Four decades after Birkett

Madeleine Simms

The Report of the Lane Committee is due out next week. The following article, which shuuld not be taken to represent the view of The Spectator, puts a contrary argument to that by Robert Lindsay published in our issue of January 19. The writer, Madeleine Simms (author with Keith Hindell of Abortion Law Reformed), is a Research Fellow at the Eugenics Society.

In May 1937, Sir John Simon and Sir Kingsley Wood appointed an Inter-Departmental Committee of the Home Office and the Ministry of Health to "inquire into the valence of abortion, and the law relating thereto, and to consider what steps can be taken by more effective enforcement of the law or otherwise, to secure the reduction of maternal mortality and morbidity arising from this cause."

In February of the previous year, Sir Kingsley Wood, then the Minister of Health, had received a deputation from the National Council of Women. The Council, alarmed by growing evidence that illegal abortion was rife, had urged the minister to set up a government committee without delay, to ascertain the incidence of abortion, and to consider what measures might be required to improve the existing position. Sir Kingsley, who had been badgered persistently on this subject by the women's organisations, the maternal mortality crusaders and the birthcontrollers, assured the deputation that he had the matter under active consideration. giving as his personal opinion that with slum clearance and improvements in maternity and child welfare services, the problem would solve itself in time. The following year, however, he yielded to public pressure, and established the committee of inquiry.

The Ministry of Health had indeed long been plagued by the maternal mortality statistics. "Since the beginning of the present century," Wrote the Chief Medical Officer in his Annual Report for 1931, "the general death rate has been reduced by one third, the TB mortality by one third, and the infant mortality by more than one half. But the maternal mortality has remained stationary. The mother, in fact, has not shared equally with her child in the benefit arising from the improvement in the public health."

Concern about the impact of clandestine abortion on the maternal mortality statistics was shared by leading medical authorities. In his textbook Maternal Mortality and Morbidity published in 1933, Professor Munro Kerr of Glasgow University doubted "if .there was any bigger problem facing local authorities at the present time than that of providing adequate hospital accommodation for large numbers of abortions." An editorial in the Lancet in 1936 recorded the view that "in this country 16-20 per cent of all pregnancies are believed to terminate in abortion, and there is evidence that in the majority of cases it is artificially induced." At a meeting of the Royal Institution of Public Health a paper was read on the euphemistically named traffic in 'female remedies', which was described as "very considerable." The joint authors, Drs Borland and Bennet, noted that "practically every pharmaceutical chemist stocked one or other of the preparations as a regular line; they were even more prominently displayed by the herbalists and 'hygienic' stores."

In 1933the birth rate fell below 15 per 1,000, which occasioned dire warnings of impending disaster. Letters from leading medical men in the medical journals denounced the "slack tolerance of such racial decline" and warned that "the unchecked development of this attack on the strength of our race threatens the destruction of our ideals and our Empire." The

League of National Life, a Catholic front organisation dedicated to the crusade against birth control, declared that the practice of contraception was not only damaging to the national birth rate but "physically harmful to the female." Dame Louise McIlroy, the most eminent medical woman of her time, opined that the induction of abortion "had been one of the causes of the downfall of Greece and Rome owing to the attitude of their intellectual women, who shirked the responsibilities of motherhood." As did Dame Louise herelf. Books were published with titles like The Menace of British Depopulation and The Twilight of Parenthood.

The committee duly assembled, with Mr Norman Birkett, KC, a leading silk, later to be appointed a High Court judge, as chairman. His colleagues included fashionable gynaecologists, representatives of the royal colleges and medical organisations, a London coroner, a lawyer, and four women. Lady Ruth Balfour was an upper-class suffragette and doctor. Lady Williams, a daughter of the Edwardian novelist Elinor Glyn was, surprisingly, an economist (Elinor Glyn like Dame Louise did not hold with intellectual women); Mrs Stanley Baldwin, the Prime Minister's wife, offset Mrs Dorothy Thurtle, Labour leader on the Shoreditch Borough Council, a daughter of George Lansbury MP and wife of Ernest Thurtle, MP.

The committee noted gloomily that deaths attributed to, or associated with, abortion had numbered between 400 and 600 in each year during the past decade. Nor was this necessarily the whole story: "It must be remembered also that the mention of the occurrence of abortion may be omitted by the certifying practitioner on the certificate of cause of death." This suspicion had been confirmed by Sir Bernard Spilsbury, the noted forensic scientist, who had pointed out that "the patient rarely took the doctor into her confidence, and facecronly with the symptoms of her secondary infection, he might never 'suspect that he was dealing with a septic abortion, especially if called in some time after abortion had taken place. It was, therefore, a reasonable assumption that criminal abortion was more frequent than was generally suspected."

When he came to give evidence to the Birkett Committee, Sir Bernard remarked that many doctors in fact concealed evidence of abortion, and ascribed abortion deaths to 'natural' causes. He also noted disapprovingly that the women themselves were "usually loyal to the abortionists" which made prosecutions difficult. He had no doubt criminal abortion was on the increase and thought the only solution was "long sentences."

The committee was not more cheered by the evidence presented by Dr Barbara Macewen, who had carried out an abortion survey on behalf of the Ministry of Health: "It is evident that abortionists practise extensively in the country, as in over twenty of the areas visited they were known to be active, while in many others there was reason to believe that abortionists were at work ... One male abortionist who was convicted confessed to having procured between 200 and 300 abortions by means of a syringe and injections of carbolic soap solutions."

