- Address delivered before the Sixth International Neo-Malthusian 
 and Birth Control Conference 
 Hore, McAupin, New Yorx Crry 
 
 March 26, 1925 
 
 BY 
 LOUIS I. DUBLIN, Pu. D., Statistician 
 Metropolitan Life Insurance Company, New York 
 1925 
 
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 The Excesses of Birth Control 
 
 By 
 LOUIS I. DUBLIN, Px. D., Statistician 
 Metropouitan Lire Insurance Company, New York 
 
 When your President graciously extended her invitation to 
 me to read a paper before this Congress, I very frankly reminded 
 her that I was generally considered an “anti,” and, that in my 
 writings I had, by implication, criticized rather severely the 
 current propaganda of the Birth Control League; that I con- 
 sidered your movement in its present form a distinct social 
 danger and that I, therefore, could not support it. Imagine 
 my surprise when I received Mrs. SANGER’S reply urging me 
 to accept a place on your programme for the very reason that 
 she wanted my dissenting views placed before your Convention— 
 ““We want to be guided by facts,” she said. Of course, I 
 was completely disarmed and here I am within the ranks of 
 the enemy and entirely at your mercy. 
 
 Let me say at the outset that I consider your invitation 
 not only a fine courtesy, but a very real privilege. That I 
 disagree with your founder does not alter my sincere respect 
 for her. I admire her courage, her sincerity and her readiness 
 to tackle a difficult social question in spite of the obstacles 
 which constantly have been placed in her path. However great 
 our disagreement may be, regarding the means of attaining 
 the common goal—an efficient and happy society—I fully 
 agree with her that the problem of birth control in all its 
 ramifications is one which sincere and decent people must 
 discuss. We can get absolutely nowhere by burying our heads 
 in the sand and pretending that no problem exists; or that 
 we must avoid its discussion as something unmentionable and 
 even contaminating. Honest men and women should not avoid 
 or fear to discuss openly any question so vital to their well- 
 being. 
 
 Why, then, do I disagree with you? It is because your 
 propaganda until yesterday has been based essentially on an 
 emotional reaction and not on a scientific analysis. You have 
 observed, as everyone else has, that there are poverty-stricken 
 
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and diseased people whose families are far too large for their . 
 own good or for the good of the community in which they live. 
 Granted; but does that justify a nationwide programme of 
 broadcasting contraceptive information without reserve? You 
 do not appear to have considered that the problem of birth 
 control is only one aspect of the larger population problem. 
 There is a bigger issue than the immediate preference of the 
 individual. ‘The very life of the State is involved as soon as 
 we begin to tamper with who shall and who shall not be born. 
 My objection has been that your programme has been elaborated 
 prematurely, without due regard to the permanent interest of 
 the State; without adequate consideration of the real population 
 tendencies which today prevail; without sufficient regard to 
 the reliability and safety of the procedures that you recommend 
 and to the consequences on the spiritual life of those who are 
 influenced by your advices. I am afraid that your effort will 
 simply replace an evil of which we are fully aware and which 
 we all deplore with even greater evils lurking less obviously 
 in the background. ‘There is need for caution; for you are 
 playing with fire. Mistakes in population policy are more 
 easily made than rectified. 
 
 I shall now proceed to consider some of my objections in 
 detail. There is first, your disregard of the interest of the State. 
 One would think from reading your literature that the matter 
 of parenthood was entirely an individual affair. As one gentle- 
 man recently put it “I suit myself with regard to the number 
 of my children. I owe the State nothing.” ‘This attitude is 
 obviously very short-sighted and indefensible. It serves, how- 
 ever, to focus attention to the conflict between the immediate 
 interests of the individual and the more permanent interests of 
 the State. The average man or woman generally determines 
 his or her personal conduct without much consideration to the 
 good of the community. We are most of us rather selfish and 
 need very little encouragement to avoid parental responsibility. 
 It is often pleasanter and always easier to keep the number 
 of our dependents down to a minimum. ‘Today, we live; 
 tomorrow, we die. But, the logical consequence of such attitudes 
 is nothing short of a challenge to the permanence of the State. 
 Society, accordingly, seeks to protect itself against such a 
 contingency. It expresses a general disapproval of celibacy 
 and proscribes the dissemination of birth control practices. On 
 the other hand, it recognizes the dignity of parenthood and as 
 
