London's Pulse: Medical Officer of Health reports 1848-1972

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Fulham 1938

[Report of the Medical Officer of Health for Fulham Borough]

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of children per 100 women of child-bearing age in 1901 and 1931. Moreover, the movement acquires
increasing momentum, for while each woman bears fewer children, so, when those children reach
marriageable age, the number of fecund women declines. Thus, in 1901, in Fulham, the number of
children under five was over 17,000 and the number of women over 40,000 ; in 1931, the children
numbered less than 10,000 and women over 39,000. In 1961, therefore, the number of women will
probably not exceed 30,000, producing (at the present rate; i.e., assuming that the rate does not further
decline) about 8,000 children. Should the birth-rate decline in the same proportion as it has in the
last 30 years, the number will be little over 5,000. It is this cumulative effect that has led to the use
of the phrase "race-suicide"; for the present lack of fertility is piling up for the future a burden
which the people of the future may be physically incapable of bearing.
There have been many and varied causes suggested to explain this decline, ranging from the
purely biological, through the economic and political, to the religious or metaphysical. It has been
suggested, on the one hand, that modern biological conditions diminish fertility; and on the other,
that European culture as a whole is dying of exhaustion. Such technical or metaphysical theories
are obviously beyond our scope, fascinating as they may be.
The possible effect of economic conditions is a little obscure. It was laid down by Adam
Smith, and later confirmed by Doubleday, that poverty was favourable to generation, and that
fertility was in inverse ratio to the standard of living. In the wide view, nothing has yet disproved
that dictum. The graph (Figure 3) seems to show, however, that in a small area, and over a short
period, the economic standard (here taken from the number of unemployed) has an immediate effect
upon the marriage and birth rates, exactly the reverse of the general theory. A rise in the number
of unemployed is simultaneous with a fall in the marriage rate, and is followed a year later by a
decline in the birth rate. It seems probable that the truth is a reconciliation of these two tendencies.
Fertility is in inverse ratio to the general long-term standard of living; but temporary and local
conditions modify in direct ratio the general level of fertility. Thus the general rise in the standard
of living from the last century has lowered the general birth rate : but local and temporary depressions
affect the general birth rate in the opposite way to that expected, i.e., they lower it still further. It
is, moreover, an undoubted fact that for those on the lowest level of subsistence, the size of family is
relatively unimportant. There is, at any time, a standard of life below which it is impossible to fall,
and for those living at that standard, the number of dependants makes little difference. Only when
we reach the standard above that of mere subsistence do we find any attempt deliberately to limit
the size of family, as any increase will bring the standard of living possible down towards that lowest
level. The rise in the general standard in the last 50 years has meant that a large number of those
formerly at the subsistence level (and therefore fertile) have been raised to what we may call the
"responsible" stage, and that they now deliberately limit their families to a size which they can
maintain at that level. Fluctuations in the basic standard are, therefore, judged by the "responsible
" method and produce variations which are in direct ratio.
We see the effect of these economic considerations particularly in the fact that expectation of
a higher standard of living delays marriage. The average age of marriage is now considerably higher
than it was in Victorian times, and almost solely because young people do not earn enough to maintain
a family at the current standard of life. The best child-bearing years of a woman's life are, therefore,
usually passed in spinsterhood, and marriage only takes place at an age when confinement is more
difficult, and the number of children that can be expected less.
An argument commonly occurring in literature upon the subject is that the fall in the birth
rate is due to the wider knowledge of methods of birth control. This argument, however, avoids the
main issue. Modern birth control methods may be the means of limiting the family. What requires
explanation is that a small family should be the aim. The question is not how the children are avoided,
but why. And to talk of modern selfishness or timorousness is equally beside the point, for such a
theory is based upon premises which, to say the least, are not proven, and gets no nearer to an
explanation of this sudden outbreak of selfish fear than vague damnatory opinions of modern life
in general. If there be selfishness, I think we shall find its origin in the economic factors I have
outlined.