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Women—the Impact of Advances in Fertility Control on Their Future: A Presidential Address*
Vol. 22, No.6, June 1971 Printed in U.S.A.
FERTILITY AND STERILITY
Copyright
©
1971 by The Williams & Wilkins Co.
WOMEN-THE IMPACT OF ADVANCES IN FERTILITY CONTROL ON THEIR FUTURE A Presidential Address* GEORGEANNA SEEGAR JONES, M.D.
Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland
.
t
i
In a Presidential Address, one is privileged to foresake the hard facts of science and to philosophize. This address will be somewhat philosophic, somewhat speculative, but based upon my experience as a woman women's doctor, I hope it will be provocative. It is a truism to say the place of women in the world today has and is changing, but this change has been possible to a large extent through advances contributed by our supraspeciality, many of these advances, which were in fact inaugurated and implemented by members of this very society. We have seen the society grow from a small group of people initially interested in problems of infertility broadening into an interest in reproductive pathophysiology, and finally encompassing all areas of fertility including contraception and demography. What lies ahead for us in the next 20 years? It has been only yesterday, in the broad perspective of history since the beginning of time, that women have been considered, anywhere in the world, as other than property. True, in many instances, the most prized property, but still property. The biologic demands of human reproduction and child raising have made this so but, largely through your efforts, this is no longer true. Although control of population has been practiced throughout the history of man, as far as we know this has, until quite recently, taken the form of infanticide. This, * Presented at the Twenty-Seventh Annual Meeting of the American Fertility Society, March 25-27, 1971, New Orleans, Louisiana.
though relieving the woman and "family group" of child nursing and rearing, still left her with the burden of pregnancy and delivery. As more sophistication developed, men learned to control their fertility. Phallus splitting with deposition of semen externally seems to be one of the more ingenious methods devised. Coitus interruptus was developed late in the Middle Ages, and finally the condom made its appearance. By these technics man controlled the family destiny. Finally, in the first part of the 20th Century, and largely developed in this country, diaphragm contraception allowed women some control over their own reproductive capacity. But it was really not until the era of the pill in the 60's that absolute control of reproduction, which allowed women to separate their reproductive capacities from their sexual activities, was a reality. The development of improved intrauterine devices and rapid methods for tubal sterilization have all contributed. This new dimension in self-determination, along with the universal concern for global overpopulation, led to the further step of legalized abortion. The tremendous economic pressures present in Japan after the second World War had demonstrated the efficiency of this measure in rapidly accomplishing national population control. With the present technology then, imperfect though it may be, we have the potential at this moment, in this country, to accomplish the demographer's stated ideal of "two children to every family," and thereby theoretically accomplish the sociologist's ideal "every
347
348
JONES
child a wanted child." Now what? I submit that our next two goals, which are intimately interwoven should be (1) improvement of quality of the progeny; and (2) education of women to be happy, productive, and fulfilled in their expanded role of individuals as well as reproducers and thereby better mothers, if they choose to assume this role. It is interesting how each changing sociologic factor affects another. Already in the State of Maryland, with legalized abortion only 2 years old, the adoption agencies have no babies for adoption and are sending clients to the Infertility Clinic for counseling. Thus, the obstetrical deliveries have declined, while the Infertility Clinics have increased. Another unexpected finding has been that the prematurity rate has dropped dramatically. Does this mean that the unwanted child was in fact also conceived as a high risk pregnancy and thus, subject to the increased hazards of such high risk pregnancies, e.g., fetal anomalies, brain damage, mental retardation and mental illness? Are we then, by preventing the birth of these unwanted children, already improving the quality of future progeny? It is obvious that we need to improve all aspects of genetic counseling, and to continue our investigations into the effects of nutrition on fetal development, particularly neurologic development. As an addendum, it is interesting to speculate on this aspect of the development of the species. Is it possible that evolution and survival of the fittest has contrived to build also into this scheme survival of the more humanized? The male has always been the hunter. The female the gatherer. To him belonged the protein, to her the carbohydrate. Is it possible that those men, with consideration and compassion enough to feed their pregnant wives protein, thereby improved their offspring and insured their own tribal survival? Pure fantasy! But let us move from an area of established science, genetic counseling, and fetal monitoring, into an area