 us 
 
a crudely constructive measure, it has recently begun to take 
 into consideration the number of children as an item in fixing 
 the amount of taxes. In some countries, as Professor DOUGLAS 
 has told us, the size of the family is becoming a factor in deter- 
 mining the amount of extra compensation of the worker. These 
 are a few initial steps in the plan of the State to make more 
 attractive to its people the obligation of parenthood. The 
 State insists on its perpetuation and cannot condone or argue 
 its own suicide. We may express our freedom as individuals 
 only within the limitation that the continued existence of the 
 State is assured. 
 
 The birth control problem is, secondly, only one aspect of 
 the larger population question and will never be settled satis- 
 factorily except as the larger issue is solved. Your propaganda 
 to date has emphasized almost altogether the necessity for 
 population reduction as though there could be no doubt of 
 over-population in the United States. I shall be willing enough 
 to admit when I go home by subway tonight that there are too 
 many people in the world, and I have often felt that way in 
 considering the congested areas of our large cities. These 
 undoubtedly represent ineffective community organization. On 
 the other hand, we have a problem of under-population in our 
 open rural areas. But neither picture alone justifies a snap 
 judgment on the present status of our population, whether it 
 contains too many or too few people. A sound population 
 analysis is called for, which would attempt to relate our present 
 population structure to the natural resources of the country 
 and the efficiency with which we utilize our resources. These 
 are highly technical matters which cannot be decided out of 
 hand, not even by generous and high-minded people. If there 
 ever was a question which called for expert handling, it is this 
 one. For this reason, the American Statistical Association at 
 its recent meeting in Chicago gave five sessions to the con- 
 sideration of the various phases of the population problem as 
 it confronts America today. It was illuminating to note the 
 great variety of opinion that still prevails among serious students 
 of social science on virtually every topic under discussion. 
 Where there are so many conflicting points of view, there is 
 little room for easy dogmatizing. ‘There can be, in fact, no 
 simple solution, and no ready panaceas in a matter of this sort. 
 
 But, if there is no consensus of opinion on details, there is 
 at least general agreement that the population problem can 
 
 3 
 
be attacked ‘only through long and intensive study of our 
 present composition with due regard to the natural resources 
 of the country, to our future immigration policy, to the organiza- 
 tion of industry, the improvement of our channels of distribu- 
 tion, the training and direction of our labor supply and a host 
 of other factors which will determine the limits of our future 
 population. Such an approach is a hopeful and constructive 
 one. It is a far cry from the hasty and rather depressing 
 assumptions which have determined the policy of your organiza- 
 tion. Without much hesitation, you have ascribed most of 
 our social and economic troubles to over-population and have 
 proceeded to remedy them by striking at the very root of our 
 procreating capacity. 
 
 This leads to my third objection, namely, that you have 
 not read correctly the current tendencies in our population 
 growth. Your impression that our numbers are increasing too 
 rapidly might perhaps follow from a cursory examination of the 
 population figures of the country, but not from a more intensive 
 study of the facts. It is true that past decades have shown 
 large increases; but, we must not forget that this growth 
 certainly in recent years, has been mainly the result of immigra- 
 tion and the relatively high fertility of the newcomers. It is 
 only in the southern states and in the rural communities that 
 the native population has much more than maintained itself 
 in late years. Now that immigration has been almost completely 
 cut off as a source of population increase, we must look to the 
 fertility of the groups within the country and learn what the 
 conditions of natural increase are among them. After careful 
 study of the situation, I have become convinced that we are, 
 in fact, rapidly approaching a condition of a stationary popula- 
 tion. Our study shows that the crude rates of natural increase 
 in the United States are spurious and misleading. We have 
 been living in a fool’s paradise heretofore, overlooking altogether 
 the sources of our successive increases. Immigration has 
 enormously padded the proportion of our people at the repro- 
 ductive ages, and this has, in turn, resulted in increasing our 
 crude birth rates and in decreasing our crude death rates. If, 
 on the other hand, we determine what the present birth rate 
 would be if the age distribution of our population were the 
 result of a prolonged continuation of our present rate of pro- 
 creation, unaffected by padding from without, you will find 
 that the figure would fall from 23 per 1,000, which it is approxi- 
 
