In many countries today, gynecologists seem to lead a professional life of permanent contradictions. Thus, in the course of a single morning, they may be expected to sterilize someone and to reverse a sterilization. They may be asked for a safe contraceptive and for artificial insemination. They may have to assist in the birth of a child and immediately thereafter perforrn an abortion. Indeed, they may do all this not only on the same day for different patients, but for one and the same patient over a period of time.
This simple observation hints at an obvious individual and professional ambivalence toward human fertility, and, as even a superficial historical study reveals, this ambivalence is not a modern phenomenon. Technological and scientific progress have perhaps sharpened the issue by increasing and refining the options, but they have not created it. Fertility and infertility have always provoked mixed human responses. In short, the physician who wonders how he should meet the contlicting demands of our time is actually dealing with age old problems which have never been settled, and which may simply be part of the human condition.
The ambiguous history of human procreation is perhaps best illuminated by a discussion of two perennial descrepancies: that between actual and potential births and that between actual and potential population growth.
Tuming to the first of these discrepancies, we discover that the human race has never tried to reproduce to its full capacity. That is to say, human fertility (measured in actual births) has never matched human fecundity (measured in potential births). No society, past or present, has ever allowed reproduction to its biological limit. All societies have, more or less consciously, created obstacles to fertility, and, following Kingsley Davis, we can divide these into five groups: 1. Taboos on the association of males and females (purdah, celibacy, status and financial barriers), 2. taboos on sexual intercourse (marriage age limits, prohibition of intercourse before and outside of marriage, or after childbirth), 3. restraints on conception (castration, sterilization, contraception), 4. abortion, and 5. infanticide (in case of plural births, unwanted females, illegitimate births, defommed or weak children) (Davis 1949: 557 561).
Of course, while all of these obstacles to fertility may be present in a certain society, they may not all receive an official endorsement. Still, at least some of them are always openly recognized and justified. This is true in spite of the fact that fertility has long been one of the most widely accepted human ideals. To "be fruitful and multiply", has been the declared goal of most individual families, tribes, and whole nations since the dawn of history.
Indeed, this goal usually also had the support of religious belief, as for example in the once nearly universal fertility cults. Nevertheless, even then fertility was not an absolute value. For instance, in ancient Greece, where various fertility cults were still openly practiced, one also found socially approved contraception, abortion, and infanticide. Indeed, Aristotle even derived the origin of homosexual behavior from a political decision to limit the population of Crete (Politics, II, 10).
Such attitudes, on the other hand, seem to be contradicted by the so called Hippocratic Oath which expressly prohibits abortion. The very fact however that the oath was deemed necessary proves that abortion was a widespread practice. In fact, the Hippocratic school itself practiced it, and the famous, but misattributed oath has been shown to be document of an atypical small religious group of physicians, possibly linked to Pythagoras (Pollack 1969: 130 133 ; Dolan & Adams Smith 1978: 28 31).
It is also quite interesting to note that the present great world religions originally developed in response or even opposition to older fertility cults and certain sexual customs associated with them. Hinduism, as a syncretistic religion, simply absorbed a fertility cult in the worship of Shiva as a god of reproduction. Buddhism, in contrast, derived its first impetus from an ascetic rebellion against all earthly entanglements, including family and offspring. Judaism fought long and hard against the baals, local fertility gods. Christianity suppressed the licentious Greek and Roman fertility rites, and Islam started as a refomm movement which, among other things, restricted the Arab polygamy of its time (Fagley 1960).
We know however that after some transformation, the ideal of fertility survived not only in Islam and Judaism, where it formed the "reproductive bias" of Mosaic law, but also in the Christian Church. After an initial period of indifference to worldly matters, a strong pronatalist sexual morality was adopted, and even some pagan fertility rites survived, in Christianized form, well beyond the Middle Ages (Wright 1866).
Taking a long view of these developments, one cannot be surprised to discover a certain ambivalence in our cultural heritage. Throughout history, our ancestors have both promoted and discouraged fertility, often at the same time. Still, one should not assume that these policies were necessarily always in conflict, because they were often directed at different segments of society or reflected some larger policy design, such as eugenics or an effort to raise the standard of living. Fertility then simply became one of several factors which invited manipulation.
