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The committee on maternal health
Department of Maternal Welfare CONDUCTED BY FRED L. ADAIR, M.D.
THE COMMITTEE ON MATERNAL HEALTH Organization and Plans.-The Committee on Maternal Health, controlled by and under the direction of physicians, was organized March 9, 1923, to undertake a scientific investigation of contraception, sterilization and general p1·oblems of sterility and fertility from a medical and public health point of view. While it recognizes the importance of the ethical or moral and the economic considerations involved, the Committee aims to confine itself to the medical aspects of these questions. 'fhe Committee's working plan has been approved by the American Gynecological Society, the New York Obstetrical Society, and the Public Relations Committee of the New York Academy of Medicine. Orga1llieation.-The members of the Executive Committee who are directly responsible for the organization's activities are as follows: Doctors Samuel vV. Lam· bert, chairman, Robert L. Dickinson, secretary, Haven Emerson, Robert T. Frank, Frederick C. Holden, George W. Kosmak, James Pedersen, and William F. Snow, Mr. Bailey B. Burritt, Mrs. Gertrude Pinchot, and Miss Marguerite A. Wales. There are two active subcommittees: one on medical service, which is in charge of the clinical investigation outlined below-Dr. Frederick C. Holden, chairman, Dr. William E. Caldwell, and the secretary; and one in charge of resE'arch-Dr. Robert T. Frank, chairman, Dr. Herbert M. Evans of the University of California, Dr. C. R. Stockard of Cornell University, and the secretary. Dr. G. W. Kosmak serves as a committee of one to advise on publications. As it has seemed increasingly important to attempt to determine or at lea~t to study and discuss the medical indications for contraception and sterilization to the end that the medical profession may more fully recognize contraception as a preventive measure, the Committee is at present organizing a subcommittee on medical indications. Dr. Nellis B. Foster will be chairman of this committee, which proposes as an initial undertaking to draft and submit for medical comment and eriticism a tentative list of medical indications for contraception. There is a medical advisory group who are frnm time to tinw consultPd on pol· ieies and procedmes. There are also advisOl'y, legal, nur~ing, and lay groups. ~'he recently employed full-time executive secretary is a physician, The work of the Committee has been supported by voluntary contributions. One of the Foundations has assisted with funda for research. 'fhe office of the Committee is at 370 Seventh Avenue, New York City, in the ~nme building with various national health organizations. Clinical Investigation.-Part of the work that the Committee has undertaken is a clinical study of contraception in which the following New York Hospitals are cooperating: Lebanon, Lenox Hill, Jewish, Mt. Sinai, New York Infirmary for 'iVomen and Children, New York Nursery and Childs, Sloane, and Woman's Hospitals. The purposes of the clinic service are; (1) to prov:de meuical service for women needing contraceptive advice 1 ' to cure or prevent disease'' as permitted under the 2i8
THE COMMITTEE ON MATERNAL HEAJJTH
27!l
Now York State Law; (2) to g·ather evidcner as to indic~ations, i.e., conditions under which advice for or against pregnancy shall h!l giv!;n, including application of sterilization; (3) to gather a st>rics of histories of patients who are using vari· ou~ c•ontraceptive methods under medical advice ancl ~upet·vision; the analysis of sueh histories to provide evidence as to the efficacy, harm, or harmlessness of the several methods. The collection of sudt a series of case histories under the supervision of physicians in institutions of high standing is essential if the :medical profession is to be able to speak with any degree of scientific accuracy about questions such as t!1e following: What are the physiologic and psychologic effects of contraception upon the in olividual1 What are the effects of contraception upon subsequent fertility' What is the rela,tive value of contraceptives as to reHability, simplicity, and harmlessness' rrhe Committee on Maternal Health through hundreds of interviews both in Eu rope and America has secured a great deal of valuable opinion upon those questio11~, but the opinions differ widely. They are therefore making an unbiased clinical investigation of the facts. They are keeping a uniform history. They have offere
Reseat·oh.-The Committee's three main objectives in the domain of resean·h have direct bearing upon the problems both of sterility and fertility, namely: (1) spermatoxins; (2) when does human ovulation oecur, anoi (:l) the period of re ceptivity in the female. The subcommittee on research is studying this field and has been able to promote, and in some instances to assist financially, with the study of these problems. When it is able to secure further financial assistance it pnposes to increase its research activities. Needless to say in this field even more than in its clinical in· vestigation the Committee expects no immediate or starthng results. Other Activitit8.-Sorne of the other activities of the Committee on Maternal H(•alth are: 1. 2. :l. 4.
