The Need for Birth Control in Germany
Bund für Mutterschutz (League for Protection of Motherhood and Sexual Reform)
Kaiser Wilhelm Institute
This article provides an overview of the population of post-WWI Germany and the need for birth control.
Margaret Sanger, ed. International Aspects of Birth Control, vol. 1 of the Proceedings of the Sixth International Neo-Malthuisian and Birth Control Conference (New York, 1925), 124-133.
American Birth Control League
Choudhry, Misha (metadata and transcription)
The American Birth Control League became Planned Parenthood Federation of America in 1939. Contact Planned Parenthood for rights.
Moscow, Soviet Union
St. Petersburg, Soviet Union
Text Item Type Metadata
THE NEED FOR BIRTH CONTROL IN GERMANY BY
DR. HELENE STÖCKER
President of the Germany Bund für Mutterschutz
Science, even in its most conservative representatives, can no longer deny that Birth Control is one of the most important means for the hygienic propagation of the species. There is only a very small section, among the Eugenists, that still hold to the pseudo-Darwinian standpoint that very many die "in the interests of natural selection," on the ground that those who survive represent the fittest. This school, which looked upon every attempt to combat infant mortality, infectious diseases, tuberculosis, every scheme of social insurance - in short, the entire endeavor to maintain and protect life, as a hindrance in the operation of the forces of elimination, this school is today, nevertheless, in its blindness and one-sidedness, hardly in a position to win the sympathy and support of the majority of the population of all countries. Nevertheless, the representatives of this view - of whom there are still a few in Germany - are in agreement with us in one point, namely, that as a rule a high birth rate is accompanied by a high death rate; only, they attach different values to this correlation and this inference. They believe that "this high mortality, in a general unfavourable environment, tends naturally to ensure in a high degree, the survival of the fittest."
But they overlook the fact, as shown by recent experiments - such as those carried out by Prof. Neuberg of the Kaiser Wilhelm Institute - that, while it is true on the one hand that epidemics do in reality carry away "the weakest" in contrast to the manner by which the best life has hitherto been destroyed by war, it is also true on the other hand that by better nourishment, human beings, especially children, are made immune to epidemics. In other words, that, as an underfed child is by no means a worthless factor in cultural development, we need not, when faced with this process of elimination which is chiefly determined by social conditions, throw up our hands in resignation, in the belief that thereby the best and the strongest would naturally be "selected." Even these few observations regarding the premises of this problem show how Birth Control has become a burning question for Germany, in the interests of her higher development. For although before the war Germany through her social legislation was in many ways ahead of other States and we had also particularly succeeded in creating - through sick insurance - the modest beginnings of Maternity Insurance, nevertheless, the last ten years have brought about such violent convulsions that all that had been reduced to uncertainty.
At the beginning of the war it did seem that, in spite of everything, it would turn out to be for the good of the women and children. The State Maternity benefit was created.
In a like manner, as a result of a petition from our Association for the Protection of Motherhood, we succeeded in having extended to the illegitimate children, who were socially exposed to the greatest peril - the war pension granted to the families of the soldiers. If therefore, at the moment when adult life was being sacrificed by hundreds of thousands and millions, it at first seemed that the lives of the women and the children were being insured and protected, it soon became manifest that the interests of all the living were intimately bound up with one another, because at the end of the war the condition of all those who were left behind became continually worse. Germany especially, in its peculiar position as an industrial country with an insufficient food supply of its own, was soon thrown into the most dangerous condition of underfeeding. The worst period of privation lay in the years 1917 to 1919, at the end of the war, four times as many children died of tuberculosis as before the war. This development will perhaps become clearest when we recollect what the general outlook was at the end of this period, which, let us hope, represented the very lowest depths touched as regards the health of the people.
Bouton, an American, wrote in his paper "Chiefly Concerning Garet Garrett": "Before the war 1,200 Germans committed suicide yearly, while today the figure is about 80,000, brought about by financial difficulties," a statement which has been confirmed by the publications of the International Red Cross. The employers' insurance has broken down. The State Insurance department has had to limit to the very minimum the arrangements for lung treatment, which were responsible for the greater part of the expenses; so that, at the end of this inflation period, 30 per cent, in Mannheim, 50 per cent. in Nuremberg and in Hamburg nearly 100 per cent. of the open tuberculosis patients lat in beds without sheets. Simultaneously with this, there was an increase in general starvation.
From the memorandum which was submitted to the Prussian parliament on the health conditions, I should like to mention a few of its characteristic points.
