Status of birth control in India, 1930s

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Need background on the status of birth control before MS's trip in 1935-1936 and how it changed afterward.

Says that many of the "educated persons" in India have become aware of the population problem. Notes Nehru, Naidu, and Tagore as among those who" fully recognize the importance and urgency of the birth-control movement in this country." Quotes President B.S. Chandra Bose saying that "If the population goes up by leaps and bounds as it has done in the recent past, our plans are likely to fall through. Even Gandhi wrote "long ago as follows: 'I must not conceal from the reader the sorrow I feel when I hear of births in this land.'"

Says there is a difference of opinion on how conception-control should be achieved in India. Says that they can all agree for sexual abstention "on the part of normal young people who are living a single life; one can at any rate argue that even if it is not in every way desirable, it is at least practicable. We are all stronger when the temptations are not too great. But the position is entirely different with normal young people who are living together in marriage. If they love one another, any gesture of affection may be a sexual stimulus. Overwhelming emotions are likely to be generated by the mere fact of sharing the same room, commonly the same bed."

Excepting a few who are not normal, "the masses must receive immediate instruction in the proper means of prevention of conception and adequate facilities much also be provided for the use of the same. It is mainly having recourse to these methods that many of the most advanced countries could raised the standard of living of their people and maintain it at a high level."

Says they have no change of building wealth if they are weighed down "by an avalanche of rapid births." Says Royal Commission on Indian Agriculture says there will be no lasting improvement of standard of living while population is rising. Formally asks Gov't for education and means of Family Limitation.  "Especially, arrangements for sterilization by surgical operation would be very effective."

"Fortunately, even Mahatma Gadhi seems to have no objection to vasectomy. He says: 'As regards sterilization, I consider it inhumane to impose it as a law on the people. But in the case of individuals with chronic diseases, it is desirable to have them sterilised, if they are for it. Sterilization is a sort of contraceptive, and though I am against the use of contraceptives in the case of women, I do not mind voluntary sterilisation in the case of men, since he is the aggressor.'

How-Martyn is in India to help with a conference

"The Bombay clinics between ourselves  are very disappointing,. The number of patients is decreasing & tho' I question many people on the point I can get no satisfactory explanation. Pillay said the other day he wanted more money to start clinics & hardly liked my comment that it is not good to start more clinics while others have so few patients. Masani is willing to bring up the questions of clinics at the Municipality but again I suggested trying to make present clinics a success. This position must be faced. Indians as yet have little staying power or persistence and we much plan accordingly. Articles in newspapers & speeches  on B.C. yes but good attendance at clinics--No--

"I am touring the Bombay Presidency visiting small towns & villages under the auspices of this Council which has Lady Jehangir as chairman. In most places there has never been a B.C. lecture before & I am urging including B.C. in the Matl Centres already there & giving the Duofoam Powder as they are giving cod liver oil, milk & medicines. It is no use pleading poverty as the small numbers who wd. be willing to try it at first wd. make  cost very little. After a mtg. for women here Dr. K. R. Patil the lady Medical Office of the State General Hospital of Baroda came to see me. You had a long talk with her in Baroda & also gave her some appliances but it is again disappointing to find she fitted in 1936-14 women in 1937-21 - total 39 and I think from what she says all middle class women.

Reports that Edith How-Martyn has left India and "has made a good impression for sincerity, simplicity, and devotion to propaganda for the liberation of women. I had known her only by name during the suffragette campaign so it was fr the first time that I met her in Karachi. She suffered under the disadvantage there of not having come to the Women's Conference on the same kind of invitation as the two English women & some of us indeed had to fight out for her  in the Subject Com. so that she might have full 20 minutes for speaking during the Birth Control debate as an expert on the subject. Muslims & Catholics here are just so opposed to B.C. as in West countries but Hindus generally are free minded."

"Well, Edith did wonderfully well I thought & made splendid contacts for you for later on, especially in Mysore State & in Bombay through her speech to the Leg. Council Members....It was like a miracle certainly a life-dream come true, to see her in an American medical missionary's house showing the model & the items of equipment to 20 or 30 of our leading Indian women after an address to a mixed audience. Our Indian woman doctor here, Dr. Chorley, is very keen on helping every women who applies to her."

Says she received material from the BCIIC, and will try to have MS invited to the AIWC "similar to Corbett-Ashby or Royden. The matter must be discussed in July at the Half-Yearly Standing Com. meeting."

