , " P o p u l a t i o n " , L o u i s e B. Young, ed., P o p u l a t i o n i n P e r s p e c t i v e , New Y o r k , 1968, pb, pp. 1 1 6 - 2 1 . / ^James A l f r e d F i e l d , o p . c i t . , p. 86, 87; a l s o F r y e r , o p . c i t . , p. 124, 178. 1  • ^ F r y e r , o p . c i t . , pp. 1 3 f - l 4 6 . 18 C h a r l e s B r a d l a u g h , d e f e n d a n t , The Queen V C h a r l e s B r a d l a u g h and Annie B e s a n t , London, 1877> P« i» ii» -^Annie B e s a n t , The Law o f P o p u l a t i o n ; I t s Consequences and I t s B e a r i n g Upon Human Conduct and i Jora!s, Jj'reetnought P u b l i s h i n g Co., London, n.d., p. 48. v  ¥alter R. A r n s t e i n , The B r a d l a u g h Case, O x f o r d , p. 22. 20  1965,  21Marie S t o p e s , E a r l y Days o f B i r t h C o n t r o l , London, 1 9 2 3 , p. 2 3 ; Himes, o p . c i t . , p. 2 5 7 . A n n i e B e s a n t : An A u t o b i o g r a p h y , The T h e o s o p h i c a l P u b l i s h i n g House, London (1908), pp. 2 4 2 - 4 4 . 2 2  ^ A r t h u r H. N e t h e r c o t , The L a s t Four L j y s o f Annie B e s a n t , London, 1963., p. 3 9 3 . e  **James A l f r e d F i e l d , O p . C i t . , p. 2 1 3 ; Kingsley Davis, " P o p u l a t i o n " , S c i e n t i f i c American, September, 1 9 6 3 * 2  209  (3):  62-71.  25  Frank W. N o t e s t e i n , Dudley K i r k , & Sheldon S e g a l , "The Problem o f P o p u l a t i o n C o n t r o l " , The P o p u l a t i o n Dilemma, P h i l i p M. Hauser, ed., 2nd ed. pb. Englewood C l i f f s , 1 9 6 9 , p. 141. ?6 J.A. & O l i v e Banks, Feminism and F a m i l y P l a n n i n g i n V i c t o r i a n E n g l a n d , L i v e r p o o l , 1964, pp. 1, 5 , 1 2 3 ; Ireland was an e x c e p t i o n because o f l a t e m a r r i a g e . N o t e s t e i n , K i r k , S e g a l , o p . c i t . , p. 142. ^D.V. G l a s s , ed., I n t r o d u c t i o n t o M a l t h u s , London, PP. ^ 7 - 5 0 . 28 P e e l and P o t t s , o p . c i t . , pp. 7 4 , 7 6 . ^C.P. B l a c k e r , " F a m i l y P l a n n i n g and E u g e n i c Movements i n t h e M i d - T w e n t i e t h C e n t u r y " , The E u g e n i c s Review, J a n u a r y , 1 9 5 6 , 4 7 , 4, pp. 2 2 6 - 2 7 . 30 2  1953,  2  Himes, o p . c i t . , p. 257• 3 1  I b i d . , p.  211.  P e e l & P o t t s , o p . c i t . , p. 3 3 i b i d . , p.  21.  23.  34c.P. B l a c k e r , o p . c i t . , p.  226.  ^^Marie S t o p e s , o p . c i t . , pp. 2 0 - 2 5 ; S t o p e s , C o n t r a c e p t i o r t , London, 1 9 2 3 , p. 3 6 p e e l & P o t t s , o p . c i t . , p. 3 7 p y e r , o p . c i t . , p. r  Marie C a r m i c h a e l 69.  75.  278.  3^Among i t s members were L o r d B r a i n , S i r A l e x a n d e r C a r r - S a u n d e r s , and S i r J u l i a n H u x l e y . There was one h o l d e r o f the Order o f M e r i t , two N o b e l P r i z e w i n n e r s , two P r e s i dents of t h e R o y a l S o c i e t y , one P r e s i d e n t o f t h e R o y a l C o l l e g e o f P h y s i c i a n s , two Regius P r o f e s s o r s o f M e d i c i n e , two O x f o r d and Cambridge c o l l e g e heads, and f o u r o t h e r F e l l o w s o f t h e R o y a l S o c i e t y . Margaret Pyke, " F a m i l y P l a n n i n g , An Assessment," The E u g e n i c s Review, J u l y , 1963» P»6. 3 9 P e e l & P o t t s , op. c i t . , p. ^°Blacker, o p . c i t . , p. 2 2 6 ;  36. P e e l & P o t t s , o p . c i t . , p.  ^ M a r g a r e t Pyke, o p . c i t . , p. ^ F r y e r , o p . c i t . , p. 2  13-  7.  296.  ^3(3.P. B l a c k e r , "The I n t e r n a t i o n a l Planned Parenthood F e d e r a t i o n : A s p e c t s o f I t s H i s t o r y " , The E u g e n i c s Review, O c t o b e r , 1 9 6 4 , p. 1 3 8 ; a l s o "Family P l a n n i n g and Eugenic Movements", o p . c i t . , p. 2 2 8 . ^ e e l  & P o t t s , o p . c i t . , p. 14.  ^ M a r g a r e t Pyke, op. c i t . , p.  8.  ^ " F a m i l y P l a n n i n g S e r v i c e s , a Guide f o r S o c i a l Workers," The F a m i l y P l a n n i n g A s s o c i a t i o n , Nov. 1968 ( l e a f l e t ) ; F a m i l y P l a n n i n g on F i v e C o n t i n e n t s , I P P F , London, August, 1969, p. 3 1 . 47  Family P l a n n i n g . J u l y , 1970,  pp.  45-6.  48  George Cadbury, I n t e r v i e w , O a k v i l l e , O n t a r i o ,  7.12.69.  >  CHAPTER - I I  The  S o c i a l Reformers:  The  United States of America  In the U n i t e d S t a t e s the " b i r t h c o n t r o l movement  was  s t a r t e d by Robert Dale Owen, son o f the S c o t t i s h r e f o r m e r a l r e a d y mentioned.  An a d m i r e r o f Bentham and P l a c e , the  younger Owen had emigrated  from B r i t a i n i n 1825*  a c q u i r e d a copy o f Every Woman's Book and was i t p u b l i s h e d i n the new a prospectus  was  issued.  country.  He  had  urged t o have  In s p i t e of h i s r e f u s a l  But he m a i n t a i n e d  his decision  u n t i l someone c i r c u l a t e d anonymous.suggestions about h i s morality. In 1831  Owen then f e l t o b l i g e d t o make h i s p o s i t i o n  he p u b l i s h e d h i s own  72-page b o o k l e t , M o r a l  clear.  Physiology:  o r a B r i e f and P l a i n T r e a t i s e on the P o p u l a t i o n Q u e s t i o n . i t he gave s o c i a l and eugenic  arguments f o r f a m i l y l i m i t a -  t i o n and, d e s c r i b i n g the p h y s i o l o g y o f r e p r o d u c t i o n as understood  In  he  i t , gave d e t a i l s r e g a r d i n g w i t h d r a w a l , the condom  and the sponge.  The book, w h i c h was  a l s o p r i n t e d and s o l d i n  the U n i t e d Kingdom, earned the p r a i s e o f e x - P r e s i d e n t James Madison and  others.  Owen d i d n o t make promotion of c o n t r a -  c e p t i o n a l i f e t i m e a v o c a t i o n however.  Prom I 8 3 6 he  p o l i t i c s , promoting education, emancipation, He a l s o h e l p e d t o found the S m i t h s o n i a n Washington, D.C.  1  and  entered  spiritualism.  Institution in  N e v e r t h e l e s s , h i s Moral P h y s i o l o g y  was  the b a s i s on w h i c h D r . C h a r l e s Khowlton c o u l d b u i l d . Khowlton, the f i r s t of the medical p r o f e s s i o n i n the U n i t e d S t a t e s t o promote b i r t h c o n t r o l , i n 1832 o r 1833 publ i s h e d f o r h i s own p a t i e n t s , F r u i t s o f P h i l o s o p h y , ... showing how d e s i r a b l e i t i s , b o t h i n a p o l i t i c a l and a s o c i a l p o i n t o f v i e w , f o r mankind t o be a b l e t o l i m i t , a t w i l l , the number o f t h e i r o f f s p r i n g , w i t h o u t s a c r i f i c i n g the pleasure that attends the g r a t i f i c a t i o n o f the reproductive instinct. Knowlton n o t e d t h a t Malthus had suggested  no s o l u t i o n b u t  c e l i b a c y , and t h a t t h e absence o f b i r t h c o n t r o l encouraged p r o s t i t u t i o n and intemperance. possible.  E a r l y marriages were i m -  Human n a t u r e would n o t change, and, w i t h o u t  b i r t h c o n t r o l , t h e mind would become u n s e t t l e d and judgment waiver.  A l l men had a r i g h t t o t h e knowledge.  He d i s c u s s e d  v a r i o u s methods, d i s c a r d i n g w i t h d r a w a l as u n s a t i s f a c t o r y , and condoms because they were r e l a t e d t o t h e p r e v e n t i o n o f vener e a l disease.  H i s v e r s i o n o f t h e rhythm method was i n c o r r e c t ,  and recommendations o f douching were l a t e r proven u n r e l i a b l e , 2 but Knowlton d i d advocate  t h e sponge.  He had been p r o s e c u t e d and j a i l e d a l r e a d y i n t h e Massachusetts  c o u r t s when a s t u d e n t ( f o r i l l e g a l  dissection,  and f o r p e d d l i n g a book on m a t e r i a l i s m ) and was n o t p u n i s h e d f o r t h e b o o k l e t on b i r t h c o n t r o l .  Since h i s medical  col-  l e a g u e s would g i v e him no s u p p o r t , he decided n o t t o pursue the t o p i c .  F r u i t s o f P h i l o s o p h y was r e p r i n t e d i n B r i t a i n ,  and enjoyed some p o p u l a r i t y among w o r k i n g  c l a s s r a d i c a l s and  f r e e t h i n k e r s , and i t was d e s t i n e d t o become i n t e r n a t i o n a l l y  known as t h e f o c u s o f t h e B r a d l a u g h - B e s a n t t r i a l a l r e a d y r e f e r r e d t o i n Chapter *T.  I n t h e meantime, a n o t h e r f l u r r y o f  3 e x c i t e m e n t a r o s e i n t h e S t a t e o f New Y o r k . I n 1847 John Noyes founded t h e c o n t r o v e r s i a l Oneida Community, w h i c h f l o u r i s h e d n e a r Syracuse f o r about years.  thirty  I t was a r e l i g i o u s " P e r f e c t i o n i s t " and communal s o c i e t y  w h i c h p r a c t i s e d complex m a r r i a g e and mating f o r e u g e n i c r e a s o n s . As an unorthodox i n t e r p r e t e r o f t h e B i b l e and opponent o f marr i a g e as a sacrament, and as an advocate o f c o i t u s r e s e r v a t u s 4 and t h e s e x u a l r i g h t s o f women, Noyes was f i e r c e l y  criticized.  H i s o r g a n i z a t i o n e v e n t u a l l y broke up, and i s remembered t o - d a y m a i n l y f o r i t s b u s i n e s s a c t i v i t i e s - c a r r i e d on from 1881 as a s t e e l t r a p and s i l v e r w a r e m a n u f a c t u r i n g company - "Oneida" and "Community" b e i n g well-known t r a d e names.^ The c i r c u l a t i o n o f pornography was i n c r e a s i n g i n New Y o r k S t a t e a n d , i n 1868, a f t e r a campaign  l e d by t h e YMCA,  the G e n e r a l Assembly made d i s t r i b u t i o n o f such m a t e r i a l an offense. obscenity.  C o n t r a c e p t i o n was a l s o f o r b i d d e n as a n o t h e r form o f Other S t a t e s f o l l o w e d s u i t , and, i n 1873, t h e  F e d e r a l P o s t a l Law was amended t o f o r b i d the use o f t h e m a i l s f o r obscene m a t e r i a l , i n c l u d i n g i n f o r m a t i o n about b i r t h cont r o l or contraceptive supplies.  This e f f e c t i v e l y  blocked  a c t i o n i n f a v o r o f c o n t r a c e p t i o n by a l l b u t t h e b r a v e s t o f 6 social  reformers. C h i e f e n f o r c e r was Anthony Comstock, a drygoods s a l e s -  man who i s s a i d t o have had a g u i l t complex about h i s y o u t h f u l sexual aberrations.  He a l s o founded t h e New Y o r k S o c i e t y f o r  t h e S u p p r e s s i o n o f V i c e i n 1873•  Believing himself inspired  by God and a l o v e o f c h i l d r e n , Comstock h e l d t h e unshakeable c o n v i c t i o n t h a t " i n f i d e l i t y ( i . e . a t h e i s m ) and o b s c e n i t y shared t h e same bed...."  D e a l e r s i n c o n t r a c e p t i o n were  " a b o r t i o n i s t s " , and f o r them he had no p i t y .  Dancing, thei  a t r e , a r t and p r e s s s e n s a t i o n a l i s m were e q u a l l y r e p r e h e n s i b l e . W i t h t h e support was  appointed  o f Theodore R o o s e v e l t  and t h e YMCA, Comstock  a s p e c i a l i n s p e c t o r o f t h e post o f f i c e , and  commenced h i s crusade.  Through p o s i n g as one s e e k i n g i n -  f o r m a t i o n f o r h i s a i l i n g w i f e , o r t h r o u g h h i r e d decoys o r f a l s e m a i l i n g addresses,  Comstock assembled e v i d e n c e -  a b o r t i f i c i e n t s , c o n t r a c e p t i v e s and obscene p u b l i c a t i o n s and was r e s p o n s i b l e f o r t h e a r r e s t o f more than 3*600  persons,  the m a j o r i t y o f whom were c o n v i c t e d and n o t o n l y f i n e d (up t o g $ 5 , 0 0 0 ) , b u t j a i l e d as w e l l . In order t o maintain support, Comstock f r e q u e n t l y i n v i t e d s e l e c t a u d i e n c e s t o v i e w c h o i c e 9 items o f pornography b e f o r e they were d e s t r o y e d .  So i n f l u -  e n t i a l was he t h a t few o f t h e m e d i c a l p r o f e s s i o n would s t a n d a g a i n s t him. the m e d i c a l  I n f a c t , s u p p o r t i n g t h e Comstock v i e w , some o f j o u r n a l s even j u s t i f i e d t h e i r p o s i t i o n by e x -  p l a i n i n g t h a t , i f the b i r t h r a t e were t o d e c l i n e , m e d i c a l 10  incomes might a l s o d e c l i n e 1  Comstock a l s o w r o t e Traps  f o r t h e Young i n which he d e s c r i b e d how he had l o c a t e d i t e m s , and h i s e x p e r i e n c e s  i n b r i n g i n g the offenders t o t r i a l .  A l l s o c i a l i l l s were due t o " e v i l r e a d i n g " , he s a i d . The new  these  ± X  f i r s t United States c i t i z e n t o run f o u l of the  l a w (soon t o be known as t h e Comstock Law) was D r . Edward  B l i s s F o o t e , whose pamphlet, Words i n P e a r l ( " P e a r l " - a  p r i n t e r ' s t y p e s i z e ) s o l d more than 250,000 c o p i e s b e f o r e i t was  suppressed i n I876.  D r . Foote advocated  for  the c h r o n i c a l l y i l l ,  or p h y s i c a l l y or mentally  contraception handi-  12 capped, f o r f a m i l y w e l f a r e , and t o reduce d i s e a s e . I n b r i e f , I w o u l d , i f p o s s i b l e , so f i x t h i n g s t h a t none b u t t h e h e a l t h y people s h o u l d p r o c r e a t e a t a l l . and t h a t w i v e s s h o u l d p r o c r e a t e o n l y ax w i l l . 1  3  A few o t h e r proponents o f t h e s o c i a l and eugenic b e n e f i t s o f b i r t h c o n t r o l were a l s o e f f e c t i v e l y s i l e n c e d by t h e Comstock Law and i t s c i r c u m v e n t i o n was a l o n g , s l o w p r o c e s s , w h i c h l a s t e d about f o r t y The  years.  f i r s t f a v o r a b l e o p i n i o n t o appear i n any m e d i c a l  j o u r n a l i n t h e w o r l d was p r i n t e d i n t h e M i c h i g a n i n 1882.  Here O.E. H e r r i c k m a i n t a i n e d  t h a t c o n t r a c e p t i o n was  a woman's r i g h t , and a l s o t h e o n l y r e a s o n a b l e the w i d e s p r e a d scourge o f a b o r t i o n .  M e d i c a l News  alternative to  On t h e grounds o f f a m i l y  w e l f a r e and m a r i t a l harmony, and as an a n t i d o t e t o p o v e r t y and d e l i n q u e n c y , he r e c e i v e d some m e d i c a l  support.  Those who  agreed w i t h him observed t h a t b i r t h c o n t r o l was e s s e n t i a l t o compensate f o r t h e men who would n o t r e f r a i n from i n t e r c o u r s e even when t h e i r w i v e s ' h e a l t h was a t s t a k e .  Among t h e oppo-  s i t i o n were some who a v e r r e d t h a t i t was a woman's " r e l i g i o u s " 14 duty t o a l l o w a man h i s " r i g h t s " .  Around t h e t u r n o f the  c e n t u r y D r . W i l l i a m J . R o b i n s o n , who e d i t e d s e v e r a l m e d i c a l p e r i o d i c a l s , wrote many a r t i c l e s f e a t u r i n g c o n t r a c e p t i o n .  In  1905 he a l s o p u b l i s h e d a l e a f l e t on t h e s u b j e c t f o r p h y s i c i a n s . Based on t h e needs o f t h e poor and o f e u g e n i c s , D r . Robinson  a l s o persuaded Dr. Abraham J a c o b ! t o i n c l u d e s u p p o r t f o r b i r t h c o n t r o l i n h i s P r e s i d e n t i a l Address t o t h e American Medical A s s o c i a t i o n i n 1912.  But the AMA  was not ready t o  pass a r e s o l u t i o n t o t h i s e f f e c t f o r more than f i f t y About t h i s t i m e , however, t h e cause was  years.  t a k e n up  by  Margaret Sanger - perhaps the most e n e r g e t i c and f e a r l e s s of a l l the b i r t h c o n t r o l p i o n e e r s .  Though her d e c i s i o n s were  sometimes u n p r e d i c t a b l e , and h e r p e r s o n a l r e l a t i o n s h i p s somet i m e s unhappy, h e r d e t e r m i n a t i o n on t h i s s u b j e c t was t h a t she i s r e c o g n i z e d as the founder o f the b i r t h  such control  movement i n the U n i t e d S t a t e s , and a l s o o f the I n t e r n a t i o n a l P l a n n e d Parenthood  Federation.  No o b s t a c l e s were too g r e a t ,  no c r i t i c i s m too h a r s h , and no j a i l too f o r b i d d i n g (she  was  j a i l e d e i g h t t i m e s ) t o shake h e r d e c i s i o n to make i t a c c e p t a b l e as a h e a l t h s e r v i c e .  U s i n g an a b i l i t y t o f i n d  s u p p o r t e r s among w e a l t h y p h i l a n t h r o p i s t s , and  staunch  considerable  s k i l l i n g a i n i n g the maximum news mileage from every  situ-  a t i o n , she worked s i n g l e - m i n d e d l y f o r b i r t h c o n t r o l u n t i l was  over e i g h t y .  She d i e d i n 1 9 6 6 ,  a t the age o f e i g h t y - s e v e n ,  h a v i n g l i v e d t o see the 5 0 t h A n n i v e r s a r y o f the P l a n n e d hood movement i n the U n i t e d S t a t e s , and i t s acceptance government r e s p o n s i b i l i t y  she  Parentas a  i n many c o u n t r i e s . Because the  t a c t i c s o f the Women's L i b e r a t i o n and o t h e r r a d i c a l movements t o - d a y are s i m i l a r , and because o t h e r c o u n t r i e s sometimes borrowed h e r i d e a s , s p e c i a l a t t e n t i o n w i l l be g i v e n t o her story. Margaret H i g g i n s Sanger was  the s i x t h of eleven  c h i l d r e n , and r a i s e d i n C o r n i n g , New Y o r k . always i n s t r a i t e n e d c i r c u m s t a n c e s  The f a m i l y was  because h e r f a t h e r , a s t o n e -  c u t t e r , b e s i d e s b e i n g a s o c i a l i s t was a l s o a v o c a l f r e e t h i n k e r . I n consequence, l i t t l e  employment came h i s way.  Her mother,  d i e d i n h e r f o r t i e s from t u b e r c u l o s i s , e x a c e r b a t e d , maintained,  by t o o much c h i l d b e a r i n g .  N u r s e , she had f i r s t haM e x p e r i e n c e t i o n s , and w i t h t h e i g n o r a n c e  Margaret  As a P u b l i c H e a l t h  w i t h New Y o r k slum c o n d i -  o f t h e women-about t h e i r own  b o d i e s , about r e p r o d u c t i o n and about v e n e r e a l d i s e a s e ;  Poli-  t i c a l l y she became a s u p p o r t e r o f the a n a r c h i s t , Emma Goldman, and was a f r i e n d o f B i l l Haywood, a l e a d e r i n t h e I n d u s t r i a l Workers o f t h e Worid("The W o b b l i e s " ) .  Emma was a l s o an advo-  cate o f b i r t h c o n t r o l , and M a r g a r e t , t o o , saw i t as a weapon i n t h e s t r u g g l e t o g a i n r e v o l u t i o n a r y muscle f o r t h e w o r k i n g classes against the " c a p i t a l i s t  exploiters". ^ 1  A f t e r t e n y e a r s o f d o m e s t i c i t y as the w i f e o f W i l l i a m Sanger, an a r c h i t e c t cum p a i n t e r , she r e t u r n e d t o n u r s i n g i n 1912.  Though t h e y now had two sons and a d a u g h t e r , and Sanger  shared h e r r a d i c a l p o l i t i c a l v i e w s , Margaret was c h a f i n g a g a i n s t h o u s e h o l d r e s p o n s i b i l i t i e s and l o n g i n g f o r a more a c t i v e p a r t i n the c l a s s s t r u g g l e she b e l i e v e d was coming. A new i n f l u e n c e on h e r t h i n k i n g was p r o v i d e d by t h e works o f H a v e l o c k E l l i s , a w o r l d famous s e x u a l p s y c h o l o g i s t who b e l i e v e d t h a t more h o n e s t y about human s e x u a l i t y should be a p a r t o f p e r s o n a l r e l a t i o n s h i p s and t h a t women should have the same s e x u a l freedom and s a t i s f a c t i o n as men. I n a d d i t i o n , w i t h d e p r e s s i n g r e g u l a r i t y she saw mothers o f l a r g e f a m i l i e s i n  the slums d i e o f s e l f - i n d u c e d a b o r t i o n o r neighborhood quacks.  $5.00  v i s i t s to  D o c t o r s would n o t r i s k g i v i n g them i n -  f o r m a t i o n about c o n t r a c e p t i o n , and Mrs. Sanger began t o see h e r s e l f as t h e l e a d e r o f a campaign f o r a l l t h e s e She  goals.  i d e n t i f i e d t h e death o f one Sadie Sachs from i l -  l e g a l l y induced  a b o r t i o n as t h e event which t r i g g e r e d h e r  d e c i s i o n t o campaign f o r b i r t h c o n t r o l f o r a l l who wanted i t . Though i n f o r m a t i o n on methods e x i s t e d i n s e v e r a l nearby  li-  b r a r y s o u r c e s , and many Americans were a l r e a d y p r a c t i s i n g b i r t h c o n t r o l , Mrs. Sanger c l a i m e d t h a t she had t o v i s i t to g e t i t from t h e r e v o l u t i o n a r y l a b o r movement t h e r e .  France I t may  be t h a t American d o c t o r s would n o t h e l p h e r , o r t h a t , as D a v i d Kennedy s u g g e s t s , t h e f a m i l y t r i p t o France f o r a y e a r i n 1913 was arranged  by h e r husband i n a l a s t d i t c h attempt t o h o l d  h e r a f f e c t i o n and i n t e r e s t .  B u t , whatever t h e r e a s o n ,  after  a few months i n P a r i s , Margaret and the c h i l d r e n r e t u r n e d t o New Y o r k ahead o f h i m . From t h a t time on they l i v e d ,. l6 lives *  separate  Back i n t h e U n i t e d S t a t e s , she devoted much time t o e d i t i n g Woman R e b e l , an e i g h t page p e r i o d i c a l w h i c h was d e d i c a t e d t o r a d i c a l p o l i t i c s and the advocacy o f b i r t h  control.  Because i t d i d n o t d e s c r i b e c o n t r a c e p t i o n methods, i t o n l y challenged the law f o r b i d d i n g o b s c e n i t y .  After several  i s s u e s , Mrs. Sanger was charged w i t h v i o l a t i o n s , b u t no i n f o r m a t i o n was g i v e n as t o how t h e l a w had been b r o k e n .  After  a r r a n g i n g w i t h h e r husband f o r the care o f t h e c h i l d r e n , she adopted an assumed name and f l e d t h e c o u n t r y .  A variety of  reasons have "been g i v e n , none o f w h i c h i s v e r y c l e a r , but i t appears t h a t she f e l t she had to have time to marshal more support.  (She had a l s o w r i t t e n and p u b l i s h e d 100,000 c o p i e s  o f a pamphlet on methods, w h i c h d i d b r e a k the l a w , but  Family  L i m i t a t i o n was not y e t d i s t r i b u t e d . ) Margaret s a i l e d from M o n t r e a l f o r England  and, w h i l e a t  s e a , sent a message i n s t r u c t i n g h e r s u p p o r t e r s t o r e l e a s e the pamphlet.  C i r c u l a t i o n was  o b t a i n e d t h r o u g h t r a d e unions  o t h e r s y m p a t h e t i c o r g a n i z a t i o n s , and i t was received i n working c l a s s  and  enthusiastically  districts.  On a r r i v a l i n England l e a d e r s o f the Neo-Malthusian  she met  the C.V.  League.  e f f o r t s t o c h a l l e n g e the Comstock Law,  Drysdales,  They applauded h e r t o l d h e r the h i s t o r y  o f b i r t h c o n t r o l and the law i n t h e i r c o u n t r y , arranged f o r h e r t o do r e s e a r c h on the s u b j e c t a t t h e B r i t i s h Museum, and i n t r o d u c e d h e r t o Havelock E l l i s .  Of c o n s i d e r a b l e s i g n i f i c a n c e  i s the f a c t t h a t the M a l t h u s i a n s and E l l i s urged h e r t o drop h e r exaggerated  s t a n c e s a g a i n s t c a p i t a l i s m , r e l i g i o n and mar-  r i a g e , and t o c o n c e n t r a t e on one i s s u e o n l y - the p r o v i s i o n o f b i r t h c o n t r o l i n f o r m a t i o n and s e r v i c e s .  Another s i g n i f i c a n t  i n f l u e n c e a r o s e from a v i s i t t o The Hague, where Dr. Johannes R u t g e r s , who  had p i o n e e r e d c o n t r a c e p t i o n i n h i s c o u n t r y ,  urged  h e r t o work f o r m e d i c a l s u p p o r t , and to promote the use of the 17 Mensinga diaphragm.  She f o l l o w e d t h i s a d v i c e , by and  large,  but was n e v e r a b l e t o overcome h e r o l d resentments e n t i r e l y o r t o a l l o w o t h e r s t o l e a d h e r movement. E a r l y i n 1915 > W i l l i a m Sanger was  a r r e s t e d by one  of  Comstock's s p i e s f o r g i v i n g him a copy o f F a m i l y L i m i t a t i o n . R a t h e r than pay a f i n e , Sanger e l e c t e d t o s t i c k "by t h e p r i n c i p l e t h a t t h e l e a f l e t was n o t obscene, and chose t o s e r v e a t h i r t y - d a y j a i l sentence i n s t e a d . w i t h o u t adequate  This l e f t the children  s u p e r v i s i o n , so Margaret had t o h u r r y home.  On a r r i v a l she found b i r t h c o n t r o l under p u b l i c d i s c u s s i o n i n the p r e s s , and a group o f i n f l u e n t i a l women r e a d y t o h e l p h e r campaign. The n u c l e a r f a m i l y , w i t h i t s r i g h t t o independence  was  an e s t a b l i s h e d c h a r a c t e r i s t i c o f urban l i v i n g ; i n t e r e s t i n e u g e n i c s was growing; a n d , i n s p i t e o f warnings o f p o p u l a t i o n d e c l i n e s and r a c e s u i c i d e , many o f t h e middle and upper income groups were p r a c t i s i n g b i r t h c o n t r o l .  The e m a n c i p a t i o n o f  women, i n c l u d i n g a s i n g l e s t a n d a r d , was much d i s c u s s e d . As E l l i s had a l s o c o n v i n c e d h e r t h a t , b e s i d e s b e i n g a p r o t e c t i o n f o r women, b i r t h c o n t r o l was a l s o a key t o r a c e b e t t e r m e n t and adjustment o f p o p u l a t i o n t o w o r l d r e s o u r c e s , she t o o k up t h e cause w i t h renewed  energy."^  At t h e same t i m e , she was i n f o r m e d t h a t , i f she would promise t o obey t h e l a w i n f u t u r e , t h e charges a g a i n s t h e r over Woman R e b e l would be g r e a t l y r e d u c e d . and b r a c e d h e r s e l f f o r t h e t r i a l .  M r s . Sanger r e f u s e d ,  Her hopes o f more p u b l i c i t y  f o r h e r cause were d i s a p p o i n t e d , however, f o r t h e charges were suddenly dropped i n F e b r u a r y , 1916. d i d n o t want t o make a m a r t y r o f h e r .  Some s a i d t h e a u t h o r i t i e s Whatever t h e r e a s o n , she  was then f o r c e d t o f i n d a new means o f c h a l l e n g i n g t h e l a w . I n 1916 she o r g a n i z e d a b i r t h c o n t r o l c l i n i c i n Browns-  v i l l e , a Brooklyn  slum.  I t was i n s t a n t l y p o p u l a r ; a l e g a l  charge under S e c t i o n 11^2 o f t h e New Y o r k S t a t e P e n a l Code was s p e e d i l y l a i d ; and Mrs. Sanger and h e r s i s t e r , E t h e l B y r n e , were a r r e s t e d . 30-day s e n t e n c e .  E t h e l was t r i e d f i r s t , c o n v i c t e d and g i v e n a She a c h i e v e d w o r l d fame by g o i n g on a hunger  s t r i k e - a f a m i l i a r feminist technique.  Force-feeding l e n t  drama t o t h e s i t u a t i o n and M a r g a r e t , out on h a i l , i s s u e d d a i l y b u l l e t i n s ' on h e r c o n d i t i o n .  F i n a l l y E t h e l ' s h e a l t h was so  endangered t h a t Margaret guaranteed t o t h e Governor t h a t E t h e l would t a k e no f u r t h e r p a r t i n t h e movement w h i l e h e r case was b e i n g a p p e a l e d , and E t h e l was r e l e a s e d . followed.  M a r g a r e t ' s own case  She was o f f e r e d a l i g h t sentence i f she would obey  the l a w , b u t r e f u s e d , s t a t i n g t h a t she c o u l d n o t obey a l a w f o r w h i c h she had no r e s p e c t .  Her 30-day s o j o u r n i n j a i l  p r o v i d e d h e r w i t h an o p p o r t u n i t y t o c r i t i c i z e c o n d i t i o n s on the i n s i d e , and, b e f o r e  she was r e l e a s e d , she r e f u s e d t o be  f i n g e r p r i n t e d on t h e ground t h a t she was n o t a c r i m i n a l . I t was decided t o appeal h e r c o n v i c t i o n , b u t the case was l o s t .  I n handing down h i s d e c i s i o n however, t h e judge  r e - d e f i n e d S e c t i o n 11^5 so t h a t , h a v i n g p r o v i d e d  f o r doctors  t o g i v e c o n t r a c e p t i v e i n f o r m a t i o n " f o r t h e cure and p r e v e n t i o n o f d i s e a s e " t o men ( t r e a t m e n t  a g a i n s t v e n e r e a l d i s e a s e ) , he  broadened " d i s e a s e " t o mean any s i c k n e s s o r d i s o r d e r - w h i c h meant t h a t b i r t h c o n t r o l a d v i c e c o u l d be g i v e n t o m a r r i e d women t o p r o t e c t t h e i r h e a l t h .  Birth control clinics  now be e s t a b l i s h e d l e g a l l y so l o n g as t h e y were r u n b y 19 doctors.  could  T h i s r u l i n g d i d n o t a l l o w b i r t h c o n t r o l f o r any and a l l p u r p o s e s , and t h e r e was argument over whether a l l r e s t r i c t i o n s s h o u l d be a b o l i s h e d , o r whether b i r t h c o n t r o l s h o u l d be made a v a i l a b l e o n l y by a d o c t o r .  Quackery would be p o s s i b l e  i f a l l r e s t r i c t i o n s were removed, so Mrs. Sanger f a v o r e d "doctors o n l y " .  Support from t h e d o c t o r s themselves was t h e  n ext chal1eng e. Dr. R o b e r t L a t o u D i c k i n s o n , a l e a d i n g g y n a e c o l o g i s t and head o f t h e N a t i o n a l Committee on M a t e r n a l W e l f a r e , wanted t o see h i s c o l l e a g u e s i n v o l v e d i n b i r t h c o n t r o l t o p r e v e n t to p a t i e n t s ' h e a l t h from v i s i t s t o quacks.  But other  damage doctors  f e a r e d t h a t quacks might f u n c t i o n j u s t t h e same, and were r e l u c t a n t t o be i n v o l v e d i n a f i e l d i n which s u c h a c o n f l i c t could occur.  Many o f t h o s e who f a v o r e d b i r t h c o n t r o l d i s l i k e d  Mrs. Sanger's t a c t i c s and h e s i t a t e d t o be a s s o c i a t e d w i t h h e r sensationalism.  Others argued a g a i n s t b i r t h c o n t r o l f o r non-  m e d i c a l - i . e . eugenic o r socio-economic were p o o r l y i n f o r m e d  reasons.  Most d o c t o r s  i n any case, and l a c k o f a s i m p l e , e f -  f e c t i v e b i r t h c o n t r o l method a l s o o b s t r u c t e d t h e i r  co-operation.  To b e g i n t o answer t h e i r needs i n a s c i e n t i f i c way, Mrs. Sanger o r g a n i z e d a C l i n i c a l R e s e a r c h Bureau i n New Y o r k and h i r e d a woman d o c t o r t o open i t i n J a n u a r y ,  1923*  Dr. D i c k i n s o n had r u n a h o s p i t a l - b a s e d r e f e r r a l s e r v i c e , b u t m e d i c a l e t h i c s had prevented  p u b l i c i t y , and t h e Sanger  p r o j e c t , under no such r e s t r a i n t s , was much more s u c c e s s f u l . I t s f i n d i n g s were n o t e l i g i b l e f o r p u b l i c a t i o n i n r e p u t a b l e m e d i c a l j o u r n a l s , however, so i t was obvious t h a t t h e r e was  a need f o r mutual  support.  Dr. D i c k i n s o n t r i e d t o arrange f o r a m e d i c a l  research  c o u n c i l t o t a k e over t h e Bureau, b u t h i s c o l l e a g u e s h e s i t a t e d because o f M r s . Sanger's c o n n e c t i o n w i t h i t , and Mrs. Sanger r e f u s e d t o g i v e up h e r predominant p o s i t i o n . was supported  I n t h i s she  by h e r n o n - m e d i c a l b o a r d members - n o t e d b i o l o -  g i s t s , s o c i o l o g i s t s and t h e l i k e , and t h e c o n f l i c t was i n s o l u b l e . At l e a s t part of the r e s p o n s i b i l i t y f o r the t r a g e d y o f c o n t i n u i n g m e d i c a l i g n o r a n c e o f c o n t r a c e p t i o n had t o be l a i d t o Margaret Sanger. Had she r e l i n q u i s h e d c o n t r o l o f the c l i n i c t o D i c k i n s o n i n 1925, she would have f a c i l i t a t e d r e s e a r c h , opened up t h e best medical j o u r n a l s f o r the p u b l i c a t i o n s o f t e s t r e s u l t s , and made t h e c l i n i c much more e f f e c t i v e as a t r a i n i n g c e n t r e f o r p h y s i c i a n s i n t e r e s t e d i n c o n t r a c e p t i o n .... M i l l i o n s o f women, f i n d i n g no h e l p w i t h r e g a r d t o c o n t r a c e p t i o n from orthodox m e d i c i n e , t u r n e d t o t h e quacks. And as i n t h e n i n e t e e n t h c e n t u r y , t h e absence o f c l e a r l e g a l r e g u l a t i o n s exacerbated t h e situation. 2 0  The  impasse c o n t i n u e d , a l t h o u g h b y 1930 t h e r e were  clinics  i n twenty-three  cities.  When Mrs. Sanger  fifty-five finally  detached t h e Bureau from t h e American B i r t h C o n t r o l League and  l e f t that organization  terself  t h e same y e a r , a l s o 1930,  Dr. D i c k i n s o n j o i n e d t h e Board o f t h e Bureau. At t h e same time Margaret d e c i d e d t o o r g a n i z e a r e p e a l o f t h e Comstock Law and t o r e p l a c e i t w i t h a b i l l t o a l l o w d o c t o r s , h o s p i t a l s o r d r u g g i s t s f r e e use o f t h e m a i l s .  