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The unmarried mother as a medical and social problem
THE
UNMARRIED W.C.
T
MOTHER AS A MEDICAL SOCIAL PROBLEM
DANFORTH, M.D.,F.A.C.S.,
AND
EVANSTON, ILL.
HE mode of dealing with the unmarried mother and her child has come down from The English Poor Law and the English Property Law. In earlier days the bearing of an infant outside of wedlock was not considered an offense against the criminal laws, but the bringing into the world of a child who might become a burden upon the parish in which it was born was an offense. In other words, having a child without being married was not legally wrong but the producing of a child who might add to the sum of public expense was against the law. This attitude, not greatly modified by the passage of time, continued until the beginning of the twentieth century. The changes, legal and otherwise, which have come about, have been largely motivated by organizations of women, who have recognized that the older view of this problem was too severe and that it did not serve the best interests of society. The first move in our own country toward a change in attitude seems to have been the publication in 1920, by the Federal Children’s Bureau, of the first of a number of studies on “Illegitimacy as a Child Welfare Problem.” These have done a great deal of good in emphasizing the fact that, in cases of illegitimacy, there is always an infant, which is wholly innocent and has rights, legal and moral, to consideration. I would quote in this connection from a publication of The School of Social Service Administration of the University of Chicago, which deals comprehensively with the question of illegitimate births in the State of Illinois during the year 1928. We find in that year, in a state with more than seven million people, there were 129,668 births. Of these, 2,381 were illegitimate, or 18.36 per thousand. This study indicates clearly that the problem of the unmarried mother and her infant is one of youth, 84 per cent of the mothers being under twenty-five years of age. Forty per cent were under eighteen years, and 11.06 per cent were fifteen years of age or less. Only 7.05 per cent were over thirty years of age. From the standpoint of the most rudimentary humanity. it seems obvious that, if, in one state in one year, there are 2,381 births out of wedlock, and if 146 of these mothers are girls of fifteen years or less, and 787 more of them are from sixteen to eighteen years of age, we have before us a situation which merits the most careful consideration, not only of social workers and physicians, but of every intelligent and socially minded citizen. The mother and the baby must both be cared for. The insistence which has been made by certain social workers that in all cases the mother be made to keep her child, seems in the face of figures such as those just given, to be ridiculous. What can a child under fifteen, or even the large group of mothers between sixteen and eighteen, do for 637
the support of an infant unless they l~a\.(l families which art’ financially ;~ble ant1 willing to take th,k chilli into I hccir Pamil>- ! This ix oFt(ln not the case. There seems to have been a clefinite trend toward a gentler and tnorc merciful attitude on the part of the law towartl both the unfortunate unmarried mother and her child. 111a decision rendered in one of the c0urt.s of the State of Illinois. the following expression seems significant : “The harsh doctrines of the common law which gave au LLUmarried mother and her illegitimate child little standing or protection, have been modified by the legislature and court decisions of this state.” The very sane conclusion of the t~sex4lent st.udy from which I have quoted is that “the child born out of wedlock should be considered first, as a child, and accorded at least an approshnation of the rights accorded other children.” During a service of two years on a Cotllmittee of the Chicago (louneil of Social Agencies, which tried to draw up an improved adoption law for the State of Illinois. I \v;\s strllck with the fact that t,he infant is not yet adequately protectctl. As most adoptions are of illegitimately born chilclren, this primarily concerns t.his group of children. In adoptions, the interests of the child demand that a home be found which is suitable for the child rather than to find babies for homes which arp childless. .tn some cases the latter motive seems to be the ruling one. Adequate protection of the c?hiltl to he adopted should be provided in all states. The question which particularly interest,s physicians is the medical care which this group should rer4v-e. Hans Zinsser of Harvard, in his recent book, speaks of t,he doctor as bein,0‘ so conditioned, by his training, that he is indifferent. to social st.atus, morality, or even eriminality in those who come under his hand as patients. The