Vol. 22
for future consideration. The investigation of the ideal environment for raising children. This brings us face to face with the question of the monogamous marriage and family formation. There are those in the field of education who believe that the monogamous family unit is not only not the ideal setting for child raising, but actually detrimental and should be destroyed by any possible means. In addition to these educators, who seek to do this thoughtfully, there are those who seem to be bent on doing it unwittingly, for our young people who use sex as a method of communication or as a game are establishing habit patterns which have been previously shown to be largely incompatible with successful monogamous marriages. Thus, they are, either through ignorance or self-indulgence, destroying this social system. How do we then counsel our young people who are exploiting or allowing exploitation of their sex? There is a difference in accepting the sex act as a joyful and beautiful experience and in regarding it as "the big girl's game," the diaphragm as the "big girl's toy," as one of my college patients expressed it. Sex which is for fun and games, without the deep personal commitment and responsibility to the other individual involved, is an impersonalization and escape from reality. If we say we do not care how a person behaves sexually, so long as he or she does not add to the birthrate, illegitimacy rate, or venereal disease rate, we are saying we do not care about humane, responsible, and sensitive sexuality. We should care about the fulfillment of the individual as a total person. Irresponsible sex behavior, e.g., the separation of the sexual act from the acceptance of responsibility, is a sign of immaturity. Maturity is knowledge and acceptance of the necessity to make choices, and the ability to make these choices, taking into consideration the fact that every action taken affects other individuals, family, friends, and society. Experience indicates that far from learning or ma-
June 1971
..
t
j.
PRESIDENTIAL ADDRESS
turing from casual sexual experiences, immature habit patterns are established, and these are not conducive to successful monogamous marriage patterns. I submit that when youngsters come requesting contraceptive advice to indulge in this type of behavior, they should be given some awareness of the possible consequences to society oftheir actions. This paragraph is in the subjunctive mood. Further documentation of the facts is needed. What is the alternative to the family? A state institution for child raising or adoption of children by the state? Surely this would be preferable to the battered child syndrome but, if we are to attain the ideal of every child a wanted child, it would seem that theoretically we do not need the state to raise the children. This experiment furthermore has been tried in Russia in 1918 and in Israel, first in 1901 and later and more extensively since 1948, and finally in China, although this we must ignore because as far as I know, there are no facts available about the Chinese experiment. Tne facts about the Russian and Israel experiment are available. In both Russia and Israel the institutionalization of child rearing was attempted in order to raise the status of women to that of an individual equal to and with equal opportunities of man. In 1948, Russia abandoned this approach and returned to the family situation encouraging monogamous marriages. The stated reason was for the better education and development of the children. In Israel, after twenty some years of experience, the system of institutionalized child rearing has been largely abandoned, and the majority of families maintain their children within the home. These were both experiments performed in good faith and with high expectations and can only be called failures. The reason for these failures seems obvious, if we consider that children do not become human automatically by being born. They must learn to be human. Institutions are by and large dehumanized. The best learn-
349