States that the general consensus of Indian economists is that the only "practical method of limiting the population is by the introduction of artificial means of birth control." Dilemma is how to put this in practice in a society "where the propagation of male offspring is considered a religious duty, and barrenness a retribution for crimes committed in a former incarnation." There has been a marked increase in demand for the knowledge, "among certain classes" and there seems to be less prudery in India than in "some countries that claim to be more civilised." Aside from the support of medical writers, leagues have begun starting up and are supported by "two Maharajas, three High Court Judges, and four or five men very prominent in public life and its sponsors." Says that while the educated are interested, the practical results of their support has been "almost nil."

Until that happens there is not much that can be done, "Some authorities have been forced to the conclusion that the only alternative means of checking the population would be by relaxing the efforts to reduce the infant mortality rate; and despite the extraordinarily beneficent work which is performed in the child-welfare and maternity centres, the purely scientific arguments which can be adduced in support of this view are substantial." Notes that offering instruction in birth control at maternity clinics and "Baby Week" instructions are a good step. Notes the Mysore State sanctioned birth control to be offered at 4 state hospitals in 1930.

Only other option would be to increase the food supply, because rising standards of living usually create falling birth rate. Says that to have the desired effect, the increase in standard of living "must be substantial. A mere increase in the food supply, among poverty-stricken masses who constitute the vast majority of the population, might easily have contrary result, bu encouraging them to breed right up to, instead of to some degree short of, the subsistence level. Quote provided (no source) that says that in order to affect reproduction, the higher living standard needs to "increase education and culture involved, but also a psychological appreciation of a higher probability of survival." But in India, this factor is not likely to be found.

"Let me give you the low-down at once on Mysore one of the first states in the world to set up birth control clinics well there is nothing that
you would call a clinic. At Bangalore which is the capital & the biggest city in the State I saw the Senior Surgeon who told me tho' they were still anxious to do it--it was not working satisfactorily--then I saw the Dewan or Prime Minister who said he would be glad for me to see everything & also would like to know what I thought of it. Well I went to the Maternity Hospital and saw the women doctor who is at the Head of the Hospital.  There is no stated time to give B.C. advice & it is done in the Out Patients Dept. I asked to see the equipment, there was no pessary in the
Hospital! The patient is sent to an office to buy a pessary she then returns with it & the doctor puts it in--can you believe it? Dr. Natarajan of the Public Health Institute was sent to America and went to your Clinic and was shown the clinic by Dr. Hannah Stone but did not see you-- He got out two rather battered pessaries, tubes of jelly & slides he had prepared to show the technique. He has instructed 176 men with 2 failures that is he explains it & then the men fit their wives! it really is rather 'quaint.' To-morrow I am going to see what is being done in the Hospital at Mysore City  but as it is only about a third of the size of Bangalore I don't suppose it is any better but I will add the information at the end of this letter. The Madras people get their pessaries from Germany and sell them ab. 4- each here in Mysore then get them from Holland & sell them to patients about 2/- each.

I saw the Prime Minister again & explained as tactfully as I could the shortcomings-- He asked me to prepare a Report for him and he will then give instructions-- In both Bangalore & Mysore new Maternity Hospitals are being built & it is a great opportunity to put in proper clinics. I am going to suggest that he send you an invitation to come in October and put the Clinic on a proper footing as it is a chance to set up a model clinic which would serve to train doctors from all over India and the neighboring countries."

Added to the end her visit to the Mysore  City Clinic: "is just a bit better than Bangalore from 1930-33, 22 women have been advised but there is no place or time set apart for B.C. Two excellent women doctors an Indian & a German who wd. I am sure be most teachable."

"As a conformed believer in Birth Control, I have not hesitation in saying that if there is any country in the World which is in need of immediate action in this behalf, it is India, and even with the best of talents and wisdom, I wonder whether the masses will be apprised of the true significance of this movement. I thought it would be of some assistance to you if I were to lay before you some of the inherent difficulties, which a foreign propagandist may encounter in India in her noble effort to popularise birth control movement, and I would therefore place before you the following facts, an appreciation of which will no doubt enable you to understand the psychology of the Indian mind."

Says conditions in India cannot be compared to the West, and "India is slow to exhibit any reformist tendencies on social questions." Says that 90% of the 350million "live in villages, and it is no exaggeration to say that a majority of these villagers are steeped in poverty and illiteracy. As such, your message to India and your mission in this country will, I am afraid, have little chance of reaching those masses within the brief time that you will be spending in India. Under such circumstances, there should be no cause for wonder or even despair, if even after your weeks' of arduous work and fervent appeals, if the masses failed to realize the importance of the movement."