 S 
 
mately today, to well below 20 per 1,000; and the corresponding 
 death rate would increase from a little over 12, the present 
 crude figure, to well over 15. The effect of these two corrections 
 resulting from an artificial age distribution, will be ultimately 
 to reduce the rate of natural increase from over one per cent. 
 per annum to only one-half of one per cent. Our crude birth 
 rate, however, is falling very rapidly. It has declined over 
 30 per cent. in the last thirty years and the end is not yet in 
 sight. How much lower it may go, I do not know. But, even 
 at its present level and with our current death rate, it will 
 take over 120 years to double our numbers if we continue to 
 depend on natural increase alone. These figures agree closely 
 with the estimates of Professor PEARL who, on biological assump- 
 tions, forecasted a population of close to two hundred millions 
 in 2040. Certainly, no country with the wealth of natural 
 resources of the United States will fail to provide its people 
 with the necessities of civilized life if it continues to increase so 
 slowly. 
 
 Another and perhaps more instructive approach is to con- 
 sider the number of births that it requires under present condi- 
 tions of mortality to keep our population stationary. According 
 to the mortality and marital rates prevailing in 1920, it is 
 necessary on the average for every ten married couples to have 
 26 children in order to replace the original quota from which 
 the parents sprang. But, not all families have children; one 
 marriage in every six is either sterile or does not lead to live 
 issue. The burden of childbearing, therefore, falls on the 
 remaining families, every ten of whom must have not 26 but 
 31 children. In other words, present conditions of mortality 
 and fecundity require that families having children shall 
 average better than three in order to maintain a stationary 
 population. All groups of urban American families recently 
 investigated have shown fewer children than this minimum. 
 It is only because of the greater fertility of the newcomers and 
 of those in most rural areas that our annual figures of increase 
 show up as favorably as they do. I would venture the opinion 
 that this very audience would, on investigation, illustrate the 
 current tendency that those who are most able to assume the 
 obligations of parenthood are not reproducing themselves. 
 
 This state of affairs is almost altogether a new thing. Until 
 recently, it was the American fashion to have good-sized 
 families. Professors BABER and Ross, investigating this subject 
 
 5 
 
among middle class families of the present generation in the 
 Middle West, found a shrinkage in family size from 5.4 to 3.3 
 children in the course of one generation. This is equivalent to 
 a drop of 38 per cent. in the number of offspring in the space of 
 only a relatively few years. Others have found exactly the 
 same situation in other localities. The tendency toward small 
 families has apparently become a fixed habit among the American 
 people. I cannot consider the underlying causes for the decline 
 in our birth rate except to point to the very obvious influence 
 of the widespread knowledge of contraceptive methods. One 
 would imagine from your literature that such methods were a 
 recent discovery which, if only applied generally, would release 
 a long suffering world from all its troubles. But, this is clearly 
 a misconception. ‘There is evidence on all sides that birth 
 control practices are in vogue to an enormous degree in the 
 United States. Every doctor, every nurse, every druggist, and 
 every social worker, will, I believe, admit as much. In no 
 other way can we explain the falling birth rate of the country 
 in recent years. 
 