ing experiences are by example, and the experiences of Money and Hampson and Hampson indicate that the first 2 years of life may be the most important in this respect. To learn to be truly human, a child should have both a mother and a father figure for an example, but this brings us to our second point. We need preparation for both mother and fatherhood. How do we prepare our women to be well-adjusted, contributing members of society, if they are not to be allowed to plan their lives around bearing and rearing large numbers of offspring? The first step must be to train our patients of today, and in tum their husbands, to raise their daughters from the day of birth with this concept. They are people in their own right who must choose their field of endeavor to excel therein, or express their creativity, or derive their satisfactions and fulfillment from a job well-done. If in addition they choose to bear and raise children, they should plan specifically for this interlude in their lives. But not one should feel that this is an expected obligation. Some are suited, others are not. Both life patterns are acceptable. Child rearing patterns, which train women only for roles of housewives and mothers, cannot be considered appropriate in the last quarter of the 20th Century. Work and family must be balanced. Family formation is to be regarded as a time away from work. Society in tum must be arranged so that women will be able to fulfill their time-limited biologic and related social responsibilities while continuing to develop and express their own individuality. We need to provide a number of human service outlets for both men and women to substitute for the needs of loving and being loved, the sense of importance and the opportunity to protect, which is lost when there is no family or a small family. We need to learn to recognize those who should not plan child rearing and help them to recognize themselves. In closing, we have come a long way in
350
JONES
the past decade in achieving the goals of two children or no children to every family and every child a wanted child. What will be the effects of these aims if achieved? First, we must make sure that the quality of those two children is the best by controlling all those factors related to fetal growth and development, but also by studying those factors which relate to environmental development. Secon<;i, we must educate women to use their fifth freedom* wisely. I am reminded of my friend from Holland who remarked that she did not care to be asked who her father was or where her brothers went to school. She preferred to be asked, "What do you think?" Ladies who wish to be asked "What do you think?" must learn to think. REFERENCES BETTELHEIM, B. The Children of the Dream: Communal Child-Rearing and American Education. MacMillan, New York, 1969. BULLOUGH, V. L. The History of Prostitution. Unity Books, Lee's Summit, Mo., 1964. CALVERTON, V. F., AND SCHMALHAUSEN, S. D. Sex in Civilization. MacCauley, New York, 1929. CHiLMAN, C. S. Probable social and psychological consequences of an american population policy aimed at the two-child family. Ann N Y Acad Sci 175:868, 1970. GEIGER, H. K. The Family in Soviet Russia. Harvard Univ. Press, Cambridge, Mass., 1968.
* Sir Dugal Baird: "Capacity to Control One's Own Fertility."
Vol. 22
HALL, M. H. A conversation with Masters and Johnson. Psychol Today 3 (suppl. 2):50,1969. KINGSBURY, S. H. AND FAIRCHILD, M. F. Factory, Family and Women in the Soviet Union. Putnam, New York, 1935. KOMAROVSKY, M. Blue-Collar Marriage. Random House, New York, 1964. Koos, E. Families in Trouble. King's Crown Press, Oxford, Eng., 1946. MACE, D., AND MACE, V. The Soviet Family. Doubleday, New York, 1963. MAKARENKO, A. S. The Collective Family. Daglish, R. Trans. Doubleday, New York, 1967. MALINOWSKI, B. Sex and Repression in Savage Society. Humanities Press, New York, 1927. MALINOWSKI, B. Sex, Culture and Myth. Harcourt, New York, 1962. MEAD, M. "Cultural Determinants of Sexual Behavior." In Sex and Internal Secretions (vol. 2, ed. 3), Young, W. C., Ed. Williams & Wilkins, Baltimore, 1961,pp.1433-1479. MILNER, E. Our species learns to be human. Ann N Y Acad Sci 175:935, 1970. O'NEILL, W. Divorce in the Progressive Era. Yale Univ. Press. New Haven, Conn., 1967. PARSONS, T., AND BALES, R. Family, Socialization and Interaction Process. Free Press, New York, 1955. PLATO. "The Communal Rearing of Children." In The Republic. Book 5. RUDERMAN, F. A. Our species learns to be human: some societal and individual life-career implications. Ann NY Acad Sci 175:918, 1970. SCHLESINGER, R. The Family in the USSR. Routledge, London, 1949. SCHUR, E. M., Ed. The Family and the Sexual Revolution. Univ. Indiana, Bloomington, Ind., 1964. WESTERMARCK, E. The Future of Marriage in Western Civilization. MacMillan, London, 1936. WINCH, R. F., MCGINNINS, R., AND BARRINGER, H. R., Eds. Selected Studies in Marriage and the Family. Holt, Rinehart, New York, 1962.
t
FERTILITY AND STERILITY
Copyright
©
1971 by The Williams & Wilkins Co.