A  monster l o b b y i n g campaign was s e t i n motion i n Washington, and, by 1931,  she was t e s t i f y i n g t h a t b i r t h c o n t r o l would  lower i n f a n t and m a t e r n a l m o r t a l i t y r a t e s and improve f a m i l y  welfare.  She a l s o noted i t s eugenic v a l u e and r e l e v a n c e t o 21  w o r l d p o p u l a t i o n problems.  There was c o n s i d e r a b l e  Catholic  o p p o s i t i o n on t h e ground t h a t b i r t h c o n t r o l would encourage i m m o r a l i t y and weaken f a m i l y r e l a t i o n s h i p s . A d e c l i n i n g popul a t i o n would be a n o t h e r consequence, and a g r i c u l t u r e , b u s i n e s s and i n d u s t r y would s u f f e r .  An e x e c u t i v e o f t h e M e t r o p o l i t a n  L i f e I n s u r a n c e Company s u p p o r t e d t h e C a t h o l i c c l a i m . r e p l i e d t h a t b i r t h c o n t r o l would ease p o v e r t y and reduce t a x e s . continue  Mrs. Sanger  and unemployment  W i t h o u t i t , t h e l o w e r income groups would  t o m u l t i p l y , whereas middle and upper income l e v e l s  would s h r i n k , c a u s i n g an imbalance i n the age s t r u c t u r e .  In  t h e end, i n s p i t e o f h e r campaign, no amendment t o t h e l a w was passed.  I t was b e i n g c i r c u m v e n t e d i n any case by a w i d e r  i n t e r p r e t a t i o n o f t h e l a w , so t h e m a t t e r was no l o n g e r The  only remaining  o b s t a c l e f o r d o c t o r s was t h e r u l e  which prevented i m p o r t a t i o n o f c o n t r a c e p t i v e s . t h a t t h e Second F e d e r a l C i r c u i t Court (New Y o r k , and Vermont) decided permissible.  urgent.  I t was i n 1936 Connecticut  t h a t i m p o r t a t i o n o f c o n t r a c e p t i v e s was  Increased  l e g a l l a t i t u d e and a b r o a d e r d e f i n i t i o n  o f h e a l t h as w e l l as Mrs. Sanger's p e r s i s t e n c e , brought American Medical A s s o c i a t i o n approval of b i r t h c o n t r o l f o r other than p a t h o l o g i c a l reasons i n 1937* I n t h e meantime, d u r i n g t h e twenty y e a r s s i n c e Brownsv i l l e , Margaret Sanger had promoted t h e f e m i n i s t s i d e o f h e r case by w r i t i n g two b o o k s , Woman and t h e New Race, and The P i v o t o f C i v i l i z a t i o n , i n w h i c h she urged women t o a s s e r t t h e i r r i g h t t o v o l u n t a r y motherhood, p l e a d e d f o r p o p u l a t i o n  "quality -  n o t q u a n t i t y " , and f o r s p a c i n g or l i m i t i n g p r e g n a n c i e s t o p r e v e n t t h e a r r i v a l o f unwanted c h i l d r e n .  Marxism, t r a d e  u n i o n s and the Roman C a t h o l i c Church were a t t a c k e d f o r t h e i r 22  opposition. D u r i n g t h i s p e r i o d a l s o , Mrs. Sanger formed a new the American B i r t h C o n t r o l League i n 1921,  group,  s e v e r i n g h e r con-  n e c t i o n w i t h the c o n s e r v a t i v e N a t i o n a l B i r t h C o n t r o l  League.  To honor the new o r g a n i z a t i o n , she s c h e d u l e d a p u b l i c meeting i n New Y o r k ' s Town H a l l t o d i s c u s s B i r t h C o n t r o l : I s I t M o r a l ? Two  thousand people crowded i n t o the h a l l t o h e a r i t , but when  Margaret a r r i v e d w i t h t h e guest s p e a k e r , the p o l i c e were b a r r i n g the d o o r .  I t i s s a i d t h e i r presence was i n s p i r e d by  A r c h b i s h o p ( l a t e r C a r d i n a l ) P a t r i c k J . Hayes.  An eager p r e s s  p r i n t e d a c o n t i n u i n g debate between Mrs. Sanger and H i s G r a c e , w h i c h was more noted f o r i t s heat t h a n i t s r e a s o n .  But M a r g a r e t  managed t o t u r n t h e p u b l i c i t y t o t h e advantage o f her cause 23  as she was a l s o a b l e t o do on many o t h e r s i m i l a r o c c a s i o n s . Funds t o c o n t i n u e the campaign were always a problem, however. A f t e r a q u i e t d i v o r c e from W i l l i a m Sanger i n 1 9 2 0 , Margaret a c q u i r e d an a r d e n t a d m i r e r i n J . Noah S l e e , P r e s i d e n t o f the Three-in-One O i l Company. went, s e e k i n g t o marry h e r .  He f o l l o w e d h e r wherever  she  A f t e r numerous r e f u s a l s , she  f i n a l l y agreed t o marry him, p r o v i d e d t h e y c o u l d l i v e  inde-  pendent l i v e s and she would be a l l o w e d t o pursue h e r b i r t h c o n t r o l campaign under h e r own name and w i t h o u t i n t e r f e r e n c e . From S l e e she got funds f o r the B i r t h C o n t r o l League, and a l s o f o r t h e C l i n i c a l R e s e a r c h Bureau.  He a l s o s u p p o r t e d the N a t i o n a l  Committee on F e d e r a l l e g i s l a t i o n f o r B i r t h C o n t r o l , and contributed to i n t e r n a t i o n a l conferences.  When she f e l l  out  w i t h the League ( a g a i n , o v e r P r e s i d e n t i a l p r e r o g a t i v e s ) S l e e w i t h d r e w h i s League s u p p o r t as w e l l , g i v i n g h e r  considerable  f i n a n c i a l l e v e r a g e t o m a i n t a i n her l e a d e r s h i p . When t h e N a t i o n a l Committee d i s s o l v e d t h e r e was  a move  t o c o - o r d i n a t e the work o f the ABCL and the C l i n i c a l R e s e a r c h B u r e a u and, was  i n l a t e 1937> the B i r t h C o n t r o l C o u n c i l o f A m e r i c a  the r e s u l t .  A y e a r l a t e r i t was  dent s h o u l d be a man,  and  suggested  the C o u n c i l was  t h a t the  r e p l a c e d by  Presi-  the  B i r t h C o n t r o l F e d e r a t i o n o f A m e r i c a , headed by D r . R i c h a r d Pierson.  N.  "A few y e a r s l a t e r , (l9*+2) over Mrs. Sanger's l o u d  p r o t e s t s , the name was  changed t o P l a n n e d  Parenthood  Federa-  2k  t i o n o f A m e r i c a , and o t h e r s t o o k o v e r the r e i n s .  This  c o i n c i d e d w i t h Mr. S l e e ' s s e r i o u s i l l n e s s and Mrs. departure  f o r A r i z o n a t o n u r s e him.  She  Sanger's  r e t a i n e d c o n t r o l of  t h e C l i n i c a l R e s e a r c h B u r e a u , however, u n t i l I 9 6 0 , and she had two more major c o n t r i b u t i o n s t o make t o the movement i n 25 the U n i t e d S t a t e s . From 1938  Mrs. Sanger and h e r s u p p o r t e r s had  pressed  i n c r e a s i n g l y h a r d f o r b i r t h c o n t r o l f a c i l i t i e s i n the government h e a l t h s e r v i c e s . w i t h Eleanor Roosevelt  I t was  US  not u n t i l her f r i e n d s h i p  l e d t h e l a t t e r t o i n t e r v e n e , and White  House Conferences were c a l l e d , t h a t the logjam o f h e s i t a t i o n was  broken.  I n 19^2  t h e US P u b l i c H e a l t h S e r v i c e (USPHS) was  able to begin t o o f f e r , both through c o n t r o l program and m a t e r n a l  i t s venereal  disease  and c h i l d h e a l t h s e r v i c e , the  n e c e s s a r y i n f o r m a t i o n and s u p p l i e s .  Her second  contribution  was t o a r r a n g e some o f t h e i n i t i a l f i n a n c i n g f o r r e s e a r c h i n t o hormonal methods o f b i r t h c o n t r o l .  She had always wanted a  s i m p l e , r e l i a b l e method, the use o f w h i c h would n o t be r e l a t e d t o the time o f i n t e r c o u r s e , and w h i c h would n o t r e q u i r e particular privacy.  any  I n 1952 she s e c u r e d a l a r g e d o n a t i o n f o r  Dr. Gregory P i n c u s t o s t a r t the r e s e a r c h which c u l m i n a t e d i n 27 "The P i l l " ,  a c o m b i n a t i o n o f p r o g e s t e r o n e as a s u p p r e s s a n t  o f o v u l a t i o n and e s t r o g e n  (used by Dr. John Rock i n the  treatment of s u b - f e r t i l i t y ) . A f t e r World War  I I , the p r e s s u r e s f o r b i r t h c o n t r o l on  a l a r g e s c a l e , b o t h w i t h i n t h e U n i t e d S t a t e s and i n d e v e l o p i n g c o u n t r i e s brought a c o n s i d e r a b l e change i n p u b l i c a t t i t u d e s i n i t s favor. 1970,  R e s t r i c t i v e laws began t o be r e p e a l e d and, by  P l a n n e d Parenthood was o p e r a t i n g 620 c l i n i c s i n 350  c i t i e s i n 40 s t a t e s , and the D i s t r i c t o f Columbia, and had s e r v e d more t h a n 5°0,000 women.  I t s budget was  $30  million,  and 57 p e r c e n t of i t s p a t i e n t s had incomes o f l e s s t h a n $75*00 a week.  A f t e r a slow s t a r t , p u b l i c a g e n c i e s were a l s o s e r v i n g  an a d d i t i o n a l 2 0 0 , 0 0 0 , b u t an e s t i m a t e d 5*3  m i l l i o n low income  women i n t h e U n i t e d S t a t e s would use the s e r v i c e i f i t were provided.  As an i l l u s t r a t i o n o f t h e change i n p u b l i c a t -  t i t u d e s , i n the 1960s P r e s i d e n t s Kennedy, Johnson and M x o n , i n v a r y i n g d e g r e e s , s u p p o r t e d f a m i l y p l a n n i n g , and t h e y were e v e n t u a l l y j o i n e d by former P r e s i d e n t s Eisenhower as members o f a s p o n s o r s ' c o u n c i l o f Planned  and Truman  Parenthood.  I n summary, as i n the U n i t e d Kingdom, l e a d e r s h i p i n  the f a m i l y p l a n n i n g  movement i n the- U n i t e d  the educated c l a s s e s . the u l t i m a t e g o a l .  States  came from  M o t i v e s v a r i e d , "but s o c i a l r e f o r m was  Opposition  came from t h e same i n t e r e s t  groups - p o l i t i c a l , c o m m e r c i a l , r e l i g i o u s and m e d i c a l - "but many members o f t h e g e n e r a l p u b l i c were a l r e a d y p r a c t i s i n g birth control.  Death c o n t r o l and i n d u s t r i a l i z a t i o n had  created the climate, the volunteers ance b u t , i n t h e U n i t e d  speeded i t s w i d e r a c c e p t -  S t a t e s , t o o , a t t h e end o f 1969,  government s u p p o r t was n o t y e t e f f e c t i v e ! . S i m i l a r d e v e l o p ments were o c c u r r i n g i n c o n t i n e n t a l Europe and E a s t A s i a .  FOOTNOTES  -  Chapter  II  P e t e r F r y e r , The B i r t h C o n t r o l l e r s , London, 1965, ph., pp. 1 0 3 - 0 9 ; See a l s o Norman E. Himes, M e d i c a l H i s t o r y o f C o n t r a c e p t i o n , B a l t i m o r e , 1963» P"b •, p. 224. ^ C h a r l e s Knowlton, M.D., F r u i t s o f P h i l o s o p h y : An Essay on the P o p u l a t i o n Q u e s t i o n , 2nd ed. w i t h n o t e s , Preethought P u b l i s h i n g Company, London, n.d. pp. 1 2 - 1 7 » 45; Rhythm was f i r s t e x p l a i n e d , though i n c o r r e c t l y , by Adam R a c i b o r s k i , a P o l i s h p h y s i o l o g i s t , about 1850. F r y e r , o p . c i t . , p. 124. ^Himes, o p . c i t . , p. 233* 4 B i b l e Communism: A C o m p i l a t i o n from the A n n u a l R e p o r t s o f t h e " O n e i d a A s s o c i a t i o n and i t s Branches', B r o o k l y n , 1853, pp. 5-38. C o i t u s r e s e r v a t u s - a t e c h n i q u e i n w h i c h no e j a c u l a t i o n t a k e s p l a c e , and detumescence t a k e s p l a c e s l o w l y , over a p r o l o n g e d p e r i o d . ^ F r y e r , o p . c i t . , p.  154.  ^Anthony Comstock, Traps f o r the Young, R o b e r t Bremner, ed., Cambridge, 1967> PP. v i i - x i v . 22;  ^ I b i d . , pp. v i i , v i i i , p.  8Anthony Comstock, o p . c i t . , p. 137; 131. 9Anthony Comstock, o p . c i t . , p. H i m e s , o p . c i t . , p.  ±x  C o m s t o c k , o p . c i t . , p.  1  Also Fryer, o p . c i t . ,  xii.  286.  x 0  1 2  213.  A l s o F r y e r , o p . c i t . , p.  xxiii.  F r y e r , op.cit.,pp. 130-32.  3 H i m e s , o p . c i t . , p.  ^ I b i d . , pp.  279.  286-87.  ^Da.vid M. Kennedy, B i r t h C o n t r o l i n A m e r i c a : The o f Margaret Sanger, New Haven, 1970, pp. 1-16. x  l 6  I b i d . , pp.  1 7  I b i d . , p.  Career  4-35. 32.  ^ E m i l y T a f t D o u g l a s , Margaret Sanger: P i o n e e r o f the F u t u r e , New Y o r k , 1970, p. 69. x  Kennedy, o p . c i t . , pp. 87-8. 20 I b i d . , pp. 211-12. 2 1  I b i d . , p. 2 3 3 .  22  1920. 2  2  Margaret Sanger, Women and t h e Hew Race, New Y o r k , The P i v o t o f C i v i l i z a t i o n . New Y o r k . 1922. p a s s i m .  3 p r y e r , o p . c i t . , p p . 236-37. ^Kennedy, o p . c i t . , pp. 256-57.  5Lawrence Lader and M i l t o n M e l t z e r , Margaret Sanger; P i o n e e r o f B i r t h C o n t r o l , New Y o r k , I 9 6 9 , p . 1 5 5 . Renamed t h e Margaret Sanger R e s e a r c h Bureau, i t i s b e i n g amalgamated w i t h Columbia U n i v e r s i t y ' s I n t e r n a t i o n a l I n s t i t u t e f o r t h e Study o f Human R e p r o d u c t i o n , and w i l l add t o i t s e d u c a t i o n f o r marriage and c l i n i c s e r v i c e s , s u r g i c a l s t e r i l i z a t i o n and r e s e a r c h i n s t e r i l i z a t i o n . 2  2  2  ^Kennedy, o p . c i t . , p p . 266-67. ? l b i d . , p. v i i ;  E m i l y T a f t B o u g l a s , op. c i t . , pp. 2 5 4 - 5 5 .  . "The F u t u r e i s Now", P l a n n e d Parenthood - World P o p u l a t i o n , New Y o r k , l e a f l e t , 1 9 7 0 . 2t5  CHAPTER  III  Some Developments i n Europe and E a s t A s i a  On the European c o n t i n e n t M a l t h u s i a n l e a g u e s were 1885  f o r m i n g - i n the N e t h e r l a n d s , 1881; i n P r a n c e , i n  1901;  (though i t was not a c t i v e u n t i l 1898) ; Bohemia, S p a i n , 1904; 1911;  B e l g i u m , 1906;  and I t a l y , 1913;  S w i t z e r l a n d , 1908;  Sweden,  but t h e y were not v e r y v i g o r o u s  and, w i t h two e x c e p t i o n s , l i t t l e p r o g r e s s was  made.  The most s u c c e s s f u l among them was the Dutch Nieuw M a l t h u s i a a n s c h e n Bond (1MB), founded t o promote the s p a c i n g of p r e g n a n c i e s f o r b e t t e r m a t e r n a l and i n f a n t h e a l t h .  One  of t h e l e a d e r s , Dr. A l e t t a J a c o b s , saw c o n t r a c e p t i o n as a weapon i n t h e s t r u g g l e f o r women's r i g h t s , and i n opened the f i r s t b i r t h  1890  c o n t r o l c l i n i c i n Europe i n Amsterdam.  In h e r s e a r c h f o r the b e s t method, she came t o p r e f e r the Mensinga diaphragm, and i t s use i n t h e NMB spread t h a t i t was  dubbed the "Dutch cap".  f r e e c l i n i c s were o p e r a t i n g .  became so w i d e By 1892  four  Another member o f t h e NMB  D r . Johannes R u t g e r s , o f The Hague, who  was  opened o t h e r c l i n i c s  and t r a i n e d midwives and w o r k i n g c l a s s women t o f i t the devices.  H i s p o l i c y l e d t o a s p l i t between the m e d i c a l and  n o n - m e d i c a l workers i n t h e movement, and Dr. J a c o b s r e s i g n e d in disillusionment.  (By the time Mrs. Sanger  visited  Dr. R u t g e r s he must have changed h i s mind, f o r i t has been n o t e d t h a t he recommended a g a i n s t u s i n g n o n - m e d i c a l  personnel  t o f i t diaphragms. Around the t u r n o f the c e n t u r y , r i g h t w i n g p a r t i e s i n the Netherlands  became i n f l u e n t i a l enough t o  s t r u c t the o r g a n i z a t i o n , and i t was i t r e v i v e d and the p o l i c y b r e a c h was o f the NMB presented  was  clerical ob-  not u n t i l the 1930s t h a t healed.  The  c o n s i d e r a b l y enhanced when Queen  prestige Wilhelmina  i t w i t h a medal o f honour and a c h a r t e r , and  the o r g a n i z a t i o n as a p u b l i c b e n e f a c t i o n .  I t now  f i f t y f a m i l y p l a n n i n g c e n t r e s i n the N e t h e r l a n d s ,  praised  operates and  the  Dutch government has r e c e n t l y g i v e n f i n a n c i a l support t o the I n t e r n a t i o n a l P l a n n e d Parenthood Federation."'" A n o t h e r Western European c o u n t r y i n w h i c h the c o n t r o l movement i s w e l l advanced i s Sweden.  birth  As i n o t h e r  r e l a t e d f i e l d s , Swedish p o l i c y i s o f t e n i n c o r r e c t l y r e p o r t e d and m i s u n d e r s t o o d . i n 1911»  Although  p r o g r e s s was  the M a l t h u s i a n l e a g u e was  n o n - e x i s t e n t u n t i l 1933  formed  when  Mrs. E l i s e O t t e s e n - J e n s e n o r g a n i z e d the Swedish N a t i o n a l Union f o r S e x u a l I n f o r m a t i o n .  Advocating  i n the s c h o o l s and u n i v e r s i t i e s , she was and a d u l t e d u c a t i o n g r o u p s .  T r a i n i n g was  sex  information  supported  by l a b o r  arranged  for  t e a c h e r s , y o u t h l e a d e r s and d o c t o r s , and Mrs. O t t e s e n - J e n s e n h e r s e l f gave many of the l e c t u r e s . Among opponents were members o f the L u t h e r a n A n o t h e r n e g a t i v e i n f l u e n c e was  a book by A l v a and  M y r d a l , P o p u l a t i o n C r i s i s , i n which a t t e n t i o n was  Church.  Cunnar drawn t o  the d e c l i n e o f t h e Swedish b i r t h r a t e .  Pro-natalist policies,  i n c l u d i n g g l o r i f i c a t i o n o f t h e f a m i l y and s o c i a l r e s p o n s i b i l i t y , and t a x and o t h e r i n c e n t i v e s were o f f e r e d by t h e government.  F a m i l y P l a n n i n g , which had been a v a i l a b l e  m a t e r n a l and c h i l d h e a l t h c e n t r e s , was f o r b i d d e n .  through  The b i r t h -  r a t e c o n t i n u e d t o d e c l i n e , however, i n d i c a t i n g p r i v a t e use o f birth control.  As t h e p o p u l a t i o n a l s o c o n t i n u e d t o i n c r e a s e ,  r e s t r i c t i o n s were l i f t e d i n 1938, f a m i l y p l a n n i n g s e r v i c e s were r e s t o r e d , and a b o r t i o n , on s o c i o - m e d i c a l grounds was legalized.  However, c o n t r a c e p t i o n c o n t i n u e d t o be 2  advocated  i n preference to a b o r t i o n . Besides her other educational a c t i v i t i e s , Mrs. O t t e s e n - J e n s e n  opened homes f o r unmarried  mothers,  and gave l e c t u r e s on f a m i l y p l a n n i n g and p r e v e n t i o n o f v e n e r e a l d i s e a s e t o t h e Swedish army. a c t i v i t i e s a r e . d e s c r i b e d on page 83»)  (Her i n t e r n a t i o n a l I n 19^6 sex e d u c a t i o n  i n t h e s c h o o l s became compulsory, and Mrs. Ottesen-Jensen a s s i s t e d i n the p r e p a r a t i o n o f a teacher's guide.  She was  honored by t h e IPPF i n 1965 because, a t t h e age o f 80, s h e , t o o , was s t i l l a c t i v e i n t h e movement.  Today, t h e Swedish  Family P l a n n i n g A s s o c i a t i o n operates three f a m i l y planning c e n t r e s , t r a i n s m e d i c a l and p a r a m e d i c a l p e r s o n n e l , i s p r e s s i n g f o r improved f a m i l y p l a n n i n g s e r v i c e s i n r u r a l a r e a s , p r o motes sex e d u c a t i o n and i s r e p r e s e n t e d on two government commissions on sex e d u c a t i o n and a b o r t i o n .  The Swedish  government s u p p o r t s t h e v o l u n t a r y o r g a n i z a t i o n , d i r e c t s sex e d u c a t i o n programs i n . t h e s c h o o l s , t e s t s  imported  condoms and, a t the u r g i n g o f Mrs. O t t e s e n - J e n s e n ,  has adopted  a p o l i c y of g i v i n g f o r e i g n a i d i n the f a m i l y planning  field.  Through the Swedish I n t e r n a t i o n a l Development Agency  (SIDA),  two o f the c h i e f h e n e f i c i a r i e s have been Ceylon and P a k i s t a n . In 1968,  f a m i l y p l a n n i n g a s s i s t a n c e amounted t o t w e l v e  percent  o f the t o t a l Swedish f o r e i g n a i d b u d g e t , and $500,000 o f i t 3  was  a l l o c a t e d t o the I P P P . A f t e r World War  I I new  a c t i v i t y t o o k p l a c e i n some o t h e r  c o u n t r i e s o f Western Europe - Denmark, Prance and West Germany, for  example - b u t , because o f o p p o s i t i o n o r imagined o p p o s i -  t i o n , i n no c o u n t r y was  t h e r e an a l l - o u t program e i t h e r by  a  f a m i l y p l a n n i n g a s s o c i a t i o n o r government. In  the communist c o u n t r i e s o f E a s t e r n Europe the German  Democratic R e p u b l i c , P o l a n d and Y u g o s l a v i a have f a m i l y p l a n n i n g o r g a n i z a t i o n s a f f i l i a t e d w i t h the I P P P .  There i s g e n e r a l  c u r i o s i t y about f a m i l y p l a n n i n g i n t h e P e o p l e ' s  Republic of  China ( M a i n l a n d ) , where the p o p u l a t i o n i s e s t i m a t e d t o have reached  approximately  750  million.  A l t h o u g h no o f f i c i a l i n -  f o r m a t i o n i s a v a i l a b l e , and i t i s n o t known whether  any  v o l u n t a r y a c t i v i t y i s p r e s e n t , c e r t a i n t r e n d s are e v i d e n t . Government p o l i c y advocates l a t e marriage  and s m a l l f a m i l i e s .  B i r t h c o n t r o l i n f o r m a t i o n and a l l methods are p r o v i d e d , p a r t i c u l a r l y the IUD.  O r a l c o n t r a c e p t i v e s are i n u s e .  and s t e r i l i z a t i o n s are i n c r e a s i n g . How  Abortions  e x t e n s i v e a r e the  f a m i l y p l a n n i n g s e r v i c e s i s n o t known, but i t would seem t h a t at  l e a s t some M a t e r n a l and C h i l d H e a l t h C e n t r e s , h o s p i t a l s  and m e d i c a l s c h o o l s are i n a c t i o n , and mobile m e d i c a l teams  are b e i n g used on an i n c r e a s i n g s c a l e . The  postwar w o r l d has been f a s c i n a t e d by  (but somewhat  m i s i n f o r m e d on the r e a s o n s f o r ) the v e r y r a p i d r e d u c t i o n  of  n e a r l y 50 p e r c e n t i n the crude b i r t h r a t e of J a p a n i n the decade f o l l o w i n g 1949.  The  Japanese r e c o r d does not  neces-  s a r i l y prove t h a t a s i m i l a r speedy r e d u c t i o n i n b i r t h r a t e s i s possible i n other Asian are A s i a n .  The  c o u n t r i e s j u s t because t h e y , t o o ,  d i f f e r e n c e l i e s i n the f a c t t h a t , t o a l l  i n t e n t s and p u r p o s e s , Japan i s a modern i n d u s t r i a l i z e d  so-  c i e t y l i k e t h o s e i n the West, and t h e r e , t o o , a demographic t r a n s i t i o n has o c c u r r e d . back t o 1868, country  I r e n e Taeuber t r a c e s i t s b e g i n n i n g  when the M e i j i R e s t o r a t i o n began t o open the  t o Western i d e a s .  o f 35 m i l l i o n , Japan had s t r u c t u r e , but i t was  As a f e u d a l and a g r a r i a n an a r c h a i c s o c i a l and  u n i t e d and  disciplined.  society  political Mortality  r a t e s were h i g h enough to keep p o p u l a t i o n growth w i t h i n the absorptive  c a p a c i t y o f the economy.  B u t , from the  beginning  o f the m o d e r n i z i n g p e r i o d , m o r t a l i t y began t o d e c l i n e . i t was  f o l l o w e d by a f e r t i l i t y d e c l i n e , n a t u r a l  As  increase  d i d not r e a c h 2 p e r c e n t per y e a r u n t i l a f t e r World War I I . But t h e n , a baby boom o c c u r r e d ,  s i m i l a r to that i n other  industrialized nations.Deathrates and p o p u l a t i o n  growth became a c r u c i a l problem.  a c t i l l e g a l a b o r t i o n , and sterilization,  continued  though a b o r t i o n was  To  counter-  f o r e u g e n i c and h e a l t h r e a s o n s ,  induced a b o r t i o n , and  l e g a l i z e d under the new  to d e c l i n e ,  contraception  E u g e n i c P r o t e c t i o n Law  not p r o v i d e d  were  o f 1948.  by the p u b l i c s e c t o r , so  Al-  many were performed t h a t i t was  f e a r e d t h a t , not o n l y the  h e a l t h , but the l i v e s o f many women were t h r e a t e n e d . 1952,  the government i n a u g u r a t e d  v o l u n t a r y c o n t r a c e p t i o n was women. i t was  So, i n  a p o l i c y s t r e s s i n g that  p r e f e r a b l e and f o r b o t h men  and  Through i n d i v i d u a l approaches and mass p u b l i c e d u c a t i o n 6 very s u c c e s s f u l .  In Japan, p o p u l a t i o n pressures  on  f o o d , s p a c e , employment, and e d u c a t i o n , combined w i t h a t o t a l t r a n s f o r m a t i o n of the n a t i o n a l economy to b r i n g about a s i t u a t i o n p a r a l l e l t o European i n d u s t r i a l i z e d s o c i e t i e s .  These  c o n d i t i o n s , coupled w i t h government encouragement o f the  use  o f b i r t h c o n t r o l , b r o u g h t about a l o n g t e r m , and then a sharp drop i n f e r t i l i t y . Two c h i l d r e n a t most, per f a m i l y , became 7 the vogue.  I n the meantime, c o n c u r r e n t w i t h demographic  change i n the t w e n t i e t h c e n t u r y a v o l u n t a r y e f f o r t t o promote b i r t h c o n t r o l a l s o developed. The  F a m i l y P l a n n i n g A s s o c i a t i o n of Japan began i n  Y o r k i n 1920, i n the K a i z o  New  where Baroness I s h i m o t o , then w i f e o f a l e a d e r (Young R e c o n s t r u c t i o n L e a g u e ) , t o o k a b u s i n e s s  course under YWCA a u s p i c e s .  I n s t r u c t e d by her  engineer  husband t o f i n d a u s e f u l r o l e f o r h e r s e l f i n s e r v i n g the modernizing  needs of her c o u n t r y , Shidzue d e c i d e d t h a t  would s t a r t a b i r t h c o n t r o l movement - t o r e l i e v e and  she  maternal  c h i l d h e a l t h problems and t o r a i s e the s t a t u s o f Japanese  women.  She  met  Mrs. Sanger, and, t h r o u g h her h e l p , the  Kaizo  s e t up a b i r t h c o n t r o l committee, t r a n s l a t e d F a m i l y L i m i t a t i o n , and began a s u s t a i n e d campaign i n J a p a n . i n v i t e d t o v i s i t the c o u n t r y as one  Mrs. Sanger was  o f f o u r s p e a k e r s on  soon  Western thought - A l b e r t E i n s t e i n , B e r t r a n d R u s s e l l and H.G. W e l l s were t h e o t h e r s .  (The K a i z o suggested Mrs. Sanger  s h o u l d speak about t h e p r e v a l e n t w e s t e r n concern about t h e " Y e l l o w P e r i l " and i t s teeming m i l l i o n s as a t h r e a t t o peace.) The Japanese government's  r e l u c t a n c e t o admit h e r was w e l l  p u b l i c i z e d , a n d , a l t h o u g h she was n o t a l l o w e d t o g i v e p u b l i c a d d r e s s e s , she gave many t o p r i v a t e o r g a n i z a t i o n s , and h e l d numerous p r e s s i n t e r v i e w s .  Baroness I s h i m o t o went on w i t h  h e r t o a t t e n d t h e F i f t h I n t e r n a t i o n a l M a l t h u s i a n and B i r t h C o n t r o l Conference i n London i n 1 9 2 2 . By 1935» t h e m i l i t a r i s t f a c t i o n had t h e upper hand i n Japan and t h e b i r t h c o n t r o l c l i n i c s were c l o s e d .  The Baroness  was a r r e s t e d , and then kept under a l o n g s u r v e i l l a n c e .  Her  husband changed h i s p o l i t i c a l sympathies and t h e r e was a d i vorce.  S h i d z u e then m a r r i e d Kanjo K a t o , a l a b o r l e a d e r , and  i n 19^6 b o t h were e l e c t e d as S o c i a l Democrats t o t h e Japanese Parliament.  As an advocate o f an end t o m i l i t a r i s m and r a i s i n g  the s t a t u s o f women, Mrs. Kato was a b l e t o i n f l u e n c e t h e w r i t i n g o f t h e new postwar c o n s t i t u t i o n .  The b i r t h c o n t r o l  clinics  were reopened and r u n under t h e d i r e c t i o n o f a D r . Majumi, w i t h the co-operation of the Health M i n i s t r y .  I n 1951 t h e  Japanese once more i n v i t e d Mrs. Sanger t o v i s i t , b u t t h i s time G e n e r a l Douglas M a c A r t h u r , commander o f t h e o c c u p a t i o n forces, refused her a v i s a .  An outspoken American f e m i n i s t  i n Japan may have been c o n s i d e r e d u n d e s i r a b l e f o r a number o f r e a s o n s - i n c l u d i n g h e r advocacy o f c o n t r a c e p t i o n i n p r e f e r e n c e t o a b o r t i o n - b u t Mrs. Sanger and t h e Tokyo p r e s s c l a i m e d t h a t  73 g m i n o r i t y Roman C a t h o l i c i n t e r e s t s were "behind the d e c i s i o n . She was  a b l e t o pay h e r v i s i t i n 195^,  the M a i n i c h i P r e s s .  She  however, sponsored "by  spoke to a committee of the Japanese  D i e t and gave many o t h e r t a l k s and i n t e r v i e w s , but the need 9  and means f o r b i r t h c o n t r o l were a l r e a d y e s t a b l i s h e d . In  1952  the C a b i n e t C o u n c i l announced t h a t b i r t h c o n t r o l  s e r v i c e s would be made a v a i l a b l e f r e e f o r a l l t h r o u g h M a t e r n i t y and C h i l d H e a l t h C e n t r e s . B e s i d e s a b o r t i o n , t h e c h i e f methods were condoms and rhythm.  ( O r a l c o n t r a c e p t i v e s and IUDs are  n o t y e t i n c l u d e d i n the o f f i c i a l program.)  W i t h the added  s u p p o r t o f i n d u s t r y and the v o l u n t e e r s , a b o r t i o n r a t e s began to  d e c l i n e and the use o f c o n v e n t i o n a l c o n t r a c e p t i o n to r i s e .  In  1955  more than 1 , 1 0 0 , 0 0 0  a b o r t i o n s were done.  t h i s f i g u r e had dropped t o 7^0,000.  Health Insurance  were f i n a n c i n g b i r t h c o n t r o l f o r the employed, and 10  1967  In  schemes  welfare  a g e n c i e s f o r the i n d i g e n t . T h i s a l l - o u t a t t a c k on the p o p u l a t i o n problem had proved h e a l t h and w e l f a r e a s p e c t s and r e l i e v e d t h e h i g h dependency r a t i o w h i c h t h r e a t e n e d economic r e c o v e r y . b i r t h r a t e i s now  about 19  imyouth  The  per thousand - s t i l l more than  double the d e a t h r a t e o f 7> and the r a t e o f p o p u l a t i o n i n c r e a s e i s 1.1 103.5 and  p e r c e n t per y e a r .  The p o p u l a t i o n i s a p p r o x i m a t e l y  m i l l i o n ; the d o u b l i n g time i s e s t i m a t e d t o be 63 25 p e r c e n t o f the p o p u l a t i o n i s under the age o f 15  years; - about 11  the same r a t i o as i n most European i n d u s t r i a l i z e d c o u n t r i e s . But t h e r e i s growing concern  about the l o n g t e r m e f f e c t o f  d r a s t i c a l l y lowered f e r t i l i t y r a t e s on the age  s t r u c t u r e of  the p o p u l a t i o n , and f e a r t h a t , as t h e r a t e o f i n c r e a s e o f l a b o r f o r c e has  slowed, t h e r e w i l l be a l a b o r s h o r t a g e ,  i n c r e a s i n g numbers of middle and o l d e r age The  and  Japanese.  i n t e r i m r e p o r t of the P o p u l a t i o n Problems I n q u i r y  C o u n c i l , dated August 5 ,  1969,  n o t e s t h a t , s i n c e 1957,  fertility  r a t e s have been lower t h a n r e q u i r e d f o r a s t a t i o n a r y (2.0  the  i n s t e a d of 2.13  v a l u e s , and  children).  The  population  nuclear family, material  inadequate h o u s i n g have c o n t r i b u t e d t o the  adoption  o f the s m a l l f a m i l y norm; and the C o u n c i l recommends t h a t country  should  t a k e immediate a c t i o n t o r e c t i f y these  ences t h r o u g h s o c i a l r e f o r m s .  the  influ-  B u t , as the e f f e c t s o f  any  i n c r e a s e i n the f e r t i l i t y r a t e w i l l not be f e l t f o r a t l e a s t f i f t e e n y e a r s , o t h e r i n t e r i m measures are a l s o e s s e n t i a l : movement o f l a b o r must be p r o d u c t i v i t y increased couraged.  (The  c o n t r o l l e d , retirement  and  age  labor-intensive a c t i v i t i e s  C o u n c i l does not t a k e up the q u e s t i o n  the  re-studied, disof  whether c o n t i n u i n g economic e x p a n s i o n i s the o n l y means of  12. a c h i e v i n g improvements i n the s t a n d a r d I n s p i t e o f t h i s new  of  preoccupation  living.) w i t h i t s own  popu-  l a t i o n p r o b l e m s , Ja.pan has announced f o r e i g n a i d i n f a m i l y p l a n n i n g , f o r the IPPF and lation Acitivities. nesia.  the U n i t e d N a t i o n s Fund f o r Popu-  D i r e c t a i d i s a l s o b e i n g g i v e n i n Indo-  D o c t o r s , v i s u a l a i d s , e d u c a t i o n a l m a t e r i a l s and  are b e i n g p r o v i d e d .  