The abstracting and indexing of literature The inspection of birth control clinics and their records A critical survey of foreign experience and American practice Furnishing clinics with supplies not otherwise procurable.
Legal.-As both our federal and state laws in differing degrees hamper phy· sicians in giving contraceptive advice to their patients, the Committee has made some effort to secure consideration by organized medicine to the end that these Ia ws may be amended. The following suggested amendment has been submitted to and endoraed by the Section on Obstetrics, Gynecology and Abdominal Surgery of the Ame1·ican Medical Association: ''Resolved, that we hereby rccomnwnd the alteration of ex· isting laws wherever necessary so that physicians may l·~gally give contraceptive information to their patients in the regular course of practice.'' Because the Postal Law forbids transmission of practieal information and even medical publications concerning birth control, the following suggested amendment was submitted to and endorsed by the Americ•an Gyn<'eolo~;ieal Society: ''Standard
280
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
medical and scientific journals and reprints therefrom and standard medical works whieh contain information with reference to the prevrnting of conception are not nonmailable under this section.' ' Conclusion.-The Committee on Maternal Health realizes that in studying contraception they are entering a difficult field where they will meet with opposition not only from those who are biased or prejudiced hut al~o from those who Hl'C sincerely opposed because of religion~ or ethical considerations. Their efforts to stud~· sterility and fertility do not, of eourse, meet with these Rame difiicultie~. The Committee, feels, however, that as every physician meets situations where he must consider contraception as a health nwasure, it is e~sential that the qtw~ tion be squarely faced as an important mellieal prohlf'm Hnd receive proper ,;cirntitic consideration.
'rHE PHYSICIAN'S PART IN A PRACTICAL S'l'ATE PROGRAM 0.11"' PRENATAL CARE* BY M~RED
L.
ADAIR, M.D., MINNEAPOLIS, MINN.
(Chairman, Joint Committee on Maternal Welfare)
GOOD understanding of the significance and purpose of prenatal or antepartum care must be had before an attempt is made to elaborate an intelligent and practical program and to define the relationship of the physician to such a plan for the state. The word ''state'' in this article refers to the geographic or governmental unit and not to the abstract definition. According to a committee which recently drew up some standards of prenatal care for the Children's Bureau, "Prenatal care is that part of maternal care which has as its object the complete supervision of the pregnant woman in order to pre· serve the happiness, health, and life o:f the mother and child. Therefore all prf'gnant women should be under medical supervision during their entire pregnancy, for it is only by careful routine prenatal care that pregnancy and labor can be made safer.'' If we are created to create, and the chief end of man is man, dare one in this modern era say that maternity is the chief function of woman f The carrying out of this physiologic law is vital to the perpetuation of the human race, which we assume to be the desire of human beings. We fully realize that much can be done by caring for mother and future off~ spring during the period of pregnancy. We are convinced, for instance, that eongenital syphilis can be more effectually treated during pregnancy than during infancy, but no one doubts that it could be still more adequately handled prior to the onset of pregnancy itself. This specific instance illustrates the general p1·incip1e that while much can be done by our present plan of prenatal care to presen-e the happiness, health, and lives of offspring, this plan is too limited to fully accomplish the purposes which are promulgated. While we are striving to perfect and carry out universally the care of the pregnant woman we must also begin to enlarge our conception of prenatal care, or coin another name, such as antecouceptional care or preembryonic care. Prenatal usually implies during pregnancy, but one is led to coll!lider when prenatal care begins, and though we may not accept the name we must recognize the fact that causes operate to affect the offspring for good or ill prior to the fertili· zation which leads to the ultimate development of an individual.
A
•Read at the Third Annual Conference of State Directors of Maternity and InFor complete paper, see official
fancy Work, Washington, D. C., January 11, 1926. report.