"But this need not necessarily discourage you, for the problem is no less serious even among the middle and upper classes who are the more educated and enlightened members of the Society, and there is therefore immense scope for a well-wisher like you to popularise this movement among these sections of the people. But unfortunately even among these educated classes, the faith in birth control movement has not yet taken deep root, and though they are sadly aware of the rapidity with which India's teeming millions are increasing year after year, opinion in regard to the efficiency of contraceptive methods is sharply debated. It is not too much to say that there are doubting Nestors who wish to be assured of complete success and the least harm, before they can have any recourse to birth control appliances. More often than not the discussions run entirely along academic lines without any reference to the realities of the situation. The objections, as you might have already observed may be broadly classified as follows:- 1) Religious 2) Against Nature 3) Moral Degeneration 4) Economic Fallacy 5) Efficacy of the means to achieve the end, etc. In your Calcutta speech you have admirably answered some of these objections, and I have no doubt wherever you go in India, the questions that will be asked of you will more or less be confined to these aspects; and I am sure you are fully equipped to meet such criticism. You will indeed be doing a real service to the country, if you impress upon the people the full economic significance of this movement, and especially how a poor country like India with a growing population cannot with equanimity allow this problem to bet the better of the people. The chief objective of your propaganda, I venture to suggest, should be to dispel the clouds of suspicion among the educated classes and rouse them into action, casting aside their sceptical temperament." He encloses a pamphlet by Col. Russel "On the Overpopulation of India" which will provide authoritative info. for her speeches. 

Suggests that if she wants "that this movement should be kept alive even after you leave Indian Shores, it would be imperative that persons should be found all over India to follow the trail that you have blazed. In order to achieve this end, you would be well-advised if you were to confer with prominent persons of each province in India, impress upon them the necessity of an intense propaganda in India, and also the setting up of a wide organizations and the establishment of Birth Control Clinics in every important town with or without the assistance of the Government. You will no doubt find it an exacting work to convince many of our leaders; for instance, Mahatma Gandhi as you have yourself stated 'has a certain inhibition against the sex idea itself' and that 'his reason against birth control are psychological and not religious.' There are many such personalities in India, whose objections are based on such fallacious grounds and you will indeed be adding a bright feather to your colours if you only succeed in converting them to your point of view. If only you set these leaders in motion in favor of this movement, you may rest assured that this noble task will be kept going on and the consciousness of the people aroused in a measurable distance of time."

He describes himself as a 27 year old typist in a commercial organization in Calcutta, married to a 21 year old woman. He is the father of 2 despite a small salary. Gives a history of his contraceptive practice, nothing for the first child, ineffective for the second. Asks her for advice on methods.

Says that he thinks the poor conditions in India are directly related to uncontrolled childbirth.  "To my mind the chief hindrance to the more rapid and more effective spread of the movement in India are the following: 1) Ignorance of the practicability of of controlling child-birth by scientific methods, 2) The inherent modesty of Indian women there are thousands of them who long to be freed from the ever-recurring appearance of unwanted children, but who dare not suggest that they need help. 3) The thoughtlessness and beastliness of men. As a rule, menfolk seem to think that their responsibility stops with the sexual act and that the upbringing of the children is the sole responsibility of women. 4) The absence of a recognized institution to issue reliable information on the subject an, above all, to sell genuine appliances at a price that the poverty stricken women in India can pay. At present just a few firms under certain pseudo-medical names, sell useless Japanese articles at prohibitive prices and make large profits for themselves. Only the rich and the educated people can afford to get down genuine articles from abroad. The result is the poor women who need to be protected cannot get the knowledge of the subject or the appliance required. So what is immediately required is a responsible organization with branches throughout the country. This organization should issue information and sell genuine articles as cheaply as possible. It is my considered view that you will never reach the poor who stand in need of family limitation unless you ake it possible for them to buy the appliances at a maximum price of 2 annas per piece" Wishes her success.

[An anna was a coin valued at 1/16 of a rupee]

She writes in response to an editorial called "The Case for Birth Control" published in Dec. 21 issue. In it the writer accuses her of "not stating 'the evils of propaganda among people who are not yet ready for it.' This is not the case at all. The evils referred to are those resulting from the exploitation of contraceptive devices. This is the case in question and the point referred to in the article by Miss Elizabeth Garrett. If the writer had looked into the case before accusing me of discourtesy, he would have found that in every address I have given before medical groups since my arrival in India I have urged the physicians to profit by the mistakes we made in the United States and to take hold of the birth control movement and direct it themselves. I have pointed out that our archaic laws have prevented the medical profession from leading the movement in the United States and that consequently articles and devices came upon the market from manufacturers like mushrooms over night. Some of these articles were entirely worthless."