I n I 9 6 8 the Fa.mily P l a n n i n g  Japan s e t up the Japanese O r g a n i z a t i o n operation  i n Family Planning  s e c t o r s and  vehicles  Federation  for International  to r a i s e money from p r i v a t e  government and to m o b i l i z e Japanese e x p e r t i s e  Co-  of  i n the i n t e r n a t i o n a l f i e l d . I n summary, the v o l u n t e e r s i n f a m i l y p l a n n i n g i n t h e i n d u s t r i a l i z e d c o u n t r i e s were educated s o c i a l many were p a c i f i s t , and  reformers,  a l l were o f middle c l a s s background.  Over the y e a r s t h e i r o b j e c t i v e s broadened from  improving  w o r k i n g c l a s s wages t o i n c l u d e women's r i g h t s , m a t e r n a l  and  c h i l d h e a l t h , r a c e b e t t e r m e n t , f a m i l y w e l f a r e , n a t i o n a l and i n t e r n a t i o n a l w e l l - b e i n g and, f i n a l l y , c o n s e r v a t i o n o f r e sources and the environment. F a m i l y p l a n n e r s i n i n d u s t r i a l i z e d c o u n t r i e s were not i n f l u e n t i a l i n reducing b i r t h r a t e s u n t i l other f a c t o r s , p a r t i c u l a r l y d e a t h c o n t r o l and downward t r e n d .  economic c o n d i t i o n s , had  induced  a  T h e i r f r e q u e n t c o n f l i c t s w i t h a u t h o r i t y were  w e l l p u b l i c i z e d , however, and i n c r e a s e d p u b l i c i n t e r e s t knowledge of methods was  the  and  result.  Because t h e i r movement was  c o n t r o v e r s i a l , and  o p p o s i t i o n i n p o l i t i c a l , c o m m e r c i a l , c l e r i c a l and  aroused  medical  c i r c l e s , i n p a r t i c u l a r , d e f e n s i v e t a c t i c s were i n t r o d u c e d . I t was  c l a i m e d t h a t b i r t h c o n t r o l was  n a t i v e to a b o r t i o n .  I t was  the o n l y s e n s i b l e a l t e r -  a means o f s p a c i n g p r e g n a n c i e s  b e t t e r h e a l t h o f b o t h mother and  child.  D i a g n o s i s and  for  treat-  ment o f i n f e r t i l i t y , m a r r i a g e c o u n s e l l i n g , g e n e t i c c o u n s e l l i n g , and f a m i l y l i f e e d u c a t i o n were added as time went on. Because t h e r e was  no background o f i n f o r m a t i o n o r  t r a i n i n g i n t h i s f i e l d , a workable system had t o be developed t h r o u g h t r i a l and e r r o r . was  But the e x p e r i e n c e  of the  volunteers  a v a l u a b l e f o u n d a t i o n on w h i c h government programs c o u l d  be  built. Much o f the f i n a n c i a l support f o r F a m i l y P l a n n i n g  A s s o c i a t i o n s i n m o d e r n i z i n g c o u n t r i e s has come t h r o u g h the I n t e r n a t i o n a l Planned Parenthood  Federation.  FOOTNOTES  -  Chapter  III  H i s t o r y o f C o n t r a c e p t i v e s , I P P F , London, 196?, pp. 2 3 - 4 . E m i l y T a f t D o u g l a s , Margaret Sanger; P i o n e e r o f t h e F u t u r e , New Y o r k , 1970, pp. 8 2 - 8 3 , 108. 2 V e r a Houghton, I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d F e d e r a t i o n ( I . P . P . F . ) . I t s H i s t o r y and I n f l u e n c e , I P P F , London, A p r i l , 1962. R e p r i n t from The E u g e n i c s Review, p. 7. 3 T h o r s t e n S j o v a l l , "Planned P a r e n t h o o d , Background and Development i n Sweden" paper g i v e n a t F o u r t h I n t e r n a t i o n a l Teach-In, T o r o n t o , 27 O c t o b e r 1968; B i r g i t t a L i n n e r , "The S e x u a l R e v o l u t i o n i n Sweden", Impact, V o l . x v i i i . No. 4, O c t . D e c , 1968, Sex, S c i e n c e ana T e c h n o l o g y , UNESCO, pp. 232, 243, 248; F a m i l y P l a n n i n g i n F i v e C o n t i n e n t s , I P P F , London, A p r i l , 1970, pp. 3 0 - 3 7 . 4 I b i d . , p p . 2 5 , 30-37;"Governmental P o l i c y Statements on P o p u l a t i o n : An I n v e n t o r y , " R e p o r t s on P o p u l a t i o n / F a m i l y P l a n n i n g , The P o p u l a t i o n C o u n c i l , F e b r u a r y , 1970, pp. 1 9 - 2 0 ; Dorothy Nortman, P o p u l a t i o n and F a m i l y P l a n n i n g Programs: A F a c t b o o k , P o p u l a t i o n C o u n c i l , R e p o r t s on P o p u l a t i o n / F a m i l y P l a n n i n g , J u l y , 1970, p. 355 Leo A. O r l e a n s , "Evidence from Chinese M e d i c a l J o u r n a l s on C u r r e n t P o p u l a t i o n P o l i c y " , The China Q u a r t e r l y , 0 t . - D e c , 1969. PP. 137-1^6, c i t e d , C u r r e n t P u b l i c a t i o n s i n P o p u l a t i o n / F a m i l y P l a n n i n g , No. 7, A p r i l , 1970, P o p u l a t i o n C o u n c i l , p. 4 . 1  c  ^ P h i l i p M. Hauser, "World P o p u l a t i o n Growth", P h i l i p M. Hauser, ed., The P o p u l a t i o n Dilemma, Englewood C l i f f s , 1969, p. 17; P o p u l a t i o n was about 25 m i l l i o n i n 1800, about 37 m i l l i o n i n 1880, 50 m i l l i o n i n 1910, and 73 m i l l i o n i n 1940 - a s t e a d i l y i n c r e a s i n g r a t e o f growth. "Governmental P o l i c y S t a t e m e n t s " , o p . c i t . , p.  19*  ^ I r e n e B. Taeuber, " P o p u l a t i o n Growth i n L e s s Developed C o u n t r i e s , " Hauser, ed., o p . c i t . , pp. 4 7 - 5 0 . g E m i l y T a f t D o u g l a s , o p . c i t . , p. 247. I b i d . , p. 251; "Margaret Sanger and the I P P F , " P r o c 7th Conference o f t h e I n t e r n a t i o n a l P l a n n e d Parenthood F e d e r a t i o n , Amsterdam, 196^, p. 7. 9  • ^ F a m i l y P l a n n i n g i n F i v e C o n t i n e n t s , p.  27•  E W o r l d P o p u l a t i o n Data S h e e t , P o p u l a t i o n R e f e r e n c e B u r e a u , Washington, D.C., A p r i l , 1970. " J a p a n : I n t e r i m R e p o r t of t h e P o p u l a t i o n Problems I n q u i r y C o u n c i l " , S t u d i e s i n -Family P l a n n i n g , No. 56, The P o p u l a t i o n C o u n c i l , New Xork, A u g u s t , 1970, pp. 1-4. x 2  PART  TWO  CHAPTER  IV  I n t e r n a t i o n a l C r o s s - F e r t i l i z a t i o n and E x p a n s i o n  Nor knowest t h o u what argument Thy l i f e t o t h y n e i g h b o r ' s creed has l e n t . A l l a r e needed by each one; ^ N o t h i n g i s f a i r o r good a l o n e . I n t e r n a t i o n a l a c t i v i t y i n the family planning f i e l d began w i t h t h e F i r s t I n t e r n a t i o n a l N e o - M a l t h u s i a n Conference h e l d i n P a r i s i n 1900 under t h e c h a i r m a n s h i p o f D r . C.R. D r y s d a l e , b r o t h e r o f t h e author o f The Elements o f S o c i a l S c i e n c e .  Suc-  c e e d i n g meetings t o o k p l a c e i n o t h e r European c i t i e s - 1905 i n L i e g e , 1910 i n The Hague, and 1911  i n Dresden.  These s e s s i o n s  were s p a r s e l y a t t e n d e d underground a f f a i r s u s u a l l y t a k e n up w i t h t e d i o u s debates about t h e r e l a t i o n o f M a l t h u s i a n p r i n c i p l e s to Marxism. By 1922 however t h e t o p i c had g a i n e d enough i n r e s p e c t a b i l i t y t h a t such a r e p u t a b l e speaker as John Maynard Keynes g r a c e d t h e London program, and o v e r one hundred p h y s i c i a n s a t t e n d e d a s e s s i o n devoted t o c o n t r a c e p t i v e t e c h n i q u e s . 2  The F i f t h I n t e r n a t i o n a l N e o - M a l t h u s i a n and B i r t h C o n t r o l Conf e r e n c e i n London i n 1922 was n o t a b l e f o r t h e presence o f Margaret Sanger, f r e s h from an A s i a n t o u r i n w h i c h she had  been shocked by the c o n d i t i o n o f women and c h i l d r e n , and had become c o n v i n c e d t h a t p o p u l a t i o n p r e s s u r e s l e a d t o war.  In  c o n f i r m a t i o n of h e r b e l i e f , Keynes warned t h a t p o p u l a t i o n would become b o t h an economic and a p o l i t i c a l p r o b l e m .  The  Conference urged the l e a g u e o f N a t i o n s t o warn i t s members. P r e s s coverage was  extensive.  Because she f e l t the message s h o u l d have an e q u a l impact i n t h e U n i t e d S t a t e s , Mrs. Sanger persuaded t h e American  Birth  C o n t r o l l e a g u e t o i n v i t e the n e x t c o n f e r e n c e t o meet i n New Y o r k i n 1925, and f i n a n c e d i t from d o n a t i o n s f r o m s u b s c r i b e r s to t h e B i r t h C o n t r o l Review. v a r i e t y of professions, countries attended. the  More t h a n 1,000  p e r s o n s from a  ( i n c l u d i n g m e d i c i n e ) , from e i g h t e e n  Two  p r a c t i c a l i n n o v a t i o n s were i n c l u d e d ,  d e l e g a t e s heard e v a l u a t i o n s o f e x i s t i n g methods o f b i r t h  c o n t r o l ( p r e p a r e d by Americans) and r e p o r t s o f D o c t o r Stone's work at the Margaret Sanger R e s e a r c h Bureau. use o f the diaphragm and j e l l y was  As a r e s u l t , the  c o n f i r m e d as the most r e -  l i a b l e method t o d a t e , and Dr. D i c k i n s o n a r r a n g e d f o r the d e t a i l s t o be p u b l i s h e d i n The M e d i c a l J o u r n a l and Record the  f i r s t t i m e such r e s e a r c h i n f o r m a t i o n was i n c l u d e d i n a  professional journal.  T h i s must have been the b e g i n n i n g o f  w o r l d - w i d e acceptance o f the "d & j " method by f a m i l y p l a n n e r s a p o l i c y t o be c r i t i c i s e d  l a t e r as a "middle c l a s s " s o l u t i o n  u n s u i t e d t o the p o v e r t y - s t r i c k e n masses o f South A s i a . Chapter  (See  V)? Demographers were now a s s e s s i n g the r a t e o f p o p u l a t i o n  growth and t h e e s t i m a t e d time r e q u i r e d t o add more b i l l i o n s .  I n the hope o f j o l t i n g the League of N a t i o n s i n t o r e a l i z i n g how  i n e x o r a b l e t h i s i n c r e a s e would be, Mrs.  Sanger  organized  a World Conference on P o p u l a t i o n  i n Geneva i n 1927.  f i n a n c e d the g a t h e r i n g , and Mrs.  S t a n l e y McCormick, d a u g h t e r -  i n - l a w o f the founder of the I n t e r n a t i o n a l H a r v e s t e r commenced h e r i n t e r e s t i n the movement a t t h i s  Mr.  Slee  Company,  time.  A s s i s t e d by an a b l e committee w h i c h i n c l u d e d J u l i a n H u x l e y , Mrs.  Sanger a r r a n g e d f o r p a r t i c i p a t i o n by  many famous a u t h o r i t i e s .  At the l a s t minute, however, the  chairman, S i r B e r n a r d M a l l e t t , was  warned by the  Secretary-  G e n e r a l o f t h e League, S i r E r i c Drummond, t h a t Europeans would b o y c o t t ized i t . name was  the meeting i f t h e y thought a woman had  There was  organ-  a l s o r e l i g i o u s o p p o s i t i o n because her  associated with b i r t h c o n t r o l .  a n o t h e r f e m i n i s t , was  Mrs. E d i t h How-Martyn,  a l s o w o r k i n g on the c o n f e r e n c e .  Sir  B e r n a r d i n d i c a t e d t h a t the names o f a l l women a s s o c i a t e d the program s h o u l d be removed.  The  entire staff  resigned,  but Margaret persuaded them t o r e t u r n t o t h e i r t a s k s . meeting was  with  The  h e l d , and t h e f a c t s on p o p u l a t i o n became b e t t e r  known but the League remained u n a l t e r a b l y opposed t o n i t i o n of the problem.  Two  recog-  w o r t h w h i l e developments d i d , how-  e v e r , emerge w i t h the f o r m a t i o n  of a continuing  Medical  Committee (which e v e n t u a l l y became the m e d i c a l committee o f the IPPF) and the I n t e r n a t i o n a l Union f o r the  Scientific  Study o f P o p u l a t i o n , a p r e s t i g i o u s o r g a n i z a t i o n w h i c h subseq u e n t l y sponsored two one  i n 195^  f u r t h e r Y/orld P o p u l a t i o n  i n Rome, and  another i n 19&5  a  ^  Conferences,  Belgrade.  That t h e r e should he no m i s t a k e about i t ,  i n 1930,  the Seventh I n t e r n a t i o n a l B i r t h C o n t r o l Conference was h e l d i n Z u r i c h , and many new g o a l s were d e f i n e d . was  Birth control  d e c l a r e d t h e best way t o reduce a b o r t i o n .  I t s h o u l d be  p a r t o f t h e p u b l i c h e a l t h s e r v i c e s and o f p r e v e n t i v e  medicine  and i n s t r u c t i o n should'ibe i n c l u d e d i n t h e c u r r i c u l a o f a l l medical  s c h o o l s and c o l l e g e s .  The conference a l s o agreed  t h a t no d o c t o r would p r e s c r i b e any c h e m i c a l  contraceptive  u n l e s s t h e f o r m u l a was known t o h i m . S t e r i l i z a t i o n was a l s o 5 approved, p a r t i c u l a r l y f o r eugenic r e a s o n s . I n t h e same y e a r a B i r t h C o n t r o l I n t e r n a t i o n a l I n f o r m a t i o n Centre was o r g a n i z e d  i n London, w i t h Mrs.  How-Martyn  as Honorary D i r e c t o r and Mrs. Sanger as P r e s i d e n t .  This  centre  made many c o n t a c t s i n A s i a , and had many v i s i t o r s , i n c l u d i n g J a w a h a r l a l Nehru, then chairman o f t h e P l a n n i n g Committee o f the I n d i a n N a t i o n a l Congress, and Smt. Dhanvanthi Rama Rau, a l e a d e r i n t h e A l l I n d i a Women's C o n f e r e n c e , and, l a t e r , founder o f t h e F a m i l y P l a n n i n g A s s o c i a t i o n o f I n d i a . A Conference on B i r t h C o n t r o l i n A s i a ( I n d i a , C h i n a , Japan) was h e l d i n London i n 1933 t o i d e n t i f y o b s t a c l e s t o b i r t h c o n t r o l and p o s s i b l e s o l u t i o n s and i t was a f f i r m e d t h a t b i r t h c o n t r o l was a n e c e s s a r y c o n d i t i o n o f economic d e v e l o p ment . As d e s c r i b e d i n Chapter I I I , i n d i v i d u a l I n d i a n s had a l r e a d y s t a r t e d some b i r t h c o n t r o l s e r v i c e s i n t h e i r  country,  and i n 1934 Mrs. How-Martyn was i n v i t e d t o t h e A l l - I n d i a Women's Conference (AIWC).  Mrs. Sanger was i n v i t e d t o t h e i r  s e s s i o n i n Travancore i n the w i n t e r o f 1935-36, Mrs. How-Martyn r e v i s i t e d I n d i a i n 1936-37 and When the work o f the Centre was  and 1937-38.  combined w i t h o t h e r b i r t h 1938,  c o n t r o l o r g a n i z a t i o n s i n t h e U n i t e d Kingdom i n  Mrs. Rene D a t t a , E n g l i s h w i f e o f an I n d i a n , s e r v e d  as  7  organizer i n India u n t i l Up t o World War  19^5.  I I , t h e n , f a m i l y p l a n n e r s i n the  U n i t e d Kingdom and the U n i t e d S t a t e s had developed  the move-  ment t o a s t a t e o f some, i f not t o t a l , p u b l i c acceptance as a means o f r e l i e v i n g p o v e r t y and promoting the o f the f a m i l y .  welfare  Though no n a t i o n a l government programs were  i n e x i s t e n c e i n e i t h e r c o u n t r y , the F a m i l y P l a n n i n g A s s o c i a t i o n had been o r g a n i z e d i n B r i t a i n , and the Planned hood F e d e r a t i o n was United States.  Parent-  soon t o emerge f r o m u n i f i c a t i o n i n the  Comparable groups had  developed  i n some  European c o u n t r i e s and J a p a n , and some s e r v i c e s and d i s c u s s i o n had been s t a r t e d by i n d i v i d u a l s i n I n d i a . I n t e r n a t i o n a l conferences were now  commonplace, and  cross-fertilization  among the p i o n e e r s and t h e i r o r g a n i z a t i o n s had  developed  on  a d i r e c t b a s i s and under the a u s p i c e s o f the I n t e r n a t i o n a l Information Centre.  At t h i s p o i n t another r e l a t i v e l y s t r o n g  i n f l u e n c e e n t e r e d the i n t e r n a t i o n a l p i c t u r e - from Sweden. A f t e r World War  I I Mrs. O t t e s e n - J e n s e n r a l l i e d  f a m i l y p l a n n i n g workers i n Europe, and l a i d the f o r a new  international voluntary organization.  a f r e s h s e r i e s of conferences  was  inaugurated  former  foundation In  19^6,  i n Stockholm,  w i t h r e p r e s e n t a t i v e s f r o m B r i t a i n , Denmark, F i n l a n d , N e t h e r -  l a n d s , Sweden and the U n i t e d S t a t e s . the  I t was agreed t h a t , as  term " b i r t h c o n t r o l " had been dropped i n t h e U n i t e d S t a t e s  i n f a v o r o f "Planned P a r e n t h o o d " o r " F a m i l y P l a n n i n g " i n the U.K.  and o t h e r c o u n t r i e s , i t s h o u l d a l s o be dropped  nationally.  inter-  The newer terms more a d e q u a t e l y conveyed the  b r o a d e r concept o f " s p a c i n g " and t h e t r e a t m e n t o f Q would be encompassed.  infertility  As t h e t h r e a t o f o v e r - p o p u l a t i o n was  n o t y e t e v i d e n t t o many w o r l d l e a d e r s , and as t h e h o r r o r s of H i t l e r ' s  s t e r i l i z a t i o n s and genocide were s t i l l f r e s h i n  a l l minds, t h i s was the o n l y p o l i c y under w h i c h an  inter-  n a t i o n a l v o l u n t a r y o r g a n i z a t i o n o f t h i s t y p e c o u l d hope t o encourage new n a t i o n a l o r g a n i z a t i o n s t o s e r v e t h e h e a l t h and 9 w e l f a r e o f t h e masses. I t was agreed t o s e t up an i n t e r i m committee t o l a y p l a n s f o r a permanent o r g a n i z a t i o n , and t o h o l d a n o t h e r conf e r e n c e i n Cheltenham, E n g l a n d , i n 1948.  The S e c r e t a r y o f  t h i s committee was Mrs. Dorothy B r u s h ( l a t e r W a l m s l e y ) , a philanthropist friend  o f Margaret Sanger, whose p e r s o n a l and  f i n a n c i a l c o n t r i b u t i o n s were s u b s t a n t i a l .  As t h e B r i t i s h  were r e l u c t a n t t o p l a y h o s t s because o f war damage, the second c o n f e r e n c e was o r g a n i z e d and f i n a n c e d by Mrs. Sanger v i a Mrs. McGormick's l a r g e s s e and the B r i t i s h F a m i l y P l a n n i n g A s s o c i a t i o n co-operated.  The t o p i c chosen was P o p u l a t i o n and  World o n t to w the p r e s i d eResources d and v o l ui nnt Re e lr sa t ifrom e n t y F- at mh ri el ey .c o lu onrtdr i eHorder s attended. A n o t h e r I n t e r i m Committee on P l a n n e d P a r e n t h o o d , w i t h two r e p r e s e n t a t i v e s each from B r i t a i n , t h e N e t h e r l a n d s and Sweden,  and t h r e e from the U n i t e d S t a t e s , was  s e t up, and a g r a n t o f  $5,000 t o a s s i s t i n f i n a n c i n g an o f f i c e i n London was by the B r u s h Foundation Ohio.  The Eugenics  the new  given  f o r Race B e t t e r m e n t o f C l e v e l a n d ,  S o c i e t y gave r e n t - f r e e accommodation to  group as w e l l .  From 1949  t o 1951  the ICPP met  n u a l l y i n London, e s t a b l i s h e d c o n t a c t w i t h groups and  ansupport-  e r s i n some twenty c o u n t r i e s , and made p l a n s f o r r e g i o n a l • committees.  The need f o r a s i m p l e , cheap, e f f e c t i v e 11  c o n t r o l method was  birth  also agreed.  As i n t e r e s t i n b i r t h c o n t r o l was  growing i n I n d i a ,  and as the q u e s t i o n o f p o p u l a t i o n growth i n r e l a t i o n t o economic needs was b e g i n n i n g to be r e c o g n i z e d Keynes had p r e d i c t e d t h e problem i n 1922 f i r m e d i n 1951  (John Maynard  and i t had been con-  "by K i n g s l e y D a v i s ) , an economic f o c u s f o r f a m i l y 12  planning a c t i v i t i e s presented  itself.  I t was  decided to 1952.  h o l d the T h i r d I n t e r n a t i o n a l Conference i n Bombay i n  W i t h f i n a n c i a l h e l p from Mrs. Sanger's f r i e n d s , the newly formed F a m i l y P l a n n i n g A s s o c i a t i o n o f I n d i a ( F P A I ) , headed by Smt.  Rama Rau,  undertook t o o r g a n i z e i t .  The t h e n V i c e - P r e s i d e n t  o f I n d i a , Dr. S a r v e p a l l i R a d h a k r i s h n a n , i n a u g u r a t e d the sions.  Here i t was  agreed t o form t h e I n t e r n a t i o n a l Planned  Parenthood F e d e r a t i o n , w i t h h e a d q u a r t e r s  i n London.  P l a n n i n g A s s o c i a t i o n s o f Hong Kong, I n d i a , the Singapore,  ses-  The  Netherlands,  Sweden, the U n i t e d Kingdom, the U n i t e d S t a t e s  West Germany were the c h a r t e r members.  Mrs. Sanger and  Rama Rau became j o i n t Honorary P r e s i d e n t s .  The  Family  and Smt.  former had  f o u g h t f o r f a m i l y p l a n n i n g f o r n e a r l y f o r t y y e a r s , had  seen  t h e movement b e g i n t o f l o u r i s h i n the U n i t e d now  i n d u c i n g the b i r t h o f an i n t e r n a t i o n a l o r g a n i z a t i o n  well.  Smt.  Rama Rau  represented  t h e f i r s t o f the d e v e l o p i n g  w h i c h l e d t o the f o r m a t i o n  of the new  w i f e of a B r i t i s h Labour M.P.,  was  had  t a k e n the  fought  initiative  organization,  e l e c t e d Chairman of the Governing Body.  and  areas i n w h i c h the  Mrs. O t t e s e n - J e n s e n , who  f a m i l y p l a n n i n g i n Sweden and had  was as  s y m b o l i z e d non-Western l e a d e r s h i p ,  program c o u l d expand. for  S t a t e s , and  was  Mrs. V e r a Houghton,  s e c r e t a r y from 1953  to  1959. A new d r a f t e d , and  C o n s t i t u t i o n f o r the F e d e r a t i o n was i t was  and B i r t h C o n t r o l  (the  e v e n t u a l l y changed t o I n t e r n a t i o n a l P l a n n e d  Parenthood News).  The  e a r l y i s s u e s were f i n a n c e d by  B r u s h F o u n d a t i o n and e d i t e d by Mrs. 1957*  be  d e c i d e d t o p u b l i s h a monthly b u l l e t i n ,  Around the World News o f P o p u l a t i o n t i t l e was  to  B r u s h , from 1952  the to  In i t s f i r s t t e n y e a r s , i t s c i r c u l a t i o n climbed  from  5,000 to 1 3 , 5 0 0 , and i t i s now p u b l i s h e d i n E n g l i s h , F r e n c h 13 and German. The h i s t o r y o f the I n d i a n F a m i l y P l a n n i n g movement w i l l be g i v e n i n the n e x t c h a p t e r , but i t i s o f i n t e r e s t t o n o t e t h a t , s h o r t l y a f t e r the Bombay m e e t i n g , Prime M i n i s t e r Nehru recommended t o the I n d i a n  parliament  t h a t f a m i l y p l a n n i n g be i n c l u d e d i n the F i r s t F i v e - Y e a r Rs.  6 , 5 0 0 , 0 0 0 (-c U.S.  $ 1 , 6 2 5 , 0 0 0 ) were e v e n t u a l l y ,14  Plan.  allotted  t o the M i n i s t r y o f H e a l t h f o r t h i s p u r p o s e . I n 1953  the F o u r t h I n t e r n a t i o n a l Conference on P l a n n e d  P a r e n t h o o d , h e l d once a g a i n i n Stockholm t o commemorate the  t w e n t i e t h a n n i v e r s a r y of the Swedish N a t i o n a l l e a g u e f o r Sex E d u c a t i o n ,  adopted a new  c o n s t i t u t i o n , to  ... advance t h r o u g h e d u c a t i o n and s c i e n t i f i c r e s e a r c h the u n i v e r s a l acceptance o f f a m i l y p l a n n i n g and r e s p o n s i b l e parenthood i n the i n t e r e s t s of f a m i l y w e l f a r e , community w e l l - b e i n g and i n t e r n a t i o n a l g o o d w i l l . Membership would be o f f e r e d i r r e s p e c t i v e of r a c e , creed c o l o r ; and  commercial i n t e r e s t s would be e x c l u d e d 15  s o c i a t i o n w i t h the new  or  from a s -  organization.  When the F i f t h I n t e r n a t i o n a l Conference on P l a n n e d Parenthood was and  h e l d i n Tokyo i n 1955» Mrs. Sanger, now  s u f f e r i n g from a c o r o n a r y a i l m e n t , b u r s i t i s ,  s t r a i n and  sacro-iliac  lumbago, t o o k the o p p o r t u n i t y t o l e c t u r e w o r l d  heads of s t a t e f o r t r y i n g t o use  "stop gap"  s o l u t i o n s to  w o r l d problems when, i n r e a l i t y , p o p u l a t i o n was issue".  76  She  "the b a s i c  r e g r e t t e d t h a t the q u e s t i o n had not been d i s -  cussed a t the r e c e n t Summit Conference i n G e n e v a . ^ 1  I n a d d i t i o n t o d o c t o r s , s o c i o l o g i s t s , demographers and o t h e r r e l a t e d p r o f e s s i o n s , f o r the f i r s t time b i o l o g i s t s , biochemists,  anatomists,  and o t h e r s c i e n t i s t s were g a t h e r e d  t o compare n o t e s i n the s e a r c h f o r a b i o l o g i c a l means o f contraception.  As has been n o t e d , t h i s was  a g o a l l o n g advo-  c a t e d by Mrs. Sanger because of the w o r l d wide need f o r a s i m p l e , cheap and r e l i a b l e method, the use o f w h i c h would be 17 u n r e l a t e d t o the time o f i n t e r c o u r s e .  I t had been p a r t l y  t h r o u g h her i n t e r e s t t h a t Dr. P i n c u s had  received a grant  b e g i n the s t u d y o f p r o g e s t e r o n e as a means of ovulation.  suppressing  to  I n t h e meantime, i t was  agreed t h a t a b o r t i o n s h o u l d not be  c o n s i d e r e d a p r i m a r y s o l u t i o n t o p o p u l a t i o n problems. The S i x t h I n t e r n a t i o n a l Conference D e l h i i n 1959 > and was  was h e l d i n  New  memorable f o r a number o f r e a s o n s :  I t was p a r t l y f i n a n c e d by a g r a n t o f Rs. 50,000 from the government o f I n d i a , and i n a u g u r a t e d by Prime M i n i s t e r Nehru^ 800 d e l e g a t e s and o b s e r v e r s from t w e n t y - n i n e n a t i o n s - i n c l u d i n g f i f t e e n A s i a n c o u n t r i e s - were p r e s e n t , and an o b s e r v e r  from  t h e USSR was  last  on hand.  v i s i t t o t h e IPPP.  Margaret Sanger, a t 80, made h e r  The theme o f the conference was,  Pamily  P l a n n i n g : M o t i v a t i o n s and Methods, and the m o t i v a t i o n o f governments, t o o , was n o t n e g l e c t e d . As has been n o t e d , some I n d i a n s were a l r e a d y aware t h a t p o p u l a t i o n growth was h i n d e r i n g economic development. and D a v i s had p o i n t e d t h e way,  and A n s l e y J . Coale  Keynes  and  Edgar M. Hoover had r e c e n t l y p u b l i s h e d t h e i r s t u d y o f I n d i a ' s prospects.  (See a l s o Chapter  V.)  The A s i a n f a m i l y p l a n n e r s t o o k up the c h o r u s , p r e s s i n g t h e i r governments t o do something t h r o u g h WHO,  e f f e c t i v e i n the U n i t e d N a t i o n s  PA0, EC0S0C, and the Human R i g h t s Commission t o  support p o p u l a t i o n c o n t r o l programs.  Countries planning to  a t t e n d the f o r t h c o m i n g ECAPE (Economic Commission f o r A s i a and t h e Par E a s t ) c o n f e r e n c e , were urged t o g i v e the q u e s t i o n  19 s e r i o u s a t t e n t i o n when i t was taken up.  7  A s t u d y group on  p o p u l a t i o n problems under the c h a i r m a n s h i p o f Dr. W i l l i a m Vogt, N a t i o n a l D i r e c t o r o f The Planned Parenthood A m e r i c a , s t a t e d t h a t h i s c o u n t r y was  F e d e r a t i o n of  an example o f "over-  development" and warned t h a t i t , t o o , had a p o p u l a t i o n problem - an i d e a warmed over by P a u l E h r l i c h i n 1968 i n The P o p u l a t i o n Bomb. to a m e d i c a l  The group recommended t h a t , i n a d d i t i o n  committee, another on economic and s o c i a l p r o b -  lems be a p p o i n t e d , b u t , by t h e S e v e n t h C o n f e r e n c e , i n 19^7» o n l y a committee on b a s i c s c i e n c e had been added. On f a m i l y p l a n n i n g p o l i c y , t h e S i x t h Conference how f o r m a l l y approved t h e p r i n c i p l e o f s p a c i n g p r e g n a n c i e s f o r b e t t e r h e a l t h , and urged members t o p r o v i d e , wherever p o s s i b l e , d i a g n o s i s and t r e a t m e n t been a c c e p t a b l e  of i n f e r t i l i t y .  Though i t had  i n 1930, a r e s o l u t i o n f o r m a l l y s u p p o r t i n g  s t e r i l i z a t i o n was r e j e c t e d - n o t because t h e i d e a o f s t e r i l i z a t i o n was a b h o r r e n t  t o a l l members, but because i t was t o  some, and, s i n c e 1955 and t h e r e s o l u t i o n i n Tokyo on a b o r t i o n , i t had become IPPP p o l i c y t o a v o i d t a k i n g a s t a n d f o r o r a g a i n s t any s p e c i f i c b i r t h c o n t r o l method.  (Chapter  V, p. 129»)  R e s e a r c h i n a l l a s p e c t s o f human f e r t i l i t y was u r g e d , however. S i n c e 195^, trials  Dr. P i n c u s had had t h e P i l l under a c c e p t a b i l i t y  i n t h e U n i t e d S t a t e s and P u e r t o R i c o , and he was  interested i n further t r i a l s  i n Asia.  I t i s reported that  I n d i a n a u t h o r i t i e s would n o t a g r e e , r e p u t e d l y because o f the c o s t o f s u p e r v i s i o n , t h e f e e l i n g t h a t i l l i t e r a t e women would n o t be a b l e t o manage i t , and f e a r s o f s i d e - e f f e c t s . C e y l o n , however, was more r e c e p t i v e .  (Chapter V I , p. 1 9 0 . )  George Cadbury, who had spent t h e p r e c e d i n g t e n y e a r s as head o f t h e U n i t e d N a t i o n s T e c h n i c a l A s s i s t a n c e A d m i n i s t r a t i o n , had r e c e n t l y j o i n e d t h e IPPP as Honorary P i e l d  D i r e c t o r and S p e c i a l R e p r e s e n t a t i v e .  I n p u r s u i t o f h i s new  r e s p o n s i b i l i t i e s , Mr. Cadbury and h i s w i f e , B a r b a r a , eleven Asian countries advocating maternal  f a m i l y p l a n n i n g as p a r t o f  and c h i l d h e a l t h s e r v i c e s , and a l s o u r g i n g  Nations a c t i o n .  visited  United  Mrs. Cadbury's r e p o r t i n c l u d e d t h i s  statement:  We expected t h a t we s h o u l d be c o n c e n t r a t i n g on ways o f e d u c a t i n g A s i a n people t o use f a m i l y p l a n n i n g s e r v i c e s ; we expected t h a t r e l i g i o n , s u p e r s t i t i o n , myth and a n c i e n t custom would make i t d i f f i c u l t f o r t h e o r d i n a r y p e o p l e o f A s i a t o accept b i r t h c o n t r o l . On t h e whole we were wrong. The problem i s t o p r o v i d e t h e s e r v i c e , not t o educate people t o use i t . It is not O r i e n t a l r e l i g i o n s and c u l t u r e s which are a b a r t o i t s widespread u s e , but O c c i d e n t a l Roman C a t h o l i c i s m , and the w a r i n e s s o f p o l i t i c i a n s o f t h e Roman C a t h o l i c v o t e r i n t h e O c c i d e n t a l democracies. To a s s i s t t h e v o l u n t e e r s i n t h e s e needed g r e a t l y i n c r e a s e d f u n d s . combined e f f o r t s o f t h e Cadburys  c o u n t r i e s t h e IPPF  These were r a i s e d by t h e and Mr. Cass C a n f i e l d ( a  l e a d e r o f P l a n n e d P a r e n t h o o d i n t h e U n i t e d S t a t e s ) , and f r o m 2?  $ 7 0 , 0 0 0 i n I 9 6 0 t h e IPPF budget r o s e t o $935,000 i n 1965. L i a i s o n was e s t a b l i s h e d w i t h t h e P o p u l a t i o n C o u n c i l i n New Y o r k ; C o n s u l t a t i v e S t a t u s w i t h t h e U n i t e d N a t i o n s was a c h i e v e d ; the IPPF became a member o f t h e I n t e r n a t i o n a l Conference o f S o c i a l Work; and, i n 1 9 6 3 , t h e I n t e r n a t i o n a l C o u n c i l o f Women passed a r e s o l u t i o n recommending w o r l d - w i d e e d u c a t i o n i n family planning.  Mrs. Margaret P y k e , w i f e o f a n o t e d  B r i t i s h s c h o o l master, was a p p o i n t e d  General  Secretary  a f t e r Mrs. Houghton. I t i s o f i n t e r e s t t h a t i n March, I 9 6 2 i n Tokyo, ECAFE  s e t up a team o f demographers t o a d v i s e and a s s i s t A s i a n 23 governments i n d e v e l o p i n g f a m i l y p l a n n i n g a c t i o n programs. The  Seventh I n t e r n a t i o n a l Conference on P l a n n e d  hood, h e l d i n Singapore  i n 19&3,  w  a  s  Parent-  attended by f o u r hundred  delegates from t h i r t y - e i g h t c o u n t r i e s .  Scientific,  medical  and demographic papers were read on t h e theme, Changing P a t t e r n s i n F e r t i l i t y t S o c i a l and C u l t u r a l F a c t o r s .  S e s s i o n s were  h e l d on c u r r e n t r e s e a r c h and a workshop was conducted motion and p u b l i c i t y .  on p r o -  R e s o l u t i o n s u r g i n g a b a l a n c e between  p o p u l a t i o n , p r o d u c t i v i t y and r e s o u r c e s were p a s s e d . were r e - s t a t e d : t o promote r e s p o n s i b l e parenthood  Aims  f o r family  w e l f a r e , community w e l l - b e i n g and i n t e r n a t i o n a l g o o d w i l l . E d u c a t i o n , t r a i n i n g and conferences would be c o n t i n u e d . Members s h o u l d c o n s i d e r o f f e r i n g sex e d u c a t i o n and marriage counselling.  