Spectator February 9, 1974 She found that the use of the Higginson's Syringe and slippery elm were the most common methods of procuring abortion, and listed thirty-eight drugs and 'concoctions' including 'gunpowder sandwich,' a heady mixture of sulphur, saltpetre and charcoal. (The Parmaceutical Society in its own evidence later, was able to extend this list still further.) She had discovered doctors, nurses, midwives, RAMC orderlies and herbalists among the ranks of the illegal abortionists, and also "many persons ignorant of medicine, nursing or pharmacy." She noted that "more accommodation for the in-patient treatment of cases of abortion is needed in practically all districts" and concluded: "Doctors will not tell, women will not give evidence, and magistrates and judges are too lenient."

One of the midwives giving evidence on

behalf of the Midwives' Institute had worked in a home for unmarried mothers. She found that many of the girls had tried exceedinglY dangerous drugs to bring on abortions. "Su many of them are between fourteen and sig" teen years of age, that they have n° knowledge of what they can use or take to bring on an abortion." Many of them, indeed, did not even realise that attempting selfabortion, or the use of drugs, was illegal. Nor was backstreet abortion for working" class women the only problem to be faced. Sir Comyns Berkeley, FRCS, theleading gynaecologist on the committee, in accepthl his appointment to serve, had written to Si. Kingsley Wood saying: "I think you know nlY, opinion on this subject, and I am certain 01 my facts, that many so-called 'therapeutic., abortions' are merely a cloak for what I ano others know are not really justified, an which are performed for conditions whic" should not appeal to anyone."

Evidence was made available to the corn'

mittee to show that this was not a probleill peculiar to Britain. Many European countries and the United States were similarly afflicted. In Germany, Hitler was busily shutting dovin birth control clinics, increasing penalties against illegal abortion, and instituting 3 medical abortion referee system in a deter' mined attempt to push up the birth rate. The radical organisations that gave evidence to Birkett, such as the Abortion LaW Reform Association, advocated liberalisation of the abortion law to save women's lives arT health, combined with improvements in we': fare and birth control services. The religiou', organisations, on the other hand, advocaten more propaganda against contraception an4 stiffer penalties against abortionists. Tilt Mothers' Union was of the opinion tha, legalising abortion "would be the heaviest.' blow possible to the highest expression womanhood." The League of National 01,

• took the view that not even rape merited4 legal abortion: "Where the shock of rape h,,, already been experienced, it is high'2,. undesirable and inexpedient to add the furth'' shock of abortion." ; erlY The Birkett Committee steered g■ng-,,,,d between the two extremes. Since 1937it ..e held forty-seven meetings and taken evider1,1-.5 from fifty-five witnesses. In 1939 it issued Rai report. It thought it likely that the and number of abortions was between 110,000 ae“se 150,000, and that about 40 per cent of ti,loe were criminally induced. It noted that u,ed law relating to abortion is freely disregar,, among women of all types and classes.. .0 recommended that the law be amendecit„ make it "unmistakably clear" that abortioua" was legal on health grounds. It hedge.c1,401 birth control provision, though indiviu _ed members of the committee did not and issu

NOY NOY

outspoken reservations on this point. Do Thurtle presented a Minority Report ;14 vocating sweeping reform of the abortion tirfic and the widespread availability of "scien_rid tcoen contraception." was h ." s Then shelved. he war broke ou

h t rot' It took nearly thirty years for Do

Thurtle's principles to become embodied in legislation, in the 1967 Abortion Act and in the National Health Service (Family Planning) Act. In 1971, Sir Keith Joseph appointed a committee of enquiry under Mrs Justice Elizabeth Lane to investigate the working of the Abortion Act. During the intervening years the abortion situation in Britain had been quite transformed. Abortion deaths had fallen to twenty-five a year, and hospital abortion emergencies declined. The most recent issue of the report on Confidential Enquiries into Maternal Deaths for the years 1967-1969, shows that of the seventy-four.; women who died from illegal abortion during those three years, thirty-two were coloured immigrants. These, it might be reasonable to assume, were not very familiar with the machinery of the National Health Service, and found it quicker to resort to an illegal abortionist. To have reached a situation in which only about a dozen resident women each year die of illegal abortion, represents a triumph of public health which Mr Birkett, KC, surveying the scene from the nineteen-thirties, could hardly have dared anticipate.

About 110,000 British women obtain legal abortions each year now. The legal abortion death rate for early terminations is about three per 100,000. The problems that face the Lane Committee are therefore quite different from those that once faced Birkett in the days when backstreet abortion was rampant, and all abortion relatively dangerous. The Lane Committee is in no position to recommend serious restriction of the Abortion Act, even if it was inclined to do so, because it knows that this would drive women back into the arms of the backstreet operators. Moreover, it has before it the doleful example of Rumania, that recently restricted its once liberal abortion law in order to force up the birth rate, only to find that within two years the criminal abortionist had come back into his kingdom.

The realities of the situation will compel Lane to seek to encourage the wider provision of out-patient abortion facilities, within both the National Health Service and the growing charity sector of private medicine, which between them now cater for more than 80 per cent of British abortions. Such facilities will do more than any other device to relieve, pressure on gynaecological departments, saving expensive hospital beds for patients whose condition really warrants in-patient treatment. Cost-conscious Americans tumbled to this long since, and now nearly all early abortions in the United States are carried out iti day-clinics.

If Birkett's problem was preventing women dying, the problem facing Lane is how to replace the traditional abortion habits of British women with "scientific contraception."