Birth Control Part 3

"With respect to the greater mortality amongst the poor than the rich, we have yet to learn that the only hope of lessening the death-rate lies in diminis.h.i.+ng the birth-rate. We have no _proof_ as yet that the majority of the evils at present surrounding the poor are necessarily attendant upon poverty. We have yet to see a poor population living in dry, well-drained, well-ventilated houses, properly supplied with pure water and the means of disposal of refuse. And we have yet to become acquainted with a poor population spending their scant earnings entirely, or in a very large proportion, upon the necessities of life; for such is not the case when half the earnings of a family are thrown away to provide adulterated alcoholic drinks for one member of it.

Until reforms such as these and others have been carried out, and the poor are able and willing to conform to known physiological laws, it is premature to speak of taking measures to lessen the birth-rate--a proposal, be it said, which makes the humiliating confession of man's defeat in the battle of life." [25]

It will be seen that the qualifications practically remove the question from dispute. [26] If the conditions of the poor were thus altered, poverty, as it exists to-day, would of course disappear. As things are, we find that a high death-rate is related to poverty, as is proved, for example, by the death-rate from tuberculosis being four times greater in slums than in the best residential quarters of a city.

The correct answer to the birth controllers is that a high birth-rate is not the cause of a high death-rate, because high birth-rates, as shown in the previous chapter, are not the cause of poverty, but vice versa.

Moreover, all the statistical evidence goes to prove that in this matter we are right and that Malthusians are wrong.

Section 2. HIGH BIRTH-RATE NOT THE CAUSE OF HIGH DEATH-RATE: PROVED FROM STATISTICS

In China, where there is said to be a birth-rate of over 50 per 1,000, and where over 70 per cent. of infants are helped to die, the high death-rate is due clearly to degraded social customs. In the slums of Great Britain the high death-rate is also due to degraded social conditions. It is not due to the birth-rate. Of this the proof is simple, (a) Among the French Canadians, where the average family numbers about nine, this high birth-rate is not a.s.sociated with a high death-rate, but with the increase of a thrifty, hard-working race. In Ontario the birth-rate went up from 21.10 in 1910 to 24.7 in 1911, and the death-rate _fell_ from 14 to 12.6.

(b) Again, in 1911 the corrected birth-rate for Connaught was 45.3 as against a crude rate of 24.7 for England and Wales; and in Connaught, where there is no need for Societies for preventing Parents being Cruel to their Children, the infant mortality rate [27] is very much lower than in England, although the birth-rate is much higher and the poverty much greater. In Bradford, a prosperous English town which pays particular attention to its mothers and children, the infant mortality in 1917 was 132 per 1,000 and the birth-rate 13.2. In Connaught, where there are no maternity centres or other aids to survival, but on the contrary a great dearth of the means of well-being, the infant mortality was only 50, whilst the birth-rate was actually 45! [28] So untrue is it to say that a high death-rate is due to a high birth-rate.

Section 3. A LOW BIRTH-RATE NO GUARANTEE OF A LOW DEATH-RATE

Again, birth controllers claim that a low birthrate leads to a low infant mortality rate. Now, it is really a very extraordinary thing that, whatever be the statement made by a Malthusian on the subject of birth-control, the very opposite is found to be the truth. During the last quarter of last century a _falling_ birth-rate in England was actually accompanied by a _rising_ infant mortality rate! During 1918 in Ireland [29] the crude birthrate was 19.9, with an infant mortality rate of 86, whereas in England and Wales [30] the crude birthrate was 17.7 with an infant mortality rate of 97, and in the northern boroughs the appalling rate of 120. In England and Wales the lowest infant mortality rate was found to be in the southern rural districts, where the rate was 63, but in Connaught the rate was 50.5.

This means that in England a low birth-rate is a.s.sociated with a high infant mortality rate, whereas in Ireland a high birth-rate is a.s.sociated with a low infant mortality rate. [31] These cold figures prove that in this matter at least the poorest Irish peasants are richer than the people of England.

Section 4. VITAL STATISTICS OF FRANCE

The Malthusian claim that a low birth-rate leads to a low death-rate is also disproved by the vital statistics of France.

"The death-rate of France has not declined at the same rate as the birth-rate has, and, while the incidence of mortality in France was equal to that of England in the middle of the seventies, the English mortality is now only five-sevenths of the French. England thus maintains a fair natural increase, although the birth-rate has declined at an even faster pace than has been the case in France....

"The French death-rate is higher than is the case with most of her neighbours, and it can quite well be reduced. The reasons for her fairly high mortality are not to be found in climatic conditions, racial characteristics, or other unchangeable elements of nature, nor even in her occupations, since some of the most industrial regions have a low mortality." [32]

I have tabulated certain vital statistics of twenty Departments of France.