Previous r e s o l u t i o n s r e q u i r i n g  impartiality  r e g a r d i n g r a c e , creed and c o l o r , were broadened t o i n c l u d e "politics". I n response  t o c r i t i c i s m s about m o t i v e s , Mrs. O t t e s e n -  J e n s e n , r e t i r i n g p r e s i d e n t , noted t h a t , w h i l e t h e y were n o t the f i r s t , women had j o i n e d t h e movement because i t was devoted to f a m i l y w e l f a r e .  Men had j o i n e d f o r t h e same r e a s o n s , and  r e c e n t l y a l s o because o f t h e economic and s c i e n t i f i c ficance of family planning.  signi-  Smt. Rama Rau was e l e c t e d p r e s i d e n t  o f t h e IPPF, and Cass C a n f i e l d and George Cadbury, Chairman and V i c e - C h a i r m a n ,  r e s p e c t i v e l y , o f t h e G o v e r n i n g Body.  A  former B r i t i s h c i v i l s e r v a n t w i t h wide e x p e r i e n c e i n t h e Caribbean  a r e a , S i r C o l v i l l e D e v e r e l l , was a p p o i n t e d S e c r e t a r y -  G e n e r a l , s u c c e e d i n g Mrs. P y k e . I n a d d i t i o n t o i t s w o r l d c o n f e r e n c e s , t h e IPPF had "been d e v e l o p i n g r e g i o n a l c o n f e r e n c e s and s e m i n a r s . o f these had "been h e l d from 1955 "to 19&3.  Eighteen  A l l o f i t s meetings  were now a t t r a c t i n g h i g h l y q u a l i f i e d p e r s o n n e l from many p a r t s o f t h e w o r l d and IPPP p u b l i c a t i o n s , f i l m s and s p e c i a l s t u d i e s had a c h i e v e d e q u a l p r e s t i g e .  I t was t h e o n l y i n t e r n a t i o n a l  body s t i m u l a t i n g b o t h v o l u n t a r y f a m i l y p l a n n i n g o r g a n i z a t i o n s and government a c t i o n , and t h e r e were now t h i r t y - f i v e  member  countries i n f i v e continents.  Help was b e i n g g i v e n t o more  than s i x t y non-member n a t i o n s .  The IPPP would c o n t i n u e t o  f u n c t i o n i n f a m i l y p l a n n i n g promotion  a t l e a s t u n t i l the 24  World H e a l t h O r g a n i z a t i o n was ready t o do s o . 1964 was n o t a b l e f o r a new f o c u s - t h i s time on A f r i c a and l a t i n A m e r i c a .  I n the former, the o r g a n i z a t i o n o f Family  P l a n n i n g A s s o c i a t i o n s by t h e IPPF was welcomed, n o t so much f o r p o p u l a t i o n c o n t r o l (though t h i s would soon be a need) as f o r m a t e r n a l and c h i l d h e a l t h .  In the l a t t e r continent,  governments were s t i l l h e s i t a n t , b u t u n i v e r s i t i e s were f r e e r t o a c t and a c c e p t e d h e l p .  The j u s t i f i c a t i o n was t h e need t o  reduce t h e a p p a l l i n g l y h i g h a b o r t i o n r a t e s e v i d e n t from h o s p i t a l a d m i s s i o n s and m a t e r n a l d e a t h  statistics.  Coupled w i t h t h e s e a c t i v i t i e s , a d r a m a t i c development i n b i r t h c o n t r o l methods, was t h e c o n f i r m a t i o n by t h e Popul a t i o n C o u n c i l i n New Y o r k o f e x h a u s t i v e t e s t s and a c c e p t a b i l i t y t r i a l s o f t h e p o l y t h e n e IUD, on which work had been done by Japanese as w e l l as American d o c t o r s .  As a r e s u l t o f  i n s e r t i o n s i n Taiwan and Korea, the C o u n c i l recommended t h a t the ITJD be adopted f o r g e n e r a l use throughout many b e l i e v e d t h a t h e r e , a t l a s t , was 25 to  mass u s e .  (See Chapter T  L i a i s o n was  the w o r l d ,  the method b e s t  and  suited  f o r f u r t h e r comment.)  s e t up w i t h the U n i t e d S t a t e s Agency f o r  I n t e r n a t i o n a l Development ( A I D ) , the government o f the U n i t e d Kingdom, and Oxfam.  C o n s u l t a t i v e s t a t u s was  established with  UNESCO, the U n i t e d N a t i o n s C h i l d r e n ' s Fund, the World H e a l t h O r g a n i z a t i o n , the Pood and A g r i c u l t u r e O r g a n i z a t i o n , and I n t e r n a t i o n a l Labor O r g a n i z a t i o n . was  The  IPPP M e d i c a l Committee  s e t t i n g s t a n d a r d s o f c l i n i c a l procedure  and t r a i n i n g , as  w e l l as the m e d i c a l a s p e c t s o f c o n t r a c e p t i o n . ing  the  I t was  conduct-  e v a l u a t i o n and o t h e r r e s e a r c h , and had a c c e s s t o l a b o -  r a t o r y f a c i l i t i e s i n E n g l a n d , I n d i a , P o l a n d , the  Netherlands  and the U n i t e d S t a t e s . The E i g h t h I n t e r n a t i o n a l Conference, h e l d i n A p r i l I 9 6 7 i n S a n t i a g o , C h i l e , was  i n a u g u r a t e d by P r e s i d e n t P r e i ,  and a t t e n d e d by more t h a n 1,500 countries.  d e l e g a t e s from e i g h t y - s e v e n  These i n c l u d e d not o n l y v o l u n t a r y o r g a n i z a t i o n s ,  but government a g e n c i e s , r e l i g i o u s o r d e r s , and s t a f f members. than 1,000  university  A s p e c i a l s e s s i o n f o r y o u t h a t t r a c t e d more  people.  On the theme, P l a n n e d Parenthood:  A Duty  and a Human R i g h t papers were g i v e n on p o p u l a t i o n growth i n r e l a t i o n t o economic and s o c i a l development i n L a t i n  America,  w o r l d f o o d problems, e d u c a t i o n , h o u s i n g , and m a t e r n a l child health.  and  The widespread, problem o f i l l e g a l a b o r t i o n ,  e s p e c i a l l y i n L a t i n A m e r i c a , the need f o r b o t h  medical  promotion  and i n c r e a s e d f a m i l y p l a n n i n g s e r v i c e s was  discussed.  B a s i c s c i e n c e and m e d i c a l s e s s i o n s were a l s o h e l d , and, once again, the proceedings was  subsequently p u b l i s h e d .  This  conference  f i n a n c e d by government g r a n t s f r o m Denmark, The Netherlands^:  Norway, Sweden, t h e U n i t e d S t a t e s ( A I D ) , t h e B r u s h and t h e Ford and R o c k e f e l l e r F o u n d a t i o n s .  Foundation,  I n t h e opening  s e s s i o n , L o r d Caradon, then U n i t e d Kingdom Permanent Repres e n t a t i v e t o t h e U n i t e d N a t i o n s , urged t h a t t h e U.N. take c o n c e r t e d a c t i o n i n t h e coming Human R i g h t s Year (1968) and announced t h a t h i s government would make an a n n u a l g r a n t o f ?6 $140,000 t o t h e IPPF f o r f i v e y e a r s . A s p e c i a l d r i v e f o r funds t o support expanded a c t i v i t i e s by t h e IPPF was undertaken Parenthood,  i n the U n i t e d S t a t e s by Planned  and headed by G e n e r a l W i l l i a m S. D r a p e r , J r .  Known as t h e V i c t o r - B o s t r o m Fund, i t a c h i e v e d i t s i n i t i a l t a r g e t o f $3 m i l l i o n by t h e f a l l o f 1968.  A further target  o f $3 m i l l i o n t o a s s i s t t h e IPPF t h r o u g h 1971 was o v e r s u b s c r i b ed, and was i n c r e a s e d t o $6 m i l l i o n .  From i t s p r e v i o u s l y  modest t o t a l o f j u s t under $1 m i l l i o n i n I 9 6 5 , t h e 1970 budget o f t h e IPPF t o t a l l e d $13 m i l l i o n , a n d , f o r 1971,  $20 m i l l i o n .  A f a r c r y from t h e h a n d f u l o f e n t h u s i a s t s from s i x c o u n t r i e s who met i n Sweden i n 1946, F a m i l y P l a n n i n g A s s o c i a t i o n s i n s i x t y - f o u r c o u n t r i e s had a f f i l i a t e d w i t h t h e I P P F by t h e end o f 1969, as had s e v e r a l i n d i v i d u a l governments. Six  r e g i o n a l o f f i c e s ( S i n g a p o r e , R a w a l p i n d i , Tokyo, N a i r o b i ,  London, New Y o r k ) had been e s t a b l i s h e d ; and a n o t h e r , i n B e i r u t , was  opened i n March, 1970 t o serve t h e Middle E a s t and N o r t h  Africa.  The IPPF was a s s i s t i n g i n more than 70 o t h e r coun-  t r i e s , and i t s government support was s w e l l e d "by a g r a n t f r o m Japan.  IPPF s t a t u s i n UNESCO had been r a i s e d t o "Category,B.,  i n f o r m a t i o n and c o n s u l t a t i v e " , and Mr. ( l a t e r S i r ) D a v i d Owen, f o r m e r c o - a d m i n i s t r a t o r o f t h e U n i t e d N a t i o n s Development P l a n , was a p p o i n t e d S e c r e t a r y - G e n e r a l o f the I P P F , s u c c e e d i n g Sir Colville Deverell.  I n November, 19&9, Mr. George  Cadbury  succeeded Mr. C a n f i e l d as Chairman o f the G o v e r n i n g Body, and Dr. Agnete B r a e s t r u p o f Denmark, succeeded Smt. Rama Rau as P r e s i d e n t .  D i r e c t government a s s i s t a n c e t o t h e IPPF was  now an e s t a b l i s h e d p r o c e d u r e - a r e c o g n i t i o n o f t h e u s e f u l n e s s o f a non-government, n o n - p o l i t i c a l , i n t e r n a t i o n a l agency i n t h e f r e q u e n t l y d e l i c a t e promotion o f a needed program.  The  work o f t h e F e d e r a t i o n , always keyed t o h e a l t h and w e l f a r e on a worldwide b a s i s , was  still  ... based on the b e l i e f t h a t knowledge o f planned parenthood i s a fundamental human r i g h t and t h a t a b a l a n c e between the p o p u l a t i o n of the w o r l d and i t s n a t u r a l r e s o u r c e s and p r o d u c t i v i t y i s a n e c e s s a r y c o n d i t i o n o f human h a p p i n e s s , p r o s p e r i t y and peace.2o I n summary, the v o l u n t e e r s from the U n i t e d Kingdom, the U n i t e d S t a t e s and some European  countries held a series  o f i n t e r n a t i o n a l g a t h e r i n g s from 1900 t o 1939 w h i c h l a i d  a  f o u n d a t i o n f o r i n t e r n a t i o n a l o r g a n i z a t i o n t o promote the s p r e a d o f t h e f a m i l y p l a n n i n g movement.  Though t h e s e  g a t h e r i n g s i s s u e d warnings o f the danger t o peace o f popul a t i o n p r e s s u r e s , no one l i s t e n e d .  Meetings were renewed  i n 19^8, and t h e I n t e r n a t i o n a l P l a n n e d Parenthood w i t h headquarters  Federation,  i n London, E n g l a n d , wa.s o r g a n i z e d i n  Bombay i n 1952. The member a s s o c i a t i o n s have always i n s i s t e d t h a t b i r t h c o n t r o l be v o l u n t a r y , and t h a t i t s h o u l d be o f f e r e d w i t h no d i s t i n c t i o n as t o r a c e , c o l o r , creed o r p o l i t i c s .  Though  some methods, such as t h e diaphragm and j e l l y , and s t e r i l i z a t i o n , were -recommended b e f o r e 1939» i t was d e c i d e d  after  1955 t h a t t h e IPPP would n o t s i n g l e o u t any p a r t i c u l a r one i n p r e f e r e n c e t o any o t h e r . I n 1964 t h e main f o c u s o f t h e i n t e r n a t i o n a l o r g a n i z a t i o n t u r n e d from A s i a t o A f r i c a and L a t i n A m e r i c a , where it  could continue to f i l l i t s t r a d i t i o n a l r o l e o f h e l p i n g  v o l u n t a r y o r g a n i z a t i o n s t o s t a r t , and t o be t h e c a t a l y s t s o f government a c t i o n .  I n t h i s , t h e IPPP was g r e a t l y a s s i s t e d  by i n c r e a s e d income from b o t h v o l u n t a r y d o n a t i o n s and d i r e c t g r a n t s by governments.  By 1969 t h e r e were 64 member c o u n t r i e s .  The U t i l i t a r i a n and h u m a n i t a r i a n p h i l o s o p h y i n w h i c h the F a m i l y P l a n n i n g movement had had i t s o r i g i n s ,  appealed  t o t h e Western-educated l e a d e r s h i p i n South A s i a when t h e y were p l a n n i n g , n o t o n l y f o r independence, b u t a l s o f o r s o c i a l and economic p r o g r e s s f o r t h e i r  people.  FOOTNOTES  -  Chapter  IV  •J-Ralph Waldo Emerson, "Each and A l l " , S t a n z a I , B a r t l e t t ' s F a m i l i a r Q u o t a t i o n s , B o s t o n , 1955, P« 5 0 3 . D a v i d M. Kennedy, B i r t h C o n t r o l i n A m e r i c a , The C a r e e r o f Margaret Sanger, New Haven", 1970, p. 1 0 1 , f . n . 2  ^Vera Houghton, The I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d F e d e r a t i o n , (I.P.P.j? .), i t s H i s t o r y and i n f l u e n c e , 1-bTi? , London, 1962, pp. 1 - 3 . 1  ^ I b i d . , p. 3 ; A l s o E m i l y T a f t D o u g l a s , Margaret P i o n e e r o f t h e F u t u r e , New Y o r k , 1 9 7 0 , pp. 1 9 6 - 9 8 .  1  Sanger:  5" "The S t o r y o f Margaret Sanger and t h e I P P F " P r o c . Seventh Conference o f t h e I n t e r n a t i o n a l P l a n n e d Parenthood F e d e r a t i o n , S i n g a p o r e , Amsterdam, 1963. P. 6. °Vera Houghton, o p . c i t . , p. 3» 7  8  "The S t o r y o f Margaret Sanger and The I P P F " , o p . c i t . , p . 8 . Ibid.  ^ F r e d e r i c k S. J a f f e , Steven P o l g a r , " E p i d e m i o l o g i c a l Indications f o r F e r t i l i t y Control: Preliminary Formulation" Journal of the Central Medical A s s o c i a t i o n of I n d i a , Family P l a n n i n g P r o j e c t Supplement, September, 1967, p. 1 2 . A B r i t i s h d o c t o r agreed b u t t o o k no a c t i o n . Assistance was g i v e n by J u l i a n H u x l e y and S i r John Boyd O r r . M r s . Sanger bought c o - o p e r a t i o n v i a Mrs. S t a n l e y McCormick's pocketbook. E m i l y T a f t D o u g l a s , P i o n e e r o f t h e F u t u r e , Margaret Sanger, New Y o r k , 1970, pp. 244-45. x 0  N i n t h Report, I n t e r n a t i o n a l Planned Parenthood F e d e r a t i o n , 1967-68, London, p. 15; Vera Houghton, "Report o f a Meeting o f t h e I n t e r i m Committee on P l a n n e d P a r e n t h o o d " , E u g e n i c s Review, V o l . x l i i i , No. 3 , Ap., 1951 - J a n . , 1952, p. 142. x l  1?  K i n g s l e y D a v i s , A Study o f t h e P o p u l a t i o n o f I n d i a and P a k i s t a n , P r i n c e t o n , 1951> P» 222. 1 3 P r o c . Seventh C o n f e r e n c e , o p . c i t . , p. 9« c  l ^ P r o g r a m , Seventh Conference o f t h e I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d F e d e r a t i o n , S i n g a p o r e , 1 9 6 3 , P« 8 .  1 5 P r o c . Seventh Conference, o p . c i t . , p.  7.  • ^ P r o c . F i f t h I n t e r n a t i o n a l Conference on Planned Parenthood, Tokyo, 1955, P» 6 . 1 "^Program, Seventh Conference, o p . c i t . , p.  9.  18  • A n s l e y J . Coale and Edgar M. Hoover, P o p u l a t i o n Growth and Economic -Development i n Low Income C o u n t r i e s : I n d i a ' s P r o s p e c t s , P r i n c e t o n , 1958, passim. LO  I n 1962 ECAFE (Economic Commission f o r A s i a and the Par E a s t ) adopted a program of r e s e a r c h i n t o p o p u l a t i o n problems and began to g i v e advice to governments on economic and s o c i a l p l a n n i n g . 1 9  OA  ^"George .Cadbury,  Interview, O a k v i l l e , Ontario, 7 . 1 2 . 6 9 .  ^ B a r b a r a Cadbury, "Eastern Advance" i n Marian Maury, ed., B i r t h r a t e and B i r t h r i g h t , New York, 1963, p. 1 3 0 . S u b s t a n t i a t e d i n person by Cadburys, O a k v i l l e , 7 . 1 2 . 6 9 . ^The V i c t o r Fund f o r the I.P.P.P., Report No. F a l l , 1967, i^ew l o r k , p. 2 9 . ' c  2  -^Program, Seventh Conference, o p . c i t . , p.  7,  9.  24 1955 1957 1958 1960  -  Puerto Rico West B e r l i n Jamaica The Hague  S c i e n t i f i c Seminars 1955 - Bombay 1959 - Lahore 1961 - Hyderabad  196I I962 1963 1964  - Barbados - Dacca, Warsaw - Ceylon - Puerto R i c o , Hong Kong, Nepal, London.  I 9 6 2 - Bombay, Singapore 1963 - Ceylon  S i x t h Report, I n t e r n a t i o n a l Planned Parenthood F e d e r a t i o n , London, I 9 6 3 , pp. 1-2; a l s o Program, Seventh Conference, o p . c i t . , p. 9? Tenth Annual R e p o r t , Family P l a n n i n g A s s o c i a t i o n o f Ceylon, Colombo, I 9 6 3 , p. 1 2 . 2 5 " S e c r e t a r y - G e n e r a l ' s Survey", Seventh Report, I.P.P.F., London, 1964, pp. 1-2.  26  P r o c . E i g h t h I n t e r n a t i o n a l Conference o f the I.P.P.F., Santiago, 1967, pp. 11-16.  7 V i c t o r Fund f o r t h e I.P.P.F. R e p o r t s P a l l 1 9 6 7 , S p r i n g , 1969, S p r i n g , 1970, Mew * o r k and Washington, IPP News, No. 191, J a n u a r y , 1970. 2  N i n t h R e p o r t . I P P P , o p . c i t . , p. 3; IPP News, March, 1970; P o p u l a t i o n Program A s s i s t a n c e . USAID, Washington, O c t o b e r , 1969, p. 53. 2 8  J'00  noQ  A--  1910  I9Z0  REPLACEMENT  8* REPLACEri£NT C • PEPL*C£M£A/T  1920  LEVEL  LEVEL LEVEL  SOURCE-. INTERNATIONAL "US. BUREAU OF THE  1940  i?S0  FERTILITY  FERTILITY FERTILITY  I960  REACHEO  PEACHED REACHES  PEMOGRAPhjIC  l$70  BY  BY BY  1980  \ 990  198^  /99S~  ST/\TIST<CS  CENTRE  '20O0  PART  THREE  S o c i a l Reformers and Government i n South A s i a  CHAPTER  V  India  ... I b e l i e v e t h a t t o w a i t u n t i l the moral sense o f man becomes a g r e a t d e a l more p o w e r f u l than i t i s now, and t i l l t h e n t o a l l o w c o u n t l e s s generations of children to s u f f e r p r i v a t i o n s and u l t i m a t e l y death f o r no f a u l t o f t h e i r own i s a g r e a t s o c i a l i n j u s t i c e w h i c h s h o u l d not be t o l e r a t e d . 1 As i n t h e Western c o n t e x t , concern over p o p u l a t i o n growth i n South A s i a began w i t h M a l t h u s .  A l t h o u g h he d i d  not v i s i t t h e c o u n t r y , he noted i n t h e 1803 v e r s i o n o f h i s E s s a y t h a t I n d i a was a c l a s s i c example o f h i s t h e o r y .  Such  p o s i t i v e checks on p o p u l a t i o n growth as a s c e t i c i s m and  taboos  a g a i n s t widow r e m a r r i a g e , were o f f s e t by the compulsion f o r male h e i r s and e a r l y and u n i v e r s a l m a r r i a g e .  Consequently,  the "lower c l a s s e s " were so numerous t h a t t h e y were reduced t o f r u g a l i t y , and, t h e r e f o r e , v e r y v u l n e r a b l e t o any d e t e r i o r a t i o n i n the food s u p p l y . o f M a l t h u s , who  Abbe' D u b o i s , a  contemporary  d i d v i s i t the c o u n t r y , d e s c r i b e d the I n d i a n  scene s o u t h o f the K i s t n a R i v e r , and noted p a r t i c u l a r l y the  i n f e r i o r s t a t u s o f women: The o p i n i o n i s f i r m l y e s t a b l i s h e d throughout t h e whole o f I n d i a , t h a t women were o n l y c r e a t e d f o r t h e p r o p a g a t i o n o f t h e s p e c i e s , and t o s a t i s f y men's d e s i r e s . A l l women are o b l i g e d t o marry .... Only c o u r t e s a n s a r e a l l o w e d an e d u c a t i o n . P a r a l l e l l i n g the nineteenth  century  i n t e r e s t i n population  growth and i t s s o c i a l and economic consequences i n European c o u n t r i e s , t h e r e was g r o w i n g d i s c u s s i o n o f t h e t o p i c by B r i t i s h a d m i n i s t r a t o r s and I n d i a n s  reformers i n the Indian  sub-continent. I n 1888,  t h e V i c e r o y , l o r d P u f f e r i n , commented w i t h  some a s p e r i t y t h a t t h e r e c e n t l y - o r g a n i z e d  Indian  National  Congress would be b e t t e r a d v i s e d t o w o r r y over t h e e f f e c t s of over-population  than over t h e i r e x c l u s i o n f r o m p a r t i c i -  p a t i o n i n government. No one can pass even a few months i n I n d i a w i t h o u t b e i n g aware t h a t we a r e s i t t i n g under t h e shadow o f an enormous danger - o v e r p o p u l a t i o n o f t h e c o u n t r y , o r a t a l l events o f l a r g e d i s t r i c t s and t e r r i t o r i e s , whose i n h a b i t a n t s a r e y e a r l y , nay monthly and w e e k l y , m u l t i p l y i n g beyond t h e numbers t h e s o i l i s capable o f s u s t a i n i n g - y e t d u r i n g t h e f o u r y e a r s I have been h e r e t h i s most i m p o r t a n t s u b j e c t has n o t a t t r a c t e d the a t t e n t i o n o f a s i n g l e N a t i v e newspaper a s t i l l l e s s o f any N a t i v e p u b l i c body By 1929 t h e B r i t i s h p o s i t i o n i n I n d i a had become u n c e r t a i n , and,  a l t h o u g h a f t e r 1921 t h e p o p u l a t i o n growth r a t e had begun  t o s p i r a l upward, no a d m i n i s t r a t i o n wanted t o i n t e r f e r e .  N o t h i n g would end B r i t i s h r u l e more q u i c k l y than any attempt t o i n t r o d u c e j u s t those r e f o r m s w h i c h would do t h e most t o improve t h e w e l l - b e i n g o f the masses. A w e l l - p r o p o r t i o n e d decrease i n t h e b i r t h r a t e would u n q u e s t i o n a b l y r e s u l t i n an i n c r e a s e i n income p e r head .... Where i s t h e I n d i a n Malthus who w i l l i n v e i g h a g a i n s t t h e d e v a s t a t i n g torrent of Indian children?^ M a j o r - G e n e r a l S i r John Megaw, former P u b l i c H e a l t h Commissioner w i t h t h e Government o f I n d i a , and  subsequently  P r e s i d e n t o f t h e M e d i c a l Board a t t h e I n d i a O f f i c e i n London, knew what was needed. The t r u t h i s t h a t t h e i n h i b i t i o n s connected w i t h t h e study o f t h e popul a t i o n problem have been c h i e f l y on our s i d e : we have been accustomed t o p l a n our own l i v e s i n s u c h a way as t o secure a c o m f o r t a b l e e x i s t e n c e , but we have assumed, q u i t e w r o n g l y , that education i n l i f e , p l a n n i n g i s inadmissible i n I n d i a . 0  Some I n d i a n s o f t h e educated c l a s s e s had been  developing  a growing i n t e r e s t i n s o c i a l improvement and one o f t h e o b v i o u s avenues was h e a l t h and w e l f a r e .  A n a t u r a l e x t e n s i o n was i n -  t e r e s t i n c o n t r a c e p t i o n , and, by t h e time o f Megaw's in 1 9 3 4 ,  comment  some were p r e p a r e d t o promote f a m i l y p l a n n i n g as a  form o f n a t i o n a l s e r v i c e . One o f t h e i n f l u e n c e s which l a i d t h e groundwork f o r t h i s i n t e r e s t was t h e f o u n d i n g - i n 1828 - o f t h e Brahmo Samaj, a H i n d u r e f o r m movement, s t a r t e d i n B e n g a l by Ram Mohun Roy, a f r i e n d o f Jeremy Bentham and an a d v o c a t e , among o t h e r t h i n g s , of u n i v e r s a l adult s u f f r a g e .  At the end o f t h e n i n e -  t e e n t h c e n t u r y , t h e t e a c h i n g s o f t h e sage Ramakrishna and h i s  d i s c i p l e , Swami Vivekananda added impetus t o t h e i d e a o f service.  By t h e end o f t h e c e n t u r y , t h e Moderates o f t h e  I n d i a n N a t i o n a l Congress were u r g i n g t h e i r countrymen t o borrow from t h e West whatever measures would b e n e f i t people.  their  " S o c i a l s e r v i c e " became p o p u l a r among t h e educated  middle and upper c l a s s e s .  Gandhi used s e r v i c e t o t h e s t a t e  as a r a l l y i n g c r y f o r t h e Independence Movement, a d v o c a t i n g e q u a l r i g h t s f o r women on t h e b a s i s o f a n c i e n t Hindu tion. the  tradi-  I t was n a t u r a l , t h e r e f o r e , f o r " s o c i a l w o r k e r s " ( a s  v o l u n t e e r s were c a l l e d ) t o p a r t i c i p a t e i n v o l u n t a r y o r -  g a n i z a t i o n s d e d i c a t e d t o s o c i a l improvement, and t h a t t h e i r w e s t e r n e d u c a t i o n would i n d u c e them t o adopt models o f w e s t e r n o r i g i n such as t h e Boy S c o u t s , G i r l G u i d e s , Red C r o s s and t h e A l l - I n d i a Women's C o n f e r e n c e . In 1916 S r i Pyare W i t t a l , w r i t i n g The P o p u l a t i o n P r o b lem i n I n d i a , urged I n d i a n s t o p l a n t h e i r f a m i l i e s i n a c c o r d 7  ance w i t h t h e i r s o c i a l , economic and h e a l t h needs.  What  was more n a t u r a l than t o p r e s s f o r b i r t h c o n t r o l s e r v i c e s as a means o f s o c i a l reform?  Who were t h e f i r s t t o do so?  l i k e t h e "European" f a m i l y p l a n n e r s , t h e l e a d e r s o f the  movement i n I n d i a b e f o r e World War I I were men, b u t t h e y  were j o i n e d l a t e r by women.  Advocates o f f a m i l y p l a n n i n g  appeared f i r s t i n C a l c u t t a , Bombay, and Madras, t h e t h r e e c i t i e s where c o n t a c t s w i t h t h e West had been most p r o l o n g e d . I n 1911 Babu N i l a m b u r a M u k e r j i , as P r e s i d e n t o f t h e C a l c u t t a o  M u n i c i p a l C o u n c i l , s t r o n g l y advocated c o n t r a c e p t i o n .  0  Pro-  f e s s o r Raghunath Dhondo K a r v e , a t e a c h e r i n t h e C h r i s t i a n  m i s s i o n a r y - s u p p o r t e d W i l l s o n C o l l e g e , opened t h e f i r s t c o n t r o l c l i n i c i n I n d i a i n 1 9 1 5 i n Bombay.  birth  Though B r i t i s h  o f f i c i a l d o m was i n d i f f e r e n t , so much l o c a l c r i t i c i s m  was  aroused by t h e c l i n i c and by P r o f e s s o r Karve's speeches  and  w r i t i n g s on the s u b j e c t , t h a t he was asked t o r e s i g n from the c o l l e g e .  T h i s he d i d , b u t , w i t h h i s w i f e , he spent t h e  r e m a i n i n g t w e n t y - e i g h t y e a r s of h i s l i f e w o r k i n g f o r the  9 f a m i l y p l a n n i n g movement.  Another development  was the o r -  g a n i z a t i o n i n 1 9 2 9 i n Madras of a N e o - M a l t h u s i a n l e a g u e , headed by two d i s t i n g u i s h e d c i t i z e n s - a j u s t i c e o f the H i g h C o u r t , who had t e n c h i l d r e n , and a member o f t h e E x e c u t i v e C o u n c i l , who was  childless.  Governor's  The League p u b l i s h e d  a r e g u l a r b u l l e t i n on b i r t h c o n t r o l and s o l d r u b b e r sponges and j e l l i e s .  I n June 1 9 3 0 , the p r i n c e l y s t a t e o f Mysore  1 0  opened the f i r s t s t a t e - s u p p o r t e d c l i n i c i n the w o r l d i n B a n g a l o r e , and t h e B r i t i s h p r o v i n c e o f Madras s h o r t l y a f t e r followed  suit.  1 1  I n 1 9 3 2 , i n s p i t e o f o p p o s i t i o n from some o f i t s members, the A l l - I n d i a Women's C o n f e r e n c e , a c o - o r d i n a t i n g body o f women's v o l u n t a r y o r g a n i z a t i o n s , passed an u n p r e c e dented r e s o l u t i o n s u p p o r t i n g b i r t h c o n t r o l c l i n i c s f o r b o t h men  and women.  T h i s was the f i r s t t i m e the s u b j e c t was  dis-  cussed o p e n l y a t t h e i r m e e t i n g s , and t h e r e was much e n t h u s i a s m . But the P r e s i d e n t , Smt. Lakshmi N. Menon, observed t h a t a l though i t was a h u m a n i t a r i a n program, the B r i t i s h government would not want t o i n t r o d u c e i t " f o r f e a r of o f f e n d i n g the  12 r e l i g i o u s s e n t i m e n t s o f the p e o p l e . "  A l s o i n 1932, The Senate o f Madras U n i v e r s i t y passed a r e s o l u t i o n favoring i n c l u s i o n i n the curriculum of i n s t r u c t i o n i n family planning.  Two y e a r s l a t e r a new f a m i l y  p l a n n i n g o r g a n i z a t i o n was s t a r t e d i n Bombay.  I t began t o  p u b l i s h a j o u r n a l , M a r r i a g e Hygiene, e d i t e d by D r . A.P. P i l l a i , and, f o r t h e f i r s t time i n t h e w o r l d , i n c l u d e d m a r r i a g e couns e l l i n g i n i t s program. the  I n 1 9 3 5 Snit C o w a s j i J e h a n g i r founded  S o c i e t y f o r t h e Study and P r o m o t i o n o f F a m i l y Hygiene,  a l s o i n Bombay, and a f r e e c l i n i c f o r women was opened i n a 13 l o c a l cotton m i l l . In  1 9 3 5 t h e I n d i a n N a t i o n a l Congress s e t up a N a t i o n a l  P l a n n i n g Committee, headed by J a w a h a r l a l Nehru.  T h i s body  s u p p o r t e d b i r t h c o n t r o l on s o c i o - e c o n o m i c g r o u n d s , b o t h f o r the  sake o f , t h e i n d i v i d u a l and f o r s o c i e t y .  the  h e a l t h o f t h e mother and i n f a n t , i n c r e a s e f a m i l y h a p p i -  n e s s , and h e l p t o combat i n d u c e d a b o r t i o n .  I t would improve  The p l a n n i n g  committee was t h e f i r s t a l s o t o d i s c u s s t h e q u e s t i o n o f p o p u l a t i o n growth i n the c o n t e x t o f economic p l a n n i n g and n a t u r a l r e s o u r c e s , b u t t h e r e was disagreement b o t h as t o p r i o r i t i e s and methods.  B o t h s e l f - r e s t r a i n t and c o n t r a -  c e p t i v e s were approved, as was e u g e n i c s t e r i l i z a t i o n - a p o p u l a r cause i n some Western c o u n t r i e s a t t h e t i m e . ^ I n h i s P r e s i d e n t i a l Address t o t h e Congress a t i t s f o r t y - n i n t h s e s s i o n i n 1 9 3 6 , Nehru urged t h e m i d d l e c l a s s e s t o renew t h e i r e f f o r t s f o r t h e cause o f I n d i a n independence, and to work more c l o s e l y w i t h t h e "people a t l a r g e " - an e x h o r t a t i o n to  g r e a t e r i n v o l v e m e n t i n s o l v i n g n a t i o n a l problems. -' 1  In t h e meantime, Mrs. How-Martyn had v i s i t e d I n d i a i n 1935 on b e h a l f o f the B i r t h C o n t r o l I n f o r m a t i o n C e n t r e ; as a r e s u l t , the A l l - I n d i a Women's Conference i n v i t e d Margaret to  Sanger  speak a t t h e i r meeting i n Travancore a t the end o f 1 9 3 5 ^  Though a r e s o l u t i o n s u p p o r t i n g b i r t h c o n t r o l was opposed  by  E u r a s i a n Roman C a t h o l i c members, and the chairman, t h e Maharani o f Travancore was h a r d p r e s s e d t o keep the meeting 17 on an even k e e l , the v o t e was passed by a 3 t o 1 margin. ' In  r e c a l l i n g t h o s e days, Smt. B h a n v a n t h i Rama Rau, who  later  founded t h e F a m i l y P l a n n i n g A s s o c i a t i o n o f I n d i a , n o t e d t h a t the  educated people i n I n d i a concerned w i t h p o p u l a t i o n p r o b -  lems wondered why Americans c o n s i d e r e d Miss ( s i c ) Sanger 18 immoral when she t a l k e d about the l i m i t a t i o n o f f a m i l y s i z e . Paramount i n Mrs. Sanger's a p p e a l was the need t o reduce  infant  m o r t a l i t y and the importance o f s p a c i n g p r e g n a n c i e s f o r b e t t e r 19 h e a l t h o f b o t h mothers and c h i l d r e n . Mrs. Sanger t r a v e l l e d  10,000  miles, v i s i t e d eighteen  c i t i e s and towns, gave s i x t y - f o u r l e c t u r e s , saw s c o r e s o f government o f f i c i a l s ,  and met many l e a d e r s o f I n d i a n o p i n i o n .  Mrs. How-Martyn, on h e r 1 9 3 5 v i s i t and a subsequent one i n  1937-38,  travelled  6,500  m i l e s and addressed f o r t y - o n e meet-  i n g s , i n c l u d i n g the A l l - I n d i a M e d i c a l Conference; the I n s t i t u t e of P o p u l a t i o n R e s e a r c h , Lucknow; the M a r r i a g e W e l f a r e and C h i l d Guidance A s s o c i a t i o n o f C a l c u t t a ; and t h e Bombay Women's Work G u i l d . cal  Taken t o g e t h e r , t h e s e two women spoke t o 3 2 medi-  associations. I t i s not known whether the v o t e was unanimous, but  t h e A l l - I n d i a M e d i c a l Conference r e s o l v e d t h a t i n s t r u c t i o n in  c o n t r a c e p t i o n s h o u l d he i n c l u d e d i n a l l m e d i c a l c u r r i c u l a .  The r e s o l u t i o n had l i t t l e i m p a c t , b u t a B i r t h C o n t r o l I n f o r m a t i o n C e n t r e , a l r e a d y opened i n C a l i c u t , was strengthened,, and i n a d d i t i o n t o t h e c l i n i c a t B a n g a l o r e c l i n i c s were o p e r a t i n g i n D e l h i , Nagpur, A k o l a , S a t a r a , I n d o r e , C a l c u t t a , Poona and Mysore C i t y .  The Bombay M o f u s s i l M a t e r n i t y , C h i l d W e l f a r e ,  and H e a l t h C o u n c i l adopted a. b i r t h c o n t r o l p o l i c y and a r r a n g e d  21 for  i t s medical s t a f f to take t r a i n i n g . The f i r s t o r g a n i z e d s t e p toward t h e s c i e n t i f i c  of  study  p o p u l a t i o n i n I n d i a was t a k e n mil 1 9 3 6 when D r . Radhakamal  Mukerjee  convened the f i r s t o f a s u c c e s s i o n o f I n d i a n popu-  l a t i o n c o n f e r e n c e s a t t h e U n i v e r s i t y o f Lucknow.  Papers on  demography, n u t r i t i o n , h e a l t h , economics, 22  f a m i l y h y g i e n e , and  e u g e n i c s were p r e s e n t e d and d i s c u s s e d .  