unwed expectant mother, to him, is a pregnant woman who presents exactly the same obstetric problem which her more fortunate married sist,er does. The care of both the mother and the infant aft,erward may be. and in many cases is, a social pr~ohlem. to be dealt with by those who are competent in the field of social service. There is a clear-cut need for both efficient medical care and c+ompetent~help in making such social adjustments as may be needed. Many illegitimate births have been cared for in “maternity homes.” the efficiency of which varies grcatlg. Some of these arc, or have been, poorly run, providing medical (*are of a mediocre sort. F’rom the point of view of the physician, nothin, 11‘seemsadequate, or just, but proper obstetric care of the sort, which may be had in a well-staffed hospital. It should be said that most hospitals have been willing to undertake their fair share of this task. Some facts are quoted in the TJniversity of Chicago Report to which I have already referred. The great majority of the hospitals which answered a questionnaire as to their attitude toward the unmarried mother responded that they cared for them. During the year 1928, 877 illegitimate babies, out of 1.346 labors. were born in hospitals in Chicago, while, in t,he rest of t,he st,atc, 0111~ 283 labors out of 1,035 were cared for in hospitals. Tn the city of Chicago a few institutions did t,he hulk of t,he work, seven hospitals having cared for 655 cases,
DANFORTH:
UNMARRIED
MOTHER
AS A SOCIAL
PROBLEM
639
While insisting that the obstetric care extended to the unmarried mother and her infant be adequate in quality, neither physicians, who have had experience with these cases, nor social workers, are disposed to insist that all unmarried mothers are wholly worthy women. There are among them some who are irresponsible, lacking in morals and often in intelligence. It is often difficult to make anything more of them than they appear to be at first. Obstetric care and subsequent social help must, however, be given. The social worker, in such cases, has the more difficult task. Our present economic situation probably is responsible for at least some of the illegitimate pregnancies which occur among girls of a much higher social group. The impossibility of supporting a wife and family upon the income of many young men interferes with marriage and the establishment of a home at an age at which it is physiologically desirable. This, unless young people are entirely separated, and hormonal stimuli being what they are, inevitably leads to an occa,sional pregnancy. These young mothers may be girls of education, breeding, refinement, in every way capable of fulfilling the responsibilities of wife and mother. Indeed, their potential worth to society may be greater than that of some of those who condemn them most severely. I, and no doubt many of the readers of this JOURNAL, have seen young women pass through an experience of this sort and later occupy useful and respected positions in their respective communities as wives and mothers. The girl should be persuaded not to have an abortion done. It is dangerous and it evades the situation too easily. The man may be more than willing to adopt a course which will, immediately free him from embarrassment and all of the danger of which is borne by the girl. She is partly responsible for the existence of the unborn human being, and she should give it a fair deal and not take its life. Abortion is merely adding to the wrong already committed another of greater degree. The difficulty may be solved sometimes by sending the expectant mother to some other place, where the infant may be born, and, if necessary, adopted. The mother may then return without harm to her reputation. This device is somewhat more likely to be useful in the case of the unemployed girl whose parents have some means and who may make it possible for her to live away from home for the necessary time. The two things which must be accomplished in any illegitimate pregnancy are the safeguarding of the health of the young woman and the preservation of her self-respect. She should be brought back to normal life in good physical condition and with her morale intact if possible. And she should not return, particularly if she is to work, until her strength is entirely restored. In the case of the very young child, it is difficult to condemn her severely. The blame rather rests upon faulty care and supervision for which the parents are to blame. To assume that she is irreclaimable is an evidence of prejudice rather than justice, especially as young male offenders are labored with in the hope of making useful citizens of them. From the viewpoint of the obstetrician, it is difficult to ima,gine a group of patients who are more completely in need of proper