Quite apart from such considerations, however, we know that our own Judeo Christian tradition has long limited fertility by supporting restrictions on male female associations as well as on sexual intercourse.
Such support may have been more selective with regard to sterilization, contraception and abortion, but it seems to have grown in recent years. Only infanticide remains strongly and universally condemned by Jewish and Christian authorities.
To the extent that our culture today supports more limitations on fertility than before, it is of course, responding to the modern dramatic world population growth produced by a lowering of the death rate. In previous ages this growth had been so gradual as to be almost imperceptible. In times of plenty some populations saw a great increase, but famine, disease, and war sooner or later produced a great loss, and thus the general population curve, with various zigzag movements, climbed at an extremely slow pace. For example, it is estimated that the population of India in the fourth century B.C. was approximately 100 million, and at the beginning of the seventeenth century A.D. it was still the same. Thus, in two thousand years there was virtually no population growth. Since that time however India's population has doubled to 200 million and then again tripled to over 600 million (Thomlinson 1965:11).
As already mentioned, this kind of unprecedented increase became possible through a sharp drop in the death rate, which, in turn, was caused by scientific industrial progress. In the case of India, of course, such progress was not organically home grown, but rather imported from (or imposed by) Western colonial powers. Thus, the Indian birth rate still reflected pre industrial reproductive habits, and the accumulative population growth became all the more dramatic. (World wide, because of a lower death rate, a proportionally larger and still growing segment of the population is now engaged in reproduction. In some countries, many couples in this segment may, very well individually, have fewer children than their ancestors had, but the grand total of all of these couples nevertheless produces a greater increase than ever before.)
In the fast developing West, the increase, while substantial, was far less pronounced, because people almost "naturally" developed new attitudes while creating their industrial system. Beginning in the seventeenth century, improved industrial and agricultural production made food and other necessities regularly available to a greater number of people, thus raising the general life expectancy. In the nineteenth century medical science and improved sanitation lowered mortality even further, and thus the population could increase at an even faster rate. On the other hand, and this is important, with their increasing health, longevity, and comfort, people also found new reasons to limit their families. As a result, amidst a generally growing population, fertility gradually declined.
One must understand, however, that the general change in attitude was not restricted to individuals. The industrial revolution created not only a "new man" with different values and personal habits, but also new forms of government and new social forces. Indeed, in the eighteenth century, as individuals began to adjust to the emerging modern world, governments discovered "population" as a phenomenon and as a problem. The population was not merely a sum of loyal "subjects" or another name for "the people", but a new concept describing an entity amenable to deliberate planning. Birth and death rates, life expectancy, housing, educational level, general hygiene, income distribution, production and consumption began to appear as manageable factors or at least as matters of legitimate government concern (Foucault 1976).
Needless to say, the Age of Enlightenment saw here an opportunity for improving the human lot and for eventually bringing about a perfect society. Social utopians like William Godwin and the Marquis de Condorcet envisioned an ideal future as a result of increasing rational control over all natural and social forces.1 Some more conservative writers expressed certain misgivings, but could not dampen the general spirit of hope.
Malthus then tried to explain the discrepancy and found that it reflected the contrast between two unequal powers—the enormous capacity of the human race to produce children and the modest capacity of the earth to produce food. When unchecked, the first of these capacities would grow at a geometrical rate (1, 2, 4, 8, 16, 32, etc.), while the second would grow only arithmetically (1,2,3,4,5,6, etc.). It followed that the population had to be limited, and this was accomplished by the operation of two unpleasant permanent checks—misery and vice. Furthermore, both of these checks were mutually exclusive, but together exhaustive, and thus each of them could be weakened only by strengthening the other. Vice could be reduced only by increasing misery and vice versa.