I n t h e same y e a r  Dr. A.P. P i l l a i s e t up t r a i n i n g courses i n Bombay, and t o u r e d South I n d i a t o promote t h e p r o v i s i o n o f b i r t h c o n t r o l s e r v i c e s but d o c t o r s t h e r e showed l i t t l e i n t e r e s t . ^ 2  B i r t h C o n t r o l World Wide opened c l i n i c s i n what a r e now U t t a r P r a d e s h and Madhya P r a d e s h ; and C o l . B.L. R a i n a , l a t e r D i r e c t o r o f F a m i l y P l a n n i n g i n t h e C e n t r a l Government, and e v e n t u a l l y D i r e c t o r o f the C e n t r a l F a m i l y P l a n n i n g I n s t i t u t e i n New D e l h i , s t a r t e d a c l i n i c a t U j j a i n , a l s o i n Madhya Pradesh.  I n 1938 the Second A l l - I n d i a P o p u l a t i o n and F i r s t  F a m i l y Hygiene Conference was h e l d i n Bombay, and the N a t i o n a l P l a n n i n g Committee o f t h e I n d i a n N a t i o n a l Congress once a g a i n warned o f t h e need f o r f e r t i l i t y c o n s t r a i n t .  I n 19^0  S r i . P.N.  S a p r u " s u c c e s s f u l l y moved" a r e s o l u t i o n i n the  C o u n c i l of S t a t e s f o r the establishment of b i r t h c o n t r o l c l i n i c s - a much broader p l a n .  That year a l s o , the  P l a n n i n g A s s o c i a t i o n of London sent Mrs. Rena D u t t a ,  Family Scottish  w i f e o f the I n d i a n head o f a m i s s i o n a r y c o l l e g e i n L a h o r e , on an e x t e n s i v e t o u r o f the s u b - c o n t i n e n t , where she met  with  . 2 6 v a r y i n g success m o r g a n i z i n g s e r v i c e s . Thus, the i n i t i a t i v e i n s e t t i n g up f a m i l y p l a n n i n g c l i n i c s i n the 1930s came from a few o r g a n i z a t i o n s , but t h e i r a c t i v i t i e s were i n t e r r u p t e d by the war. No d a t a on t h e i r a c h i e v e ments are a v a i l a b l e , but i t seems t h a t o n l y a few middle c l a s s , educated, urban d w e l l e r s who were m o t i v a t e d towards f a m i l y p l a n n i n g made use o f the f a c i l i t i e s p r o v i d e d ; the g e n e r a l p o p u l a t i o n remained untouched.27 Between 1921 to  and 1941,  6 7 . 3 m i l l i o n people were added  the I n d i a n p o p u l a t i o n and i n 1943  o f f i c i a l cognizance  the government t o o k  o f the problem and a p p o i n t e d a H e a l t h  Survey and Development Committee, headed by S i r J o s e p h B h o r e . F o r the f i r s t t i m e , b i r t h c o n t r o l was of p u b l i c p o l i c y .  d i s c u s s e d as a q u e s t i o n  A l t h o u g h t h e Committee was  d i v i d e d on  whether t o i n t r o d u c e f a m i l y p l a n n i n g t o the poor on economic grounds, i t d i d agree t h a t i t s h o u l d be p r o v i d e d on h e a l t h grounds and t h r o u g h o f f i c i a l m e d i c a l s o u r c e s . s h o u l d be f r e e t o women who  needed them and the s t a t e s h o u l d  c o n t r o l t h e i r manufacture and s a l e . 28 s h o u l d be s t a r t e d .  The  Contraceptives  An i n f o r m a t i o n program  f i n d i n g s o f the Bhore Committee  were s u b s t a n t i a t e d by the B e n g a l Famine E n q u i r y  Commission  i n 1946,  w h i c h recommended a c t i v e government p a r t i c i p a t i o n  i n a f a m i l y p l a n n i n g program.  B u t , when t h e p r o v i n c i a l  governments were c o n s u l t e d , t h e i d e a was n o t f a v o r e d of the f e a r o f r e l i g i o u s o p p o s i t i o n .  because  The number o f b e n e f i c -  i a r i e s would have been low, i n any c a s e , because t h e p r o p o r t i o n o f d o c t o r s t o p o p u l a t i o n was were l o c a t e d i n urban a r e a s . t o p o p u l a t i o n was  1:400,000,  1:6,300  and  The r a t i o o f H e a l t h  75  percent  Visitors  and h e a l t h s e r v i c e s were few.  Even i n S t a t e s l i k e Madras where t h e s u g g e s t i o n s o f t h e Bhore Committee were s u p p o r t e d , t h e number o f people who were g i v e n a d v i c e must have been v e r y limited. ° 2  N o n e t h e l e s s , t h e p r e l i m i n a r y groundwork was l a i d . The  Bhore Committee recommendations were s h e l v e d  until  a f t e r Independence i n 1 9 4 7 , when t h e e f f e c t s o f wartime s h o r t ages and i n f l a t i o n were e x a c e r b a t e d by t h e a r r i v a l o f e i g h t 30  m i l l i o n r e f u g e e s from P a k i s t a n as a r e s u l t o f P a r t i t i o n . I t was seen t h a t a " p o p u l a t i o n problem", w i t h s o c i a l , economic, p o l i t i c a l and i n t e r n a t i o n a l a s p e c t s , was one o f t h e c h a l l e n g e s w h i c h t h e I n d i a n people would have t o f a c e . I n t h i s t h e y were n o t alone.... I t was a t such a time t h a t , as a r e s u l t o f t h e p e r s i s t e n t demand by a group o f men and women i n t e r e s t e d i n the h e a l t h and w e l f a r e o f women and c h i l d r e n , two f r e e f a m i l y p l a n n i n g c l i n i c s were s t a r t e d under t h e Bombay M u n i c i p a l H e a l t h S e r v i c e s . Two y e a r s l a t e r , some o f t h e s e workers found t h a t t h e s e c l i n i c s were n o t b e i n g p u t t o f u l l use because many needy mothers i n t h e c i t y were n o t even aware o f t h e i r e x i s t e n c e . In J u l y , 1 9 4 9 , t h e r e f o r e , a handful of women s o c i a l workers formed a. Committee t o b r i n g t h i s f a c i l i t y t o the n o t i c e o f f a m i l i e s l i v i n g i n Bombay c i t y . 3 1  Ill P u b l i c i t y b r o u g h t i n t e r e s t e d men and women t o meetings i n d i f f e r e n t p a r t s o f Bombay.  T h i s F a m i l y P l a n n i n g Committee,  headed by Smt. Rama Rau, a p p l i e d f o r and was g r a n t e d a l i c e n s e t o import and s e l l c o n t r a c e p t i v e s a t c o s t t o t h e M u n i c i p a l and o t h e r bona f i d e c l i n i c s .  T h i s would f i l l t h e  gap between t h e Bhore Committee recommendations and t h e i r implementation.  By March, 1 9 5 0 , t h e F a m i l y P l a n n i n g Committee  had become a f u l l - f l e d g e d F a m i l y P l a n n i n g A s s o c i a t i o n , i n 12  c o r p o r a t i n g s e v e r a l o f t h e i n t e r e s t e d groups. Objectives included education of the general p u b l i c on t h e n e c e s s i t y o f f a m i l y p l a n n i n g ; and c e n t r e s f o r a d v i c e on s p a c i n g p r e g n a n c i e s , marriage  counselling.  f o r treatment  o f i n f e r t i l i t y and f o r  C o n t r a c e p t i v e a p p l i a n c e s would be  p r o v i d e d f o r m a r r i e d couples as c h e a p l y as p o s s i b l e , so t h a t low and middle income groups might b e n e f i t . were r e s e a r c h and " t o f o s t e r and develop  Other o b j e c t i v e s  contacts w i t h organ-  i z a t i o n s engaged i n a s i m i l a r type o f work i n I n d i a and abroad."33 to "to  To a c h i e v e t h e s e  t h e newly-appointed  aims  r e p r e s e n t a t i o n s were made  I n d i a n Government P l a n n i n g Commission  i n c l u d e f a m i l y p l a n n i n g as one o f t h e measures f o r econo-  mic development".  An i n t e g r a t e d scheme f o r propaganda,  c l i n i c s , t r a i n i n g , f i e l d studies, research, guidelinesf o r a l l v o l u n t a r y a g e n c i e s and s t a n d a r d s f o r a l l c l i n i c s was 34 suggested. The  y  leaders of the Family Planning A s s o c i a t i o n (FPAl)  have been accused o f b e i n g "middle  c l a s s women, b a t t l i n g  s i m u l t a n e o u s l y a g a i n s t t h e s h a c k l e s o f p u r i t a n i s m and t h e  t y r a n n y o f men."35 women.  i  t h e f i r s t p l a c e , t h e y were n o t a l l  n  Men were a c t i v e l y i n v o l v e d i n t h e o r g a n i z a t i o n from  1953 when a C o l . R.N. K h o s l a o f t h e F a m i l y P l a n n i n g A s s o c i a t i o n o f t h e P u n j a b , and P r o f e s s o r S r i p a t i Chandrasekhar (who became M i n i s t e r o f S t a t e f o r F a m i l y P l a n n i n g from 196? t o 1970) were members o f t h e A s s o c i a t i o n ' s d e l e g a t i o n t o the IPPP c o n f e r e n c e i n S t o c k h o l m .  P r o f e s s o r Chandrasekhar was  a l s o the f i r s t e d i t o r o f Planned P a r e n t h o o d , a f o u r page b u l l e t i n s t i l l p u b l i s h e d monthly by t h e A s s o c i a t i o n .  Other  men have been members o f t h e A l l - I n d i a c o u n c i l end i n 1969» two o f t h e t h r e e " V i c e - P r e s i d e n t s were men*  Male d o c t o r s  headed t h e c l i n i c s e r v i c e s from t h e b e g i n n i n g .  Male  parti-  c i p a t i o n has been prominent i n each o f t h e b i e n n i a l A l l - I n d i a Conferences on F a m i l y P l a n n i n g , and t h e s e v e r a l i n t e r n a t i o n a l c o n f e r e n c e s sponsored by t h e A s s o c i a t i o n ; and t h e y r e p r e s e n t e d a c r o s s s e c t i o n o f u n i v e r s i t y f a c u l t y , m i l i t a r y and g o v e r n ment i n s t i t u t i o n s . the  The P r e s i d e n t o f I n d i a , t h e V i c e - P r e s i d e n t ,  l a t e Prime M i n i s t e r Nehru, and M i n i s t e r s o f r e l e v a n t de-  partments o f t h e c e n t r a l and s t a t e governments meetings and g i v e n keynote a d d r e s s e s .  have i n a u g u r a t e d  The v o l u n t e e r s have  been r e p r e s e n t e d on h i g h l e v e l government c o u n c i l s and comm i t t e e s and have been urged by government t o u n d e r t a k e s p e c i f i c tasks.  B a t t l i n g women would h a r d l y l i k e l y have been a c c o r d e d  such c o u r t e s i e s . 3 7  j  n  t h e second p l a c e , i n a s o c i e t y where  s e x u a l freedom was r a r e , and male d o m i n a t i o n s t i l l  solidly  e n t r e n c h e d , i t i s n o t l i k e l y t h a t , whatever t h e i r a i m s , FPAI l e a d e r s expected t o change t h e s e c o n d i t i o n s o v e r n i g h t .  Feminism i n the Western sense was There was n a l and  a s p e c i f i c and  child health.  not t h e i r  inspiration.  urgent need i n the f i e l d s of materAt l e a s t two  t h i r d s of the deaths o f  women i n the r e p r o d u c t i v e age group were from causes connected w i t h pregnancy and  childbirth.  per 1 , 0 0 0 p o p u l a t i o n and  The  maternal  deathrate was 2 5  i n f a n t m o r t a l i t y was  as h i g h as 2 0 0  per 1 , 0 0 0 . 3 9 I n d i a n Family p l a n n i n g l e a d e r s welcomed o u t s i d e contacts.  T h e i r a t t i t u d e s were expressed  very w e l l i n 1 9 5 9 ,  in  the 1PAI r e p o r t of work over a ten-year p e r i o d , The c o u n t r i e s of Western Europe have an .experience of s e v e r a l decades i n the management and c o n t r o l of human f e r t i l i t y , and l a t e l y , Japan has made significant strides in this direction. The movement i n I n d i a , although d i r ected by Indians on l i n e s s u i t e d to t h e i r own country and c u l t u r e , has had the great advantage i n t h a t i t s l e a d e r s are able to study and analyse f a c t o r s which have i n f l u e n c e d Western and Far E a s t e r n p o p u l a t i o n t r e n d s . A l s o , the exchange o f i n f o r m a t i o n by way of c o r respondence and p e r s o n a l meetings and conferences between I n d i a n and Overseas workers through the IPPF and i t s member o r g a n i z a t i o n s , the P o p u l a t i o n C o u n c i l , Inc., the UN P o p u l a t i o n Commission and other expert b o d i e s , have helped cons i d e r a b l y i n p l a c i n g the Indian movement on a sound b a s i s . ^ But, as f a r as a t t r a c t i n g p r o s p e c t i v e users of b i r t h c o n t r o l was  concerned, t h e r e were b u i l t - i n o b s t a c l e s - j u s t  as i n Western c o u n t r i e s . The  d i f f e r e n c e was  combination  Some were the same,  other3  differed.  not so much o r g a n i z e d o p p o s i t i o n as a  of n a t i o n a l i s m , inadequate  s o c i a l and  medical  s e r v i c e s , c u l t u r a l t r a d i t i o n , poor communications and p o l i t i c a l caution. B e f o r e Independence, t o many educated n a t i o n a l i s t s , t h e cause o f I n d i a n p o v e r t y was n o t p o p u l a t i o n e x p l o i t a t i o n of the sub-continent.  growth, hut B r i t i s h  In spite of high  birth-  r a t e s , Japan had made p r o g r e s s a f t e r h e r v i c t o r y over t h e R u s s i a n s i n 1905•  Her i n d u s t r i a l expansion had been i m p r e s -  s i v e and I n d i a c o u l d f o l l o w t h e same c o u r s e , t h e y s a i d . i f her population t r o l was b a r b a r i c .  Even  growth was too r a p i d , a r t i f i c i a l b i r t h conS e l f - r e g u l a t i o n s h o u l d be t h e o n l y means,  and would h e l p t o i n s p i r e people t o r e t u r n t o Aryan t r a d i t i o n s o f s e l f - r e l i a n c e and r e a s o n . B o t h t h e p r o g r e s s o f i n d u s t r y and the more c o n s c i o u s l i m i t a t i o n o f families w i l l follow i n strict measure t h e r e a l i z a t i o n o f p r o g r e s s i v e n e s s and p u r p o s e f u l a c t i o n i n our c o n d u c t . 1  S i m i l a r o b j e c t i o n s were heard a f t e r Independence, and s u p p o r t e d a l s o by M a r x i s t argument t h a t o v e r - p o p u l a t i o n by b r i n g i n g c a p i t a l i s m t o an end.  c o u l d be cured  As f o r c u l t u r a l  obstacles  i n d i v e r s e I n d i a , a few g e n e r a l i z a t i o n s a r e p o s s i b l e . I n d i a n c u l t u r a l t r a d i t i o n was s t i l l m a l e - c e n t r e d .  Sons  were v i t a l - t o share t h e work i n t h e f i e l d s and t o s u p p o r t p a r e n t s i n t h e i r o l d age.  They ensured f a m i l y c o n t i n u i t y and  f i l l e d an i m p o r t a n t r o l e i n p a t e r n a l f u n e r a l r i t e s by p r o p i t i a t i n g t h e dangerous s p i r i t s w h i c h might impede t h e p a t h t o reincarnation.  A t l e a s t two sons were d e s i r e d , i n hopes t h a t  one would l i v e t o m a t u r i t y .  Therefore,  t h e number and b i r t h  o r d e r of sons i n f l u e n c e d the degree of m a r i t a l f e r t i l i t y . Shyness, and  i g n o r a n c e o f the physiology o f r e p r o d u c t i o n  p l a y e d a p a r t - f o r example, i n the cases where the p e r i o d " was  known, i t was  days o f m i d - c y c l e c e p t i o n was led  "safe  f r e q u e n t l y b e l i e v e d t h a t the  were the s a f e d a y s .  p o s s i b l e a t a l l was  The  fact that  i t was  going to  fifteen  contra-  unknown t o the m a j o r i t y  t o the commonly a s s e r t e d p h r a s e , " I t ' s God's w i l l "  meaning t h a t n o t h i n g  also  and -  c o u l d be done t o a v e r t a pregnancy i f  occur.  On the o t h e r hand, t r a d i t i o n a l s o p r o v i d e d t i l i t y regulation.  some f e r -  I n some p a r t s o f I n d i a , i n t e r c o u r s e i s  f o r b i d d e n on more than one hundred f e s t i v a l days a y e a r . Some people b e l i e v e t h a t c o i t u s by the p a r e n t s for  a baby who  p r a c t i c e ) , and  i s inauspicious  i s b e i n g b r e a s t f e d (an almost u n i v e r s a l t h a t the p e r i o d of s e l f - r e s t r a i n t s h o u l d  s h o r t e n e d o n l y by i t s d e a t h o r premature weaning. taboo i s o b s e r v e d , i t t e n d s t o l e n g t h e n pregnancies.^  be  When t h i s  the p e r i o d between  P r a c t i t i o n e r s of i n d i g e n o u s  medicine also  b e l i e v e t h a t semen, when r e t a i n e d , produces energy ( o j a s ) w h i c h i s d i f f u s e d over the body v i a the h e a r t .  This 43  idea  has been used t o support the case f o r vasectomy. R e l a t e d to the idea, of energy t h r o u g h r e s t r a i n t , among m i d d l e and upper income g r o u p s , a t l e a s t , t h e r e i s the H i n d u t r a d i t i o n of a s c e t i c i s m d u r i n g the f i r s t , t h i r d and stages of l i f e  (the a s r a m a s ) .  Gandhi was  a very  e n t i a l proponent of t h i s r u l e , b e l i e v i n g t h a t was  a very important  i n g r e d i e n t f o r s o c i a l and  fourth influ-  self-control economic  p r o g r e s s , and, as a l e a d e r o f t h e Independence movement ( a n d , h a v i n g f a t h e r e d t h r e e l i v i n g c h i l d r e n ) he d e c i d e d l i v e a continent l i f e .  i n 1899 t o  I n 1906 he t o o k a f o r m a l vow o f  c e l i b a c y (Brahmacharya).  Thus, when Margaret Sanger p a i d  him a v i s i t i n 1935» he agreed t h a t women should have c o n t r o l o v e r t h e i r own b o d i e s and t h a t f a m i l y s i z e s h o u l d he l i m i t e d , hut was adamant t h a t c o n t i n e n c e was t h e o n l y a c c e p t a b l e of b i r t h c o n t r o l .  method  Women must say "No" t o t h e i r husbands; a n d ,  a f t e r three o r f o u r c h i l d r e n , couples  should l i v e  apart.  O t h e r w i s e t h e y would n e v e r l e a r n t h e v i r t u e o f s e l f - r e s t r a i n t . ^ 5 Gandhi was a l s o convinced for  t h a t , i f each person l a b o r e d o n l y  s u f f i c i e n t t o s a t i s f y h i s i n d i v i d u a l need, a l l would have  enough, and t h e r e would be an end t o the c r y o f o v e r - p o p u l a t i o n . On t h e o t h e r hand, an e q u a l l y noted I n d i a n , B r . S a r v e p a l l i R a d h a k r i s h n a n , former p r e s i d e n t o f I n d i a , and a s c h o l a r o f r e p u t e , always m a i n t a i n e d  that b i r t h c o n t r o l i s necessary,  and t h e r e i s no s p e c i f i c o p p o s i t i o n i n Hinduism t o c o n t r a -  47  ception. I f r e l i g i o n was n o t a s e r i o u s o b s t a c l e , o t h e r impeded f a m i l y p l a n n i n g . were s c a n t .  Welfare  conditions  programs and m e d i c a l s e r v i c e s  I n a d d i t i o n , l a c k o f t r a i n i n g f o r d o c t o r s and  o t h e r s i n b i r t h c o n t r o l s e r v i c e s a l s o o b s t r u c t e d t h e program. Western t r a i n e d p h y s i c i a n s had a c q u i r e d Western a t t i t u d e s t o c o n t r a c e p t i o n , and w i t h t h e few i n d i v i d u a l e x c e p t i o n s the r e s u l t was m e d i c a l i n e r t i a .  noted,  R e s o l u t i o n s might be passed  a t m e d i c a l meetings i n support o f f a m i l y p l a n n i n g and i n r e sponse t o s u c h l e a d e r s as Margaret Sanger and M r s . How-Martyn,  but t h a t v/as t h e end o f i t .  A l t h o u g h by 1966 some A s i a n  c o u n t r i e s were r e p o r t e d t o be g i v i n g f i v e times as many h o u r s o f i n s t r u c t i o n i n f a m i l y p l a n n i n g i n t h e i r m e d i c a l courses as were t h e U n i t e d S t a t e s , t h e U n i t e d Kingdom, and Canada, i n 1967 Dr. Chandrasekhar was s t i l l e x h o r t i n g I n d i a n 48  medical  s c h o o l s and c o l l e g e s t o g r e a t e r e f f o r t . B u t , as a r e s u l t o f these o b s t a c l e s , and because t h e r e was no way o f e s t i m a t i n g t h e p o l i t i c a l consequences, t h e Union government v/as slow t o p u t i n t o e f f e c t a f u l l y supported  fam-  i l y p l a n n i n g program, and S t a t e governments were even s l o w e r . Not o n l y were p o l i t i c a l ; : p i t f a l l s f e a r e d , b u t t h e s t a t e s were r e l u c t a n t t o spend money on a program f o r which n e c e s s i t y had not been p r o v e n .  Furthermore, the f i r s t M i n i s t e r of Health  i n t h e C e n t r a l government, an I n d i a n p r i n c e s s named R a j Kumari A m r i t Kaur ( a P r o t e s t a n t , b u t a devotee o f t h e Mahatma), s t o o d 49 i n t h e way o f any method but rhythm f o r t e n y e a r s . N e v e r t h e l e s s , as a t e n t a t i v e h e a l t h and w e l f a r e measure, the Union government was prepared  t o s u b s i d i z e t h e FPAI i n  i n c r e a s i n g amounts t o c a r r y out an a c t i o n program o f b i r t h c o n t r o l s e r v i c e s , and t o have i t s r e p r e s e n t a t i v e s s i t on planning bodies, effective  These funds were n e v e r enough t o do an  j o b , however.  Vast amounts were r e q u i r e d f o r  t r a i n i n g , f o r r e s e a r c h , f o r propaganda, and t h e e x t e n s i o n o f s e r v i c e s , and, though t h e FPAI knew i t , they were never given carte blanche.  On t h e o t h e r hand, o f f i c i a l s i n t h e  f i e l d o f p o p u l a t i o n p o l i c y d i d n o t h e s i t a t e t o t a k e advantage o f o p p o r t u n i t i e s a v a i l a b l e through t h e FPAI t o t r a v e l , t o  p a r t i c i p a t e i n conferences  and. to l e a r n what t h e y c o u l d .  Un-  f o r t u n a t e l y , because of r e l u c t a n c e f o r the f i r s t t e n  years,  p o p u l a t i o n p r e s s u r e s have g r e a t l y i n c r e a s e d , and now  that  the government i s s e r i o u s l y promoting b i r t h c o n t r o l ,  politi-  c a l l y l e d communalism - b o t h r a c i a l and r e l i g i o u s - has posed a new  t h r e a t to the program. The Jan Sangh, a r i g h t wing H i n d u e x t r e m i s t p a r t y ,  has  a t t a c k e d the f a m i l y p l a n n i n g program as a t h r e a t t o H i n d u n u m e r i c a l supremacy, and Dr. Chandrasekhar, as M i n i s t e r , was f o r c e d t o counter w i t h the i n f o r m a t i o n t h a t ... M u s l i m s , C h r i s t i a n s ( b o t h P r o t e s t a n t and C a t h o l i c ) and o t h e r m i n o r i t y r e l i g i o u s communities are a l l coming t o government c l i n i c s , and the communal r a t i o of the I n d i a n p o p u l a t i o n shows no s i g n s o f c h a n g i n g . A l l evidence shows t h a t these H i n d u e x t r e m i s t f e a r s are g r o u n d l e s s and t h a t educated and m o t i v a t e d husbands and w i v e s r e s o r t to f a m i l y p l a n n i n g w h i l e the v e r y p o o r , the i g n o r a n t and the unm o t i v a t e d do not - among a l l r e l i g i o u s groups. He observed t h a t Muslims, i n t h e o r y , had  the p r i v i l e g e of  f o u r w i v e s , but t h a t , i n p r a c t i c e , 9 5 p e r c e n t had o n l y  one,  and f u r t h e r r e f o r m must o r i g i n a t e w i t h t h e M u s l i m s , thems e l v e s , p a r t i c u l a r l y the Muslim w o m e n . I n d i a n and  Foreign  News A noted t h a t the P a p a l E n c y c l i c a l o f J u l y , 1 9 & 8 , a g a i n s t a r t i f i c i a l means of c o n t r a c e p t i o n , had provoked a c r i s i s o f conscience  f o r the Roman C a t h o l i c s o f I n d i a ( t h e r e are o n l y  1 0 . 5 m i l l i o n C h r i s t i a n s a l t o g e t h e r ) and s p e c u l a t e d whether t h e y would i n i t i a t e a campaign a g a i n s t government p o l i c y  and  t h u s c r e a t e f u r t h e r communal t e n s i o n s , but no a c t i o n of t h i s s o r t i s apparent,  the p r e l a t e s on the spot b e i n g  realists.  But what o f t h e i n d i v i d u a l s who used b i r t h  control?  As f a r as t h e y were concerned, f o r t h e i n t e l l e c t u a l l y m o t i v a t e d , t h e r e was c o n t i n e n c e .  The more p r o s a i c middle and  upper c l a s s e s p r a c t i s e d c o i t u s i n t e r r u p t u s o r used t h e d i a phragm o r o t h e r a r t i f i c i a l methods.  C o i t u s i n t e r r u p t u s was  p r a c t i s e d by some v i l l a g e people as w e l l , b u t i n d u c e d  abortion  or "unconscious" or d e l i b e r a t e i n f a n t i c i d e ( o f g i r l s , i n p a r t i 52 c u l a r ) v/as t h e i r main a l t e r n a t i v e t o u n l i m i t e d I n p r o p o r t i o n t o the p o p u l a t i o n  fertility.  o f I n d i a , those who used  c o n t r a c e p t i o n were v e r y few, and m o t i v a t i o n t o a c c e p t t h e s e r v i c e s o f f e r e d by t h e FPAI and, l a t e r , by government, depended l a r g e l y on t h e i n f l u e n c e o f t h e o b s t a c l e s a l r e a d y cussed.  dis-  The r o l e performed by t h e FPAI was i n p r o v i d i n g a  forum f o r d i s c u s s i o n and exchange o f i n f o r m a t i o n among i n f l u e n t i a l I n d i a n s , and i n t e s t i n g p u b l i c r e a c t i o n t o b o t h p r o motion and p r o v i s i o n o f s e r v i c e s .  I t also marshalled  t o persuade t h e government t h a t a c t i o n should  and c o u l d be  t a k e n w i t h s a f e t y , and developed t h e p r o t o t y p e s and  evidence  f o r promotion  the d e l i v e r y of s e r v i c e s . C o - o p e r a t i o n between t h e government and t h e PPAI was  c l o s e from 1 9 5 0 °n, when t h e v o l u n t a r y o r g a n i z a t i o n was i n v i t e d t o send r e p r e s e n t a t i v e s t o t h e a d v i s o r y p a n e l s on h e a l t h and w e l f a r e  of the Planning  Commission.  the former and Smt. Wadia t h e l a t t e r .  Smt. Rama Rau j o i n e d F a m i l y p l a n n i n g was  i n c l u d e d i n t h e F i r s t F i v e Y e a r P l a n , and Rs. cated f o r the program.53  i  n  6,500,00  -the meantime, t h e FPAI  allo-  inaugurated  the f i r s t i n a s e r i e s of i n c r e a s i n g l y p r e s t i g i o u s p e r i o d i c  A l l - I n d i a c o n f e r e n c e s on f a m i l y p l a n n i n g which have had an i m p o r t a n t e d u c a t i o n a l f u n c t i o n , and i n which the i n t e r a c t i o n between the FPAI and the p r o f e s s i o n a l s i s o f i n t e r e s t . was h e l d i n Bombay i n December of 1 9 5 1 •  Dr.  It  Chandrasekhar,  then D i r e c t o r o f the I n d i a n I n s t i t u t e o f P o p u l a t i o n S t u d i e s , U n i v e r s i t y o f Baroda, and a Board member of t h e PPAI, gave the  inaugural address.  The presence o f 1 1 0 d e l e g a t e s , i n -  c l u d i n g many d o c t o r s , i n d i c a t e d w i d e r i n t e r e s t i n the i d e a of  f a m i l y p l a n n i n g than had been a n t i c i p a t e d .  I n s t e a d of the  " b i r t h c o n t r o l " concept o f former y e a r s , the theme was, "Conscious and R e s p o n s i b l e P a r e n t h o o d " .  Resolutions  cating a n a t i o n a l i n s t i t u t e of population research,  advodemographic,  s o c i o l o g i c a l , h e a l t h , and o t h e r s t u d i e s were adopted. for  Education  m e d i c a l and p a r a - m e d i c a l p e r s o n n e l was u r g e d , and i t was  agreed t h a t t r e a t m e n t o f i n f e r t i l i t y and marriage guidance s h o u l d be g i v e n . tee,  As had been recommended by t h e Bhore Commit-  a. wide c h o i c e o f c o n t r a c e p t i v e s s h o u l d be manufactured i n  I n d i a , and d i s t r i b u t e d f r e e t o a l l .  Better public education,  t r a i n i n g , d a t a c o l l e c t i o n , and e v a l u a t i o n were e s s e n t i a l . ^ In  1 9 5 2 the o r g a n i z a t i o n o f t h e T h i r d I n t e r n a t i o n a l  Conference on P l a n n e d Parenthood i n Bombay and the f o r m a t i o n of  t h e IPPP, drew more a t t e n t i o n t o the movement.  Eighty  d e l e g a t e s from t h i r t e e n f o r e i g n c o u n t r i e s , and f o u r hundred from I n d i a ( i n c l u d i n g t h e Union M i n i s t r y o f H e a l t h , some S t a t e governments  and t h e I n d i a n Army) a t t e n d e d .  As has been n o t e d ,  i n 1 9 5 3 the PPAI commenced p u b l i c a t i o n o f the four-page monthly news b u l l e t i n , P l a n n e d Parenthood',  In 1 9 5  k  Dr. P i l l a i  started  t h e J o u r n a l o f F a m i l y W e l f a r e , a source o f i n f o r m a t i o n and r e p o r t s b o t h o f which a r e s t i l l p u b l i s h e d by t h e A s s o c i a t i o n , and s u b s i d i z e d by government g r a n t s . v i s u a l a i d s were a l s o  P o s t e r s , f i l m s and o t h e r  undertaken.  In t h e meantime, t h e Union M i n i s t r y o f H e a l t h had made a t e n t a t i v e s t a r t on a government program by a p p r o v i n g lization  steri-  and a d v i c e on c o n t r a c e p t i o n f o r m e d i c a l r e a s o n s , b u t  o n l y i f d o c t o r s had t i m e !  F u r t h e r m o r e , c o n t r a c e p t i v e s were  not t o be g i v e n t o t h e poor as "they might n o t use them". S t u d i e s were t o be a l l o w e d , b u t no a c t i o n was t o be t a k e n . The  M i n i s t e r o f H e a l t h , R a j Kumari A m r i t Kaur, agreed t o an  e x p e r i m e n t a l r e s e a r c h p r o j e c t on t h e "safe p e r i o d " i n w h i c h , a f t e r c o n s i d e r a b l e n e g o t i a t i o n , t h e World H e a l t h O r g a n i z a t i o n was  persuaded t o a s s i s t .  Under WHO a u s p i c e s , D r . Abraham S t o n e ,  o f t h e Margaret Sanger C l i n i c a l was  R e s e a r c h Bureau i n New Y o r k ,  loaned t o conduct experiments i n C a l c u t t a , Madras, Mysore  and t h e D e l h i a r e a .  These t r i a l s began i n May 1 9 5 2 , l a s t e d  f o r n e a r l y t h r e e y e a r s , and s u f f e r e d many v i c i s s i t u d e s .  The  women were g i v e n c h a r t s on which t o r e c o r d d e t a i l s o f t h e i r menstrual  c y c l e s , b u t t h e y proved unable t o do s o . I t was  concluded  t h a t they were t o o p o o r l y educated, so an a l t e r -  n a t i v e was d e v i s e d .  They were g i v e n s t r i n g s o f c o l o u r e d  beads - orange f o r t h e days o f m e n s t r u a t i o n , green f o r s a f e d a y s , and r e d f o r f e r t i l e days.  S p e c i a l adjustments had t o  be made f o r t h e women whose c y c l e s v a r i e d i n l e n g t h , and, because t h e c o l o r was i n d i s t i n g u i s h a b l e a t n i g h t , t h e shape o f t h e beads had t o be changed.  Some women d i s l i k e d t h e beads  because t h e y caused g o s s i p i n t h e n e i g h b o r h o o d ;  others  ( a p p l y i n g t h e commonly a c c e p t e d t a b o o s about m e n s t r u a t i o n ) would n o t t o u c h t h e beads on t h e days o f t h e i r  periods;  s t i l l o t h e r s f o r g o t t o move a bead a day, o r assumed t h a t the mere moving o f t h e bead p r o v i d e d pregnancy.  protection against  I n t h e end, o n l y a few were a b l e t o use t h e meth-  od, and t h e p r o j e c t was judged a f a i l u r e .  Because Roman  C a t h o l i c i n f l u e n c e was s t r o n g i n WHO, no f u r t h e r e x p e r i m e n t s 56 were p e r m i t t e d by t h a t agency f o r a n o t h e r t e n y e a r s . The was  Second A l l - I n d i a Conference on F a m i l y  Planning  h e l d a t Lucknow U n i v e r s i t y i n J a n u a r y , 1955*  reviewed progress  Srat. Rama Rau  i n t h e government program t o d a t e •  Little  o f t h e money a l l o c a t e d i n t h e F i r s t F i v e - Y e a r P l a n had been spent. cal  T r a i n i n g had been n e g l e c t e d , e s p e c i a l l y i n t h e medi-  colleges.  No p l a n had been d e v i s e d t o s p r e a d knowledge  o f f a m i l y p l a n n i n g among t h e p e o p l e , o r t o manufacture contraceptives i n India. methods.  No r e s e a r c h had been done on s i m p l e  A c e n t r a l i z e d i n s t i t u t i o n f o r r e s e a r c h was needed  and an i n t e r - d i s c i p l i n a r y approach was r e q u i r e d .  Marriage  c o u n s e l l i n g and h e l p f o r t h e i n f e r t i l e was a l s o a must.  Spacing  o r l i m i t i n g p r e g n a n c i e s f o r h e a l t h o r economic r e a s o n s was t h e b e s t approach.  Because t h e y were " n o n - p o l i t i c a l " ,  voluntary  s o c i a l w o r k e r s c o u l d p l a y a v i t a l r o l e x-/ith government, and with organisations i n other countries."  5  D r . Radhakaraal M u k e r j e e ,  V i c e - C h a n c e l l o r o f Lucknow U n i v e r s i t y , urged a s t a b l e p o p u l a t i o n , a t h r e e - c h i l d f a m i l y i d e a l , a n d , t o encourage t h e p r a c t i c e o f f a m i l y p l a n n i n g , a program f o r s o c i a l s e c u r i t y .  B i r t h c o n t r o l would not was  necessary  cause i m m o r a l i t y , but a mass campaign  to c r e a t e new  values.  