The following table, covering two periods of five years in twenty Departments, proves that _the death-rate was lower_ in the ten Departments having the highest birth-rate in France than in the ten Departments having the lowest birth-rate.

TABLE I

THE TEN DEPARTMENTS HAVING THE HIGHEST BIRTH-RATE FRANCE 1909-1913 1915-1919 Rates per 1,000 population Still- Rates per 1,000 births population Departments. Living Deaths Natural per 1000 Births deaths births increase births

Moselle 27.6 16.5 +11.1 - 14.7 15.4 Finistere 27.2 18.1 +9.1 4.0 15.9 18.2 Pas-de-Calais 26.8 17.4 +9.4 4.2 - - Morbihan 25.7 17.8 +7.9 4.4 15.0 19.0 Cotes-du-Nord 24.5 20.6 +3.9 4.2 14.4 20.0 Bas-Rhin. 24.3 16.2 +8.0 - 13.3 16.1 Meurthe-et- Moselle 23.2 19.2 +4.0 4.3 - - Lozere 22.6 17.3 +5.2 4.2 12.4 17.5 Haut-Rhin. 22.4 16.0 +6.4 - 10.3 15.4 Vosges 22.0 18.7 +3.3 4.7 - -

_Total Averages 24.6 17.7 +6.8 4.2 13.7 17.3_

THE TEN DEPARTMENTS HAVING THE LOWEST BIRTH-RATE IN FRANCE

Cote-d'Or. 15.4 18.2 -2.8 3.1 9.9 20.5 Allier. 15.1 15.7 -0.6 3.3 8.4 18.8 Gironde 15.1 17.3 -2.2 4.5 10.1 21.2 Haute-Garonne. 15.1 20.4 -5.3 4.0 9.0 22.5 Lot 15.0 21.0 -6.0 4.5 7.5 20.6 Nievre 14.9 17.4 -2.5 3.2 8.8 20.0 Tarn-et-Garonne 14.9 20.1 -5.1 4.7 7.9 20.7 Yonne 14.4 19.1 -4.7 3.8 8.9 22.0 Lot-et-Garonne 13.7 19.1 -5.4 4.4 7.4 20.1 Gers 13.2 19.2 -6.0 4.1 6.8 19.8

_Total Averages 14.6 18.7 -4.0 3.9 8.4 20.6_

Moreover, the figures show that, prior to 1914, the Departments with the lowest birth-rate were becoming _depopulated_. On the other hand, the enormous fall in the birth-rate throughout the country from 1915 to 1919 is a memorial, very n.o.ble, to the heroism of France in the Great War, and to her 1,175,000 dead. Certain other facts should also be noted. In France the regulations permit that, when a child has died before registration of the birth, this may be recorded as a still-birth; and for that reason the proportion of still-births _appears_ higher than in most other countries.

Malthusian claims are thus refuted by the vital statistics of France; but it should be clearly understood that these figures do _not_ prove that the reverse of the Malthusian theory is true, namely, that a high birth-rate is the cause of a low death-rate. There is no true correlation between birthrates and death-rates.

Section 5. COEFFICIENTS OF CORRELATION

As birth controllers rely very much upon statistics, and as figures may very easily mislead the unwary, it is necessary to point out that the Malthusian contention that a high birth-rate is the cause of a high death-rate is not only contrary to reason and to facts, but is also contrary to the very figures which they quote. A high birth-rate is often a.s.sociated with a high death-rate, but a general or uniform correspondence between birth-rates and death-rates has never been established by modern statistical methods. To these methods brief reference may be made. A coefficient of correlation is a number intended to indicate the degree of similarity between two things, or the extent to which one moves with the other. If this coefficient is unity, or 1, it indicates that the two things are similar in all respects, while if it be zero, or 0, it indicates that there is no resemblance between them. The study of correlation is a first step to the study of causation, because, until we know to what extent two things move together, it is useless to consider whether one causes the movement of the other; but in itself a coefficient of correlation does not necessarily indicate cause or result. Now in this country, between 1838 and 1912 the birth-rate and the death-rate show a correlation of .84; but if that period be split into two, the correlation from 1838 to 1876, when the birth-rate was fluctuating, is _minus_ .12, and in the period after 1876 the correlation is _plus_ .92. This means that the whole of the positive correlation is due to the falling of the death-rate, and that birthrates and death-rates do not of necessity move together. [33]

After a careful examination of the vital statistics for France, Knud Stouman concludes as follows:

"In France no clear correlation exists between the birth-rate and the death-rate in the various Departments. The coefficient of correlation between the birth-rate and the general death-rate by Departments (1909-1913) was 0.06920.1067, and including Alsace and Lorraine--0.02120.1054, indicating no correlation whatsoever. A somewhat different and more interesting table is obtained when the correlation is made with the mortality at each age cla.s.s:

TABLE II

Under 1 year 0.3647 0.0986 1-19 years 0.4884 0.0816 20-39 years 0.6228 0.0656 40-59 years 0.5028 0.0801 60 years and over 0.2577 0.1001

"A peculiar configuration is observed in these coefficients in that a quite p.r.o.nounced positive correlation exists at the central age group, but disappears with some regularity towards both extremities of life. If the mortality has any influence upon the natality this cannot be in the form of replacement of lost infants and deceased old people, therefore, as has frequently been suggested. That a high death-rate at the child-bearing age should be conducive to increased fertility is absurd, neither does it seem likely that a large number of children should make the parents more liable to diseases which are prevalent at this period of life. The reasons must, then, be looked for in a common factor.

"Now the only disease of importance representing the same age-curve as do the correlation coefficients is tuberculosis. This disease causes in France 2 per cent. of the deaths under one year, 24 per cent. of the deaths from 1 to 19 years of age, not less than 45 per cent. from 20 to 39, 18 per cent. at ages 40 to 59, and less than 2 per cent. at the ages over 60. Will a high tuberculosis mortality, then, be conducive to great fertility, or do we have to fear that a decrease of the natality will be the result of energetic measures against tuberculosis? Hardly.

The death-rate may be reduced, then, without detrimental effects upon the birth-rate.

"What can the factor be which influences both the tuberculosis incidence and the birth-rate? We know that the prevalence of tuberculosis is conditioned princ.i.p.ally by poverty and ignorance of hygiene. The Parisian statistics, as compiled by Dr. Bertillon and recently by Professor L. Hersch, show a much higher birth-rate in the poor wards than in the richer districts, and the high birth-rates may be furnished largely by the poorer elements of the population. A comfortable degree of wealth does not imply a low birth-rate, as is abundantly shown elsewhere, and one of the important questions which suggest themselves to the French statistician and sociologist is evidently the following: How can the intellectual and economic standard of the ma.s.ses be raised without detriment to the natality?

"We believe that the time is opportune for solving this question. The past half-century has been lived under the shadow of defeat and with a sense of limitations, and of impotence against fate. This nightmare is now thrown off, and, the doors to the world being open and development free, the French people will learn that new initiative has its full recompense and that a living and a useful activity can be found for all the sons and daughters they may get. The habit of home-staying is broken by the war, and new and great undertakings are developing in the ruined north-east as well as in the sunny south." [34]

[Footnote 25: _The Lancet_, 1879, vol. ii, p. 703.]

[Footnote 26: Poverty is a term of wide import admitting many degrees according as the victim is deprived more or less completely of the ordinary necessities in the matters of food, clothing, housing, education, and recreation. As used by Malthusians and spoken of here it means persistent lack of one or more of these necessary requisites for decent living. Vide Parkinson, _Primer of Social Science_ (1918), pp. 225 sqq.]

[Footnote 27: The infant mortality rate is the number of deaths of infants under one year old per 1,000 births in the same year.]

[Footnote 28: See Saleeby, _The Factors of Infant Mortality_, edited by Cory Bigger. _Report on the Physical Welfare of Mothers and Children_, vol.

iv, Ireland (Carnegie U.K. Trust), 1918.]

[Footnote 29: _Fifty-fifth Annual Report of the Registrar-General for Ireland, containing a General Abstract of the Numbers of Marriages, Births, and Deaths_, 1918, pp. x, xxix, and 24.]

[Footnote 30: _Eighty-first Annual Report of the Registrar-General of Births, Deaths, and Marriages in England and Wales_, 1918, pp. xxiv, x.x.xii, and x.x.xv.]

[Footnote 31: This is also the emphatic testimony of Sir Arthur Newsholme, in his _Report of Child Mortality_, issued in connection with the _Forty-fifth Annual Report of the Local Government Board_ (dated 191?), PP.

77-8.]

[Footnote 32: Knud Stouman, "The Repopulation of France," _International Journal of Public Health_, vol. ii, no. 4, p. 421.]

[Footnote 33: Dr. Major Greenwood. Vide _The Declining Birth-rate_, 1916, p. 130.]

[Footnote 34: _International Journal of Public Health_, vol. ii, no. 4, p.

423.]