Birth control knowledge: Scotland, 1900-1975

Abstract This thesis is an historical account of the development and dissemination of birth control knowledge in Scotland in the twentieth century up to 1975. The question posed is, given that Scotland in the twenty-first century has a higher rate of teenage pregnancies than most of Western Europe despite there being no restriction on the ability to access contraceptive advice, was advice always so readily available and if so from whom ? Post 1870 there was a pan European fertility decline which was mirrored in Scotland some forty years later. The debate amongst demographers and social historians is thus as to the causes of this fertility decline. Religion being cast as the impediment to the early development of the fertility decline ensured that an examination of the Roman Catholic versus Scottish Protestant views on birth control be explored. Historical accounts have considered that the desire for contraceptive advice was a phenomenon of the early years of the twentieth century and that letters to Marie Stopes were the first interactions between the general public and those competent to offer advice. However, the historical record shows that from the early years of the nineteenth century members of the public sought information on methods of birth control by writing to journals, a pattern that continued throughout the period covered by this thesis. Scotland remains distinctive from other parts of the UK by virtue of its separate legal system, both civil and criminal, its separate Church history with the parish church and state having been virtually one and the same and the rural parish church being a precursor of the local authorities. The employees of the local government authorities, the Medical Officers of Health were responsible, in agreement with their political masters of whatever hue, for the policies in relation to health and welfare adopted in a particular locality; in this case birth control advice. The administrative devolution of central government has meant that successive Scottish Secretaries of State have been able to obfuscate and hinder developments in Scotland which would have facilitated widespread dissemination of birth control advice and of course the fact that the NHS Acts in Scotland and England and Wales are distinct has ensured that legislative change has been delayed. The thesis draws upon medical and scientific journals and contemporary literature to set the scene by explicating the developments in the understanding of sexuality and reproductive physiology, a necessary precursor to the developments later in the twentieth century of the oral contraceptive pill and the impact that this preparation had on society, removing the procreative function of sexual intercourse from the hedonic. Thus freeing women from ‘the burden of pregnancy’ should they wish it, should it be available, from whom and at what cost. The politicians having debated from the 1930s to the 1970s the subject of contraceptive advice being available only to married women and initially, only available to those for whom a further pregnancy would be hazardous. Oral history testimony has been taken, and used to inform the discussion, from retired health care professionals, family planning nurses, GPs, family planning doctors, pharmacists and obstetricians as well as patients and retired clergymen who were involved in prescribing, dispensing, researching methods of contraception or in the case of the patients at the receiving end of the wisdom or ignorance of the professionals and of course in the case of the clergy advising on the moral questions in relation to the practice of birth control. In Glasgow, poor housing and social conditions, grassroots’ feminism and working class women were instrumental in establishing the first birth control clinics whereas in Edinburgh the Cooperative Women’s Guild organised public meetings to raise the issue and call on government to allow maternity centres to provide guidance and instruction in birth control to married women. In Aberdeen it was wealthy philanthropic women who promoted birth control ideals and facilitated the first birth control clinic in the north of Scotland. The issue however was politically sensitive, especially in the west of Scotland, as the Labour Party needed to secure the votes of the Roman Catholic Population. The medical profession were not at the forefront of providing this advice in part due to ignorance but also lack of interest and also not wishing to be seen as promoting immorality and offending the Church, a powerful body in Scotland. The Protestant and Catholic Churches in Scotland had an alliance condemning all acts of birth control until the 1930s when the clamour from the public forced politicians, heretofore virtually absent from the debate, to confirm what was and was not available at government expense. That guidance, similar to that offered in England, was not available to the public in Scotland as evidenced by contemporary accounts in the National Records of Scotland, merely highlights the differing attitudes of politicians in Scotland who at a local and national level were ever mindful not to risk offending the Roman Catholic Church’s teachings or risk suffering at the ballot box. Teaching of birth control techniques was absent from most medical schools in Scotland although Edinburgh University appointed a lecturer in family planning in 1946. Thus most young practitioners from Scottish medical schools remained ignorant and unable to help their patients even if willing to do so. Despite the Royal Commission on Population of 1949 recommending that advice on contraception to married persons be available, as part of the National Health Service, it was to take nearly another thirty years before contraceptive advice to all who wished it were freely available. In the intervening years the medical profession, although reluctant to become involved, had accepted initially that they could charge a fee for this private service and later that item of service payments for providing contraceptive advice was acceptable, although interviewees conceded that in many cases general practitioners were untrained to provide this service. This account of the history of the dissemination of birth control advice shows how the medical profession, initially uninterested in this subject, became, as reproductive physiology was better understood and with developments of hormonal manipulation of the menstrual cycle, to embrace contraception as a legitimate topic on which to provide advice to patients. The notion, of course, of general medical practitioners having responsibility for a group of patients unless as private practitioners was only apparent after the inception of the NHS