 Knowledge of contraceptive methods is more widely prac- 
 ticed here than in any other country of the world, except 
 Germany and Austria, where the aftermath of the war has 
 taken all desire and incentive for living out of the hearts of the 
 masses. Holland, which you consider the exemplar of voluntary 
 parenthood, shows a birth rate of 26 per 1,000 as compared 
 with 23 in the United States. 
 
 It is, therefore, not true that we are multiplying too rapidly 
 and that we must resort to a nationwide policy of birth reduc- 
 tion to keep our population within reasonable bounds. ‘The 
 real danger, if there is one, lies rather in the change in our 
 internal composition which will follow a too rapidly declining 
 birth rate and our approach to a stationary population. There 
 is always grave danger in such a shift of weakening the social 
 organization by increasing the proportion of defective and 
 dependent stock. For it is always the least desirable parents 
 who are the last to curtail their fecundity. We, likewise, 
 unduly increase the percentage of old people, whose support 
 falls, more or less, upon the young who, therefore, face the 
 prospect in coming years of carrying greater burdens. We must 
 remember, too, that the greatness of America and of our large 
 cities has reflected the prevailing enthusiasm and youth of our 
 people. The spirit of adventure and of progress go well together 
 
 6 
 
and have been the outstanding characteristics of our young and 
 vigorous nation. New York, which is the youngest large city 
 in the world in the average age of its citizens, is a striking 
 example of the power and ability of youth. Reducing the 
 proportion of our young people, as we shall by curtailing birth 
 rates, will at once modify the whole spirit of our intellectual 
 and economic life. This is not a hypothetical but a very real 
 danger confronting the country to which little attention has 
 as yet been paid. It is always amazing to me to consider how 
 little we have learned from the perfectly obvious story of the 
 population changes of France and how ready we are to travel 
 her easy road to national misfortune. 
 
 Your movement has also thriven on a series of confusions 
 of thought. Your efforts have been especially directed to the 
 amelioration of the lot of that large number of poor people 
 who, you say, have suffered from ignorance of contraceptive 
 knowledge. You certainly have made no plea for those whose 
 favorable economic and social status would readily enable them 
 to bring into the world normal children and to give them 
 every possible advantage for future citizenship. Yet, it is 
 among these very people who need it least that contraceptive 
 information is most widely disseminated and most intensively 
 used. Such activity is distinctly anti-social; for it enables 
 selfish people to escape their proper responsibilities, ultimately 
 to their own detriment and certainly to the injury of the State. 
 You have also won much sympathy for your program through 
 the assumption that it works in the direction of social and 
 economic improvement of the poor. But obviously economic 
 battles cannot be fought by other than economic weapons. 
 The way to meet low wages, bad housing and the other evidences 
 of maladjustment is to attack them directly through a broad 
 social programme including the better organization of industry, 
 more equitable means of distribution, constructive legislation 
 and those other methods which are gradually bringing about a 
 better day. You do not solve the worker’s problems by 
 encouraging him to lose his greatest and noblest possession, his 
 children. On the contrary, you help to maintain the status 
 quo by accepting present economic maladjustments without a 
 struggle. 
 
 The very first question which arises, then, is how best 
 to regulate the granting of contraceptive information and 
 not how to devise methods for its indiscriminate broadcasting. 
 