obstetric care, and au efficient at tcJnlpt. to restorcl 1hr2 child to psychic normality, than these young girls L\ ho have been ~(1 \mfortltnatt? as 10 find themselves among the unwed cspectant mothers. The leaders in obstetrics in this c*onntry believe* t.hat the expectant mother and her infant should have the care \vhicah is due then~ They do not condone immorality, and theft regret that. any wonmn, and particularly a young girl, should be in such a predicament. The broadening of human knowledge has brought. with it great changes in the manner of dealing with the problenls of society. The inadequate and sometimes brutal treatment, it(+C+Or(lt’d to the insane in pwvions ccr1turies has given way, with the tlrvelopment of the science of psychiatry, to a finer, more humane :rnd much more efficient mode of treating those afflicted with disensrs of the mind. The increase in the understanding of criminology has changed very greatly thr mode of dealing with those who have Pallrrk afoul of the la\y. The older, more severe, and often ineffective punishments have given way to a more constructive policy in which the tlrsire for rehabilitation finds expression. Those who have fallen vic~till~s t,cr alcohol and drugs are helped to regain control of themselves. The effort is sometimes successful and ‘sometimes not, but the clesiw IO help these unfortunates back to normal life is better than a universal condemnation. And success has sometimes paid excellent dividends. The change in the attitude toward the unwed mother and her child. and the presence of the latter must never be forgotten, is another evidence of t.he wiser, more tolerant, and more constructive attitude of mind which has come with the pasaing years. The doctor with entire sympathy looks upon the unmarried mother and her child as a problem, bot,h medical and social. Social adjustments can best be made if the mother and her child are in good physical condition. This is most likely to be if obstetric care has been adequate. All of these women cannot be made int,o valuable memhcrs of society. All of the members of the other groups mentioned earlier in this paper may not be fully restored to usefulness. But many can and any physician who has had large experience knows that, in spite of prejudiced statements to the contrary, sorne may be made into useful women. The fac.t that so many of them are very young makes it even more important that they should be given a fair chance. May WC hope that increasing improvement in social and economic conditions may cause the number to be less in the future.
UNMARRIED W.C.
T
MOTHER AS A MEDICAL SOCIAL PROBLEM
DANFORTH, M.D.,F.A.C.S.,
AND
EVANSTON, ILL.
HE mode of dealing with the unmarried mother and her child has come down from The English Poor Law and the English Property Law. In earlier days the bearing of an infant outside of wedlock was not considered an offense against the criminal laws, but the bringing into the world of a child who might become a burden upon the parish in which it was born was an offense. In other words, having a child without being married was not legally wrong but the producing of a child who might add to the sum of public expense was against the law. This attitude, not greatly modified by the passage of time, continued until the beginning of the twentieth century. The changes, legal and otherwise, which have come about, have been largely motivated by organizations of women, who have recognized that the older view of this problem was too severe and that it did not serve the best interests of society. The first move in our own country toward a change in attitude seems to have been the publication in 1920, by the Federal Children’s Bureau, of the first of a number of studies on “Illegitimacy as a Child Welfare Problem.” These have done a great deal of good in emphasizing the fact that, in cases of illegitimacy, there is always an infant, which is wholly innocent and has rights, legal and moral, to consideration. I would quote in this connection from a publication of The School of Social Service Administration of the University of Chicago, which deals comprehensively with the question of illegitimate births in the State of Illinois during the year 1928. We find in that year, in a state with more than seven million people, there were 129,668 births. Of these, 2,381 were illegitimate, or 18.36 per thousand. This study indicates clearly that the problem of the unmarried mother and her infant is one of youth, 84 per cent of the mothers being under twenty-five years of age. Forty per cent were under eighteen years, and 11.06 per cent were fifteen years of age or less. Only 7.05 per cent were over thirty years of age. From the standpoint of the most rudimentary humanity. it seems obvious that, if, in one state in one year, there are 2,381 births out of wedlock, and if 146 of these mothers are girls of fifteen years or less, and 787 more of them are from sixteen to eighteen years of age, we have before us a situation which merits the most careful consideration, not only of social workers and physicians, but of every intelligent and socially minded citizen. The mother and the baby must both be cared for. The insistence which has been made by certain social workers that in all cases the mother be made to keep her child, seems in the face of figures such as those just given, to be ridiculous. What can a child under fifteen, or even the large group of mothers between sixteen and eighteen, do for 637