This assertion later became known as the "dismal theorem", because it implies that populations will always grow to the point where they become either vicious or miserable or both. Indeed, it was noted that the theorem had a worse corollary known as the "utterly dismal theorem", because, if Malthus was correct, all human progress, every improvement in the conditions of life, would, in the long run, only increase the population and thus also increase the total amount of misery and vice.
Actually, Malthus had no desire to become the father of a new, "dismal science". As a mild mannered and benevolent clergyman, he was dismayed by his own thesis and, from the very beginning, asked for as much criticism as possible. It was with a sense of relief, therefore, that he followed a suggestion by Godwin and amended "some of the harshest conclusions" of his essay. As a result, in a revised and expanded edition, Malthus was able to overcome the earlier dilemma by adding a third population check moral restraint, whose widespread application could reduce both misery and vice.
Malthus defined this moral restraint very narrowly however as "the restraint from marriage which is not followed by irregular gratifications." (Malthus 1803: I. 15; 1970: 25). Apparently, it did not occur to him that even married couples might exercise some restraint and consciously limit the size of their families. Of course, for Malthus abortion and contraception were vices, but it is strange that he did not even consider the option of sexual abstinence within marriage. On the other hand, it is possible to regard the demand for sexual abstinence before or within marriage as an unreasonable burden and to classify it simply under the heading of misery. Therefore, the whole tripartite system, as originally presented, appears unsatisfactory and unbalanced.
If this had been all, Malthus could be forgotten, but fortunately for his lasting fame, he was not entirely consistent and also described a second, more neutral system of checks which cut across the judgmental divisions of the first. This is a simple division into posible and preventive population checks objective categories which may still be useful today.
As Malthus described them, the positive checks on population "include every cause ... which in any degree contributes to shorten the natural duration of human life" (Malthus 1803: I.15; 1970: 23) and thus have the effect of raising the death rate. In contrast, the preventive checks serve the function of lowering the birth rate. Malthus listed a number of them, although the delicacy of his phrasing leaves certain items somewhat obscure. They include the already mentioned "moral restraint" as well as contraception, abortion, "promiscuous intercourse", "violations of the marriage bed", and "unnatural passions" (Malthus 1803: I.16,II.8; 1970: 24).
Clearly, the two simple categories of positive and preventive checks work well in principle, and only a few of the details seem dated today. For example, the positive checks have proven to be less severe than anticipated, because the food supply has grown faster than allowed by a mere arithmetical progression. Malthus was simply wrong on this point, because he underestimated later scientific and agricultural progress. Furthermore, his description of the preventive checks needs to be modified. Thus, it is unclear how "promiscuous intercourse" and "violations of the marriage bed" (adultery ?) can lower the birth rate. It is also curious that Malthus lists abortion under the preventive, not the positive checks, i.e. he does not count the unborn among those possessing "human life". Finally, he seems to take monogamous marriage for granted, but fails to see that, at least in his own time, this in itself acts as a preventive check, since it often ties potentially fertile men and women to infertile spouses.
Actually, modern scientific sophistication has raised many other questions about Malthus' list of preventive population checks, even though the concept as such remains valid. Indeed, the very fact that his list has become subject to reinterpretation and augmentation reveals a formerly unsuspected opportunity for increased human control, a ray of hope that Malthus himself did not live long enough to see.
In any case, Malthus laid the groundwork for whatever progress was made, in spite of his predictions. Pessimistic as most of his conclusions were, he provided a novel approach, a frame of reference which appealed to his scientifically minded successors. By criticizing, correcting, rejecting, or amending Malthus, scholars and politicians learned first to perceive and then to address a new set of questions. The qualitative and quantitative control of the population became a major scientific theme in the nineteenth century, and the new sciences of demography, economics, sociology, criminology, penology, and psychiatry did their best to extend this control as far as possible.