 7 
 
The State expresses clearly in its legislation that such informa- 
 tion shall be restricted to cases where the life or health of the 
 mother is in danger. There is undoubtedly a larger group to 
 whom information may be extended with propriety and to the 
 welfare of all concerned. But how shall that group be defined? 
 What demarcations shall be enforced? Shall contraceptive 
 information be available to those who have already borne 
 several children? Obviously, you would not put such informa- 
 tion into the hands of young boys or girls. No sane community 
 would dream of permitting it. What consideration shall be 
 given to the economic status of families or other sociological 
 factors in releasing such information? ‘These and other vital 
 questions must be faced and answered before your association is 
 justified in launching a nationwide programme of birth control. 
 My next objection is that you have proceeded without 
 sufficient proof of the efficacy and the safety of the measures 
 which you suggest. Have you not a moral obligation to assure 
 those whom you wish to help that the procedures you sponsor 
 are at once effective and harmless? The best medical opinion 
 informs me that you are, in fact, not prepared to make any 
 such guarantees. You have collected no evidence on which to 
 predicate the measure of your success. Such information as is 
 available indicates clearly that there is still a large element of 
 uncertainty in the suggested procedures. ‘Those who have 
 studied the work of the so-called birth control clinics abroad 
 have been equally unable to discover approved methods in 
 general use. But, more vital, is the question of safety. Are 
 contraceptive practices, in fact, without hazard to those who 
 indulge in them? Gynecologists and obstetricians of the highest 
 standing have been very suspicious of some of the devices in 
 use and have traced serious affections back to them. Has that 
 been answered? Have you eliminated altogether the possibility 
 that such practices result in permanent sterility of young 
 married women? I know nothing so tragic as the case of young 
 people who avoid children in the first years of their married 
 life only to find later that they cannot have them when they 
 want them. ‘The number of childless marriages is rapidly 
 increasing to the point of becoming a first-class problem, and 
 there is good evidence that contraceptive practices by young 
 people may have a good deal to do with it. What is your 
 answer to the constantly recurring charge that various contra- 
 ceptive practices lead to mental disorders affecting either the 
 
 8 
 
husband or the wife? And what is the usual effect on the 
 spiritual life of those who, through continued control, keep their 
 families down to next to nothing? ‘This is probably the most 
 serious single consequence of the current fashion. I do not 
 put this at your door, for there are many causes. But nowhere, 
 to my knowledge, has your voice been raised to warn those who, 
 desiring more comfort and ease for themselves, lose the greatest 
 of all blessings and the source of our deepest inspiration, a 
 family to provide for and to live for. ‘Therein lies the well- 
 spring of character development for adults which is choked 
 and forfeited for what usually turns out to be a mess of useless 
 baggage. 
 
 I could elaborate my objections were there more time; 
 but I hope I have traced most of them with sufficient clearness 
 to suggest that all is not well with the present organization and 
 programme of your society. In closing, may I be permitted a 
 few constructive remarks? You have, heretofore, limited your- 
 selves almost entirely to arousing sympathy for those who have 
 suffered from over-large families. Today, you might very well 
 take up the other side of the picture and help arouse public 
 sentiment in favor of fairly good-sized families among the rank 
 and file of normal people. Help to set the fashion, not for large 
 families—the day for that is over—but for families of at least 
 three children and as many more as can be readily and effectively 
 taken care of. One should expect a well balanced theory of 
 parenthood from a society such as yours. Your organization 
 could also enormously increase its usefulness by shifting its 
 emphasis from the dissemination of propaganda to the organ- 
 ization of scientific research. What is most vitally needed 
 today is more light on the problem of population and not wider 
 dissemination of questionable contraceptive practices through 
 such agencies as your current publications. Your magazines, 
 sold promiscuously on street corners, are especially offensive 
 and alienate the good will of many thoughtful people. Your 
 first concern, in my judgment, should be to encourage study and 
 investigation of the various aspects of your subject in the spirit 
 of science which all could approve. In this way, you will win 
 the enthusiastic support and cooperation of population experts, 
 and especially of the medical profession. Through such an 
 alliance, you may well be able to remove many of the obstacles 
 which now hinder your progress. One cannot over-emphasize 
 the necessity for adequate records of your cases, their close 
 
 9 
 
follow-up and careful analysis. Only through this means will 
 you develop a sound policy. It is gratifying to note from the 
 character of your present programme that you are already 
 working along these scientific and constructive lines. It is my 
 hope that as your programme of unbiased investigation develops, 
 you may win the support of all forward-looking citizens and 
 become true leaders in one of the most important movements 
 of our time. 
 
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