WOMEN-THE IMPACT OF ADVANCES IN FERTILITY CONTROL ON THEIR FUTURE A Presidential Address* GEORGEANNA SEEGAR JONES, M.D.
Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland
.
t
i
In a Presidential Address, one is privileged to foresake the hard facts of science and to philosophize. This address will be somewhat philosophic, somewhat speculative, but based upon my experience as a woman women's doctor, I hope it will be provocative. It is a truism to say the place of women in the world today has and is changing, but this change has been possible to a large extent through advances contributed by our supraspeciality, many of these advances, which were in fact inaugurated and implemented by members of this very society. We have seen the society grow from a small group of people initially interested in problems of infertility broadening into an interest in reproductive pathophysiology, and finally encompassing all areas of fertility including contraception and demography. What lies ahead for us in the next 20 years? It has been only yesterday, in the broad perspective of history since the beginning of time, that women have been considered, anywhere in the world, as other than property. True, in many instances, the most prized property, but still property. The biologic demands of human reproduction and child raising have made this so but, largely through your efforts, this is no longer true. Although control of population has been practiced throughout the history of man, as far as we know this has, until quite recently, taken the form of infanticide. This, * Presented at the Twenty-Seventh Annual Meeting of the American Fertility Society, March 25-27, 1971, New Orleans, Louisiana.
though relieving the woman and "family group" of child nursing and rearing, still left her with the burden of pregnancy and delivery. As more sophistication developed, men learned to control their fertility. Phallus splitting with deposition of semen externally seems to be one of the more ingenious methods devised. Coitus interruptus was developed late in the Middle Ages, and finally the condom made its appearance. By these technics man controlled the family destiny. Finally, in the first part of the 20th Century, and largely developed in this country, diaphragm contraception allowed women some control over their own reproductive capacity. But it was really not until the era of the pill in the 60's that absolute control of reproduction, which allowed women to separate their reproductive capacities from their sexual activities, was a reality. The development of improved intrauterine devices and rapid methods for tubal sterilization have all contributed. This new dimension in self-determination, along with the universal concern for global overpopulation, led to the further step of legalized abortion. The tremendous economic pressures present in Japan after the second World War had demonstrated the efficiency of this measure in rapidly accomplishing national population control. With the present technology then, imperfect though it may be, we have the potential at this moment, in this country, to accomplish the demographer's stated ideal of "two children to every family," and thereby theoretically accomplish the sociologist's ideal "every
347
348
JONES
child a wanted child." Now what? I submit that our next two goals, which are intimately interwoven should be (1) improvement of quality of the progeny; and (2) education of women to be happy, productive, and fulfilled in their expanded role of individuals as well as reproducers and thereby better mothers, if they choose to assume this role. It is interesting how each changing sociologic factor affects another. Already in the State of Maryland, with legalized abortion only 2 years old, the adoption agencies have no babies for adoption and are sending clients to the Infertility Clinic for counseling. Thus, the obstetrical deliveries have declined, while the Infertility Clinics have increased. Another unexpected finding has been that the prematurity rate has dropped dramatically. Does this mean that the unwanted child was in fact also conceived as a high risk pregnancy and thus, subject to the increased hazards of such high risk pregnancies, e.g., fetal anomalies, brain damage, mental retardation and mental illness? Are we then, by preventing the birth of these unwanted children, already improving the quality of future progeny? It is obvious that we need to improve all aspects of genetic counseling, and to continue our investigations into the effects of nutrition on fetal development, particularly neurologic development. As an addendum, it is interesting to speculate on this aspect of the development of the species. Is it possible that evolution and survival of the fittest has contrived to build also into this scheme survival of the more humanized? The male has always been the hunter. The female the gatherer. To him belonged the protein, to her the carbohydrate. Is it possible that those men, with consideration and compassion enough to feed their pregnant wives protein, thereby improved their offspring and insured their own tribal survival? Pure fantasy! But let us move from an area of established science, genetic counseling, and fetal monitoring, into an area