As the various scientific experts and government agencies proceeded to a practical application of their insights, however, they often found themselves at cross purposes and even openly clashing with each other. Learned disputations, popular crusades, propaganda and pamphleteering, demonstrations, parliamentary debates and court room battles revealed that the old ambivalence toward human fertility was far from being resolved. For example, Malthus had never seriously considered contraception as an escape from the dismal outlook he presented, but after him a vigorous birth control movement arose, eventually adopting his name. The first "Neo Malthusian", Francis Place, clearly alluded to Malthus in his Illustrations and Proofs of the Principle of Population (1822), but he advanced a bold, new position: "If ... it were once clearly understood, that it was not disreputable for married persons to avail themselves of such precautionary means as would, without being injurious to health, or destructive of female delicacy, prevent conception, a sufficient check might at once be given to the increase of population beyond the means of subsistence; vice and misery, to a prodigious extent, might be removed from society; and the object of Mr Malthus, Mr Godwin, and every philanthropic person, be promoted by the increase of comfort, of intelligence and of moral conduct, in the mass of the population." (Place 1822: 165).
Curiously enough, the democratization of contraceptive knowledge, while privately denounced in many quarters, at first did not provoke any government censorship. Place and other early Neo Malthusians did not encounter much official resistance to their contraceptive campaigns. Indeed, the book of an American physician which dealt extensively with contraceptive methods, Knowlton's Fruits of Philosophy (1832), sold quietly in England for decades, before it became controversial.
Then, in the last quarter of the century, a moralistic backlash began to be felt. In 1877 two advocates of contraception, Charles Bradlaugh and Annie Besant, were brought to trial for distributing Knowlton's work, but eventually emerged victorious. To the dismay of their adversaries, their case further popularized contraceptive information and put England into the forefront of deliberate family planning. In 1878, Charles R. Drysdale founded the Malthusian League and began to edit a journal The Malthusian. From about that time, the English birth rate began a steady decline (Himes 1970: 244).
In actual practice, however, family planning had been adopted quietly in most Westem countries. The birth rate dropped not only in England, but also in France, where the Napoleonic code prohibited farmers from leaving the land to their firstborn sons and provided instead for a division. As a result, French famners (in 1850 about 70 % of the population) limited the number of their children. (French farmers in Canada, who were not subject to the Napoleonic system, retained a higher birth rate.) (van Ussel 1970: 193). Thus, it is obvious that economic considerations were beginning to have some effect. Even the "lower classes" tried, often desperately, to limit the number of their children. One result of these efforts was the growing number of abortions in both Europe and America (Ellis 1936: 602 604).
Undoubtedly, the increase in abortions was also related to the lack of effective contraceptives, especially among the poor. It is true that in the course of the century, contraceptive technology had made significant advances, but moralistic watchdogs like Comstock prevented or at least slowed down its general distribution. As early as 1838 Friedrich Adolph Wilde had developed a cervical cap, in 1843 the vulcanization of rubber made the mass manufacture of condoms possible, and in 1881 Wilhelm P.J. Mensinga invented the contraceptive pessary. Nevertheless, worker families usually had no access to these inventions, and women especially often came to perceive their fertility as a curse, because it exhausted and further impoverished them.
If Marx, Engels, and other advocates of the working class failed to support the birth control movement, certain other agents of social change were less reluctant. Under the influence of such 19th century psychiatrists as Morel, and Charcot, they began to believe in hereditary degeneration, and guided by eugenicists like Galton, they demanded practical measures to eliminate it. The result was, among other things, a program of compulsory sterilization of physical, mental, and social "inferiors." In 1907, the U.S. state of Indiana passed the world's first compulsory sterilization law, other states, and indeed other countries, such as Nazi Gemmany, followed, and thus the door was opened to a great deal of governmental abuse (Chase 1977: 15 16). In the U.S. even govemment financial support for "voluntary" sterilization led to abuses, because poor women and even teenage girls were often pressured or tricked into giving consent by greedy or racist doctors.3 It is only within recent years that complaints by various civil libertarians have succeeded in reforming or even ending these misguided policies. In the meantime, however, the larger issues have not resolved themselves. The continuing and accelerating world population growth has prompted even more radical proposals for the control of human fertility. In 1955 Alan Gregg described, for the first time, the human race as a "cancerous growth" on the planet Earth which would eventually destroy it. In 1960, Raymond B. Cowles proposed a "nonbaby bonus" to be paid by the government to potential parents for not having children. In 1964, this idea was elaborated by Kenneth E. Boulding into a "marketable license for babies". The unit for such a license would be a "deci child", and an accumulation of ten of these units, by purchase, inheritance, or gift would entitle a woman to have one legal child. In 1967, William and Paul Paddock went still further than this and proposed a system of "triage", which would cancel all American food shipments to those countries that failed to control their "overpopulation". Since they "could not be saved", they should sirnply be left to die, the sooner, the better. The Paddocks especially mentioned China as a country where mass starvation was likely to hit within less than a decade. In 1968, Paul R. Ehrlich supported this view, comparing the world population to an exploding bomb.