She says that she brought three films with her and have shown them to the medical profession that demonstrate the use of diaphragms and pessaries, but have stated that these need to be prescribed by a doctor, but she holds that there are other methods available that do not need the doctor's participation. Says that the French have controlled their families successfully with non-medical methods. "Again I say that before there was a birth control movement in the United States there were harmful methods and devices under other names advertised to the public. In India I have found shops where articles are being sold and have been sold for years which are neither safe not reliable. It is as necessary to educate the chemist as it is to educate the doctor. I do not care to discuss other aspects of the editorial which are statements not based on facts or evidence but have confined myself to the points about myself." Says she has lectured to nine medical meetings while in India thus far.

"Birth Control" is the title. Attacks the writings of the "Social Reformer" who has "very courageously indulging in fusillades from the trench of his pseudo-name." Says that he relies on "nothing but hearsay or secondary evidence when he attempts to put into the mouth of Mrs. Sanger the proposition that although Birth Control may not solve population problems, it does contribute to the health, happiness and mental poise of an individual and families." Says that "Social Reformer" needs to produce evidence to back up his claims that BC "brings on sterility, the actual experience of users of the approved methods of contraception belying that statement. Similarly, it passes one's understanding to see how even the blame for the downfall of the Roman Empire can be laid on the devout heads of the Birth-Controllers."

Reports good reception in Mysore, and her recent illness after being in Calcutta. Reports on a two-hour meeting with Gandhi at Ward'ha conducted while walking. Says that they were often joined by others and the "talk was rather discursive, but I did not feel the time was wasted even from the B.C. point of view. It was Gandhi not I who sent the news to the press about our talk and th'o many people tell me G. will never be converted I do not feel hopeless at bringing him to the point of your Supreme Court decision & the British Govt. At his own request I am corresponding with him & I just sent him your 'Woman of the Future' & I shall follow it with your 'Motherhood.' He is worth all this trouble because of his immense influence and because if he would combine BC with his work for the villages it would be fine for the women."

How Martyn wants MS and her to return in the winter and hopes that nothing will come up to keep her away. Says she will enjoy the meetings, everyone speaks English, and they have some promising advocates, including Vepa Ramesam who plans to dedicate time to BC after his retirement in July. Notes that Sir P.S. Sivaswamy Ayyar, president of the Neo-Malthusian League chaired her recent meeting. To date, EHM has found a woman doctor in every city "who will give B.C> information. Dr. Neal of Allahabad said the spread of information will be slow here due to ignorance, apathy and poverty but she added your visit & talks will make the doctors more ready to give advice & more ready to bestir themselves to get something done."

In Madras the Maharaja gave 50 pounds and they started 3 clinincs,"not what you wd. pass as a clinic--then the money was finished so the clinics are shut & about 50 patients all told came in the 6 months.  Whereas there are 12 municipal Maternity Centres and the £50 spent in appliances & pressure brought on the doctors to give advice in those maternity centres might have started something permanent. In fact the enthusiasts here need good advice which I hope I can give them tactfully & in a palatable manner but next year you can accomplish very much more."

She missed seeing Tagore because of her illness, they will need to see him in the winter. Suggests that they bring a secretary with them "for the newspapers are very accessible but rather stupid & want the articles all prepared."

Native of India who is finishing schooling in the US and plans to return to India. "As you well know India is pretty well overcrowded with people, and the mortality rate is very high. The people are not brought up to the modern standards of education, hence misery and epidemics are prevailing all over the country. Due to the early marriage system the population is increasing at a faster rate. The people lack knowledge of 'birth control'. The lower standard of living and higher death rate go hand in hand. Of course you can't blame the people for all the prevailing conditions in the country. The alien government is largely responsible for all these calamities I am talking about. So, it behooves us who are educated in the foreign countries to look after our brothers and sisters in India."

"I am going into social service in the country. I have tried my utmost to find a good material and some safe method for [?] 'birth control' but all in vain.  I like to help my people in preaching 'birth control', because they need it pretty badly. I am told that the League is doing one of the most wonderful research in this field." Requests information and literature that he can use to help India.

General congratulations, discussion of Greeting from India {probably for the American Conference on Birth Control and National Resources}; happy to meet How-Martyn though she did not see as much of her as she liked.

"Mahatma Gandhi is the greatest stumbling block to the B.C. movement in India. In plenty of things (co-education also) he has most medieval views. I have always found him unreliable on matters connected with women. But women go in spite of him and then he gives in and learns. India is an easy country for B.C. progress because no one wants to stop having children so that bogey never arises. They can easily agree to the usefulness and science and commonsense of spacing and reducing the number of children." Says that the first time it was brought up at the Conference, it "passed without difficulty." The difficulty comes in about manufacturing the contraceptive equipment in this country for of course it should be made locally for this population of 365,000,000. It is on the manufacturing and importing side of things that Mrs. How-Martyn should find her greatest usefulness in India, I think.