Vol. 22
for future consideration. The investigation of the ideal environment for raising children. This brings us face to face with the question of the monogamous marriage and family formation. There are those in the field of education who believe that the monogamous family unit is not only not the ideal setting for child raising, but actually detrimental and should be destroyed by any possible means. In addition to these educators, who seek to do this thoughtfully, there are those who seem to be bent on doing it unwittingly, for our young people who use sex as a method of communication or as a game are establishing habit patterns which have been previously shown to be largely incompatible with successful monogamous marriages. Thus, they are, either through ignorance or self-indulgence, destroying this social system. How do we then counsel our young people who are exploiting or allowing exploitation of their sex? There is a difference in accepting the sex act as a joyful and beautiful experience and in regarding it as "the big girl's game," the diaphragm as the "big girl's toy," as one of my college patients expressed it. Sex which is for fun and games, without the deep personal commitment and responsibility to the other individual involved, is an impersonalization and escape from reality. If we say we do not care how a person behaves sexually, so long as he or she does not add to the birthrate, illegitimacy rate, or venereal disease rate, we are saying we do not care about humane, responsible, and sensitive sexuality. We should care about the fulfillment of the individual as a total person. Irresponsible sex behavior, e.g., the separation of the sexual act from the acceptance of responsibility, is a sign of immaturity. Maturity is knowledge and acceptance of the necessity to make choices, and the ability to make these choices, taking into consideration the fact that every action taken affects other individuals, family, friends, and society. Experience indicates that far from learning or ma-
June 1971
..
t
j.
PRESIDENTIAL ADDRESS
turing from casual sexual experiences, immature habit patterns are established, and these are not conducive to successful monogamous marriage patterns. I submit that when youngsters come requesting contraceptive advice to indulge in this type of behavior, they should be given some awareness of the possible consequences to society oftheir actions. This paragraph is in the subjunctive mood. Further documentation of the facts is needed. What is the alternative to the family? A state institution for child raising or adoption of children by the state? Surely this would be preferable to the battered child syndrome but, if we are to attain the ideal of every child a wanted child, it would seem that theoretically we do not need the state to raise the children. This experiment furthermore has been tried in Russia in 1918 and in Israel, first in 1901 and later and more extensively since 1948, and finally in China, although this we must ignore because as far as I know, there are no facts available about the Chinese experiment. Tne facts about the Russian and Israel experiment are available. In both Russia and Israel the institutionalization of child rearing was attempted in order to raise the status of women to that of an individual equal to and with equal opportunities of man. In 1948, Russia abandoned this approach and returned to the family situation encouraging monogamous marriages. The stated reason was for the better education and development of the children. In Israel, after twenty some years of experience, the system of institutionalized child rearing has been largely abandoned, and the majority of families maintain their children within the home. These were both experiments performed in good faith and with high expectations and can only be called failures. The reason for these failures seems obvious, if we consider that children do not become human automatically by being born. They must learn to be human. Institutions are by and large dehumanized. The best learn-
349