Indiscriminate increase  would o n l y i n c r e a s e the dependency r a t i o and p l a c e an unnecess a r y d r a m on  resources.  Dr. K.C.K.E. R a j a , o f the M i n i s t r y of H e a l t h , where Gandhism s t i l l p r e v a i l e d , warned t h a t w i t h r e d u c t i o n i n m o r t a l i t y , the p o p u l a t i o n would i n c r e a s e i n any c a s e , and t h a t the r e s t of the w o r l d s h o u l d share i t s r e s o u r c e s w i t h I n d i a . S p a c i n g was  not a u s e f u l theme, as t h e r e was  o f f o u r y e a r s between p r e g n a n c i e s .  a l r e a d y an average  Women i n s t i n c t i v e l y r e -  s i s t e d a r t i f i c i a l b i r t h c o n t r o l , and those who  used i t would  c r e a t e p s y c h o l o g i c a l problems f o r t h e m s e l v e s .  Semen had  a  b e n e f i c i a l e f f e c t on them, s t i m u l a t i n g t h e i r g e n e r a t i v e powers. Cancer c o u l d r e s u l t .  I f the middle and upper c l a s s e s were  couraged i n f e r t i l i t y  c o n t r o l , the o v e r a l l i n t e l l i g e n c e  o f the p o p u l a t i o n would be r e d u c e d . were a l s o u n t h i n k a b l e .  Rhythm was  A b o r t i o n and  en-  level  sterilization  the most s u i t a b l e method,  and would be s u c c e s s f u l i f the husbands were educated t o i t s use.  Other speakers f a v o r e d c o n t r a c e p t i o n , however, and  the  u s u a l r e s o l u t i o n s u r g i n g r e s e a r c h and m e d i c a l t r a i n i n g were passed.  Dr. Chandrasekhar's arguments i n f a v o r o f b i r t h  c o n t r o l were p u b l i s h e d the same y e a r . to  abortion.  I t was  an a l t e r n a t i v e  Because people wanted t o l i m i t t h e i r  fertility,  i t should be an i n t e g r a l p a r t of the development program. Conservation essential.  of human r e s o u r c e s t h r o u g h improved h e a l t h  was  V i l l a g e women were emerging from t h e i r a p a t h y ,  and t h e i r a t t i t u d e s t o c h i l d b i r t h s h o u l d be g u i d e d  along  these  lines.  Sex e d u c a t i o n f o r women and f o r a l l s t u d e n t s i n  s c h o o l s and c o l l e g e s was e s s e n t i a l , and b i r t h c o n t r o l s h o u l d be f r e e .  "Whether i t i s m o r a l o r immoral i s n o t a matter o f  o b j e c t i v e f a c t b u t one o f s u b j e c t i v e a t t i t u d e " , he s a i d ; and the Gandhian v i e w , w h i c h f a v o r e d f r e e i n g women t h r o u g h abs t i n e n c e , i g n o r e d t h e f a c t t h a t women might e n j o y i n t e r c o u r s e . ^ ' The T h i r d I l l - I n d i a Conference on F a m i l y P l a n n i n g was held i n C a l c u t t a i n January,  1957*  Guests from E g y p t , I n d o -  n e s i a , P a k i s t a n , China ( P e k i n g ) , S i n g a p o r e , t h e U n i t e d Kingdom, t h e U n i t e d S t a t e s , t h e P a t h f i n d e r Fund (Mrs. Margaret R o o t s ) , and U.K. S a r k a r , a demographer from C e y l o n , a t t e n d e d . papers were r e a d , f o l l o w e d by a seminar on m a r r i a g e  Nineteen  counselling  and sex e d u c a t i o n , conducted by an American, D r . D a v i d Mace. Dr. J.C. Gosh o f t h e P l a n n i n g Commission p r a i s e d t h e FPAI f o r i t s c r u s a d e , and urged i t t o persuade t h e S o c i a l W e l f a r e Board (a c o - o r d i n a t i n g agency f o r women's v o l u n t a r y o r g a n i z a t i o n s ) to  support t h e cause.  Smt. Rama Rau's p r e s i d e n t i a l address  n o t e d t h a t government s u p p o r t o f f a m i l y p l a n n i n g was i n c r e a s ing,  b u t t h e r e were s t i l l many shortcomings i n t h e o f f i c i a l  program.  L e s s than h a l f t h e money a p p r o p r i a t e d had been s p e n t ,  t h e r e was no c e n t r a l i n s t i t u t e f o r c l i n i c a l work, t r a i n i n g , t r i a l s , f e r t i l i t y and i n f e r t i l i t y s t u d i e s , and n o t h i n g a t t h e state l e v e l . of  No s p e c i a l courses were b e i n g g i v e n i n s c h o o l s  m e d i c i n e , n u r s i n g , o r s o c i a l work.  Some r e s e a r c h had been  done i n g e n e t i c s , economics, and demography, b u t p r o g r e s s was uneven.  V o l u n t e e r s were s t i l l needed t o p i o n e e r where the  government was unable t o do s o , and t h e FPAI c o u l d a s s i s t i n  s t a n d a r d i z i n g p o l i c y and p r o c e d u r e s .  F a m i l y P l a n n i n g was  a p l a n to l i m i t f e r t i l i t y , but one t o space p r e g n a n c i e s h e a l t h , and  not  for  happiness.  L t . C o l . B.L.  R a i n a , S e c r e t a r y o f the C e n t r a l F a m i l y  P l a n n i n g B o a r d , and D i r e c t o r of F a m i l y P l a n n i n g , a s s u r e d audience t h a t b e t t e r o r g a n i z a t i o n was  on the way  and  that  more h e l p would be g i v e n the s t a t e s , l o c a l b o d i e s and organizations.  Dr. K.C.K.E. R a j a , now  the  voluntary  co-ordinating o f f i c e r  of  the Demographic T r a i n i n g and R e s e a r c h Centre ( t o be opened l a t e r t h a t year under I n d i a n and UN s p o n s o r s h i p ) , spoke once more. T h i s time he was  more e n t h u s i a s t i c about the program.  He  was  s t i l l opposed to a b o r t i o n , but approved s t e r i l i z a t i o n by mutual consent of p a r e n t s w i t h completed f a m i l i e s . shortage  o f d o c t o r s , so teams and  a good i d e a .  Mass e d u c a t i o n was  There was  an  camps f o r b i r t h c o n t r o l were a l s o needed.  Genetic  study  o f i n t e l l i g e n c e and h e r i t a b l e d e f e c t s s h o u l d be c a r r i e d ( t h e r e was  ample m a t e r i a l i n the c a s t e system and  marriages).  acute  Dr. C. Chandrasekharan, P r o f e s s o r o f  out  endogamous Statistics,  A l l - I n d i a I n s t i t u t e o f Hygiene and P u b l i c H e a l t h , C a l c u t t a , doubted t h a t r a i s i n g the age o f m a r r i a g e would s u c c e e d . s t e a d , r u r a l people s h o u l d be m o t i v a t e d t i t u d e s , and them do  so.^  In-  t o change t h e i r a t -  economic development s h o u l d be prompted t o h e l p 1  I t s h o u l d be n o t e d here t h a t s t u d i e s o f t h e economic a s p e c t s o f p o p u l a t i o n growth had a l r e a d y been done by and o u t s i d e r s .  I n 1 9 4 6 D. Ghosh had p u b l i s h e d P r e s s u r e  Indians of  P o p u l a t i o n and Economic E f f i c i e n c y i n I n d i a , i n w h i c h he u r g e d  a p o p u l a t i o n c o n t r o l program. i n the  1920s,  and 1 9 5 . k  c  J . M. Keynes had  suggested i t  and K i n g s l e y Davis had recommended i t i n At the C a l c u t t a conference  itself,  Dr. M.C.  1951 Balfour  o f the R o c k e f e l l e r F o u n d a t i o n , gave a summary o f a 1 9 5 6 p r e l i m i n a r y d r a f t o f a book by A n s l e y J . Coale and Edgar M. Hoover, showing the n e g a t i v e e f f e c t o f p o p u l a t i o n growth on economic progress.  I n i t s p u b l i s h e d form i t s message  was,  H i g h f e r t i l i t y i s a n e c e s s i t y f o r human s u r v i v a l when m o r t a l i t y r i s k s are g r e a t . When m o r t a l i t y r i s k s are r e d u c e d , h i g h f e r t i l i t y becomes a burden - by i n c r e a s i n g the dependency r a t i o , by d i v e r t i n g c a p i t a l from uses t h a t would r a i s e per c a p i t a o u t p u t , and i n the l o n g run by overwhelming any f i n i t e r e s o u r c e s . I f b e t t e r h e a l t h and l o n g e r l i f e are v a l u e d , h i g h f e r t i l i t y must be c o n s i d e r e d an e x t r a v a g a n c e . A p o p u l a t i o n w i t h h i g h incomes and ample r e s o u r c e s may be a b l e t o a f f o r d i t f o r a p e r i o d , perhaps f o r many decades. But a low-income a r e a w i t h h i g h f e r t i l i t y t h a t chooses the l u x u r y o f s u s t a i n e d b i r t h s i n e v i t a b l y chooses t o f o r e g o a much more r a p i d expansion o f per c a p i t a incomes. Reduced f e r t i l i t y p e r m i t s h i g h e r per c a p i t a incomes i n the s h o r t r u n and i n the i n t e r m e d i a t e f u t u r e ; i n the d i s t a n t f u t u r e i t can a v e r t the otherwise i n e v i t a b l e r e t u r n of poverty and h i g h death r a t e s . 6 3 In  the same y e a r Robert C. Cook gave I n d i a o n l y a g e n e r a t i o n  to  f i n d a s o l u t i o n , and urged i n c e n t i v e s t o speed the 64  and a v o i d The  process  catastrophe. C a l c u t t a conference  urged once more t h a t  medical  t r a i n i n g i n methods o f b i r t h c o n t r o l be g i v e n , and p r e s s e d  the  government t o i n t r o d u c e the program i n the p l a n t a t i o n areas and i n i n d u s t r i a l e n t e r p r i s e s . About the o n l y p r o g r e s s made had been i n s l o g a n s : b i r t h c o n t r o l i n the F i r s t F i v e - Y e a r  Plan  had been f o r " f a m i l y w e l f a r e " .  I n the Second  became a "key f a c t o r i n development", h e s i t a n t and t e n t a t i v e .  (1956-6I) i t  but a c t i o n was  still  The f r u s t r a t i o n o f the FPAI was  summed up by Warren S. Thompson, a p i o n e e r o b s e r v e r s i n c e  the 1 9 2 0 s : The P l a n n e d Parenthood movement i n I n d i a i s w e l l o r g a n i z e d and q u i t e v i g o r o u s , but i t s l e a d e r s would be the f i r s t t o r e c o g n i z e t h a t i t does n o t r e a c h many people and t h a t i t i s h a v i n g o n l y a n e g l i g i b l e e f f e c t on the b i r t h r a t e a t p r e s e n t . Handicapped by inadequate funds and by l a c k o f t r a i n e d w o r k e r s , i t cannot c a r r y on any l a r g e campaign.... Most o f the c l i n i c s now i n o p e r a t i o n are i n the l a r g e c i t i e s , and some o f t h e s e are n o t y e t b e i n g used t o c a p a c i t y , p r o b a b l y because o f i n a d e q u a t e propaganda. To say the l e a s t , t h i s s i t u a t i o n i s p r o f o u n d l y d i s c o u r a g i n g to those people who are t h e most d e e p l y c o n v i n c e d o f I n d i a ' s need f o r f a m i l y p l a n n i n g and who a r e g i v i n g g e n e r o u s l y b o t h o f t h e i r time and money. 5 6  The FPAI's own  summary o f t e n y e a r s o f propaganda c o n t a i n e d  the u r g e n t recommendation t h a t s e r v i c e s be extended  through  a "country-wide network o f c l i n i c s s u p p o r t e d by a massive and s u s t a i n e d e d u c a t i o n a l programme which must be w i t h p a t i e n c e and f a i t h , " but a dynamic s t a r t was 66  implemented still  five  y e a r s away. The S i x t h I n t e r n a t i o n a l Conference on P l a n n e d P a r e n t hood was h e l d by the IPPF i n New The theme was,  D e l h i i n February, 1 9 5 9 .  " M o t i v a t i o n and Methods".  I t has a l r e a d y  been d e s c r i b e d i n p a r t i n Chapter I V , but i t e m s about s h o u l d be n o t e d h e r e .  India  S i r J u l i a n H u x l e y , a famous b i o l o g i s t ,  t h e former D i r e c t o r G e n e r a l o f UNESCO, summed up I n d i a ' s  m o t i v a t i o n a l problems as c o n f o r m i t y , i l l i t e r a c y ,  under-  n u t r i t i o n , p r e s s u r e on s p a c e , u r b a n i z a t i o n , s p e c i a l problems because of m i g r a t i o n and unemployment, d e f o r e s t a t i o n , and e r o s i o n , water shortage, s p o l i a t i o n of r e c r e a t i o n areas, l a c k of conservation p o l i c y ,  l i k e Robert Cook, he,  and  too,  recommended i n c e n t i v e s t o reduce f e r t i l i t y - a r e d u c t i o n i n f a m i l y allowances  a f t e r two  c h i l d r e n , and a m o d i f i e d t a x s y s -  tem p e n a l i z i n g those w i t h l a r g e f a m i l i e s .  A paper by Dudley  K i r k , then Demographic D i r e c t o r of the P o p u l a t i o n C o u n c i l , urged more m o t i v a t i o n f o r men methods o f c o n t r a c e p t i o n .  and the promotion o f more male  I n any c a s e , a w i d e r c h o i c e o f  methods, e s p e c i a l l y those which d i d not r e q u i r e a a s s i s t a n c e , s h o u l d be u s e d .  doctor's  There s h o u l d be l e s s " c l i n i c "  o r i e n t a t i o n , more p u b l i c i t y , and more r e s e a r c h i n knowledge, a t t i t u d e s and p r a c t i c e .  P e o p l e were i n t e r e s t e d however,  m o t i v a t i o n i n urban a r e a s was  higher, but, i n both  cases,  s e r v i c e s must be w e l l o r g a n i z e d and a l l must be warned t h a t methods c o u l d  fail.  P r o f e s s o r S. Chandraskhar, by t h i s time D i r e c t o r o f the I n d i a n I n s t i t u t e f o r P o p u l a t i o n S t u d i e s i n Madras, r e p o r t e d on the Kaufman F o u n d a t i o n C l i n i c a t Mangadu (Madras S t a t e ) . T h i s p r o j e c t had been f i n a n c e d f o r f o u r years f r o m Mr. A.S.  Kaufman, P r e s i d e n t , P a r e n t s ' I n f o r m a t i o n  1955*  "by  Bureau,  l t d . , K i t c h e n e r , O n t a r i o , t o f i n d out whether the average mother wanted t o space those she had w i t h a minimum i n t e r v a l o f two y e a r s , what were the b a r r i e r s to a c c e p t a n c e , and what methods would be w e l l r e c e i v e d .  I t was  found t h a t most would  l i k e t o l i m i t f a m i l y s i z e , but t h a t the need f o r sons t o o k precedence.  There was  the need to emphasize s p a c i n g ,  care and g e n e r a l h e a l t h . government had  was  I n two-and-one-half y e a r s t h e r e were  a c c e p t o r s but 192 not u s e d .  The women were not aware t h a t the  approved the e x p e r i m e n t ^ so b e t t e r i n f o r m a t i o n  s e r v i c e s were needed. 1,200  child  f a i l u r e s because the method chosen  The r e a s o n s f o r f a i l u r e were r e p o r t e d  as:  l a c t a t i o n , a v e r s i o n t o h a n d l i n g the g e n i t a l s , or the method was  too messy.  Dr. C h a n d r a s e k h a r s American w i f e had 1  most of the work and i t was promote f a m i l y p l a n n i n g .  concluded  t h a t an o u t s i d e r c o u l d  Most of the p a t i e n t s wanted i t f o r  economic and h e a l t h r e a s o n s , but m o t i v a t i o n was enough to i n d u c e  done  l o n g t e r m use.  not  As diaphragm and  strong  jelly  was  u n s u i t e d t o a r u r a l s e t t i n g , s i m p l e r methods had been t r i e d . Tampons and o i l or s a l t s o l u t i o n were u n p o p u l a r . and foam powder were a c c e p t a b l e .  The  An i d e a l method was  sponge needed -  an i n j e c t i o n , a p i l l or the l i k e - and vasectomy s h o u l d  be  pushed because i t made an end of f e a r and  encouraged b e t t e r  c h i l d care. 68  undertaking  The  government o f Madras was  such a  campaign. A s t u d y group on s t e r i l i z a t i o n , p r e s i d e d over by Dr. C P .  B l a c k e r , and w i t h Dr. G.M.  Phadke as  appears t o have produced some c o n f l i c t . was  rapporteur,  In the meeting t h e r e  no o p p o s i t i o n i n p r i n c i p l e to the method, and a r e s o l u t i o n  u r g i n g support was  passed unanimously.  I t was  a safe,  a b l e and e f f e c t i v e method, and r e v e r s i b l e by Dr. V.N. technique;  and more i n f o r m a t i o n s h o u l d be g i v e n to the  acceptShirodkar's medical  p r o f e s s i o n and t h e p u b l i c .  The n e c e s s a r y  facilities  "should  be made a v a i l a b l e f r e e o f charge t o persons who seek them voluntarily."  Though i t was l e g a l , d o c t o r s seemed t o f e e l  the need f o r p r o t e c t i o n , and governments should make sure t h i s was p r o v i d e d . The  motion was proposed by S r i R.A. Gopalaswami o f  Madras, and seconded by a "Dr. A.M. Mehta" who appears t o have been n e i t h e r a d e l e g a t e n o r a speaker,'and, j u d g i n g from h i s name, was f r o m t h e Bombay a r e a .  When i t was c o n s i d e r e d by  the G o v e r n i n g Body o f t h e IPPP t h e f o l l o w i n g r e s o l u t i o n was passed: The G o v e r n i n g Body n o t i n g t h e recommendation... and r e a l i z i n g f u l l y t h e v a l u e o f s t e r i l i z a t i o n i n many s i t u a t i o n s , hereby r e s o l v e s t h a t , i n t h e p r e s e n t s t a t e o f knowledge, i t would be premature f o r the IPPP t o t a k e a p o s i t i o n i n t h i s matter at t h i s time. I t was d e c i d e d t o l e a v e t h e q u e s t i o n t o t h e member c o u n t r i e s 69  t o d e a l w i t h as t h e y saw f i t .  y  Dr. C. Chandra.se k h a r a n , a n o t h e r  I n d i a n demographer now  I n t e r r e g i o n a l A d v i s e r on P o p u l a t i o n a t t h e U n i t e d N a t i o n s , l i k e Thompson, noted t h a t people were i n t e r e s t e d i n f a m i l y p l a n n i n g b u t r u r a l m o t i v a t i o n was weak.  M o t i v a t i o n i n urban  areas was h i g h e r , b u t , i n b o t h c a s e s , s e r v i c e s must be w e l l 70 o r g a n i z e d , and a l l must be warned t h a t methods c o u l d  fail.  I n a p r i v a t e b r i e f t o t h e C e n t r a l Government i n O c t o b e r ,  1959j  t h e PPAI expressed  gress.  I t p o i n t e d out t h a t t h e C e n t r a l F a m i l y P l a n n i n g Board  i t s impatience w i t h the l a c k o f pro-  ( o f w h i c h Smt. Rama Rau was a member) had n o t met f o r a y e a r .  S t a t e e f f o r t s were i n a d e q u a t e , and were r e q u i r e d . zations.  More money was  c o - o r d i n a t i o n and  inspection  needed by the v o l u n t a r y  organi-  Cheap c o n t r a c e p t i v e s , manufactured i n I n d i a , were  e s s e n t i a l ; and  a b e t t e r p l a n should be made t o e n l i s t  support  o f the m e d i c a l p r o f e s s i o n , l a b o r departments and t r a d e The  FPAI urged more r e s e a r c h i n I n d i a ( i n p r e f e r e n c e  u n t i l the West d i d i t ) ;  and,  stressed.  to w a i t i n g  once more, the need of i n s t r u c -  t i o n i n m e d i c a l c o l l e g e s , n u r s i n g s c h o o l s , and s o c i a l work, was  unions.  The  so f a r as i t went, but t h e r e was  schools  of  government program was  good,  danger t h a t i t would slow  down r o u t i n e h e a l t h s e r v i c e s , t h a t i t would be s u b j e c t to usual bureaucratic would be l o s t .  c o n v o l u t i o n s , and  the  t h a t the sense o f u r g e n c y  Economic i n c e n t i v e s were recommended and  a 71  s p e c i a l m i n i s t r y was No was  r e q u i r e d to c a r r y out the whole c o n c e p t .  doubt as a r e s u l t o f t h i s c h a l l e n g e , Smt.  Rama Rau  a p p o i n t e d chairman o f the C e n t r a l F a m i l y P l a n n i n g  committee on the T h i r d F i v e - Y e a r formulate  proposals.  She  Board's  P l a n , to survey progress  and Mrs. Wadia s a t a l s o on  A d v i s o r y H e a l t h P a n e l of the P l a n n i n g  the  Commission w h i l e  c u s s i o n s o f f a m i l y p l a n n i n g were i n p r o g r e s s .  But  and  dis-  still  the  program l a g g e d . At a conference on r e s e a r c h i n f a m i l y p l a n n i n g , the same y e a r i n New s o c i o l o g i s t , now  Y o r k , P r o f e s s o r J . Mayone S t y c o s ,  o f C o r n e l l U n i v e r s i t y , who  was  held a  a l s o concerned  about the d e l a y i n e f f e c t i v e a c t i o n i n d e v e l o p i n g  countries,  blamed the  " T r a d i t i o n a l P l a n n e d P a r e n t h o o d Approach" f o r the  problems.  He r e p e a t e d the c r i t i c i s m t h r e e y e a r s l a t e r i n a  s l i g h t l y d i f f e r e n t form, and many o f h i s p o i n t s were w e l l taken.  B u t t h e had as w e l l as t h e good have s i n c e "been en-  s h r i n e d i n two hooks w h i c h a r e f r e q u e n t l y read hy s t u d e n t s o f p o p u l a t i o n problems; and t h e i m p r e s s i o n  has been c r e a t e d , by  i n f e r e n c e , t h a t t h e v o l u n t e e r s were b e h i n d t h e t i m e s , i n f o r m e d and i n f l e x i b l e . and  ill-  Because i t has a b e a r i n g on c u r r e n t  f u t u r e r e l a t i o n s between p r o f e s s i o n a l s and v o l u n t e e r s ,  the a i r s h o u l d be c l e a r e d . S t y c o s s a i d t h a t , because i t was d e r i v e d from American and B r i t i s h e x p e r i e n c e ,  t h e t r a d i t i o n a l planned parenthood  approach s h o u l d n o t be used i n d e v e l o p i n g as noted e a r l i e r , o t h e r t i o n a l " approach and,  countries. But,  countries a l s o influenced the " t r a d i -  f r o m these c o n t a c t s , I n d i a  her own a c t i o n program.  introduced  So l o n g as t h e b a s i c IPPP t e n e t s were  o b s e r v e d , t h e member o r g a n i z a t i o n c o u l d make i t f i t l o c a l cumstances and needs.  cir-  As t h e r e was no o t h e r background o f  experience than that o f the volunteers  i n the i n d u s t r i a l i z e d  c o u n t r i e s , i t was n a t u r a l t h a t some a t t i t u d e s would be t r a n s ferred.  B u t t h e r e s u l t was n o t a l l b a d . S p e c i f i c a l l y , S t y c o s s a i d t h a t t h e " t r a d i t i o n a l " approach  had  three biases - a l l unsuited t o Asian  cultures.  I t was t o o  m e d i c a l l y o r i e n t e d , t o o middle c l a s s , and t o o f e m i n i s t .  In  the f i r s t i n s t a n c e , i t was dominated by d o c t o r s , t h e most conservative  o f p r o f e s s i o n s , so t h e h e a l t h o f t h e mother and  c h i l d t o o k precedence o v e r o t h e r were c l i n i c - b o u n d .  c o n s i d e r a t i o n s , and s e r v i c e s  Even though i t was n o t n e c e s s a r i l y s u i t e d  t o a l l A s i a n u s e r s , t h e d i a p h r a g m - a n d - j e l l y was advocated  before  o t h e r methods.  Though s t e r i l i z a t i o n and a b o r t i o n might be  s o c i a l l y t h e r a p e u t i c , t h e s e p r o c e d u r e s were f o r b i d d e n , and, r e g a r d l e s s o f t h e i r v a l u e i n p o p u l a t i o n c o n t r o l , t h e IPPF had r e f u s e d t o support e i t h e r a t i t s 1 9 5 9 c o n f e r e n c e .  The  i d e a o f s p a c i n g p r e g n a n c i e s as a means o f b i r t h c o n t r o l was i n c o m p r e h e n s i b l e t o p a r e n t s i n a d e v e l o p i n g c o u n t r y who spaced them by 3 t o 4 y e a r s anyway, and t h e t r e a t m e n t o f i n f e r t i l i t y had been b u i l t i n t o t h e program t o g i v e i t a c c e p t a b i l i t y w i t h the e s t a b l i s h m e n t . Second, he s a i d t h e program was middle c l a s s and, hence, m o r a l i s t i c i n i t s approach.  I t r e f u s e d t o serve the unmarried,  and was based on. unfounded e l i t e t h e o r i e s o f t h e f e r t i l i t y o f the "lower c l a s s e s " .  I t was f r e q u e n t l y s a i d , f o r example,  t h a t r u r a l e l e c t r i f i c a t i o n would slow t h e i r r e p r o d t i c t i v e  acti-  vities. T h i r d , i t was f e m i n i s t .  S e r v i c e s were r u n by women, f o r  women, t o f r e e them from male e x p l o i t a t i o n , and p r o b a b l y even to h e l p them dominate.  On t h e grounds t h a t males were i r -  r e s p o n s i b l e , male methods such as condoms and w i t h d r a w a l were not taught.  S t y c o s approved  c o n t r a c e p t i o n f o r m a t e r n a l and  c h i l d h e a l t h , b u t suggested t h a t an e f f e c t i v e a p p e a l c o u l d a l s o be made t o men on economic grounds.  I f home v i s i t i n g o r  promotion t h r o u g h v i l l a g e l e a d e r s were b u i l t up, m o t i v a t i o n would be more s u s t a i n e d .  Simple methods s h o u l d be d i s t r i b u t e d  t h r o u g h commercial channels and w i t h d r a w a l t a u g h t .  More men  s h o u l d be employed i n promotion w i t h men.  govern-  Finally,  ment s h o u l d t a k e over a l l p o l i c y c o n t r o l , and r e p l a c e m e d i c a l  i n f l u e n c e w i t h tha.t o f s o c i a l s c i e n t i s t s , community d e v e l o p ment and communications s p e c i a l i s t s .  The amateurs s h o u l d he  r e p l a c e d hy p r o f e s s i o n a l s . 7 2 Dr. W i l l i a m Vogt o f P l a n n e d P a r e n t h o o d , George Cadbury o f t h e IPPP, and P r o f . D.V. G l a s s , o f t h e I n s t i t u t e f o r Popul a t i o n Studies the  i n England, explained  t h e r e a s o n b e h i n d some o f  " t r a d i t i o n a l " p o l i c i e s , and c e r t a i n p o i n t s s h o u l d be made  73  here.  M e d i c a l support was needed f o r acceptance o f a contro^  v e r s i a l s e r v i c e , and a l s o f o r t h e d e l i v e r y o f methods.  "medical"  I t was a l s o n e c e s s a r y i n o r d e r t o have f a m i l y  plan-  n i n g i n c l u d e d i n o r d i n a r y h e a l t h s e r v i c e s , one o f t h e most o b v i o u s r o u t e s t o m u l t i p a r o u s women.  C l i n i c s were u s e f u l as  d e m o n s t r a t i o n p r o j e c t s and f o r t r a i n i n g . home v i s i t i n g was a l s o r e c o g n i z e d ,  But t h e need f o r  and, l i m i t e d though t h e i r  e f f o r t was, t h e PPAI, had p i o n e e r e d t h e i d e a .  They had a l s o  p i o n e e r e d t h e use o f t h e mass media, and, i n a d d i t i o n , had started family planning  services i n industry.  Because t h e i r  funds were l i m i t e d , and p e r s o n n e l f e w , t h e i r work d i d n o t extend f a r i n t o t h e r u r a l a r e a s .  The diaphragm was  favored  by t h e v o l u n t e e r s  i n S o u t h A s i a , t o o , because i t was t h e most  r e l i a b l e method.  W h i l e low income women might n o t have t h e  p r i v a c y o f bathrooms, some found a way t o use i t , e s p e c i a l l y as i n t e r c o u r s e o f t e n t a k e s p l a c e w i t h o u t p r e l i m i n a r i e s , and, f o r example, when t h e y t a k e l u n c h t o t h e i r husbands when t h e 7k  crops a r e h i g h .  I n a d d i t i o n t o t h e diaphragm - sponge and  j e l l y , and foam t a b l e t s were a l s o d i s t r i b u t e d . was a s s o c i a t e d  The condom  i n the m e d i c a l mind w i t h p r o s t i t u t i o n and t h e  need f o r p r o t e c t i o n a g a i n s t v e n e r e a l d i s e a s e , so i t was n o t popular at f i r s t with the family planners e i t h e r .  Withdrawal  was opposed because i t was then b e l i e v e d t o be e m o t i o n a l l y u n s a t i s f a c t o r y , and a l s o because i t sometimes f a i l e d .  Female  s t e r i l i z a t i o n had been performed i n I n d i a as e a r l y as 195^, and vasectomy was a l s o o f f e r e d by t h e FPAI.  The l a t t e r was n o t  p o p u l a r f o r some y e a r s , however, because men thought i t was castration.  D o c t o r s were a l s o c a u t i o u s because o f imagined  legal l i a b i l i t y .  P r o f e s s o r Chandrasekhar, as a member o f t h e  FPAI, had been a d v o c a t i n g s t e r i l i z a t i o n s i n c e  1955*  Infer-  t i l i t y s e r v i c e s were i n d e e d d e f e n s i v e i n both, t h e West and i n South A s i a , and f o r good r e a s o n ; b u t , i n t h e l a t t e r , t h e y had an added a t t r a c t i o n .  I n f e r t i l i t y was such a s o c i a l t r a g -  edy f o r women t h a t t h e d i a g n o s i s o f b o t h husband and w i f e and t r e a t m e n t f o r whichever was r e s p o n s i b l e , c o u l d sometimes r e l i e v e women o f t h e s e r i o u s s t i g m a o f b e i n g " i n a u s p i c i o u s " . ^ 7  The  " t r a d i t i o n a l " approach t o induced a b o r t i o n had s e v e r a l b a s e s : i t was i l l e g a l , and, b e f o r e t h e advent o f a n t i b i o t i c s , i n d u c e d a b o r t i o n , even i n t h e b e s t c i r c u m s t a n c e s , was s t i l l dangerous.  relatively  I t would a l s o r e q u i r e massive i n v e s t m e n t i n f a c i -  l i t i e s and t r a i n i n g ; and, a f t e r a l l , Margaret Sanger and h e r c o n t e m p o r a r i e s had used t h e dangers o f a b o r t i o n as j u s t i f i c a t i o n f o r c o n t r a c e p t i o n as an a l t e r n a t i v e . The movement was i n d e e d middle c l a s s , b u t most r e f o r m s o r i g i n a t e w i t h t h e middle c l a s s .  Their a t t i t u d e s to b i r t h  c o n t r o l f o r t h e unmarried v a r i e d from c o u n t r y t o c o u n t r y , b u t , from t h e p o i n t o f view o f p u b l i c r e l a t i o n s , i t was t h e b e s t t o  emphasize t h a t i t was  f o r the m a r r i e d .  I n I n d i a and  Paki-  s t a n the f o r m a l statement uses the term "married c o u p l e s " . I n C e y l o n , i t i s " c o u p l e s " , and  i n N e p a l , the m a r r i e d s t a t e  c o u l d he i n f e r r e d , as the s e r v i c e i s f o r m a t e r n a l and 77 w e l f a r e , and  i t , too, i s a t r a d i t i o n a l s o c i e t y .  i n South A s i a , e x c e p t i o n s were made, no dious opinions  In p r a c t i c e  doubt.  As f o r i n v i -  of "lower c l a s s " f e r t i l i t y , i t would he  p r i s i n g i f some f a m i l y p l a n n e r s had personal  child  not had  sur-  them; h u t ,  e x p e r i e n c e , I b e l i e v e t h e y were few.  I n any  from case,  i n I n d i a the FPAI s e t out t o serve " m i d d l e " income groups as w e l l as the  "low".  " c l a s s " was  i r r e l e v a n t and  easy d e f i n i t i o n .  In Asian  countries  c a s t e d i s t i n c t i o n s too  Those who  stiggested t o me t h a t  complex f o r electrific-  a t i o n would reduce f e r t i l i t y , were not a c t i v e i n the planning  family  movement.  As f o r f e m i n i s t b i a s - a few f e m i n i s t s were a c t i v e i n Western c o u n t r i e s and J a p a n , but i t has been shown i n t h i s paper t h a t nowhere was The  the movement run e x c l u s i v e l y by women,  for  women.  need f o r m a t e r n a l and  child health in Asia  has  a l r e a d y been n o t e d . (See p. 1 1 3 • ) Because b i r t h  control  s e r v i c e s were u s u a l l y open i n the daytime o n l y , i t was t h a t most o f the workers and 1 9 5 2 the FPAI had  c l i e n t e l e would be women.  o f f e r e d male s t e r i l i z a t i o n , and,  condoms were prescribed.'' ^ 7  More men  the t a s k o f g e t t i n g male s u p p o r t , and s e r v i c e s , but men  natural From  from 1 9 5 ^ »  were c e r t a i n l y needed i n a l s o i n d e l i v e r i n g the  were r u n n i n g the government program, and  most d o c t o r s were men.  T h e i r s h i f t s i n p o l i c y and  emphasis  over the y e a r s show t h a t i n f l e x i b i l i t y was i s t i c of the  not a  character-  volunteers.  There were weaknesses i n the system, t o be s u r e , no background o f e x p e r i e n c e no dynamic p o l i t i c a l  had e x i s t e d , t h e r e was  support,  and  c a l problems had not been s o l v e d .  little  s o c i o - e c o n o m i c and I t was  no doubt t h a t m e d i c a l i n f l u e n c e was  or  logisti-  s t i l l a controversial  and v u l n e r a b l e program, and needed a few s a f e g u a r d s . was  but  There  s t r o n g , and  should  have been l e a v e n e d by o t h e r p r o f e s s i o n s , i n c l u d i n g s o c i a l s c i e n t i s t s , community development v/orkers and specialists. sions.  communications  But i n I960 t h e s e were r e l a t i v e l y new  profes-  Demographers and economists were a l r e a d y a c t i v e ,  t r a i n e d s o c i a l workers were b e g i n n i n g  t o e n t e r the  field,  and the v o l u n t e e r f a m i l y p l a n n e r s were p r e p a r e d t o welcome a n t h r o p o l o g i s t s and s o c i o l o g i s t s as w e l l . sponsorship  o f c o n f e r e n c e s was  For example, t h e i r  a d i r e c t means o f e n c o u r a g i n g  i n t e r d i s c i p l i n a r y communication. By the time the FPAI o r g a n i z e d  the A l l - I n d i a  Family  P l a n n i n g Conference i n Hyderabad e a r l y i n 1 9 6 1 , the  Indian  government was  beginning  t o r e a l i z e t h a t the economic conse-  quences o f p o p u l a t i o n growth were s e r i o u s , t h a t Independence by i t s e l f had not p r o v i d e d t r o l was  the s o l u t i o n , and t h a t b i r t h con-  an u r g e n t n e c e s s i t y .  