Cousins quotes the resolution passed: "On account of the low standing of physique in women, high infantile mortality and increasing poverty of the country, instruction in methods of Birth Control through recognized clinics is a necessity."

[90] The Madras Birth Control League grew slowly after its founding in 1929, becoming influential in the fields of education and gaining inroads with the government. In 1932 Madras University offered a course on birth control to all college seniors; n 1933 the government announced that they would establish birth control clinics in the Madras Presidency. Ramaswami was able to gather private funds to start a free clinic in one of the slums, and Iyer was instrumental in [91] the government clinic plans.

Mysore Government clinics [91] Mysore State had a history of benevolant rule; at the end of 1929 Iyer met with Mriza Ismail, the Dewan of Mysore (Chief Minister); they decided to ask the state government to establish clinics in the important towns in the state and the Maharaja Nalwadi Krishenraja Wodeyar approved of it. On June 11, 1930 an order issued to establish clinics at Victoria Hospital, Bangalore and at Krishnrajendra Hospital in Mysore. CV Natarayan, who studied BC in the US was put in charge of the clinics. Advice was given to improve health of women and children, for married women. Supplied contraceptives at cost for those who wanted them. This was the first government funded birth control clinic and underscored the lack of religious opposition to BC in India. With a "devout and orthodox" Hindu ruler on the throne, there could be no religious objection. No other states in India took the same action, though some of them gave support to the FP movement.  [92] Notes that Pillay said that in Travanacore the Dewan Sir CP Ramaswamy Iyer, thought that they needed birth control in order to advance economically, but that since his State had a large percentage of Roman Catholics, the Government would not take the initiative.

Women's organizations were on board with birth control from around 1930. The Bhagni Samaj Bombay started their own birth control clinic in 1930. In 1935 the Women's Welfare Society (Calcutta)conducted a birth control clinic once a week in Dufferin Hospital (1935). THe AIWC was founded in 1927 to unite women for educational and social reforms. They passed a resolution supporting birth control clinics to be opened to instruct men and women in birth control methods. Their rationale was "on account of the low physique of women, high infant mortality, and increasing poverty of the country." [93] At the 1935 meeting, Sanger was invited, her first time to India. Says that Rama Rau was in London and appointed as the Indian representative of the AIWC in London. met How-Martyn  to acquaint her with the work of the AIWC and their new plank on BC.  At the meeting the AIWC passed a resolution of the need for instruction on birth control through clinics. Rama Rau became President of the AIWC International Relations.

[94] Raina says that while medical men were not coming out for BC, medical women were. Pillay characterized male doctors as "indifferent or timid to take up the work, [95] asserting that Indian women will not practice birth control methods and there is no demand for the same. The lady doctors believe just the contrary but are often timid to seek the required knowledge and are often dominated by anti-birth control superiors." Pillay also notes that some doctors lost "lucrative practices" for supporting BC.  Notes that the Association of Medical Women in India wanted to offer birth control services, but were not as convinced that they should be offered as part of a stand-alone clinic, preferring them worked into the doctor's work. Called for education for doctors and the public, though they thought that the best way to spread propaganda was through medical profession.

[95] Municipalities in Bombay and Trivandrum took an interest in BC work. Trivandrum put forward proposals to support the provision of birth control clinics in 1934 and again 1937, piloted by Mayor N.G. Thampi. It was tied until the Mayor broke the tie and passed the legislation. M.S. Masani was the predominant figure in Bombay, became a member of the Municipal Corporation in 1935. He recalls in his autobiography Bliss was it in that Dawn: "Soon after my election to the Corporation, Margaret Sanger, a great champion of birth control in America, visited Bombay; as an enthusiast for birth control I arranged for her to be greeted by the Mayor and be give a seat to observe the proceedings. I moved that the Medical Relief and Public Health Committee.should prepare and submit to the Corporation a scheme for the provision of information and instructions in method of birth control in birth control clinics and in the existing Municipal Hospitals and dispensaries. Taking a little swipe at Marxist dogma, I mentioned that, as a socialist, I would be the last to suggest that birth control was a remedy for all ills but urged that it was certainly one of the ways of combating poverty. I pointed out that in Bombay City, the infant mortality rate was 240 out of 1000 infants born. My motion led to an exciting debate." Masani reported that the matter was referred to the Public Health Committee, but it must have died there, because "no concrete steps were taken till 1947. Two family planning clinics were started in April 1947."