ing experiences are by example, and the experiences of Money and Hampson and Hampson indicate that the first 2 years of life may be the most important in this respect. To learn to be truly human, a child should have both a mother and a father figure for an example, but this brings us to our second point. We need preparation for both mother and fatherhood. How do we prepare our women to be well-adjusted, contributing members of society, if they are not to be allowed to plan their lives around bearing and rearing large numbers of offspring? The first step must be to train our patients of today, and in tum their husbands, to raise their daughters from the day of birth with this concept. They are people in their own right who must choose their field of endeavor to excel therein, or express their creativity, or derive their satisfactions and fulfillment from a job well-done. If in addition they choose to bear and raise children, they should plan specifically for this interlude in their lives. But not one should feel that this is an expected obligation. Some are suited, others are not. Both life patterns are acceptable. Child rearing patterns, which train women only for roles of housewives and mothers, cannot be considered appropriate in the last quarter of the 20th Century. Work and family must be balanced. Family formation is to be regarded as a time away from work. Society in tum must be arranged so that women will be able to fulfill their time-limited biologic and related social responsibilities while continuing to develop and express their own individuality. We need to provide a number of human service outlets for both men and women to substitute for the needs of loving and being loved, the sense of importance and the opportunity to protect, which is lost when there is no family or a small family. We need to learn to recognize those who should not plan child rearing and help them to recognize themselves. In closing, we have come a long way in
350
JONES
the past decade in achieving the goals of two children or no children to every family and every child a wanted child. What will be the effects of these aims if achieved? First, we must make sure that the quality of those two children is the best by controlling all those factors related to fetal growth and development, but also by studying those factors which relate to environmental development. Secon<;i, we must educate women to use their fifth freedom* wisely. I am reminded of my friend from Holland who remarked that she did not care to be asked who her father was or where her brothers went to school. She preferred to be asked, "What do you think?" Ladies who wish to be asked "What do you think?" must learn to think. REFERENCES BETTELHEIM, B. The Children of the Dream: Communal Child-Rearing and American Education. MacMillan, New York, 1969. BULLOUGH, V. L. The History of Prostitution. Unity Books, Lee's Summit, Mo., 1964. CALVERTON, V. F., AND SCHMALHAUSEN, S. D. Sex in Civilization. MacCauley, New York, 1929. CHiLMAN, C. S. Probable social and psychological consequences of an american population policy aimed at the two-child family. Ann N Y Acad Sci 175:868, 1970. GEIGER, H. K. The Family in Soviet Russia. Harvard Univ. Press, Cambridge, Mass., 1968.
* Sir Dugal Baird: "Capacity to Control One's Own Fertility."
Vol. 22
HALL, M. H. A conversation with Masters and Johnson. Psychol Today 3 (suppl. 2):50,1969. KINGSBURY, S. H. AND FAIRCHILD, M. F. Factory, Family and Women in the Soviet Union. Putnam, New York, 1935. KOMAROVSKY, M. Blue-Collar Marriage. Random House, New York, 1964. Koos, E. Families in Trouble. King's Crown Press, Oxford, Eng., 1946. MACE, D., AND MACE, V. The Soviet Family. Doubleday, New York, 1963. MAKARENKO, A. S. The Collective Family. Daglish, R. Trans. Doubleday, New York, 1967. MALINOWSKI, B. Sex and Repression in Savage Society. Humanities Press, New York, 1927. MALINOWSKI, B. Sex, Culture and Myth. Harcourt, New York, 1962. MEAD, M. "Cultural Determinants of Sexual Behavior." In Sex and Internal Secretions (vol. 2, ed. 3), Young, W. C., Ed. Williams & Wilkins, Baltimore, 1961,pp.1433-1479. MILNER, E. Our species learns to be human. Ann N Y Acad Sci 175:935, 1970. O'NEILL, W. Divorce in the Progressive Era. Yale Univ. Press. New Haven, Conn., 1967. PARSONS, T., AND BALES, R. Family, Socialization and Interaction Process. Free Press, New York, 1955. PLATO. "The Communal Rearing of Children." In The Republic. Book 5. RUDERMAN, F. A. Our species learns to be human: some societal and individual life-career implications. Ann NY Acad Sci 175:918, 1970. SCHLESINGER, R. The Family in the USSR. Routledge, London, 1949. SCHUR, E. M., Ed. The Family and the Sexual Revolution. Univ. Indiana, Bloomington, Ind., 1964. WESTERMARCK, E. The Future of Marriage in Western Civilization. MacMillan, London, 1936. WINCH, R. F., MCGINNINS, R., AND BARRINGER, H. R., Eds. Selected Studies in Marriage and the Family. Holt, Rinehart, New York, 1962.
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