To start with, the death rate of infants did not rise as high as the death rate in the other age categories, because a section of the mothers were obliged to nurse their children owing to the scarcity of milk. But now this has once more changed, because the mother either had to get back to work again and therefore cannot nurse, or being herself undernourished is not in a position to feed her child.
The consequence is a considerable increase in children suffering from rickets and a softening of the eyeball with resultant blindness. For many families, the nourishment consisted once again of potatoes, salt and turnips, as it used to be in the dreadful war winters of 1916-17 and so on. Very many hospitals have had to close down as also many Warm Baths and Homes. In a few places, the midwives have had to assist in numerous deliveries without a supply of linen. In the Advisory Centres of Mothers, it was found that out of 136 infants, 6 per cent. suffered from acute and 12.5 per cent. from chronic alimentary troubles and 32 per cent. from rickets. A decrease in weight was general and in many circles, there was not a single child of normal weight.
Strikingly great was the weakness of the child in the first eight days after its birth, a fact intimately connected with the underfed condition of the mother during pregnancy. The increase in hereditary syphilis was also observed everywhere. In the occupied territory the average death-rate of the infants rose from 13 per cent. to as much as 20 per cent.
The natural consequences is that all state, municipal and private aid institutes for the health of the people, specially for the protection of mothers and children, have, under the dreadful stress of economic and financial want, decreased to a shockingly low number. Numerous Day Nurseries, Homes and other institutions have had to close down. In 1922, there were 2,400 Infant Aid homes in Prussia, but under the pressure of the rising inflation, sometimes a third or even a half of them were obliged to stop functioning. It is not at all astonishing to those who understand the facts, that in spite of a decline in the birth rate by 15 per cent., the infant mortality has risen by 20 per cent.
The increase in the death rate of the infants has been specially high in a few towns, as for example, in Munich - the capital of a practically agricultural country - the death rate rose to 40 per cent., and in Madgeburg to 21 per cent. All the towns complained of the sarcity of milk. The entire consumption of milk has decreased to one-tenth of the pre-war quantity. Formerly it amounted to one-half litre per head of the population, but now it is about one-twentieth litre of particularly inferior milk; because of the high prices of fodder for the cow, even the quality of the milk has declined. In a few parts of the occupied territory only one-forty-fifth litre is to be had for the children and the old men, which by no means satisfies the demands of the so-called "urgent cases"; or when there is milk to be had, there is not money enough with which to buy it. In Essen for example, in March, 1923, there was only one-fifth of the quantity of milk hitherto available and in January-February, 20 per cent. more children died than in the preceding year.
In the occupied town of Duisburg, the children under two years got no milk whatsoever, because the army of occupation alone consumed one-tenth of the entire milk supply for the inhabitants. In a home for the children in Cologne, only 20 litres could be had for a hundred children. But even from that small quantity, only a half of it could be bought on account of the want of money. In Coblenz, only 80 per cent. of the infants and 30 per cent. of the children between the years 1-2 were given a little milk whereas those over two years got no milk at all.
Intimately connected with this highly essential question of the milk supply are the demands of the mother. Although the need for an increase in the number of homes for would-be mothers and mothers confined to child-bed, has for years been recognised, one home after another has been closed down for financial reasons. The remaining few are consequently always over-filled. The home for the Protection of Motherhood (which the movement founded twenty years ago) has also to a very large extent been a victim of the war. It is only by indescribable anxiety and strenuous efforts that it has been possible for us to maintain the Home in Berlin and also those in a few other towns such as Breslau, Mannheim, etc. In numerous cases, the night asylum has to offer refuge to the homeless women expecting to be mothers and confined to child-bed. Often, the mother has to leave the hospital on the sixth day or the child is taken away from her on the tenth day and given over to the orphanage. Under these circumstances, it is no wonder that for some time the work in our Advisory Centres for Mothers was depressing to the highest degree. The poor mothers did not come to ask where they could find shelter for their confinement but only to find out how they could be freed from this undesired blessing, which was of course rendered impossible by reason of the existing law. Their despair is easily understood when one thinks of the sad fate of the child who is brought into a world which is still chaotic and has not yet learned to find accommodation for its highest treasure - namely, living human beings.
Specially hard is the lot of the orphan or the half orphan so to say, i.e., the illegitimate children.
Whereas formerly out of 10,000 orphans about nine-tenths of them were entrusted to the care of individual families, this system has nearly disappeared on account of the fact that the nurses were given not even sufficient money to cover the expenses of milk. By reason too, of the over-crowding of the orphanages and homes for the children, several children had often to sleep in the same bed. Although the birth rate has gone down by a third, nevertheless this cover-crowding still continues with all its hygienic, moral and economic disadvantages.
