3. The medical profession and contraception: from contempt to acceptance

Summary: Chapter 3

The Medical Profession Before Contraception: From Rejection To Acceptance

I. Introduction: Institutional Contempt For Contraception

In general, and until well into the twentieth century, institutional medicine adopted a negative attitude towards contraception. In contrast to their rejection by most doctors, the use of contraceptive methods spread among the general public, especially the well-off. The expansion of contraception use prompted the lucrative production and trade of contraceptive agents (some ineffective and potentially harmful).

As the 1930s advanced, the social and economic importance of contraception increasingly required the medical community to pay attention. Almost overnight, contraception became an exclusively medical activity.

II. The Complex History Of Rejection: From 1912 To 1937

In the first third of the 20th century, no medical institution was confronted with the need to modify its official position of rejection of contraception. The activism of advocates of “control of conception” consisted in persuading outstanding figures in medicine. But the resistance of institutional medicine to contraception persisted through1924.

First Cracks In The Dam

In the mid-1920s, cracks began to appear in the institutional rejection of contraception. The most important were caused by the combination of the contraceptive mentality and feminism. Its propaganda instrument was a short-lived clandestine newspaper called “The Woman Rebel.” Beginning in1918, this movement focused on attracting doctors to the “cause” to advance the social legitimization of the birth control movement. ‘The Woman Rebel’ was replaced by the “Birth Control Review,” which was more formal and academic. But individual doctors remained reluctant. What ended up facilitating medical acceptance was the prevailing attitude of complete rejection of non-therapeutic abortion. Contraception was seen as an “ethical” good capable of being an effective stop to abortion.

The AMA Responds To Pressure

In the mid-1920s, various requests by AMA members that the organization’s House of Delegates take an active role in favor of (and, occasionally, against) the legal and professional regulation of contraception were debated at the organization’s annual conventions.

At first, the organization’s leaders rebuffed the initiatives. Eventually, they referred the issue to the Committee for the Study of Contraception and acquiesced to the committee’s recommendations, moving from rejection to acceptance. At the 1932 AMA convention in New Orleans, a motion was introduced calling for the creation, within the AMA, of a committee to study birth control. After being rejected, the motion was resubmitted on several occasions with the significant assurance that the creation of such a committee would not be interpreted as an endorsement by the AMA for contraception.

In 1934 the AMA continued to reject endorsing birth control, although signs of ambiguity appeared that inspired the Birth Control Review to praise the AMA’s proceedings.

The transition from 1935 to 1937

At the 1935 AMA convention in Atlantic City, the organization’s Board of Directors, responding to intense pressure, finally agreed to create a committee to study contraception.

At the 1936 convention in Kansas City, the AMA’s Study Committee on Contraceptive Practices and Related Problems presented a report that generally disapproved of contraception. After noting the demographic, eugenic, economic, moral and medical aspects of contraception, the committee resolved that, 1) Given the incompleteness of the Report, the work of the Committee should be continued to inform the full membership; 2) The Committee should constitute a group to develop criteria for evaluating contraception; and 3) the AMA should condemn the propaganda aimed at the public by non-medical organizations.

The organization’s Executive Reference Committee tabled the second recommendation because 1) it considered the available information regarding the issue to be inadequate, and 2) because it is understood that the disavowal of certain contraceptive products could, by inference, be interpreted to imply the approval of others. As a result, the resolution that resulted was harshly criticized by the American Birth Control League.

III. The Resolution Of 1937

At its convention held in Atlantic City in 1937, The AMA’s House of Delegates adopted a new Report of the Study Committee on Contraceptive Practices and Related Problems that reversing the group’s earlier rejection of contraception, replacing it with a new spirit of support for birth control.

The 1937 document of the same name completely rewrote the 1936 policy, presenting both new content and new conclusions. It made three recommendations: 1) That the AMA make clear to physicians their legal rights regarding the use of contraceptives; 2) That the AMA undertake a study of the literature regarding the prevention of conception, in order to evaluate its content, and publish the results to inform the profession; and 3) That the AMA Board of Medical Education and Hospitals be asked to promote the teaching of the various factors affecting fertility and sterility. The Report was presented to the Chamber of Delegates by the Executive Reference Committee, and endorsed after incorporating modifications.

IV. What Happened To The 1937 Resolution?

Contrary to the resulting claims of birth control activists, the Atlantic City Resolution was a preliminary document, which, in order to become an effective standard, required that the AMA fulfill certain mandates. But that requirement received scant attention.

The comparison of the 1937 Resolution with that of 1936 prompted questions as to what caused the profound change of approach? The 1937 Committee’s failure to respond to those questions provoked widespread speculation regarding the possible existence of undisclosed  pressure.

On a fundamental and telling level, the 1936 Report contained a tiny section devoted to “moral considerations.” In contrast, the 1937 report offers no ethical justification for the radical change it introduced.

 

FROM THE ORIGINS OF CONTRACEPTION TO HUMANAE VITAE: SUPPRESSED STORIES

Author: Gonzalo Herranz, University of Navarra.  Email: gherranz@unav.es

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