the support of an infant unless they l~a\.(l families which art’ financially ;~ble ant1 willing to take th,k chilli into I hccir Pamil>- ! This ix oFt(ln not the case. There seems to have been a clefinite trend toward a gentler and tnorc merciful attitude on the part of the law towartl both the unfortunate unmarried mother and her child. 111a decision rendered in one of the c0urt.s of the State of Illinois. the following expression seems significant : “The harsh doctrines of the common law which gave au LLUmarried mother and her illegitimate child little standing or protection, have been modified by the legislature and court decisions of this state.” The very sane conclusion of the t~sex4lent st.udy from which I have quoted is that “the child born out of wedlock should be considered first, as a child, and accorded at least an approshnation of the rights accorded other children.” During a service of two years on a Cotllmittee of the Chicago (louneil of Social Agencies, which tried to draw up an improved adoption law for the State of Illinois. I \v;\s strllck with the fact that t,he infant is not yet adequately protectctl. As most adoptions are of illegitimately born chilclren, this primarily concerns t.his group of children. In adoptions, the interests of the child demand that a home be found which is suitable for the child rather than to find babies for homes which arp childless. .tn some cases the latter motive seems to be the ruling one. Adequate protection of the c?hiltl to he adopted should be provided in all states. The question which particularly interest,s physicians is the medical care which this group should rer4v-e. Hans Zinsser of Harvard, in his recent book, speaks of t,he doctor as bein,0‘ so conditioned, by his training, that he is indifferent. to social st.atus, morality, or even eriminality in those who come under his hand as patients. The unwed expectant mother, to him, is a pregnant woman who presents exactly the same obstetric problem which her more fortunate married sist,er does. The care of both the mother and the infant aft,erward may be. and in many cases is, a social pr~ohlem. to be dealt with by those who are competent in the field of social service. There is a clear-cut need for both efficient medical care and c+ompetent~help in making such social adjustments as may be needed. Many illegitimate births have been cared for in “maternity homes.” the efficiency of which varies grcatlg. Some of these arc, or have been, poorly run, providing medical (*are of a mediocre sort. F’rom the point of view of the physician, nothin, 11‘seemsadequate, or just, but proper obstetric care of the sort, which may be had in a well-staffed hospital. It should be said that most hospitals have been willing to undertake their fair share of this task. Some facts are quoted in the TJniversity of Chicago Report to which I have already referred. The great majority of the hospitals which answered a questionnaire as to their attitude toward the unmarried mother responded that they cared for them. During the year 1928, 877 illegitimate babies, out of 1.346 labors. were born in hospitals in Chicago, while, in t,he rest of t,he st,atc, 0111~ 283 labors out of 1,035 were cared for in hospitals. Tn the city of Chicago a few institutions did t,he hulk of t,he work, seven hospitals having cared for 655 cases,
DANFORTH:
UNMARRIED
MOTHER
AS A SOCIAL
PROBLEM
639
While insisting that the obstetric care extended to the unmarried mother and her infant be adequate in quality, neither physicians, who have had experience with these cases, nor social workers, are disposed to insist that all unmarried mothers are wholly worthy women. There are among them some who are irresponsible, lacking in morals and often in intelligence. It is often difficult to make anything more of them than they appear to be at first. Obstetric care and subsequent social help must, however, be given. The social worker, in such cases, has the more difficult task. Our present economic situation probably is responsible for at least some of the illegitimate pregnancies which occur among girls of a much higher social group. The impossibility of supporting a wife and family upon the income of many young men interferes with marriage and the establishment of a home at an age at which it is physiologically desirable. This, unless young people are entirely separated, and