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2. How is birth control to be applied?
There are two alternative methods for the application of birth control—
(a) self restraint; and (b) mechanical contraceptive methods.
(a) Control by self-restraint.—This is clearly the ideal method, leaving
both parents with a sense of personal dignity and with no possibility of impairment
of mutual respect. It is recognised that under the conditions of crowding
and lack of a sufficient number of rooms in working-class households such a
course may be difficult to adopt. It is, however, easy to exaggerate this
difficulty, and actual inspection of housing conditions from this point of view
shows that, in a large proportion of the cases in which at first sight the
application of self-restraint is impracticable, simple adjustments are actually
within the reach of the parents. The use of separate beds instead of the double
beds commonly in use, together with an adjustment of the sleeping arrangements
in the various rooms in working-class households, could, in a surprisingly
large proportion of the cases in which instruction is often regarded as
necessary, allow the establishment of birth control by self-restraint without
recourse to other methods. My own feeling is that the only method of birth
control which a public authority could in general encourage is that of selfrestraint,
for reasons mentioned in the next paragraph.
(b) Birth Control by mechanical contra-conceptive methods.—The main
difficulties in applying this method are:—
1. The information given cannot be limited to those particularly needing
it, but is certain to leak through to others, both married and unmarried, to
whom its application means degradation.
2. Unless there is the most intimate knowledge of the home circumstances
and of the relations between husband and wife, and of the possibilities
of establishing birth control (where this is necessary) by self-restraint, a vast
deal of irreparable harm may be done by changing the mental attitude of
husband and wife to one another. I feel that this, although a very difficult
matter to define, is a fundamentally important consideration; and that the basic
danger to national life arising from the adoption of mechanical means of birth
control on anything like a national scale depends not so much on the risk of
a stationary population as on that of a materialistic bias in the national
attitude towards sex and marriage. Even with individuals who adopt
mechanical contraceptive methods from the highest point of view there must,
I think, be inevitably some degree of hardening, i.e., a loss of mutual respect
owing to the fact that both parties recognise that they have not taken the
ideal course. Although each party may make allowance for this, and to that
extent minimise the moral damage, the adoption of such. a course on an
increasingly large scale by individuals not moved by such higher motives would
be a national calamity, not merely from the point of view of diminishing the
population but from the far more important standpoint of lowering the general
moral standard.
The part to be played by the Public Authority.—It is clear that if instruction
in contraceptive methods is to be given by Public Authorities in the limited
group of cases needing it, this must be only after careful investigation into
family circumstances and after personal discussion with both parents by the
medical officer undertaking the work. This throws a heavy burden of
responsibility ultimately on to the medical officer, who will need to have social
experience and experience of the problems of married life as well as medical
insight. I feel that any general authority given to local authorities to give
instruction in birth control would result in grave damage if such power were
put into the hands of medical officers not in every respect suited for the work.
If instruction is to be given by the officers of public authorities in methods
of contraception other than that of self-restraint, stringent safeguards will be
needed, among which the following should be included:—