But t h e i r approach was  " t r a d i t i o n a l " j u s t the same.  The  s a i d t h a t f a m i l y p l a n n i n g was  the "key programme f o r the  T h i r d and  Fourth Five-Year Plans".  P l a n n i n g Commission  very  D.P.  had  Karmarkar, Union  M i n i s t e r f o r H e a l t h , e x p l a i n e d t h a t f a m i l y p l a n n i n g i n the  f i r s t two p l a n - p e r i o d s had been " p r e p a r a t o r y " phases f o r the Third Plan.  L i m i t e d s e r v i c e s were now b e i n g o f f e r e d , but  t h e y s h o u l d be t a k e n t o t h e masses, e s p e c i a l l y t h o s e i n r u r a l areas.  More r u r a l l e a d e r s s h o u l d be i n v o l v e d , and t h e h e l p o f  the v o l u n t a r y o r g a n i z a t i o n s was s t i l l needed.  The  Family  P l a n n i n g Commissioner, L t . C o l . B.L. R a i n a d e s c r i b e d i n g l o w i n g terms a f o u r f o l d p l a n f o r the r e o r g a n i z a t i o n and e x p a n s i o n o f government s e r v i c e s , t r a i n i n g , e d u c a t i o n and r e s e a r c h . O r i e n t a t i o n camps f o r l o c a l l e a d e r s , and e x h i b i t i o n s were now p r o v i n g s u c c e s s f u l , and Honorary F a m i l y P l a n n i n g  Education  Leaders t o promote l o c a l v o l u n t a r y groups were a l s o e f f e c t i v e . Considerable  p r o g r e s s had been made t o d a t e , b o t h by g o v e r n -  ment and by t h e v o l u n t e e r s , and t a r g e t s f o r t h e f u t u r e were established.  I t was agreed t h a t more e f f o r t s h o u l d be made  t o e n l i s t male support S i x t h IPPF conference  (Dudley K i r k had suggested i t a t t h e in  1959).  A r e s o l u t i o n t o t h e WHO  Assembly (soon t o meet i n D e l h i ) p o i n t e d out t h a t s a v i n g l i v e s was a d m i r a b l e , but people a l s o needed i n f o r m a t i o n t o . 79 p l a n t h e i r f a m i l i e s , and t h e r e b y improve t h e i r l o t . By t h e end o f 1 9 & 3 , some 28 Knowledge, A t t i t u d e and P r a c t i c e (KAP) s t u d i e s had been done by p r o f e s s i o n a l s i n I n d i a , and t h e government p u b l i s h e d t h e r e s u l t s .  In general,  p e o p l e were r e c e p t i v e t o t h e i d e a o f f a m i l y p l a n n i n g , b u t methods and p r o v i s i o n o f s e r v i c e s were weak, and m o t i v a t i o n depended on i n d i v i d u a l c i r c u m s t a n c e s . was t h e d e s i r e d f a m i l y s i z e . munication  Three o r f o u r c h i l d r e n  There was l i t t l e o r no com-  between husbands and w i v e s on the s u b j e c t o f b i r t h  c o n t r o l and methods s u i t e d t o v i l l a g e l i f e were needed. Parents-in-law,  and the demands o f r e l i g i o n were s a i d t o have  l i t t l e i n f l u e n c e i n decision-making,  hut i n view o f t r a d i t i o n ,  o f t h e need f o r o l d age s e c u r i t y , and f o r sons t o p a r t i c i p a t e in  r e l i g i o u s r i t e s , t h i s l a s t point i s questionable. When t h e F i f t h A l l - I n d i a Conference on F a m i l y  was h e l d i n P a t n a i n J a n u a r y , 1 9 6 4 ,  Planning  3 0 0 representatives of  b o t h government and v o l u n t a r y a g e n c i e s heard S r i Asoka Mehta, Deputy Chairman o f t h e P l a n n i n g Commission, r e p e a t what t h e y a l r e a d y knew - t h a t a t t i t u d e s u r v e y s had i n d i c a t e d r e c e p t i v i t y . There were were r u r a l .  9,000  c l i n i c s and s e r v i c e c e n t r e s , o f w h i c h  7,000  S t e r i l i z a t i o n had proven t o be a c c e p t a b l e i n  Madras and M a h a r a s h t r a ; some t r a i n i n g was g i v e n i n some u n i v e r s i t y undergraduate c o u r s e s , b u t t h e h e l p o f i n d u s t r y , t r a d e u n i o n s , and v i l l a g e t e a c h e r s all,  to co-ordinate  should  a l s o be e n l i s t e d .  Above  and improve the work, each s t a t e and d i s -  t r i c t must s e t up a f i r m program.  I n c o n f i r m a t i o n of the  f a i l u r e o f t h e f a m i l y p l a n n i n g scheme t o g e t o f f t h e ground so f a r , D r . C. Chandrasekharan, t h e n D i r e c t o r o f t h e Demog r a p h i c T r a i n i n g and R e s e a r c h Centre i n Bombay, n o t e d t h a t although no  I n d i a was i n t h e midst o f h e r T h i r d F i v e - Y e a r  d e c l i n e i n t h e b i r t h r a t e was e v i d e n t .  s h o u l d be l e g a l i z e d , he s a i d .  Plan,  Induced a b o r t i o n  A b o r t i o n and s t e r i l i z a t i o n  c o u l d be promoted i n r u r a l areas as more e f f e c t i v e than ordinary  contraceptives.  Improvements i n t h e government program were made g r a d u a l l y , and more dynamism was i n j e c t e d , but i t c o n t i n u e d t o  lumber s l o w l y o n , s u f f e r i n g from l a c k o f p o l i t i c a l s c a t t e r e d s t a t e c o - o p e r a t i o n , and inadequate 81 services.  I n 19^5,  courage,  promotion and  a t I n d i a ' s request, the United Nations  T e c h n i c a l A s s i s t a n c e Program sent a team o f a d v i s e r s , headed by S i r C o l v i l l e D e v e r e l l , former S e c r e t a r y - G e n e r a l o f t h e I P P P , t o study t h e I n d i a n f a m i l y p l a n n i n g program and make recommendations f o r i t s improvement.  T h e i r r e p o r t concluded t h a t ,  i n s p i t e o f c o n t i n u e d improvement and a r e o r g a n i z a t i o n i n 1963» l i t t l e p r o g r e s s had been made i n r e d u c i n g the b i r t h rate.  Some o f t h e i r s u g g e s t i o n s were a l r e a d y b e i n g i m p l e -  mented (nor were they a l l o r i g i n a l ) , b u t i t was recommended t h a t t h e IUD, s t e r i l i z a t i o n , a.nd condoms be t h e main methods o f f e r e d , and t h a t i n c e n t i v e s be g i v e n b o t h t h e a c c e p t o r s and the m o t i v a t o r s .  These s e r v i c e s s h o u l d be o f f e r e d i n i t i a l l y  t h r o u g h h o s p i t a l s , urban c l i n i c s and h e a l t h c e n t r e s where p e r s o n n e l were a v a i l a b l e , then t a k e n t o t h e r u r a l areas IUD  and vasectomy camps.  i n c l u d e d as w e l l .  through  A p o s t partum IUD program s h o u l d be  Condoms s h o u l d be f r e e o r a t v e r y low c o s t ,  and d i s t r i b u t e d t h r o u g h h e a l t h c e n t r e s , t e a shops, g e n e r a l s t o r e s , and c h e m i s t s ' shops.  Long term p l a n s t o p r o v i d e many  more t r a i n e d people s h o u l d be made, and, i n t h e meantime, s h o r t courses s h o u l d be o f f e r e d .  Refresher courses  become permanent f e a t u r e s o f t h e t r a i n i n g program.  should Incentives  f o r d o c t o r s t o g i v e t h e i r s e r v i c e s i n t h i s f i e l d , and t o a t t r a c t them t o r u r a l areas s h o u l d a l s o be g i v e n .  H e a l t h edu-  c a t o r s and mid-wives s h o u l d be t r a i n e d , and t e a c h e r s be e n l i s t e d .  I n s t e a d o f emphasizing  should  t h e burden o f a b i g  f a m i l y , t h e b e n e f i t s o f a s m a l l one s h o u l d be s t r e s s e d .  Com-  munity development and l o c a l panchayat p e r s o n n e l s h o u l d be enrolled.  I n d u s t r i a l f i r m s , p l a n t a t i o n s , government o f f i c e s  and armed f o r c e s c o u l d e a s i l y be r e a c h e d .  Constant  r e v i e w and e v a l u a t i o n s h o u l d be u n d e r t a k e n . and S t a t e government apparatus agencies  { i t a l i c s minej  research,  The e n t i r e C e n t r a l  s h o u l d be i n v o l v e d , v o l u n t a r y  r e l i g i o u s , and o t h e r p r o f e s s i o n s ,  f a c t o r y w o r k e r s , t r a d e unions and c o - o p e r a t i v e s as w e l l .  Above  a l l , t h e e n t i r e program s h o u l d be g i v e n autonomous s t a t u s , much more f i n a n c i a l s u p p o r t , and be upgraded t o s e n i o r c a b i n e t r a n k , b o t h a t t h e Centre and S t a t e l e v e l .  Positive leadership  s h o u l d be g i v e n by a l l persons i n p o s i t i o n s o f a u t h o r i t y a t every l e v e l .  W i t h t h e s e c o n d i t i o n s , i t s h o u l d be p o s s i b l e t o  reduce t h e b i r t h r a t e by about one t h i r d i n t e n y e a r s , and t h e growth r a t e t o 1 p e r c e n t p e r annum by 1 9 8 5 . Without such t r u e p r i o r i t y t o f a m i l y p l a n n i n g , w h i c h i n e v i t a b l y means t h e d i v e r s i o n o f e f f o r t and r e s o u r c e s f r o m other d e s i r a b l e o b j e c t i v e s , the programme w i l l n o t succeed. W i t h i t , t h e r e i s g r e a t hope t h a t i t will.°2 I n d i a now had g u i d e l i n e s f o r t h e program she had l o n g needed. I n I 9 6 6 t h e new p l a n began t o take shape.  To speed  it,  the government o f f e r e d t o pay a l l s t a t e and l o c a l c o s t s - an i n v i t a t i o n w h i c h d i d much t o remove a s e r i o u s r o a d b l o c k w h i c h had e x i s t e d i n t h e p a s t . ^ 3  The Union Department o f P a m i l y  P l a n n i n g was s e t up, 6 r e g i o n a l c e n t r e s f o r l i a i s o n w i t h t h e s t a t e s and r e p r e s e n t a t i v e s t a t e , d i s t r i c t and l o c a l bureaux were e s t a b l i s h e d . The v o l u n t a r y o r g a n i z a t i o n s were g i v e n  f u l l support.  A mass communications program was put i n t o  a c t i o n u s i n g a l l media - i n c l u d i n g p r e s s , r a d i o and TV, f i l m s , f i l m s t r i p s , songs, dramas, push c a r t s and p o s t e r s - w i t h a symbol c o n s i s t i n g o f an i n v e r t e d r e d t r i a n g l e , and c a r t o o n f i g u r e s o f a man and w i f e and two c h i l d r e n w i t h the s l o g a n : "Two o r Three C h i l d r e n ... E n o u g h ! " ^ In for  mid-1967  Dr. Chandrasekhar was a p p o i n t e d M i n i s t e r  H e a l t h and F a m i l y P l a n n i n g , r e p o r t i n g d i r e c t t o a C a b i n e t  Committee c o n s i s t i n g o f t h e Prime M i n i s t e r , t h e M i n i s t e r s o f P l a n n i n g , F i n a n c e , H e a l t h , and Food and A g r i c u l t u r e . H i s C e n t r a l F a m i l y P l a n n i n g C o u n c i l was comprised o f S t a t e s M i n i s t e r s f o r H e a l t h and F a m i l y P l a n n i n g , H e a l t h e x p e r t s , and representatives of voluntary family planning organizations! On t h e s e r v i c e s s i d e , was a S e c r e t a r y , Department o f F a m i l y P l a n n i n g , a Commissioner f o r F a m i l y P l a n n i n g , and s i x R e g i o n a l Family Planning O f f i c e r s .  T h e i r t a s k was s e t o u t i n a v e r y  c o n c i s e l i t t l e handbook, backed up w i t h a s e t o f f r i g h t e n i n g statistics;  I n a d d i t i o n t o t h e fundamental problems o f 14  major languages, non  more than 2 0 0 d i a l e c t s , low l i t e r a c y and  communication, t h e r e was a n e t i n c r e a s e a n n u a l l y o f 1 3  m i l l i o n I n d i a n s , and each y e a r t h e y would r e q u i r e  126,500 372,500 2,509,000  schools school teachers hous.es  4,000,000 jobs  A l t h o u g h f o o d p r o d u c t i o n ha.d i n c r e a s e d from 5 5 m i l l i o n t o n s i n 1 9 5 1 t o 7 2 m i l l i o n tons i n 1 9 6 5 , p e r c a p i t a f o o d had decreased ployment i n  from 1 2 . 8  195-L-52  was  consumption  ounces t o 1 2 . 4 ounces p e r day. Unem-  3«5  m i l l i o n , b u t , by  I96I,  i n spite of  31  m i l l i o n new j o b s , i t had reached  10 m i l l i o n .  2 3 . 4 9 m i l l i o n c h i l d r e n were i n s c h o o l .  In  1950/51  F a c i l i t i e s had i n -  c r e a s e d b y 3 0 0 p e r c e n t , and, i n m i d - 1 9 6 7 , t h e r e were 76.5 m i l l i o n i n s c h o o l , b u t 6 3 . 8 m i l l i o n were n o t y e t accommodated'. A d e t a i l e d p l a n o f a c t i o n was i n c l u d e d and t a r g e t s s e t : 1 7 m i l l i o n l o o p s t o be i n s e r t e d , 6 m i l l i o n s t e r i l i z a t i o n s done, 86 and 400 m i l l i o n condoms d i s t r i b u t e d by 1970/71. I n t h e meantime, i n s t e a d o f t h e u s u a l p e r i o d i c c o n f e r e n c e , the amateurs t o o k charge o f t h e o r g a n i z a t i o n o f t h e S e v e n t e e n t h I n t e r n a t i o n a l Conference on t h e F a m i l y , which was h e l d i n December, 1966, i n New D e l h i .  The meeting was sponsored by  the I n t e r n a t i o n a l Union o f F a m i l y O r g a n i z a t i o n s , and the theme was, Changing F a m i l y P a t t e r n s i n A s i a .  FPAI p a r t i c i p a t i o n  27 coun-  cated i t s growing i n t e r e s t i n f a m i l y l i f e e d u c a t i o n . t r i e s were r e p r e s e n t e d by 773 p a r t i c i p a n t s .  indi-  Population prob-  lems, m a r r i a g e , f a m i l y l i v i n g , s o c i a l s e r v i c e s , and r e s e a r c h were among t o p i c s d i s c u s s e d . The FPAI r e v e r t e d t o i t s u s u a l p a t t e r n i n 1968, however, h o l d i n g i t s S i x t h A l l - I n d i a Conference a t C h a n d i g a r h i n November.  N i n e f o r e i g n c o u n t r i e s were r e p r e s e n t e d .  For the  f i r s t time i n t h e h i s t o r y o f f a m i l y p l a n n i n g , r e p r e s e n t a t i v e s o f t h e World H e a l t h O r g a n i z a t i o n (TOO), and t h e U n i t e d  Nations  E d u c a t i o n a l , S c i e n t i f i c and C u l t u r a l O r g a n i z a t i o n (UNESCO) were p r e s e n t , and addressed  the meetings.  The b l o c k a g e  at the  UN had been, a t l e a s t p a r t i a l l y , c l e a r e d by t h e D e c l a r a t i o n o f Human R i g h t s and t h e World Leaders* in  I 9 6 6  and I 9 6 7 .  ."  -  D e c l a r a t i o n on P o p u l a t i o n 450 a d m i n i s t r a t o r s ,  s c i e n t i s t s , d o c t o r s , v o l u n t e e r s o c i a l workers and o t h e r s had g a t h e r e d t o " h i g h l i g h t p r o g r e s s so f a r and i d e n t i f y needs" i n o r d e r t o a c h i e v e a b i r t h r a t e i n I n d i a o f 23 hy 1978.  News  was good and had. The r a t e o f s t e r i l i z a t i o n s had more than doubled s i n c e 19&6, and was s t i l l i n c r e a s i n g , b u t t h e g o v e r n ment IUD program had r u n d n t o s e r i o u s problems on page 1 5 1 ) . b u i l d up.  (outlined  Condom d i s t r i b u t i o n was j u s t b e g i n n i n g t o  The government r e p r e s e n t a t i v e s urged t h e v o l u n -  t e e r s t o c o n t i n u e t h e i r e f f o r t s , and t o m o b i l i z e support among t h e p e o p l e .  Family L i f e Education i n the schools 87  was a new c h a l l e n g e i n w h i c h they were needed. In  September, 19&9, t h e PPAI met f o r a s p e c i a l t h r e e  day conference t o a n a l y s e i t s a c t i v i t i e s and c o n s i d e r i t s future r o l e .  I t was agreed t o c o n t i n u e t o comment and recom-  mend r e g a r d i n g government p o l i c y and program, t o c o n t i n u e PPAI a c t i o n programs, t o i n c r e a s e t o t h e utmost i t s p r o m o t i o n al  work, t o c a r r y out p i l o t p r o j e c t s , t o f o r g e l i n k s among  r e l a t e d d i s c i p l i n e s , and t o promote c o n t a c t s w i t h f a m i l y p l a n n i n g o r s i m i l a r o r g a n i z a t i o n s abroad. c o n t i n u e t o o r g a n i z e congresses  The PPAI would  t o promote an exchange o f  i n f o r m a t i o n n a t i o n a l l y and i n t e r n a t i o n a l l y .  P o p u l a t i o n and 88  f a m i l y l i f e e d u c a t i o n i n t h e s c h o o l s would be a new p u r s u i t . In  o t h e r words, t h e r e was s t i l l a c a t a l y t i c r o l e f o r t h e  volunteers. A f t e r more than two y e a r s o f i n t e n s i v e work on I n d i a ' s p o p u l a t i o n p r o b l e m s , D r . Chandrasekhar, as M i n i s t e r o f S t a t e for  H e a l t h and F a m i l y P l a n n i n g , s t a t e d i n O c t o b e r , 19&9 t h a t  t h e t h r e e most i m p o r t a n t r e m a i n i n g needs were communication t o more than 5°0,000 v i l l a g e s , an i d e a l c o n t r a c e p t i v e , and the means t o m o t i v a t e the poor to use i t . ^ 9  The  month, the C e n t r a l F a m i l y P l a n n i n g C o u n c i l met  following  at Bhopal.  Many a s p e c t s o f the work were c o n s i d e r e d i n d e t a i l ,  including  e d u c a t i o n , a d m i n i s t r a t i o n , the r o l e o f the v o l u n t a r y o r g a n i s a t i o n s , p r i v a t e m e d i c a l p r a c t i t i o n e r s , and r e c r u i t m e n t o f l o c a l opinion leaders.  I t was  agreed t h a t t a r g e t s s h o u l d  he  more r e a l i s t i c and geared t o c a p a b i l i t y , but the o b j e c t i v e s h o u l d s t i l l be t o reduce the b i r t h r a t e , b e l i e v e d t o be 3 9 p e r 1 , 0 0 0 , t o 3 2 by 1 9 7 4 ,  and t o 2 5 by 1 9 7 9 .  f u l f i l t r a i n i n g t a r g e t s was  stressed.  T  *ie need t o  Mass e d u c a t i o n  and  e x t e n s i o n t r a i n i n g , i n c l u d i n g i n f o r m a t i o n on methods, s h o u l d be f u r t h e r expanded.  Population education i n schools  c o l l e g e s s h o u l d be promoted, and i n v o l v e m e n t d o c t o r s and homeopathic p r a c t i t i o n e r s sought.  and  of p r i v a t e The p r i v a t e  p r a c t i t i o n e r s c o u l d be o f f e r e d i n c e n t i v e s comparable t o government s t a f f members.  I f homeopathic p e r s o n n e l were  g i v e n b a s i c courses i n anatomy and p h y s i o l o g y , t h e y c o u l d become m o t i v a t o r s and a c t a l s o as depot h o l d e r s f o r convent i o n a l contraceptives.  The p a r t i c i p a t i o n o f newly-weds and  young c o u p l e s w i t h one o r two  c h i l d r e n s h o u l d be promoted,  u s i n g the theme, "Next C h i l d Not Now I t was  ... A f t e r T h r e e , Never."  agreed a l s o to e s t a b l i s h p r i m a r y h e a l t h c e n t r e s i n  400 remote B l o c k s .  Immunization a g a i n s t c h i l d r e n ' s d i s e a s e s  s h o u l d p r o v i d e another inducement t o the s m a l l f a m i l y norm everywhere i n I n d i a and a u s e f u l c o n t a c t w i t h m u l t i p a r o u s  women.  Assessment o f t h e v o l u n t a r y o r g a n i z a t i o n s s h o u l d he  "based on t h e performance o f o t h e r " e s t a b l i s h e d and r e p u t e d l o c a l centres".9°  i n r e s e a r c h , t r a i n i n g and s e r v i c e s , g o v e r n -  ment programs were i m p r o v i n g .  While d e t a i l s are scarce, the  v o l u n t e e r s , on paper a t any r a t e , a l s o had a c r e d i t a b l e r e c o r d . Prom t h e b e g i n n i n g t h e PPAI r e a l i z e d t h a t a c c u r a t e  data  were i m p o r t a n t , n o t o n l y f o r r e s e a r c h p u r p o s e s , b u t f o r e v a l u a t i o n and p l a n n i n g . the aim was a c h i e v e d .  And i t would seem t h a t , t o some e x t e n t , Unfortunately the published reports  made a v a i l a b l e t o me do n o t g i v e much s t a t i s t i c a l i n f o r m a t i o n o r a c l e a r p i c t u r e o f t h e performance o f the v o l u n t e e r s i n t h e c o u n t r y as a whole.  A good d e a l o f comment on a c t i v i t i e s a t  Headquarters i n Bombay, and i n t h e Bombay a r e a i s i n c l u d e d ; and a few branches ( f o r example, New D e l h i , (Old) D e l h i , C a l c u t t a , and Hyderabad), have been s e l e c t e d from time t o time f o r s p e c i a l m e n t i o n . - . B u t comprehensive f i g u r e s on t h e whole o r g a n i z a t i o n and i t s f i n a n c i n g , a r e l a c k i n g . The  PPAI d i d p i o n e e r work i n i n f e r t i l i t y s e r v i c e s ,  marriage guidance and sex e d u c a t i o n .  I t also pioneered  mobile  v a n s , and male m o t i v a t i o n t h r o u g h i n d u s t r i a l and commercial enterprises.  Home v i s i t i n g was u n d e r t a k e n on a l i m i t e d s c a l e ,  but whether these v e n t u r e s known.  can be c l a s s e d as r e s e a r c h i s n o t  However, w h i l e a s s o c i a t e d w i t h t h e Kutumb Sudhar Kendra,  Dr. G-.M. Phadke d i d do c o n s i d e r a b l e r e s e a r c h i n vasectomy; and s p e c i a l s t u d i e s on g e n i t a l t u b e r c u l o s i s , o v u l a t i o n d e t e c t i o n , the e f f e c t o f s c r o t a l suspenders on male f e r t i l i t y , and t h e e f f e c t o f t e s t o s t e r o n e were a l s o made.  T e s t s o f foam t a b l e t s  were conducted f o r D r . C l a r e n c e Gamble, f o u n d e r o f t h e P a t h f i n d e r Fund.  I n t h e p a s t few y e a r s , s t u d i e s f i n a n c e d by t h e  V i c t o r Fund ( a v o l u n t a r y o r g a n i z a t i o n t o r a i s e money i n t h e U n i t e d S t a t e s o f America f o r t h e IPPP) i n t h e Bombay a r e a have i n c l u d e d m o t i v a t i o n  t h r o u g h m o b i l e teams, promotion  t h r o u g h l a b o r u n i o n s and o t h e r o r g a n i z a t i o n s , and propaganda through v i l l a g e school teachers. Indore was a l s o s u r v e y e d . follow-up  I n 1969 work was b e i n g  done on a  o f 9 0 0 s t e r i l i z e d male i n d u s t r i a l w o r k e r s i n Bombay,  the f a m i l y p l a n n i n g and  Female s t e r i l i z a t i o n i n  status of  2,500  m a r r i e d A i r I n d i a employees,  Knowledge and A t t i t u d e s o f 2 8 0 t e a c h e r s  c l a s s e s , and o f 3 ^ 0 o f t h e i r p u p i l s .  of adult  literacy  9 1  I n government r e s e a r c h , b e s i d e s t h e KAP s t u d i e s , i t was shown t h a t , where s p e c i a l programs h a d been i n t r o d u c e d , r a t e s had d e c l i n e d .  birth  A t Gandhigram (Madras) t h e b i r t h r a t e had  been reduced from 40 i n 1 9 5 2 t o 3 6 . 3 i n I 9 6 5 .  I n another  p r o j e c t , t h e Demographic T r a i n i n g and R e s e a r c h Centre a t Bombay had i n d u c e d a d e c l i n e i n f e r t i l i t y o f 1 2 p e r c e n t between 1 9 6 4 and 1 9 6 6 .  At Singur, the A l l - I n d i a I n s t i t u t e  o f Hygiene and P u b l i c H e a l t h i n C a l c u t t a had a c h i e v e d a r e d u c t i o n f r o m 42 i n 1 9 5 8 t o 3 4 . 2 i n 1 9 6 6 .  I n Chotla, the  r a t e had been 2 9 i n 1 9 6 1 , b u t was reduced t o 24 i n 1 9 6 6 . C e n t r a l Family Planning the r a t e a t M e h r a u l i  I n s t i t u t e , i n New D e l h i had reduced  from  5 2 in1964  t o 48 i n 1  p r o j e c t s demonstrated t h a t i t c o u l d be done.  966.  9 2  These  One o f t h e r e -  q u i r e m e n t s , o f c o u r s e , was t r a i n i n g , and i n t r a i n i n g , t h e FPAI f i l l e d a v i t a l  The  role".  In  s p i t e o f repeated urging  by t h e v o l u n t e e r s , f o r  the f i r s t t e n y e a r s o f t h e government program i n I n d i a a l l t r a i n i n g was l e f t t o t h e F a m i l y P l a n n i n g A s s o c i a t i o n .  Static  courses were g i v e n i n Bombay, and t o u r i n g t r a i n i n g teams gave seven t o t e n - d a y courses i n o t h e r a r e a s . 1951  F o r example, between  and 1 9 6 1 , more than 2 5 0 d o c t o r s and about 6 5 0 o t h e r p e r -  s o n n e l were g i v e n i n s t r u c t i o n .  The need was so massive, how-  e v e r , t h a t a f t e r t h e 1 9 6 3 r e o r g a n i z a t i o n o f the government program, w i t h the e x c e p t i o n o f a few courses r u n on c o n t r a c t w i t h t h e Union government i n such c i t i e s  as Hyderabad, t h e »93  work was done by t h e t a x - s u p p o r t e d By  mid-1967  program.  yj  t h e government had s e t up f i v e C e n t r a l  T r a i n i n g C e n t r e s , and 2 8 more i n S t a t e s , w i t h 3 3 5 D i s t r i c t By t h e end o f I 9 6 9 ,  cells.  w o r k e r s , and  375»000  13,000  125,000  doctors,  field  p a r t time f i e l d workers had been t r a i n e d .  The A s s o c i a t i o n was s t i l l a b l e t o h o l d seminars on such s p e c i a l s u b j e c t s as s t e r i l i z a t i o n ,  and symposia  sex and f a m i l y  l i f e , and t h e p h y s i o l o g y o f r e p r o d u c t i o n , w h i c h f i l l e d a u s e f u l purpose i n support o f the government. s i m i l a r developments i n the f i e l d o f c l i n i c  There were services.  These were s t a r t e d by the FPAI i n Bombay i n 1 9 5 2 , a n d , by  1957>  t w e l v e branches were o r g a n i z e d .  By  1959  t h e r e were  e i g h t e e n - i n A g r a , Ajmer, Andhra P r a d e s h , Bombay, B e n g a l , D e l h i , I n d o r e , J a l p a i g u r i , K a l c h i n i , South K a n a r a , Madras, Manipur, Mysore, P u n j a b , T i r u c h i r a p a l l i , Trivandrum "Vidarbha.  By t h e end o f  was r u n n i n g 1 7 5 c l i n i c s .  1969*  t h e FPAI had  and  3 5 branches  and  F i g u r e s were a v a i l a b l e f o r 5 2 o f  t h e s e , and,  i n the y e a r e n d i n g March 3 1 , I 9 6 9 , 123,973 new  p a t i e n t s had "been s e r v e d , i n c l u d i n g 14,000 s t e r i l i z a t i o n s and 11,476 ITJD i n s e r t i o n s .  Most o f the p a t i e n t s i n t h e FPAI  c l i n i c s had incomes o f l e s s than Rs. 100 p e r month, were between 20 and 35 y e a r s o f age, and those w i t h the most c h i l d r e n were t h e most f r e q u e n t v i s i t o r s .  I t was recommended  t h a t c l i n i c s remain open a t n i g h t so t h a t men c o u l d v i s i t as well.  A m o b i l e van was d i s t r i b u t i n g simple  contraceptives  and p r o v i d i n g f a c i l i t i e s f o r vasectomy on a r e g u l a r b a s i s . The  I n d i a n T e a A s s o c i a t i o n ( i n B e n g a l and Assam) had had t h e  s e r v i c e s o f an o r g a n i z e r , and some s t a t e and l o c a l governments had been a s s i s t e d .  I n a d d i t i o n , t h e A s s o c i a t e d Cement Company,  t e x t i l e m i l l s , and the Reserve Bank o f Bombay were now spons o r i n g f a m i l y p l a n n i n g s e r v i c e s o r g a n i z e d w i t h FPAI h e l p . T h e i r numbers grew u n t i l , by November, 1968, 56 i n d u s t r i a l and commercial f i r m s had i n t r o d u c e d t h e i r own programs, c o v e r i n g 111,700 p e o p l e .  The government program had i n c r e a s e d  g r e a t l y , and, by the end o f I 9 6 9 , 1,779 urban and 29,675 r u r a l h o s p i t a l , c l i n i c and h e a l t h c e n t e r f a m i l y p l a n n i n g programs, and  256 m o b i l e teams were a l s o i n a c t i o n . 9 5 C o n t r a c e p t i v e s were n o t made i n I n d i a u n t i l r e c e n t l y .  I n 1952 t h e FPAI was g i v e n a l i c e n s e t o import them f o r d i s t r i bution to recognized agencies.  From the b e g i n n i n g , the A s s o -  c i a t i o n urged as wide a c h o i c e as p o s s i b l e , on t h e ground t h a t any method, used r e g u l a r l y , i s b e t t e r t h a n no method a t a l l . I t a l s o a d v o c a t e d t h a t c o n t r a c e p t i v e s be made i n I n d i a and distributed free.  Diaphragms w i t h j e l l y were known t o be t h e  most r e l i a b l e method, and some women used them v e r y s u c c e s s f u l l y , h u t t h e r e was g e n e r a l agreement t h a t an e q u a l l y r e l i a b l e method was needed w h i c h would be s i m p l e , cheap and e a s i l y a v a i l a b l e w i t h o u t t h e need f o r a d o c t o r ' s  services.  R i c e powder and s a l t m i x t u r e s w i t h v a g i n a l sponge o r pad were found t o be messy and u n s a t i s f a c t o r y f o r a e s t h e t i c reasons.  Foam t a b l e t s came c l o s e r t o t h e need, b u t i n v o l v e d  problems o f s t o r a g e i n damp weather.  S t e r i l i z a t i o n had always  been approved, and many had been done b o t h by t h e PPAI and some government p e r s o n n e l , b u t a l l were e q u i v o c a l about i n duced a b o r t i o n .  Some p e o p l e f e l t i t was a problem o f e t h i c s ;  o t h e r s t h a t common sense made i t a poor s u b s t i t u t e f o r cont r a c e p t i o n ; s t i l l o t h e r s , t h a t m e d i c a l f a c i l i t i e s were i n a d e The l a w f o r b i d d i n g a b o r t i o n had been i n t r o d u c e d 160  quate.  y e a r s b e f o r e , and amendment seemed f a r i n t h e f u t u r e .  When  the P i l l was made a v a i l a b l e i n I 9 6 0 , t h e r e were r e s e r v a t i o n s about i t t o o . R e c a l l i n g t h e rhythm f i a s c o , t h e p o s s i b i l i t y o f c o s t l y c o n f u s i o n , and r e a l i z i n g t h e need f o r m e d i c a l s u p e r v i s i o n , l i t t l e i n t e r e s t was shown by e i t h e r government o r PPAI.  P r i c e was a n o t h e r f a c t o r .  By t h e end o f I 9 6 9 ,  however, 119,000 women ( m o s t l y IUD d r o p - o u t s ) were e n r o l l e d i n government approved t e s t programs, b u t t h e I n d i a n C o u n c i l f o r M e d i c a l R e s e a r c h had n o t y e t r e l e a s e d t h e p i l l f o r w i d e spread use.  I t was c l a i m e d t h a t s i d e - e f f e c t s were s e r i o u s ,  the most l i k e l y b e i n g r e d u c t i o n i n b r e a s t m i l k f o r n u r s i n g mothers. IUDs were i n t r o d u c e d i n m i d - 1 9 6 5 , and s t e r i l i z a t i o n  had been p r o v i d e d  s i n c e 1 9 5 6 i n some s t a t e s .  t o t a l s i n thousands a t t h e end o f and  sterilization  reduction  5,513.  I969  A l l - I n d i a cumulative  were: IUDs,  (See T a b l e I , page  152).  2,989, The  i n t h e r a t e o f IUD a c c e p t o r s from 1 9 6 7 was due t o  a combination o f unfortunate f a c t o r s .  D o c t o r s were n o t g i v e n  s u f f i c i e n t i n s t r u c t i o n i n i n s e r t i n g them, and p a t i e n t s were not o f t e n warned t h a t t h e IUD might cause i r r e g u l a r b l e e d i n g , p a i n , and, i n some c a s e s , might be e x p e l l e d . though s m a l l , was a l s o o v e r l o o k e d .  The f a i l u r e r a t e ,  Of these p r o b l e m s ,  was  t h e most s e r i o u s .  and  can i l l a f f o r d t h e e x t r a l o s s o f b l o o d .  bleeding  Most l o w income I n d i a n women a r e anaemic There a r e a l s o  taboos r e l a t i n g t o m e n s t r u a t i o n w h i c h r e q u i r e t h a t a woman be isolated.  I n a d d i t i o n , i t i s rumored t h a t one o f t h e pharma-  c e u t i c a l h o u s e s , h o p i n g t o promote t h e use o f t h e p i l l ,  cir-  c u l a t e d a rumor t h a t , d u r i n g i n t e r c o u r s e , a man became e n t r a p p e d i n the nylon threads attached him, now  t o h i s w i f e ' s IUD, and, t o f r e e  h e r l i f e had t o be s a c r i f i c e d !  As improved v a r i e t i e s a r e  a v a i l a b l e and d o c t o r s a r e b e t t e r t r a i n e d , t h e r e i s hope  t h a t i t w i l l r e c o v e r i t s i n i t i a l p o p u l a r i t y , b u t known i n I n d i a as t h e " l o o p " , t h e IUD may a l s o have t o be re-named. S t e r i l i z a t i o n s have a l s o f a l l e n o f f , p a r t l y because some s t a t e s a r e n o t p r e s s i n g t h e program, p a r t l y because t h e m a j o r i t y o f t h e most r e c e p t i v e p a t i e n t s (men w i t h an average o f 4 . 5 l i v i n g c h i l d r e n ) have now been o p e r a t e d o n , and, because, i n a few c a s e s , t h e o p e r a t i o n  has f a i l e d .  cases o f pregnancy, i t h a s been found t h a t t h e w i f e  96 from t h e p a t h o f r e c t i t u d e .  