The list of such recent drastic suggestions could easily be extended, but the point is undoubtedly clear: for some social thinkers the age old ambivalence toward human fertility is now threatening to resolve itself into negativism and panic. Where life itself appears as a disease, a commodity, a catastrophe, or a weapon of destruction, reason is weakening and may even grow incapable of taking positive steps.
This attitude is just as irresponsible as the apathy of the traditional laissez faire which simply ignores the consequences of continued inaction. Positive steps must and can be taken, as some countries which were once considered beyond hope have shown. Thus, China, for which the Paddocks had predicted mass starvation in the 1970's, not only succeeded in feeding her population, but also embarked on a thorough program of limiting it. (Interestingly enough, the most striking feature of this program is the Malthusian "moral restraint", i.e. a postponement of mariage combined with an avoidance of "irregular gratifications".)
Summing up, one might say that the recent Western despair is hardly a basis for infallible judgments. Unfortunately, for some the despair has now gone beyond mere resignation in the face of misery and vice, but has grown into a fear of fertility as the ultimate harbinger of death. This represents an ironic reversal of the older belief in procreation as the main weapon against mortality. After all, the ideals of defying death and of producing abundant new life originally evolved together. Not only whole nations hoped to escape extinction by keeping the birth rate high, but also individuals saw their spiritual death prevented by a long line of descendants. At least their memory and their name would live on. By the same token, infertility was seen as a misfortune, because it weakened the nation and denied individual men and women the solace of a vicarous afterlife. Nevertheless, historical expedience and changing religious beliefs eventually tempered this absolutist view and led to the ambivalence that has characterized most of our civilized past. Fertility then came to be seen as one of several elements in a larger value system whose over all structure was flexible, and whose exact configuration was shaped by a variety of social and individual factors. Moreover, with the drastic reduction of the death rate in modern times, the once overriding importance of fertility for human survival was further and further reduced.
Still, there is a suspicion that this historical trend cannot continue to its logical extreme without producing a new, serious danger. The threat of barbarism always exists where people lose patience with ambiguities. The temptation to do so may will be great, but a historical view can teach us that human fertility and infertility as such neither guarantee nor threaten human survival. Neither can be regarded as an absolute value, and no one should ever expect to hear the last word in the matter. The ambivalence will, and indeed should, remain. Within its context, difficult decisions will always have to be made. We can only confirm this much: it is in the best historical tradition that all our decisions should be guided by hope.
NOTES1. William GODWIN's Enquiry concerning Political Justice was first published in 1793. The Marquis de Condorcet wrote his Esquisse d'un Tableau Historique des Progres de l 'Esprit Humain while hiding from the French revolutionary terror. It was first published in 1794 and then in an English translation in 1795.
2. MARX expressed his objection to the "utterly dismal theorem" most succinct ly in these words: "If Malthus'theory of population is correct, then I can not abolish this (iron law of wages) even if I abolish wage labor a hundred times, because this law is not only paramount over the system of wage labor but also over every social system. Stepping straight from this, the economists proved fifty years ago or more that Socialism cannot abolish poverty, which is based on nature, but only communalize it, distribute it equally over the whole surface of society !" (Critique of the Gotha Program, New York, 1933, p. 40).
3. See Federal Register, vol. 43, No. 217, Nov. 8. 1978, Part V, p. 52146.
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