Birth Control: The Case for the State

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From Manteo, on the North Carolina coast, to Murphy, N. C., beyond the Smokies, is 618 miles by highway. Yet only three points on that long road are more than twenty miles from a state sponsored birth-control clinic. No spot in all the big state is more than fifty miles from such a centre. North Carolina, the first of the forty-eight states to promote birth control officially, is going at the job in earnest.

North Carolina is pioneering because it has a public-health officer who spent twenty-five years as a country doctor, practicing among North Carolina's poor. He knows why North Carolina has virtually the nation's worst record on all matters connected with births. Ignorance, poverty, insanitation, disease, poor hospital facilities, little if any prenatal care -- all these contribute to infant and maternal mortality rates that are truly appalling.

Of each thousand mothers, twice as many die in North Carolina as in Connecticut. The chances that a North Carolina baby will die in its first year are 66 in 1000, compared with Connecticut's infant mortality rate of 40 and the nation's 54. Some 20,000 North Carolina mothers each year are attended by midwives, most of them untrained and ignorant of asepsis. Abortions and infanticide are rife, especially among the large Negro population. If the nation bred at the North Carolina rate, we should have a crop of 700,000 more babies a year. That might be wholly desirable -- but not if the extra babies are born into indigent, dirty homes where they are not wanted and where their chances of survival are poor.

To improve conditions so that dirt, poverty, and disease will disappear is, of course, the ideal solution. But that, to put it mildly, will take time, involving long-term medical and economic campaigns on a dozen fronts. Birth control, in the meantime, offers immediate help. Its advocates point out that at least the family without much to eat ought to have the choice as to whether it wants to bring another high chair to the table. Birth control, they say, can help to stop the infant and maternal carnage and in the end build a healthier and perhaps even a larger population.

So, too, believed Dr. George M. Cooper, to whom the appalling statistics represent people he knows. Dr. Cooper is a native of the Tarheel State, and during a quarter century of country practice he listened, observed, and sympathized. He knew many a girl wife living in a two-room mountain shack with six children and a tuberculous husband. He had heard women tearfully beg, 'Isn't there something we can do?'

He had seen a Negro couple married seventeen years who had produced twenty children -- twelve of them to die in infancy. Good, hard-working people, desperately poor -- bewildered. 'I'm for any way that will keep me from having another child,' the mother pleaded. 'Any way so long as I can keep from losing that man I got.'

When he became director of preventive medicine of the State Board of Health, Dr. Cooper preached to fellow physicians and laymen alike that North Carolina could not climb far toward better health and happiness without birth control for the poor. But his hands were tied. Unlike most states, North Carolina had no law against spreading birth-control information, but there was always the federal law -- the old Cornstock law, dating from 1878, which frightened every physician in the country into complete silence with its untested but threatening provisions. It was not until the autumn of 1936 that the federal courts ruled the law could not prevent physicians from using contraceptives 'for the purpose of saving life or promoting the well-being of their patients.' That was the battle Margaret Sanger won. It freed the doctors, but it wasn't much immediate help to those who most needed help. There were no funds for birth-control clinics, and Dr. Cooper knew the futility of taking a contraceptive promotion program before a state legislature. The situation seemed hopeless as ever.

Thereupon Fate interposed a finger. Years before, Dr. Cooper had counseled a young woman who wanted to become a nurse, had suggested Roosevelt Hospital, New York, for her training, had kept in touch with her. In 1937 she was nurse in charge of an experimental program, giving birth-control information to the natives of the densely populated little island of Bocagrande, off the Florida Everglades. The work was being financed by Dr. Clarence J. Gamble, an heir of the Procter and Gamble soap fortune, who lived in Philadelphia. Homesick, Roberta Pratt kept talking about North Carolina, and eventually she got Dr. Gamble interested. One day she was able to send word to Dr. Cooper that the philanthropist was willing to provide the funds for a three months' program in the Tarheel State.

Dr. Cooper looked the gift horse straight in the mouth. He said he would accept a year's financing -- not three months -- if no strings were attached to the gift. There were long-distance telephone consultations. Dr. Gamble agreed, put a check for $929,250 in the mails for a starter, and on March 15, 1937, Dr. Cooper had the only state health department in the United States at work on birth control.

He realized that he was out on a limb. Although he had the backing of his chief and some important laymen, his program was launched without the formal endorsement of any North Carolina organization. He was warned the limb might break. It hasn't broken.

II

When the North Carolina plan was launched there were only three birth-control clinics in the state. By the end of 1938 the state had created 56, and North Carolina, with less than 3 per cent of the national population, had 13 per cent of the nation's birth-control clinics. It now has a total of 692; only New York has more. They are situated in 58 of the state's 100 counties and, since patients are permitted to jump county lines, provide a state-wide coverage. The 58 counties participating had 50,565 births in 1937 -- a figure which is topped by only 18 entire states.

And this coverage was attained quietly and without ballyhoo. When the program was nearly a year old, there was a bare announcement that it had been endorsed by the Federation of Women's Clubs and the powerful Conference for Social Service. That is the only official public mention of contraception the state has made.

In furtherance of this policy, Dr. Cooper has never tried to force birth control upon any county. Dr. Gamble's funds -- he has extended his financing to 1940 were used to buy contraceptive supplies and to provide a consultant nurse, Miss Pratt. The state made these supplies and services available to any county health officer who wished to set up a contraceptive clinic as a part of his existing county health unit.

County health officers were asked to get the opinions of local physicians individually rather than at meetings, which might lead to unmanageable debates Particular caution was used to prevent public controversy. When opposition developed in one county Dr. Cooper called off all activities there, reasoning that it was better to lose a county than to risk losing the whole state. He was like a general employing a deep elastic defense and refusing to let the enemy come to grips with him. His program was in operation for eight months before he even broadcast a general letter telling county health officers he had a program. By that time he and his assistants, Dr. Roy Norton and Miss Pratt, had clinics going in most of the strategic counties.

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