also,  In other strayed  TABLE  I  Data on I n d i a n Government F a m i l y P l a n n i n g Program (in  thousands)  Year  A l l Methods  IUD  1964 1965 1966 1967 1968 1969  u  0 31 97 72 5 4 42  u  Oral  8 1 8 7 5  Sterilization  Other  u  u  u  u  0 0 0 0 0 0  Cumulative  1,000  u 778 u u 1,5^5 u u 1,821 u u 1,369 u E s t i m a t e d c u m u l a t i v e a c c e p t o r s t h r o u g h 1 9 6 9 as p e r c e n t o f e v e r - e l i g i b l e women = 7 « 5  u u u u u  E s t i m a t e d P e r c e n t a g e o f M a r r i e d Women U s e r s , 1 5 - 4 4 y e a r s : January, 1 9 7 0  12  1-2  0.1  9  1.1  E s t i m a t e d C u r r e n t Users (Male and Female): J a n u a r y , 1 9 7 0  11,200 Source:  1,330 1 1 9 8,711  1,029  Dorothy Nortman, P o p u l a t i o n and F a m i l y P l a n n i n g Programs: A Factbook. R e p o r t s on P o p u l a t i o n / F a m i l y P l a n n i n g , P o p u l a t i o n C o u n c i l , New Y o r k , J u l y , 1 9 7 0 , PP• 4 7 , 5 1 , 68. ( S u b - c a t e g o r i e s do n o t add t o t o t a l s because o f r o u n d i n g . )  The number o f condoms ( N i r o d h ) d i s t r i b u t e d i s not known, b u t , a t the end o f 1 9 6 9 , the IPPF e s t i m a t e d t h a t . 7 m i l l i o n c o u p l e s were u s i n g them.  They were b e i n g manufactured  i n I n d i a and d i s t r i b u t e d e i t h e r f r e e t h r o u g h h e a l t h s e r v i c e s , o r 3 f o r a f r a c t i o n o f a cent t h r o u g h commercial  channels.  F e d e r a l c i v i l s e r v a n t s were even g e t t i n g a package o f 3 each  97 month wits, t h e i r pay c h e c k s .  A n t i d o t e s f o r pregnancy had  been sought i n i n d i g e n o u s m e d i c i n e .  Government r e s e a r c h had  f a i l e d to t u r n up a n y t h i n g r e l i a b l e e x c e p t , p o s s i b l y , the seeds o f the w i l d papaw; but r e s u l t s of the r e s e a r c h were n o t y e t final. By t h e end o f 1 9 6 8 , o r g a n i z a t i o n , t r a i n i n g and for  facilities  d e l i v e r y o f f a m i l y p l a n n i n g s e r v i c e s had been g r e a t l y  im-  proved and the s t r u c t u r e f o r f u r t h e r development e x i s t e d . Though i t was  so w e l l o r g a n i z e d and so many had a c c e p t e d  a  method, the I T J D - S t e r i l i z a t i o n - C o n d o m p l a n o f the government had n o t y e t made any s i g n i f i c a n t d i f f e r e n c e i n t h e b i r t h r a t e . More d r a s t i c measures were needed.  The  c a l l went out to the  UN f o r a second A d v i s o r y M i s s i o n . Led t h i s time by Leo Mates o f B e l g r a d e , the group v i s i t e d I n d i a i n the f i r s t q u a r t e r o f 1 9 6 9 .  A g a i n , some o f the  g e s t i o n s had a l r e a d y been put i n t o e f f e c t . did  not doubt t h a t the program would succeed  p e s s i m i s t i c about e a r l y r e s u l t s . to  The  sug-  W h i l e the Commission i n t i m e , i t was  c o n t i n u i n g problem  was  e s t a b l i s h f a m i l y p l a n n i n g as a p r i o r i t y , a permanent program,  from Union c a b i n e t and o t h e r C e n t r a l government l e v e l s  through  s t a t e and on t o l o c a l a d m i n i s t r a t i o n s . F a c i l i t i e s , p e r s o n n e l ,  v e h i c l e s , equipment, s u p p l i e s and t r a i n i n g were s t i l l i n s h o r t supply.  A b o r t i o n s h o u l d he l e g a l i z e d , and the t e a c h i n g o f  p o p u l a t i o n dynamics and f a m i l y l i f e e d u c a t i o n s h o u l d 98  he  u n i v e r s a l i n the s c h o o l system. But p o l i t i c a l  t r o u b l e s i n I n d i a were i n c r e a s i n g , and  the Congress p a r t y became d i v i d e d i n t o a c o n s e r v a t i v e and more s o c i a l i s t group - the l a t t e r l e d by Mrs. G a n d h i .  a  The  Jan Sangh p a r t y a t t a c k e d the f a m i l y p l a n n i n g program as a t h r e a t to t h e n u m e r i c a l s u p e r i o r i t y o f H i n d u s , t r a d i n g on  the  p o s s i b i l i t y t h a t , i f Muslims c o n t i n u e d t o be a l l o w e d f o u r w i v e s , t h e y would soon o u t b r e e d them.  Other p o l i t i c a l  p o r t u n i s t s c l i m b e d on the bandwagon, so the p u b l i c i t y  opwas  s o f t - p e d a l l e d , a l t h o u g h the work went on. Of t h e  90-100  m i l l i o n couples i n the r e p r o d u c t i v e  age  g r o u p , a t o t a l o f 1 1 . 2 m i l l i o n had been e n l i s t e d i n the f a m i l y p l a n n i n g program, and the female component r e p r e s e n t e d 1 2 p e r c e n t o f m a r r i e d women aged 1 5 - 4 4 . ^  The  t o t a l popu-  l a t i o n o f I n d i a i s e s t i m a t e d to be 5 ^ 7 m i l l i o n , i n c r e a s i n g by 18 m i l l i o n a. y e a r .  The  o v e r a l l a n n u a l growth r a t e i s  2 . 5 p e r c e n t , and, i f t h i s r a t e c o n t i n u e s , the p o p u l a t i o n double i n 2 7 y e a r s .  41 p e r c e n t are now  will  under t h e age o f 1 5  y e a r s , and, when t h i s y o u t h group moves i n t o the r e p r o d u c t i v e y e a r s , the p o p u l a t i o n i n c r e a s e w i l l be s t a g g e r i n g . ^ ^ ^ b i r t h r a t e may  be as low as 3 9 per thousand now,  u n l i k e l y that i t w i l l reach  2 5 by  I 9 8 O  The  but i t i s  - the l a t e s t  scheduled  t a r g e t - u n l e s s a monumental e f f o r t goes i n t o the promotion from now  on.  Dr. Chandrasekhar, who  b e l i e v e s t h a t t h e r e are 9 m i l l i o n  i l l e g a l a b o r t i o n s a y e a r i n I n d i a , persuaded the C a b i n e t t o approve a d r a f t b i l l t o l e g a l i z e t h i s p r o c e d u r e .  I t has been  approved by the C o u n c i l o f S t a t e s , b u t a c t i o n i n the Sabha has not y e t been t a k e n .  The  l o a d on m e d i c a l  facilities  would be i n c r e a s e d , but i t i s an e s s e n t i a l a d j u n c t l a t i o n c o n t r o l , and t e c h n i q u e s  and b e i n g  Lok  to popu-  simplified.  Chandrasekhar ha.s a l s o appealed f o r a h i g h e r l e g a l marriage age - 18 f o r women and at p r e s e n t age  2 1 f o r men.  (Average age  i s 14.5 y e a r s f o r g i r l s and  at marriage  2 0 . 0 f o r men.  I f the  at m a r r i a g e c o u l d be r a i s e d , r e p r o d u c t i v e y e a r s would be  shortened.)  He b e l i e v e s t h a t i n c e n t i v e s f o r s t e r i l i z a t i o n  s h o u l d be i n c r e a s e d .  T a t a I n d u s t r i e s , one of the l a r g e s t  i n d u s t r i a l complexes i n I n d i a , i s now  p a y i n g i t s employees  Rs. 2 5 0 each t o be s t e r i l i z e d , and he has suggested t o Mrs. Gandhi t h a t government inducements o f Rs. 1 0 -  40,  depending on the S t a t e , are too s m a l l t o e n t i c e younger p e o p l e i n t o the program. would be d e s i r a b l e , and  S t e r i l i z a t i o n a f t e r two  children  Mrs. Gandhi s h o u l d use the $ 1 0 0  m i l l i o n i n United States counterpart  funds i n I n d i a t o o f f e r  as much as Rs. 5 0 0 as an i n c e n t i v e .  To supplement t h i s  pro-  gram, Chandrasekhar s u g g e s t s a g r e a t e r e f f o r t t o improve n u t r i t i o n , t o do away w i t h the p a r e n t s ' f e a r t h a t c h i l d r e n w i l l d i e , l e a v i n g them w i t h o u t gested man  security.  He has  a l s o sug-  t h a t r e l i g i o u s l e a d e r s promote the i d e a t h a t once a  has f a t h e r e d one  and the r a c e .  The  son he has done h i s duty by h i s  ancestors  t a r g e t of r e d u c i n g the b i r t h r a t e t o 2 5 by  1 9 8 0 has been amended t o r e a d "as soon as p o s s i b l e " .  He, t o o ,  says t h a t a t o t a l e f f o r t must be p u t i n t o t h e b i r t h c o n t r o l p r o g r a m . ( S e e Table X I , A p p e n d i x , f o r supplementary d a t a on I n d i a ) . R e a l i z i n g the c r i t i c a l s t a t e o f I n d i a ' s  population  problem, " A l l t h e k i n g ' s h o r s e s and a l l t h e k i n g ' s  men"  are w o r k i n g h a r d t o h e l p India, stem t h e f l o o d o f b a b i e s the I n t e r n a t i o n a l P l a n n e d Parenthood F e d e r a t i o n the FPAI; t h e P a t h f i n d e r Fund, t h e P o p u l a t i o n  i s helping  C o u n c i l , the  Ford F o u n d a t i o n , the R o c k e f e l l e r F o u n d a t i o n , Church World S e r v i c e , C h r i s t i a n M e d i c a l A s s o c i a t i o n o f I n d i a , World N e i g h b o r s , Oxfam, L u t h e r a n World R e l i e f , CARE, t h e Swedish I n t e r n a t i o n a l Development Agency ( S I D A ) , Denmark, t h e U n i t e d Kingdom, Canada and t h e U n i t e d S t a t e s , and t h e U n i t e d  Nations  10?  Fund f o r P o p u l a t i o n A c t i v i t i e s a r e a l s o h e l p i n g I n d i a . I n d i a ' s own e x p e n d i t u r e s t o h e l p h e r s e l f have m u l t i p l i e d  3,000  t i m e s s i n c e the s t a r t o f t h e program i n  represent budget.  1951,  and  an e v e r - i n c r e a s i n g p e r c e n t a g e o f the n a t i o n a l  TABLE I I  F a m i l y P l a n n i n g Component o f N a t i o n a l Budget (in  millions)  Allocated  1951-56 1956-61 1961-66 1966-71 1966-69 * **  Plan Plan Plan Plan  R = $U.S. R = $U.S.  Expended  Rs. 1 * ($U.S. 2 0 0 , 0 0 0 ) Rs. 2 2 Rs. 249 ** ($U.S. 3 1 m) Rs. 3 1 5 0 ($U.S. 3 9 4 m)  e e e -  Rs. 6 9 4 .21 .13  e  Percentage  0.005 0.05 1.0 2.0  A n n u a l | e r c a p i t a budget, a l l s o u r c e s , i n U.S. cents  Source:  =  7*72  Dorothy Nortman, P o p u l a t i o n and F a m i l y P l a n n i n g Programs: A F a c t b o o k . R e p o r t s on r o p u l a t i o n / V a m i l y P l a n n i n g , P o p u l a t i o n C o u n c i l , New Y o r k , J u l y , 1 9 7 0 , pp. 7 1 , 7 5 . In  t h e meantime, t h e FPAI remains p a r t o f t h e whole  program, r e c e i v i n g i t s s u b s i d y from t h e government and t h e IPPF f o r i n n o v a t i v e p r o j e c t s .  I t s branches r u n 1 7 5 v o l u n t a r y  c l i n i c s , and i t promotes s e r v i c e s through b u s i n e s s and industry.  I t i s p u r s u i n g t h e q u e s t i o n o f p o p u l a t i o n and  f a m i l y l i f e e d u c a t i o n f o r c h i l d r e n and a d u l t s , and i t s memb e r s c o n t i n u e t o a t t e n d I n d i a n Ocean Region and IPPF g e n e r a l meetings.  The FPAI r e a l i z e s the urgency o f t h e p o p u l a t i o n  program, b u t u n i v e r s a l support i s n o t y e t a f a c t i n t h e country.  Much has been accomplished  - f i r s t by t h e FPAI  and l a t e r much more by government - b u t whether i t w i l l be  e f f e c t i v e i s a question  o n l y time can answer.  To sum up, as i n t h e more i n d u s t r i a l i z e d c o u n t r i e s , the l e a d e r s o f t h e f a m i l y p l a n n i n g  movement i n I n d i a were  educated s o c i a l r e f o r m e r s , b u t t h e y had t h e s p e c i a l a d d i t i o n a l motivation  o f s e r v i c e t o t h e i r newly independent c o u n t r y .  They r e a l i z e d from t h e b e g i n n i n g t h a t p o p u l a t i o n  growth was  a t h r e a t t o i t s chances o f s o c i a l , economic and p o l i t i c a l p r o g r e s s , b u t t h e y knew a l s o t h a t , i n a c o u n t r y where c o n s e r v a t i v e t r a d i t i o n was t h e r u l e , t h e o n l y p o s s i b l e approach was t h r o u g h " s p a c i n g " . be  I f t h e time between p r e g n a n c i e s  could  l e n g t h e n e d , f e r t i l i t y and i n f a n t and m a t e r n a l m o r t a l i t y  would be r e d u c e d .  Because i n f e r t i l i t y was a l s o a t r a g e d y ,  t h e y o f f e r e d t r e a t m e n t f o r t h i s problem as w e l l . I n a d d i t i o n t o a d o p t i n g an o f f i c i a l program, t h e g o v e r n ment s u p p o r t e d t h e FPAI f i n a n c i a l l y almost from t h e b e g i n n i n g , but t h e e f f e c t i v e n e s s o f b o t h b o d i e s was c o m p l i c a t e d by t h e enormity of the challenge,  t h e l a c k o f r e a l l y dynamic p o l i -  t i c a l leadership, lack of previous experience, lack of i n c e n t i v e s f o r mass a c c e p t a n c e , and t h e l o g i s t i c a l problems o f communication, t r a i n i n g , p h y s i c a l f a c i l i t i e s , and s u i t a b l e methods o f b i r t h c o n t r o l f o r those who wanted them. the dimensions o f the t a s k , t h e v o l u n t e e r s  Knowing  were f r u s t r a t e d ,  from the s t a r t , w i t h government l e t h a r g y and r e d tape£> L i t t l e r e a l p r o g r e s s was made u n t i l the mid-1960s. Because i t was always a r e l a t i v e l y s m a l l  organization,  i t i s u n l i k e l y t h a t t h e FPAI made any impact on t h e I n d i a n f e r t i l i t y r a t e , b u t i t s e f f o r t s d i d t e s t the c l i m a t e and l a y  the f o u n d a t i o n s f o r dynamic government a c t i o n . branches proved t h a t a f a m i l y p l a n n i n g and  The FPAI  program was a c c e p t a b l e  f e a s i b l e , and t h e i r e f f o r t s i n o r g a n i z a t i o n , t r a i n i n g ,  research  and s e r v i c e s p r o v i d e d  ment a c t i v i t y c o u l d be b u i l t . ferences,  they provided  some background on w h i c h g o v e r n Through p u b l i c a t i o n s and con-  information  and a forum f o r i n f o r m e d  d i s c u s s i o n i n w h i c h a growing number o f p r o f e s s i o n a l s were p l e a s e d t o p a r t i c i p a t e and the c a r e e r s prominent i n t h e p o p u l a t i o n i n the FPAI.  o f s e v e r a l people  later  f i e l d were a s s i s t e d by membership  The v o l u n t a r y o r g a n i z a t i o n  s t i l l has a u s e f u l  r o l e i n s p e c i a l s t u d i e s , p u b l i c i t y and promotion o f f a m i l y l i f e education,  and c o n t i n u e s t o o f f e r informed c r i t i c i s m o f  official activities.  The i n t r o d u c t i o n o f b i r t h c o n t r o l p r o -  grams i n the o t h e r c o u n t r i e s o f S o u t h A s i a f o l l o w e d s i m i l a r , though n o t i d e n t i c a l l i n e s .  In Ceylon, leadership  from a Canadian who became a Ceylonese by a d o p t i o n .  came f i r s t  t  FOOTNOTES  -  Chapter  V  "''Rahindranath Tagore, c i t e d F a m i l y P l a n n i n g i n I n d i a , D i r e c t o r a t e G e n e r a l of H e a l t h S e r v i c e s , u-overnment o f I n d i a , New D e l h i , Ap. 1 9 5 6 - Nov. 1 9 5 8 , I n s i d e hack c o v e r . 2 Thos. R. M a l t h u s , An Essay on the P r i n c i p l e o f P o p u l a t i o n , Bk. i , Ch. x i , 1803, Homewood, 1963, p. 92. 2nd  Abbe D u b o i s , Hindu Manners, Customs and ed., O x f o r d , 1899, PP. 210, 340.  Ceremonies,  4  L o r d D u f f e r i n , "Minute on the Congress", Nov. 1888, i n C.H. P h i l i p s , ed. S e l e c t Documents o f the H i s t o r y o f I n d i a and P a k i s t a n , IV: The E v o l u t i o n o f I n d i a and P a k i s t a n , 1858-1947, London, 1962. p. 144. 5  V e r a A n s t e y , The Economic Development o f I n d i a , 3 r d ( r e v i s e d ) e d i t i o n , London, 1942, pp. 4 7 4 - 7 5 . 1 2 . 9 m i l l i o n were added t o the p o p u l a t i o n , 1 9 0 1 - 1 9 2 1 and 27.6 m i l l i o n added 1 9 2 1 - 1 9 3 1 ; a l s o F a c t s About P o p u l a t i o n and F a m i l y P l a n n i n g i n I n d i a , Government o f I n d i a , New D e l h i , 1967, P. 2. ^Man. Gen. S i r John Megaw, M.S. ( R e t d ) , " P o p u l a t i o n and H e a l t h i n I n d i a " , A s i a t i c Review, A p r i l , 1934, pp. 2 4 3 - 6 5 , (Paper r e a d b e f o r e E a s t I n d i a A s s o c i a t i o n , c i t e d D.G. Karve, P o v e r t y and P o p u l a t i o n i n I n d i a , O x f o r d , I 9 3 6 , pp. 3 4 - 5 • B. L. R a i n a , D i r e c t o r , C e n t r a l F a m i l y P l a n n i n g I n s t i t u t e , New D e l h i , " I n d i a " , i n B e r n a r d B e r e l s o h , ed., P o p u l a t i o n and F a m i l y P l a n n i n g Programs, Chicago, 1 9 6 6 , p. 112. o  K i n g s l e y D a v i s , The P o p u l a t i o n o f I n d i a and P a k i s t a n , P r i n c e t o n , 1 9 5 1 , p. 227. Q  R e p o r t o f "Work, 1 9 4 9 - 1 9 5 9 < F a m i l y P l a n n i n g A s s o c i a t i o n o f I n d i a , Bombay, 1 9 5 9 , p. 1 3 New  •^S. Chandrasekhar, ed., A s i a ' s P o p u l a t i o n P r o b l e m s , Y o r k , 1 9 6 7 , p. 92.  ^"C. B. Mamoria, P o p u l a t i o n and F a m i l y P l a n n i n g i n I n d i a , A l l a h a b a d , 1 9 6 3 , p. 217. I b i d . . p. 2 1 7 ; a l s o S. Chandrasekhar, op.  c i t . , p.  92.  3 c . B. Mamoria, op. c i t . , p. 2 1 7 . 14 N a t i o n a l P l a n n i n g S e r i e s , P o p u l a t i o n , 1947, p. 145, c i t e d , S a v i t r i Thapar, "Family P l a n n i n g i n I n d i a " , P o p u l a t i o n S t u d i e s , V o l . x v i i , 1963-64, P a r t I , J u l y , I 9 6 3 , pp. 4 - 1 9 . 1  1 5 l n d i a n N a t i o n a l Congress, P r o c e e d i n g s , M i c r o f i l m , UBC L i b r a r y , R 5 8 2 : 6 , p. 1 7 . 16 V e r a Houghton, " I n t e r n a t i o n a l Planned P a r e n t h o o d Federation (I.P.P.F.): I t s H i s t o r y and I n f l u e n c e " , E u g e n i c s Review, O c t o b e r , 1 9 6 1 , J a n u a r y 1 9 6 2 , r e p r i n t , I P P F , A p r i l , 1 9 6 2 , p. 5 . E m i l y T a f t Douglas, Margaret Sanger: P i o n e e r o f t h e F u t u r e , New Y o r k , 1 9 7 0 , p. 2 3 4 . 18 Smt. Rama Rau was one o f t h e f i r s t women i n I n d i a t o earn a U n i v e r s i t y degree and t o t e a c h i n a u n i v e r s i t y i n I n d i a . She was a l e c t u r e r i n E n g l i s h , Queen Mary's C o l l e g e , U n i v e r s i t y o f Madras, and an advocate o f women's s u f f r a g e . Kamala Rau t o Mary B i s h o p , 2 4 . 1 2 . 6 9 ; a l s o Dhanvanthi Rama Rau, "The Need and Promise o f Planned P a r e n t h o o d " , T o g e t h e r , M e t h o d i s t P u b l i s h i n g House, N a s h v i l l e , J a n u a r y 1 9 6 5 , P« 1 6 . l 7  ^ K i n g s l e y D a v i s , op. c i t . , pp. 227-28. 90  . ^ C . B. Mamoria, op. c i t . , p. 1 5 0 . 21 V  K i n g s l e y D a v i s , op. c i t . , p. 228. 22c. 2 3  B. Mamoria, op. c i t . , p. 2 1 7 .  Ibid.  2 ^ B . L. R a i n a , op. c i t . , p. 1 1 3 • 2^0.  B. Mamoria, op. c i t . , p. 218.  26  B. L. R a i n a , l o c . c i t . ; a l s o F a m i l y P l a n n i n g i n I n d i a , D i r e c t o r a t e G e n e r a l o f H e a l t h S e r v i c e s , Government o f I n d i a , New D e l h i , Ap. 1 9 5 6 - Nov. 1 9 5 8 , p. 2. 27 S a v i t r i Thapar, op. c i t . , p. 6 . 28 I b i d . , p. 6 ; a l s o C. Chandrasekharan and K a t h e r i n e Kuder, F a m i l y P l a n n i n g Through C l i n i c s , Bombay, 1 9 6 5 > P» 7 « 2 9 s a v i t r i Thapar, l o c . c i t . 3°Ibid.; 31  a l s o C. B. Mamoria, op. c i t . , p. 1 5 1 .  Report o f Work. 3 2  1949-1959,  op. c i t . , p.  rbid.  33proc. 2 n d All-India 1 9 5 5 ? P» i v .  Bombay,  Conference on F a m i l y P l a n n i n g ,  34  J  3.  Report o f Work, op. c i t . , pp. 5 - 6  J . Mayone S t y c o s , "Problems o f F e r t i l i t y C o n t r o l i n Underdeveloped A r e a s " , M a r r i a g e and F a m i l y L i v i n g , Feb. 1 9 6 4 , r e p r i n t e d i n Stewart Mudd, ed., The P o p u l a t i o n C r i s i s and the Use o f World R e s o u r c e s , B l o o m i n g t o n , 1966, p. 1 0 2 ; a l s o G-unnar M y r d a l , A s i a n Drama, V o l . I l l , New Y o r k , 1 9 6 8 , pp.  2156-2160.  16 Report o f Work, op. c i t . , i n s i d e back c o v e r . 3 P r o c . F i f t h A l l - I n d i a Conference on F a m i l y P l a n n i n g , P a t n a , FPAI, Bombay, 1964, pp. 168-76. From a budget o f Rs. 5 0 / - i n 1 9 4 9 , t h e budget i n I 9 6 3 7  was  Rs.  3 6 3 , 6 1 2 / - .  "Women's M e e t i n g . . . 2 2 n d March 1968", 1 5 t h A n n u a l R e p o r t , F a m i l y P l a n n i n g A s s o c i a t i o n o f C e y l o n , Colombo, 1968, p. 16; Q u e s t i o n n a i r e s t o Ceylon and N e p a l ; C o n v e r s a t i o n w i t h George and B a r b a r a Cadbury, T o r o n t o , 38  6.12.68. 39  R e p o r t on the F a m i l y P l a n n i n g Program o f I n d i a , TAO/LND/48, 2 0 F e b r u a r y , 1 9 6 8 , Item 44, p. 14; a l s o S. Chandrasekhar, P o p u l a t i o n and P l a n n e d Parenthood i n I n d i a , London, 1 9 5 5 , P» 1 " 2 T ^°Report o f Work, op. c i t . , pp. 2 0 - 2 1 . ^D.  G. K a r v e , P o v e r t y and P o p u l a t i o n i n I n d i a , London, pp. 1 1 2 - 1 3 , 1 2 2 - 2 3 . Karve c o u l d n o t f o r e s e e Japan's p o p u l a t i o n problem a f t e r World War I I , o r her d e c i s i o n i n 1 9 4 8 to c o n t r o l i t through the Eugenic P r o t e c t i o n A c t .  I936,  ^ B a l j i t S i n g h , " F a m i l y P l a n n i n g Work i n U t t a r P r a d e s h " , P r o c . Second A l l - I n d i a C o n f e r e n c e , FPAI, Bombay, 1 9 5 5 , P» 5 9 . ^A. L. Basham, op. c i t . , p. 5 0 1 ; a l s o J o s e p h L e l y v e l d , New Y o r k Times, 1 4 . 1 . 6 8 , p. 7 1 . ^ " A c c o r d i n g t o H i n d u d o c t r i n e s , the i d e a l l i f e c o n s i s t s of f o u r asramas ( s t a g e s ) : brahmacarya, the p e r i o d o f d i s c i p l i n e and e d u c a t i o n , g a r h a s t h y a , the l i f e o f the h o u s e h o l d e r and a c t i v e w o r k e r , ya.naparasth.ya, r e t r e a t f o r the l o o s e n i n g o f bonds, and f i n a l l y sannyasa, the l i f e o f a h e r m i t . " K. M. Sen, Hinduism, B a l t i m o r e , I 9 6 I , pb. p. 2 2 . ^ B . S. Nanda, Mahatma Gandhi: A B i o g r a p h y , B o s t o n , 1 9 5 8 , p. 82; a l s o E m i l y T a f t D o u g l a s , Margaret Sanger, P i o n e e r o f the F u t u r e , New Y o r k , 1 9 7 0 , p. 2 3 2 . ^ G u n n a r M y r d a l , A s i a n Drama, V o l . I I , New Y o r k , I 9 6 8 , 6  pb.,  pp. 1 4 8 4 - 1 4 8 5 .  47 ' C P . B l a c k e r , " F a m i l y P l a n n i n g and Eugenic Movements" The E u g e n i c s Review, J a n u a r y , 1 9 5 6 , p. 229.  Donald T. R i c e , " A s i a n M e d i c a l C o l l e g e s and F e r t i l i t y C o n t r o l " , JAMA, 3 May, 1968, V o l . 204, #6, pp. 106-09; a l s o S. Chandrasekhar, I n a u g u r a l A d d r e s s , Conference o f Deans and P r i n c i p a l s o f M e d i c a l S c h o o l s and C o l l e g e s , New D e l h i , 1967, pp. 4-5. 49  S. Chandrasekhar, A s i a ' s P o p u l a t i o n P r o b l e m s , New Y o r k , I 9 6 7 , P« 88; a l s o l e c t u r e , U n i v e r s i t y o f B r i t i s h Columbia, 24 March 1 9 7 1 . 5 ° S . Chandrasekhar, "How I n d i a i s T a c k l i n g Her P o p u l a t i o n P r o b l e m " , F o r e i g n A f f a i r s , O c t o b e r , I968, p. 146. 51pndia and F o r e i g n News, 1 September I968, pp. 5-6. 5 J o h n P e e l & Malcolm P o t t s , Textbook o f C o n t r a c e p t i v e P r a c t i c e , London, I969, pp. 50-1; a l s o D r . M a r i a n J t i a l l , Richmond, B . C . , s e v e r a l c o n v e r s a t i o n s , I969; a l s o S. Chandrasekhar, P o p u l a t i o n and P l a n n e d Parenthood i n I n d i a , London, 1955» P« 21. 2  e p o r t o f Work, op. c i t . , p. 4. 5 ^ I b i d . , pp. 4-5. 5 5 s a v i t r i Thapar, op. c i t . , pp. 8-9. Chandrasekhar, P o p u l a t i o n and P l a n n e d P a r e n t h o o d , p. 83, f . n . ; a l s o C . H. R o l p h , e d . , The Human Sum, London, 1957, PP. 27-8. 5 7 P r o c . Second A l l - I n d i a C o n f e r e n c e , op. c i t . , pp. 16-18. 5 i jd.. 8  P  pp. 6-10.  5 9 K . C . K . E . R a j a "Family P l a n n i n g i n R e l a t i o n t o the P o p u l a t i o n and Community W e l f a r e , " P r o c . Second C o n f e r e n c e ,  op. c i t . , pp. 19-37. 60  S. Chandrasekhar, P o p u l a t i o n and P l a n n e d P a r e n t h o o d ,  pp. 37-89. 61  P r o c . T h i r d A l l - I n d i a Conference on F a m i l y P l a n n i n g , F P A I , Bombay, 1957, p a s s i m . D. Ghosh, P r e s s u r e o f P o p u l a t i o n and Economic E f f i c i e n c y i n I n d i a , Bombay, 19^6. PP. 102-09; a l s o K i n g s l e y D a v i s , The P o p u l a t i o n o f I n d i a and P a k i s t a n , P r i n c e t o n , 1951* PP» 222-29; a l s o K i n g s l e y D a v i s , "The Demographic F o u n d a t i o n s o f N a t i o n a l Power", M. B e r g e r , T. A b e l , and C. H. Page, e d s . Freedom and C o n t r o l i n Modern S o c i e t y , New Y o r k , 195^, r e p r i n t e d , G a r r e t t H a r d i n , e d . P o p u l a t i o n , E v o l u t i o n and B i r t h C o n t r o l , 2nd e d . San F r a n c i s c o , 1969, PP. 71-4. D a v i s warned t h a t r e s o u r c e s were f i n i t e , economic e x p a n s i o n c o u l d n o t f o r e v e r absorb p o p u l a t i o n growth, and e m i g r a t i o n was no l o n g e r a p r a c t i c a l alternative.  A n s l e y J . Coale and Edgar M. Hoover, P o p u l a t i o n Growth and Economic Development i n Low Income C o u n t r i e s ; I n d i a ' s P r o s p e c t s , P r i n c e t o n , 1958, p. 3 3 1 . J  6k  R o b e r t C. Cook, P o p u l a t i o n R e f e r e n c e Bureau B u l l e t i n , XIV, No. 8, December, 1958. ^ W a r r e n S. Thompson, " I n d i a : P o p u l a t i o n " , P o p u l a t i o n and P r o g r e s s i n the Par E a s t , C h i c a g o , 1 9 5 9 , pp. 141-48. 66  R e p o r t of Work, op. c i t . , p. 2 5 . ^ D u d l e y K i r k , " P o s s i b l e Lessons from H i s t o r i c a l E x p e r i e n c e f o r F a m i l y P l a n n i n g Programmes i n A s i a " , P r o c . S i x t h I n t e r n a t i o n a l Conference on P l a n n e d P a r e n t h o o d , I P P P , London, 1 9 5 9 , p. 65. 68  S. Chandrasekhar, " F a m i l y P l a n n i n g i n an I n d i a n V i l l a g e : M o t i v a t i o n s and Methods", i b i d . , pp. 101-08. A. S. Kaufman t o Mary B i s h o p , 1 5 O c t o b e r 1<?68. Mr. Kaufman t o l d me t h a t the experiment proved t o him t h a t home v i s i t i n g o r the m o b i l e team, was the most e f f e c t i v e means o f d e l i v e r ! family planning. 6 9  pp.  " S t u d y Group IV: S t e r i l i z a t i o n " , P r o c . S i x t h I n t . Conf  341-2.  C . Chandrasekharan, " C u l t u r a l F a c t o r s and the P r o p a g a t i o n o f F a m i l y P l a n n i n g i n the I n d i a n S e t t i n g , " i b i d . , pp. 6 7 - 7 2 . Dr. P i n c u s ' s i n t e r e s t i n A s i a n a c c e p t a b i l i t y t r i a l s o f the P i l l was n o t e d i n Chapter I V , p . 8 9 . 7 0  7 1  FPAI  B r i e f , dated 2 3 - 1 0 . 5 9 , mimeographed.  J . Mayone S t y c o s , "The T r a d i t i o n a l P l a n n e d Parenthood Approach i n Underdeveloped A r e a s " . Clyde V. K i s e r , ed., R e s e a r c h i n F a m i l y P l a n n i n g , P r i n c e t o n , I 9 6 2 , pp. 4 7 7 - 5 0 1 ; a l s o "Problems o f F e r t i l i t y C o n t r o l i n Underdeveloped A r e a s " r e p r i n t e d from M a r r i a g e and F a m i l y L i v i n g , F e b r u a r y , 1 9 6 3 ; a l s o S t u a r t Mudd, ed.. The P o p u l a t i o n C r i s i s and the Use o f World R e s o u r c e s , The Hague, 1964, pp. 94-108. 7 2  7 3 "Summary o f C o n f e r e n c e " , Clyde V. K i s e r , op. pp.  cit.,  622-26.  7 ^ K e t a y u n H. G o u l d , "Sex and C o n t r a c e p t i o n i n Sherupur", Economic and P o l i t i c a l Weekly, V o l . 4, No. 49, Dec. 6, I 9 6 9 , p. 1890. The a u t h o r s u g g e s t s t h a t t h e diaphragm i s imp r a c t i c a l f o r v i l l a g e women, but Dr. M a r i a n H a l l s t a t e s t h a t some women i n R a j a s t h a n used i t s u c c e s s f u l l y ; and some low income women i n Ceylon were s i m i l a r l y m o t i v a t e d ; see a l s o R e p o r t o f Work, op. c i t . , p. 81.  I b i d . , p. 1 1 . 76 -n P l a n n e d Parenthood i n the U n i t e d S t a t e s , and F a m i l y P l a n n i n g i n the U n i t e d Kingdom and Canada make no d i s t i n c t i o n today. ^ " A i m s and O b j e c t s " , F i f t h A l l - I n d i a Conference on F a m i l y P l a n n i n g , FPAI, Bombay, 1964, i n s i d e f r o n t c o v e r ; a l s o "What i s F a m i l y P l a n n i n g ? " i n 10 Y e a r s o f F a m i l y P l a n n i n g i n C e y l o n , 1 9 5 3 - 1 9 6 3 , i n s i d e back c o v e r ; Annual R e p o r t , The F a m i l y P l a n n i n g A s s o c i a t i o n o f P a k i s t a n , L a h o r e , (1964;, f l y leaf. C o n s t i t u t i o n of Nepal Family Planning A s s o c i a t i o n , Kathmandu, A r t i c l e 2, mimeographed. ^ R e p o r t o f Work, op.  c i t . , pp. 3 0 ,  81.  7 9 " R e s o l u t i o n Passed Unanimously a t the P l e n a r y S e s s i o n H e l d on 3 r d February I 9 6 I " , F o u r t h A l l - I n d i a Conference on F a m i l y P l a n n i n g , Bombay, l § 6 l , p. 181. SQReport o f I n d i a n P a r l i a m e n t a r y and S c i e n t i f i c Committee, Government o f I n d i a , New D e l h i , May, 1964, p. 5 1 , pp. 1 4 - 1 5 . S h r i Ashoka Mehta, " I n a u g u r a l A d d r e s s " F i f t h A l l - I n d i a Conference on F a m i l y P l a n n i n g , op. c i t . , pp. 8-10, 18-24. 8 1  I n d i a : Report o f UN A d v i s o r y M i s s i o n , P o p u l a t i o n C o u n c i l , s t u d i e s i n f a m i l y P l a n n i n g , New l o r k , J u n e , I 9 6 6 , pp. 1-6. 8 2  83  B. L. R a i n a , op. c i t . , pp.  114-21.  8 ^ h e Quiet R e v o l u t i o n : Family P l a n n i n g i n I n d i a , Embassy o f I n d i a , Economic Wing, Washington, D.C., 1 9 6 7 ,  P«  ^ F a c t s about P o p u l a t i o n and F a m i l y P l a n n i n g i n I n d i a , M i n i s t r y o f H e a l t h and F a m i l y P l a n n i n g , Department o f F a m i l y P l a n n i n g , Government o f I n d i a , New D e l h i , 1967> P« 8. 86 The Quiet R e v o l u t i o n , op. c i t . , p. 5« 7 j o u r n a l o f F a m i l y W e l f a r e , S p e c i a l Conference Number, V o l . XV, No. 3 , arch 1969, p a s s i m . 8  0  8  iVJ  " F P A I A l l - I n d i a C o u n c i l M e e t i n g " , Planned V o l . X V I I , No. 4, O c t o b e r , I 9 6 9 , p. 1 . 8 8  89 "Three P r o b l e m s " , I b i d . . p.  Parenthood,  1.  ^ " C e n t r a l F a m i l y P l a n n i n g C o u n c i l Meets", P l a n n e d P a r e n t h o o d , V o l . X V I I , No. 5 , November, I 9 6 9 , P. 1 .  6.  1969,  ^ S i t u a t i o n R e p o r t , I n d i a , I P P P , London, November, P. 3 .  9 S . Chandrasekhar, " I n d i a ' s F a m i l y P l a n n i n g Programme: What We Have A c c o m p l i s h e d So F a r " , The J o u r n a l o f F a m i l y W e l f a r e , March, 1 9 6 9 , P« 14: a l s o , S i t u a t i o n R e p o r t , op. c i t . , p. 5« 2  93 ^Programmes and A c t i v i t i e s , F P A I , Bombay, I 9 6 8 ( r e c e n t undated l e a f l e t ) , pp. 8 - 9 • 94 Dorothy Nortman, P o p u l a t i o n and F a m i l y P l a n n i n g Programs: A Factbook, R e p o r t s on P o p u l a t i o n / F a m i l y P l a n n i n g , P o p u l a t i o n C o u n c i l , New Y o r k , J u l y , 1970, p. 3 8 . 7  95  I b i d . ; a l s o S i t u a t i o n R e p o r t , op. c i t . , p. 2; a l s o R e p o r t o f Work, op. c i t . , pp. 2 7 - 3 0 . ^°Alan F. Guttmacher, P r e s i d e n t ' s l e t t e r , No. 5 2 , P l a n n e d Parenthood-World P o p u l a t i o n , New York, 14 March, 1 9 7 1 , and supplement. 97 S i t u a t i o n R e p o r t , op. c i t . , p. 5 ; a l s o Canada I n d i a Times, 4.12.69* I P P News, No. 1 8 9 , I P P F , l o n d o n , November, 1 9 6 9 . 9 8  99norothy Nortman, op. c i t . , p. 6 8 . ^°°"Census i n I n d i a " , I n d i a n and F o r e i g n Review, 1 May 1 9 7 1 , p. 2 3 ; a l s o World P o p u l a t i o n Data S h e e t , P o p u l a t i o n R e f e r e n c e B u r e a u , Washington, A p r i l , 1970; a l s o S. Chandrasekhar, " P o p u l a t i o n Problems and P o l i c i e s i n I n d i a " , l e c t u r e , U n i v e r s i t y o f B r i t i s h Columbia, 24 March 1 9 7 1 . lOls. 1  Chandrasekhar, l e c t u r e , op. c i t .  AO  ^ P o p u l a t i o n Program A s s i s t a n c e , U n i t e d S t a t e s Agency f o r I n t e r n a t i o n a l Development, Washington, O c t o b e r , 1 9 7 0 ,  pp.  153-58.  FIGURE U I THREE PROTECTIONS OF CEYLON'S POPULATION GROWTH  i  IQOJ  }9)l  1921  1921  1946  CENSUS  r  r>MGf\ lot A  -T-AOI  c  e> >a  I97J  I9&3  1993  YEARS  SOURCES: STATISTICAL ABSTRACT OF CEVLON, I9(S~ DEPARTMENT TABLE. I6-P.Z6; STATISTICAL POCft.£TB00K OF CEYLON, 1966, rru  1963  /9S3 OF  C£NSUS  AND  DEPARTMENT  STATISTICS  OF CENSUS  COLOMBO.  AND  >96S  STATISTICS,  CHAPTER  VI  Ceylon  Though t h e l e a d e r s from t h e s t a r t o f t h e f a m i l y p l a n n i n g movement i n I n d i a were I n d i a n , t h e f i r s t known f a m i l y p l a n n e r i n Ceylon was a determined  little  Canadian,  Dr. Mary ( I r w i n ) Rutnam, a graduate o f T r i n i t y M e d i c a l S c h o o l i n T o r o n t o , who a r r i v e d i n t h e I s l a n d under American M e t h o d i s t a u s p i c e s as a m e d i c a l m