THE COMMITTEE ON MATERNAL HEALTH Organization and Plans.-The Committee on Maternal Health, controlled by and under the direction of physicians, was organized March 9, 1923, to undertake a scientific investigation of contraception, sterilization and general p1·oblems of sterility and fertility from a medical and public health point of view. While it recognizes the importance of the ethical or moral and the economic considerations involved, the Committee aims to confine itself to the medical aspects of these questions. 'fhe Committee's working plan has been approved by the American Gynecological Society, the New York Obstetrical Society, and the Public Relations Committee of the New York Academy of Medicine. Orga1llieation.-The members of the Executive Committee who are directly responsible for the organization's activities are as follows: Doctors Samuel vV. Lam· bert, chairman, Robert L. Dickinson, secretary, Haven Emerson, Robert T. Frank, Frederick C. Holden, George W. Kosmak, James Pedersen, and William F. Snow, Mr. Bailey B. Burritt, Mrs. Gertrude Pinchot, and Miss Marguerite A. Wales. There are two active subcommittees: one on medical service, which is in charge of the clinical investigation outlined below-Dr. Frederick C. Holden, chairman, Dr. William E. Caldwell, and the secretary; and one in charge of resE'arch-Dr. Robert T. Frank, chairman, Dr. Herbert M. Evans of the University of California, Dr. C. R. Stockard of Cornell University, and the secretary. Dr. G. W. Kosmak serves as a committee of one to advise on publications. As it has seemed increasingly important to attempt to determine or at lea~t to study and discuss the medical indications for contraception and sterilization to the end that the medical profession may more fully recognize contraception as a preventive measure, the Committee is at present organizing a subcommittee on medical indications. Dr. Nellis B. Foster will be chairman of this committee, which proposes as an initial undertaking to draft and submit for medical comment and eriticism a tentative list of medical indications for contraception. There is a medical advisory group who are frnm time to tinw consultPd on pol· ieies and procedmes. There are also advisOl'y, legal, nur~ing, and lay groups. ~'he recently employed full-time executive secretary is a physician, The work of the Committee has been supported by voluntary contributions. One of the Foundations has assisted with funda for research. 'fhe office of the Committee is at 370 Seventh Avenue, New York City, in the ~nme building with various national health organizations. Clinical Investigation.-Part of the work that the Committee has undertaken is a clinical study of contraception in which the following New York Hospitals are cooperating: Lebanon, Lenox Hill, Jewish, Mt. Sinai, New York Infirmary for 'iVomen and Children, New York Nursery and Childs, Sloane, and Woman's Hospitals. The purposes of the clinic service are; (1) to prov:de meuical service for women needing contraceptive advice 1 ' to cure or prevent disease'' as permitted under the 2i8
THE COMMITTEE ON MATERNAL HEAJJTH
27!l
Now York State Law; (2) to g·ather evidcner as to indic~ations, i.e., conditions under which advice for or against pregnancy shall h!l giv!;n, including application of sterilization; (3) to gather a st>rics of histories of patients who are using vari· ou~ c•ontraceptive methods under medical advice ancl ~upet·vision; the analysis of sueh histories to provide evidence as to the efficacy, harm, or harmlessness of the several methods. The collection of sudt a series of case histories under the supervision of physicians in institutions of high standing is essential if the :medical profession is to be able to speak with any degree of scientific accuracy about questions such as t!1e following: What are the physiologic and psychologic effects of contraception upon the in olividual1 What are the effects of contraception upon subsequent fertility' What is the rela,tive value of contraceptives as to reHability, simplicity, and harmlessness' rrhe Committee on Maternal Health through hundreds of interviews both in Eu rope and America has secured a great deal of valuable opinion upon those questio11~, but the opinions differ widely. They are therefore making an unbiased clinical investigation of the facts. They are keeping a uniform history. They have offere
Reseat·oh.-The Committee's three main objectives in the domain of resean·h have direct bearing upon the problems both of sterility and fertility, namely: (1) spermatoxins; (2) when does human ovulation oecur, anoi (:l) the period of re ceptivity in the female. The subcommittee on research is studying this field and has been able to promote, and in some instances to assist financially, with the study of these problems. When it is able to secure further financial assistance it pnposes to increase its research activities. Needless to say in this field even more than in its clinical in· vestigation the Committee expects no immediate or starthng results. Other Activitit8.-Sorne of the other activities of the Committee on Maternal H(•alth are: 1. 2. :l. 4.
