Kill or Cure Reproduction in the 20th century Aims • To introduce the theme of reproduction and reproductive health in the 20th century. • To think about reproduction in terms of biology and the broad social constructs in which we all reside. • Through focusing on the subject of reproduction, we will see how look at the history of health and medicine with a gender-sensitive lens. • To explore three aspects of reproductive health – maternity, fertility control and assisted reproduction. Part one • Reproductive health Introduction to reproductive health • Reproductive health is defined as a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life. • Good reproductive health implies that people are able to have a satisfying and safe sex life, the capability to reproduce and the freedom to decide if, when, and how often to do so. • Men and women should be informed about and have access to safe, effective, affordable, and acceptable methods of family planning of their choice. • Women should have the right to appropriate healthcare services that enable women to safely go through pregnancy and childbirth. Part two • Maternity ‘A Plea for a Pro-Maternity Hospital’ • Ballyntine was a staunch advocate for prenatal care at a time when there was no space for such care within the medical system. • In Ballantyne’s vision, a hospital dedicated to prenatal care would have 2 main purposes: • First, to treat cases of pathological pregnancy in which the mother’s health is at risk. • Second, to practice ‘antenatal therapeutics’ (treating the fetus through the mother), especially in cases where the mother’s behavior might be endangering the fetus. Mortality rates Infant mortality per thousand births 1900-1990 Annual death rate per 1000 total births from maternal mortality in England and Wales (18501970) The medicalization of birth • In the 20th century childbirth in the developed world moved from the home to the hospital. • Associated with this new birthing space were childbirth technologies. Hospitals provided a hi-tech, highly medicalised birthing experience. • Obstetricians began defining ‘normal’ standards for childbirth. The epitome was Friedman’s curve, developed by Emanuel Friedman, a graphic representation of a ‘normal’ labour. Deviations from normality were seen as reasons for medical intervention. Part three • Fertility control Reasons for the fertility decline I • 1. As the infant death rate declined more babies survived into adulthood, thus fewer pregnancies produced surviving offspring, so it was not necessary for parents to have more children than they expected to survive into adulthood. • 2. As methods of efficient birth control improved, access to contraception became easier and knowledge of them spread. • 3. There was a greater willingness to use contraceptives. • 4. Men’s attitudes towards women have softened so that they have been more willing to use contraceptives in order to help relieve women of the health risks of frequent and closely spaced pregnancies, and the hard work associated with a large family. • 5. Simon Szreter argues that abstinence was the English way of adjusting fertility in response to the perceived relative costs of having children. The perception of the escalating ‘costs’ of childrearing provided the conscious motivation to control births. The anti-sexual culture was both conducive to the use of abstinence as the method to achieve that goal and provided married men and women with a legitimating, anti-sexual rationale. Reasons for the fertility decline 2 • 6. In Britain, Joseph Banks has argued that the economic depression of the 1870s and 1880s undermined middle-class confidence in the future and encouraged the use of birth control to maintain living standards. • 7. In America, Daniel Scott-Smith has argued that the decline in middle-class fertility offers an indication of ‘domestic feminism’ (the power and autonomy exercised by women within the family). Population control movement Thomas Malthus, 13 February 1766 – 23 December 1834 • In the 20th century, population control proponents have drawn from the insights of the British clergyman Thomas Malthus who published An Essay on the Principle of Population in 1798. • Malthus argued that, ‘Population, when unchecked, increases in a geometrical ratio. Subsistence increases only in an arithmetical ratio.’ • He also outlined the idea of ‘positive checks’ and ‘preventative checks’. • ‘Positive checks,’ such as diseases, war, disaster and famine, are factors that Malthus considered to increase the death rate.’ • ‘Preventative checks’ were factors that Malthus believed to affect the birth rate such as moral restraint, abstinence and birth control. Eugenics • Eugenics, meaning "well born," was introduced in the 1880s by Sir Francis Galton, a cousin of Charles Darwin and the father of modern statistics. • Galton pioneered the use of pedigrees, twin studies, and statistical correlation for the purpose of using that knowledge to improve "the breed of man." • During the early 1900s, eugenics became a serious scientific study pursued by both biologists and social scientists. Pro-natalism • Ann Oakley argues that the Boer War 1899-1902 revealed a shockingly low standard of health among the male population recruited to fight in that war, forcing political attention on the actual condition of the Empire’s citizens and infant welfare was included in the campaign to improve physical efficiency. • Jane Lewis posits that the concern to stop the wastage of infant life ‘became even more explicit during World War I’ as the loss of population during the war increased awareness of the importance of infant mortality. • Denise Riley defines pronatalism as ‘despondency and alarm over the low birth rate, both past and as anticipated by demographers, which took the solution to the problem to be encouraging women to have more children.’ Both the concern and the proposed remedy had been building up throughout the 1930s and became more generally diffused towards the end of World War Two. Contraceptive pill • Developed by American biologist Dr Gregory Pincus, the pill works by suppressing ovulation. • It was tested in the 1950s on Puerto Rican and Haitian women and launched in the USA in 1960. • In the USA, around 1.2 million women used the pill within two years of its launch. Now the number of users is around 11 million. • Worldwide, around 100 million women take the pill. Pharmaceuticals and foreign aid • The dictates of the market play a major part in family planning and population control. • About $5 billion is spent each year on family planning by developing countries; $1 billion of this is donated by Northern governments, multilateral agencies and private organizations. • Pharmaceutical companies have global contraceptive sales of $2.6 billion to $2.9 billion per year. • This huge economic power of pharmaceuticals enables them to influence the policies of Southern governments and the priorities of the medical establishment. • According to the UN, contraceptive use in the southern hemisphere has increased five-fold in the past quarter century because of the intervention of foreign-aid donors and international institutions. International Conference on Population and Development (1994) • The ICDP brought to international recognition two important guiding principles of reproductive and sexual health: • 1) that empowering women and improving their status are important ends in themselves and essential for achieving sustainable development; • 2) that reproductive rights are inextricable from basic human rights, rather than something belonging to the realm of family planning. Move to reproductive health • Three developments were of particular importance to the reappraisal of reproductive health in the 1990s: • Firstly, the growing strength of the women’s movement and their criticism of the over-emphasis on the control of female fertility - and by extension, their sexuality - to the exclusion of their other needs. • Secondly, the advent of the HIV/AIDS pandemic; suddenly it became imperative to respond to the consequences of sexual activity other than pregnancy, in particular sexually transmitted diseases. But perhaps more important, it became possible (and essential) to talk about sex, about sexual relations outside of marriage as well as within it, and about the sexuality of young people. • Thirdly, the articulation of the concept of reproductive rights. An interpretation of international human rights treaties in terms of women’s health in general and reproductive health in particular gradually gained acceptance during the 1990s. Part four • Assisted reproduction Artificial insemination • Artificial insemination was first performed in humans by the famous English surgeon John Hunter. • It was reported by Everett Home, his nephew in 1799. • The procedure was performed by Hunter, in approximately 1790, for a linen draper who had hypospadias. John Hunter, 13 February 1728 – 16 October 1793 IVF and Louise Brown Criticisms and concerns • Ann Oakley has noted how infertility treatments are often unpleasant and their success rates remain relatively low. • Gillian Tindall has demonstrated how babies created through assisted reproduction are at excess risk at every stage in their development. • In the British context, the issue of cost to the NHS has also been an issue. • In the development of ever more powerful techniques of assisted reproduction a number of new ethical questions have emerged. They lie at the heart of what it means to reproduce, to be a parent, to be a human being. • Since 1990 many countries have been setting out to establish ethical guidelines and laws for reproductive technologies. Warnock Report • In 1982 a committee was established to inquire into the technologies of in vitro fertilisation (IVF) and embryology. • This was in response both to concern at the speed with which these technologies were developing, and also to the 1978 birth of Louise Brown in 1978, the first baby to be born using this technology. • The role of the committee was to develop principles for the regulation of IVF and embryology. The committee was chaired by the philosopher Mary Warnock, who would later become Baroness Warnock. • The committee concluded that the human embryo should be protected, but that research on embryos and IVF would be permissible, given appropriate safeguards. • The committee proposed the establishment of a regulatory authority with the remit of licensing the use in treatment, storage and research of human embryos outside the body. This body would later become the Human Fertilisation and Embryology Authority. • The findings of the committee were published in what is now referred to as the Warnock Report in 1984. In many ways, the Warnock report formed the basis for the Human Fertilisation and Embryology Act. Conclusions • Reproduction and the family are central elements in the lives of people. • In the 20th C obstetricians began defining ‘normal’ standards for childbirth. • There was a move away from ideas of population control and demographic targets towards a more holistic approach to reproductive health. • With new reproductive technologies new ethical questions have emerged. • Perceptions of sexuality have shaped medical practices, public policy, legal rights, technology and the contours of everyday experiences.
