Woman and the New Race

by Margaret Sanger

The warning has been sounded most often, perhaps, in the cases of tubercular women. "In view of the fact that the tubercular process becomes exacerbated either during pregnancy or after childbirth, most authorities recommend that abortion be induced as a matter of routine in all tubercular women," says Dr. J. Whitridge Williams, obstetrician-in-chief to the Johns Hopkins Hospital, in his treatise on Obstetrics. Dr. Thomas Watts Eden, obstetrician and gynecologist to Charing Cross Hospital and member of the staffs of other notable British hospitals, extends but does not complete the list in this paragraph on page 652 of his Practical Obstetrics: "Certain of the conditions enumerated form absolute indications for the induction of abortion. These are nephritis, uncompensated valvular lesions of the heart, advanced tuberculosis, insanity, irremediable malignant tumors, hydatidiform mole, uncontrollable uterine hemorrhage, and acute hydramnios."

We know that abortion, when performed by skilled hands, under right conditions, brings almost no danger to the life of the patient, and we also know that particular diseases can be more easily combatted after such an abortion than during a pregnancy allowed to come to full term. But why not adopt the easier, safer, less repulsive course and prevent conception altogether? Why put these thousands of women who each year undergo such abortions to the pain they entail and in whatever danger attends them?

Why continue to send home women to whom pregnancy is a grave danger with the futile advice: "Now don't get this way again!" They are sent back to husbands who have generations of passion and passion's claim to outlet. They are sent back without being given information as to how to prevent the dangerous pregnancy and are expected, presumably, to depend for their safety upon the husband's continence. The wife and husband are thrown together to bring about once more the same condition. Back comes the patient again in a few months to be aborted and told once more not to do it again.

Does any physician believe that the picture is overdrawn? I have known of many such cases. A recent one that came under my observation was that of a woman who suffered from a disease of the kidneys. Five times she was taken to a maternity hospital in an ambulance after falling in offices or in the street. One of the foremost gynecologists of America sent her out three times without giving her information as to the contraceptive means which would have prevented a repetition of this experience.

Why does this situation exist? We do not question the good intent nor the high purposes of these physicians. We know that they observe a high standard of ethics and that they are working for the uplift of the race. But here is a situation that is absurd—hideously absurd. What is the matter?

Several factors contribute to this state of affairs. First, the subject of contraception has been kept in the dark, even in medical colleges and in hospitals. Abortion has been openly discussed as a necessity under certain conditions, but the subject of contraception, as any physician will admit, has not yet been brought to the front. It has escaped specialized attention in the laboratories and the research departments. Thus there has been no professional stamp of approval by great bodies of experimenters. The result is that the average physician has felt that contraceptive methods are not yet established as certainties and has, for that reason, refused to direct their use.

Specialists are so busy with their own particular subjects and general practitioners are so taken up with their daily routine that they cannot give to the problem of contraception the attention it must have. Consultation rooms in charge of reputable physicians who have specialized in contraception, assisted by registered nurses—in a word, clinics designed for this specialty, would meet this crying need. Such clinics should deal with each woman individually, taking into account her particular disease, her temperament, her mentality and her condition, both physical and economic. Their sole function should be to prevent pregnancy. In accomplishing this purpose, a higher standard of hygiene is attained. Not only would a burden be removed from the physician who sends a woman to such a clinic, but there would be an improvement in the woman's general condition which would in a number of ways reflect itself in benefit to her family.

All this for the diseased woman. But every argument that can be made for preventive medicine can be made for birth-control clinics for the use of the woman who has not yet lost her health. Sound and vigorous at the time of her marriage, she could remain so if given advice as to by what means she could space her children and limit their number. When she is not given such information, she is plunged blindly into married life and a few years is likely to find her with a large family, herself diseased and damaged, an unfit breeder of the unfit, and still ignorant!

What are the fruits of this woeful ignorance in which women have been kept? First, a tremendous infant mortality—hundreds of thousands of babies dying annually of diseases which flourish in poverty and neglect.

Next, the rapid increase of the feebleminded, of criminal types and of the pathetic victims of toil in the child-labor factories. Another result is the familiar overcrowding of tenements, the forcing of the children into the street, the ensuing prostitution, alcoholism and almost universal physical and moral unfitness.