The abstracting and indexing of literature The inspection of birth control clinics and their records A critical survey of foreign experience and American practice Furnishing clinics with supplies not otherwise procurable.
Legal.-As both our federal and state laws in differing degrees hamper phy· sicians in giving contraceptive advice to their patients, the Committee has made some effort to secure consideration by organized medicine to the end that these Ia ws may be amended. The following suggested amendment has been submitted to and endoraed by the Section on Obstetrics, Gynecology and Abdominal Surgery of the Ame1·ican Medical Association: ''Resolved, that we hereby rccomnwnd the alteration of ex· isting laws wherever necessary so that physicians may l·~gally give contraceptive information to their patients in the regular course of practice.'' Because the Postal Law forbids transmission of practieal information and even medical publications concerning birth control, the following suggested amendment was submitted to and endorsed by the Americ•an Gyn<'eolo~;ieal Society: ''Standard
280
THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
medical and scientific journals and reprints therefrom and standard medical works whieh contain information with reference to the prevrnting of conception are not nonmailable under this section.' ' Conclusion.-The Committee on Maternal Health realizes that in studying contraception they are entering a difficult field where they will meet with opposition not only from those who are biased or prejudiced hut al~o from those who Hl'C sincerely opposed because of religion~ or ethical considerations. Their efforts to stud~· sterility and fertility do not, of eourse, meet with these Rame difiicultie~. The Committee, feels, however, that as every physician meets situations where he must consider contraception as a health nwasure, it is e~sential that the qtw~ tion be squarely faced as an important mellieal prohlf'm Hnd receive proper ,;cirntitic consideration.
'rHE PHYSICIAN'S PART IN A PRACTICAL S'l'ATE PROGRAM 0.11"' PRENATAL CARE* BY M~RED
L.
ADAIR, M.D., MINNEAPOLIS, MINN.
(Chairman, Joint Committee on Maternal Welfare)
GOOD understanding of the significance and purpose of prenatal or antepartum care must be had before an attempt is made to elaborate an intelligent and practical program and to define the relationship of the physician to such a plan for the state. The word ''state'' in this article refers to the geographic or governmental unit and not to the abstract definition. According to a committee which recently drew up some standards of prenatal care for the Children's Bureau, "Prenatal care is that part of maternal care which has as its object the complete supervision of the pregnant woman in order to pre· serve the happiness, health, and life o:f the mother and child. Therefore all prf'gnant women should be under medical supervision during their entire pregnancy, for it is only by careful routine prenatal care that pregnancy and labor can be made safer.'' If we are created to create, and the chief end of man is man, dare one in this modern era say that maternity is the chief function of woman f The carrying out of this physiologic law is vital to the perpetuation of the human race, which we assume to be the desire of human beings. We fully realize that much can be done by caring for mother and future off~ spring during the period of pregnancy. We are convinced, for instance, that eongenital syphilis can be more effectually treated during pregnancy than during infancy, but no one doubts that it could be still more adequately handled prior to the onset of pregnancy itself. This specific instance illustrates the general p1·incip1e that while much can be done by our present plan of prenatal care to presen-e the happiness, health, and lives of offspring, this plan is too limited to fully accomplish the purposes which are promulgated. While we are striving to perfect and carry out universally the care of the pregnant woman we must also begin to enlarge our conception of prenatal care, or coin another name, such as antecouceptional care or preembryonic care. Prenatal usually implies during pregnancy, but one is led to coll!lider when prenatal care begins, and though we may not accept the name we must recognize the fact that causes operate to affect the offspring for good or ill prior to the fertili· zation which leads to the ultimate development of an individual.
A
•Read at the Third Annual Conference of State Directors of Maternity and InFor complete paper, see official
fancy Work, Washington, D. C., January 11, 1926. report.