hormonal stimuli being what they are, inevitably leads to an occa,sional pregnancy. These young mothers may be girls of education, breeding, refinement, in every way capable of fulfilling the responsibilities of wife and mother. Indeed, their potential worth to society may be greater than that of some of those who condemn them most severely. I, and no doubt many of the readers of this JOURNAL, have seen young women pass through an experience of this sort and later occupy useful and respected positions in their respective communities as wives and mothers. The girl should be persuaded not to have an abortion done. It is dangerous and it evades the situation too easily. The man may be more than willing to adopt a course which will, immediately free him from embarrassment and all of the danger of which is borne by the girl. She is partly responsible for the existence of the unborn human being, and she should give it a fair deal and not take its life. Abortion is merely adding to the wrong already committed another of greater degree. The difficulty may be solved sometimes by sending the expectant mother to some other place, where the infant may be born, and, if necessary, adopted. The mother may then return without harm to her reputation. This device is somewhat more likely to be useful in the case of the unemployed girl whose parents have some means and who may make it possible for her to live away from home for the necessary time. The two things which must be accomplished in any illegitimate pregnancy are the safeguarding of the health of the young woman and the preservation of her self-respect. She should be brought back to normal life in good physical condition and with her morale intact if possible. And she should not return, particularly if she is to work, until her strength is entirely restored. In the case of the very young child, it is difficult to condemn her severely. The blame rather rests upon faulty care and supervision for which the parents are to blame. To assume that she is irreclaimable is an evidence of prejudice rather than justice, especially as young male offenders are labored with in the hope of making useful citizens of them. From the viewpoint of the obstetrician, it is difficult to ima,gine a group of patients who are more completely in need of proper
obstetric care, and au efficient at tcJnlpt. to restorcl 1hr2 child to psychic normality, than these young girls L\ ho have been ~(1 \mfortltnatt? as 10 find themselves among the unwed cspectant mothers. The leaders in obstetrics in this c*onntry believe* t.hat the expectant mother and her infant should have the care \vhicah is due then~ They do not condone immorality, and theft regret that. any wonmn, and particularly a young girl, should be in such a predicament. The broadening of human knowledge has brought. with it great changes in the manner of dealing with the problenls of society. The inadequate and sometimes brutal treatment, it(+C+Or(lt’d to the insane in pwvions ccr1turies has given way, with the tlrvelopment of the science of psychiatry, to a finer, more humane :rnd much more efficient mode of treating those afflicted with disensrs of the mind. The increase in the understanding of criminology has changed very greatly thr mode of dealing with those who have Pallrrk afoul of the la\y. The older, more severe, and often ineffective punishments have given way to a more constructive policy in which the tlrsire for rehabilitation finds expression. Those who have fallen vic~till~s t,cr alcohol and drugs are helped to regain control of themselves. The effort is sometimes successful and ‘sometimes not, but the clesiw IO help these unfortunates back to normal life is better than a universal condemnation. And success has sometimes paid excellent dividends. The change in the attitude toward the unwed mother and her child. and the presence of the latter must never be forgotten, is another evidence of t.he wiser, more tolerant, and more constructive attitude of mind which has come with the pasaing years. The doctor with entire sympathy looks upon the unmarried mother and her child as a problem, bot,h medical and social. Social adjustments can best be made if the mother and her child are in good physical condition. This is most likely to be if obstetric care has been adequate. All of these women cannot be made int,o valuable memhcrs of society. All of the members of the other groups mentioned earlier in this paper may not be fully restored to usefulness. But many can and any physician who has had large experience knows that, in spite of prejudiced statements to the contrary, sorne may be made into useful women. The fac.t that so many of them are very young makes it even more important that they should be given a fair chance. May WC hope that increasing improvement in social and economic conditions may cause the number to be less in the future.