We often feared that we stood on the verge of a complete collapse of the work for the protection of infants, children and mothers.
The Eugenists start with the calculation that the average age is 50 years and therefore, a birth rate of 20 per thousand is necessary, if the people are to be maintained at the same level.
Now for example, the birth rate in Berlin has fallen to 9.4 per thousand, while the great city of London, in the same year 1923, has still a birth rate of 20.2. As far as the surplus of births is concerned the figures for the towns in Germany has gone down by 57 per cent. and in the country by 30 per cent. The relative decrease in the town, is therefore nearly twice as high as it is in the country. The difference would perhaps be made much clearer if we compare the numbers.
In January, 1914, the number of children born alive amounted to 27 per thousand of the inhabitants of Berlin. Berlin with a population of 2,000,000 occupies the last place among the world cities. Vienna and Paris, both of which showed the same conditions before the war and were far behind Berlin, have now gone ahead of it. Moscow and Petersburg have three times as many births as Berlin.
The decrease in the youngest children is already coming to be felt in the Berlin schools. Over 120 classes had to be closed down in the summer term of 1923 because the school attendance could not be kept open with only five or ten children. One of the most famous gynecologists, the late Prof. Bumm, had also to admit that all other considerations would have to be abandoned, in the face of the misery and suffering caused by hunger and the housing problem and that the only remedy would be to take greater care of mothers and children. The period of protection ought to be extended from six to ten weeks. Half of the spontaneous miscarriages and premature births could be avoided if the women were guaranteed the necessary quiet and medical help.
The social condition is always, everywhere, a decisive factor. Unless and until a change in the social condition is brought about, it would be an idle dream to expect an increase in births or a decrease of the shockingly high numbers of artificial miscarriages, which the same gynecologist, Bumm, estimates at 500,000 yearly in Germany, of which 80 per cent. to 90 per cent. were voluntary, that is to say purposely brought about.
It is true that the latest regulations have extended the Maternity Aid since December 1924, insofar as a weekly maintenance, equal in amount to the sick-allowance is paid out four weeks before the six weeks after confinement. But this is also a retrograde measure, because the Maternity Aid for needy German pregnant women and women in confinement, who are themselves not insured and have no claim on their families, now falls under the subjective conception of "the needy," whereas formerly they were entitled to a Maternity Aid in the form of a fixed sum from the fund in every case.
That is one of the most retrograde measures decided upon by parliament, under the stress of economic difficulties and the fatal efforts at retrenchment in order to meet with the demands of the Dawes Plan. The consequences of these measures on the health of the mothers and children and therefore on the future generation are bound to make themselves felt.
The fact that infant mortality is still high everywhere, in spite of the great decline in the number of births and the decline in the birth rate, is shown by a comparison with some other countries. In England it is 6.9 per cent., in Germany 13 per cent., in Sweden 7 per cent., in Denmark 7 per cent. How strongly social position exercises an influence on the death rate of children, is proved by the fact that among university circles, 5.4 per cent. of the children die, among mechanics 15.6 per cent. and among workingmen 20.7 per cent., i.e., every fifth child dies.
If we wish to draw conclusions from this necessarily brief observation we must at any rate recognise one fact, that it is always the unfavorable character of the social position that brings about a high number of births in relation to mortality.
It is only by a fundamental improvement of social conditions, that the conditions for the rearing of the new generation can also be improved. The work must, therefore, begin from different sides, not only by publicity, by the legislation of individual countries and, let us hope, by increasingly international tries and, let us hope, by increasingly international legislation, which aims at the distribution of raw materials and foodstuffs over the whole world - but also by disseminating in all classes of the population, a knowledge as to the possibilities of Birth Control and the consequent lowering of infant mortality and the prevention of futile fertility.
We too recognise the difficulties of the problem- we realise the danger of eliminating from the process of the propagation of the species persons who represent the highest stage of cultural development. But, on the other side, we see also how limited are the possibilities of food supply for human beings, as has recently been shown by another of our most eminent and esteemed food physiologists. In his opinion, if the population continues to grow, as it has been growing in the last 50 years, the habitable area of the earth would be completely occupied in 300 years and that of the temperate zone in 150 years.
It should be the future task of humanity, instead of destroying itself in meaningless wars, to create by mutual co-operation ways and means by which this last horrid struggle for existence in the worst sense of the word, need never recur; but instead, by a well-planned control of births - a new cultural world should be created, in which life is worth while for every one who is born.
To help to come to this end, that is, as I understand, also the special aim of this movement. To work for its development - that is religion of the future.
Published conference paper