PART III.—POSSIBLE REMEDIAL MEASURES.
Having reviewed the position as it exists in New Zealand, and having set out what appear to be the main causes, it now remains to consider possible preventive measures.
(1)The Relief of Economic Stress.
In so far as hardships resulting from economic difficulties are genuine, the Committee believes that there is a real call for and that there are definite possibilities of relief by the State.
Two classes in particular call for most sympathetic consideration:—
(1) The wives of the unemployed, or of those precariously employed.
(2) The wives of those engaged in small farming, especially in the dairy-farming districts of the North Island.
For such women we consider that much could be done by way of financial, domestic, and obstetrical help.
Financial Help.—In general terms all efforts at social betterment—the reduction of unemployment, the improvement of wages and relief, the reduction of taxation, direct and indirect, and the provision of better housing conditions—should undoubtedly help to make conditions more secure and more satisfactory for the rearing of larger families.
But further than this, we believe that really adequate financial assistancedirectly related to the encouragement of the familyis urgently called for.
It is perfectly clear that general financial improvement does not, itself, necessarily bring about larger families; limitation of the family is probably more prevalent amongst those more fortunately placed. What form this financial aid to the family should take requires much consideration.
The assistance is required not merely at the time of confinement, but also during the much longer period of the rearing and the education of the family.
A general extension of the maternity allowance under any national health scheme would afford some immediate financial assistance.
Income-tax exemption for children, however generous the scale, would not benefit these badly circumstanced cases, for already they are below the income-tax limit.
It would appear that further financial provision would have to take the form of a direct children's allowance.
It is suggested that this might be put into effect by amending the present Family Allowances Act to provide that—
(1) The amount be increased;
(2) The permissible income-level be increased;
(3) That, where given, the allowance be in respect of all the children in the family; and
(4) That the age-limit of the children be increased to sixteen.
Domestic Assistance.—Equally important is the provision of domestic assistance, and here we are faced with a problem of the greatest difficulty—a national problem which is affecting women in all walks of life and of which this is but one aspect.
In many farming districts it is clear that lack of domestic help is a greater burden to the harassed mother than even financial stringency.
Many admirable efforts are being made to give assistance in this direction—in the country by the housekeeper plans of the Women's Division of the Farmers' Union and other organizations, in the cities by the Mothers Help Society and similar agencies.
Extension of such system is highly desirable, and the possibility of their organization on a much larger scale with Government subsidy well deserves consideration.
In many cases these efforts are limited as much by lack of personnel as by lack of funds.
Alternatively, we suggest—
(1) That the Government should inaugurate and recruit a National Domestic Service Corps of young women agreeable to enter the domestic-service profession;
(2) That the recruits be guaranteed continuity of employment and remuneration as long as their service was satisfactory;
(3) That they undergo whatever training is considered desirable at technical school or otherwise;
(4) That they agree to perform service wherever required by the Domestic Service Department, which Department shall ensure that the living and working conditions are up to standard;
(5) That the service be made available to all women, and that first consideration be given to expectant mothers, mothers convalescent after childbirth, and mothers who have young families, and that the service be either free or charged for according to the circumstances of each case.
Again, realizing the fact that many of the considerations involved in this question of domestic help are beyond the scope of this Committee, we recommend that a full investigation should be made of the whole matter.
Obstetrical Aid.—As for obstetrical help, we believe that the position is in the main adequate and good.
As far as the larger centres are concerned, no woman, however poor her circumstances, need lack complete ante-natal supervision, for which no charge is made, and proper confinement care, at most moderate cost, in the St. Helens Hospitals or the various maternity annexes of the public hospitals; where the mother is actually indigent, free provision is available through the Hospital Boards or St. Helens Hospitals.
The country mother in certain districts is, however, much less well placed, although the Health Department through its district nurses, maternity annexes, and subsidized small country hospitals is trying to meet the need.
We commend all possible efforts in this direction, and suggest that transport difficulties as they affect the country mother be given special consideration.
To a certain extent transport difficulties can be eliminated by making more use of public hospitals nearest to the patient's residence, or of private maternity hospitals subsidized by the Hospital Board of the district.
Certain general criticisms of the maternity services are elsewhere discussed and certain recommendations are made.
It is in respect of overburdened and debilitated women of those classes who are not in a position to obtain it privately that we have suggested that the State might make provision for birth-control advice.
It is for such mothers especially that we have recommended the establishment of birth-control clinics in connection with our public hospitals.
We realize, however, that genuine economic hardship is not confined to the unemployed, the wives of struggling farmers, and those on the lowest wage-levels; relative to their own circumstances and responsibilities, the difficulties of many women whose husbands are in the lower-salaried groups, or in small businesses, for instance, are just as anxious. For these we should also advocate the extension of the maternity allowance and such further direct financial encouragement of the family as can be devised.
Here, too, is the definite need for domestic help—possibly on a subsidized plan.
Many of these women prefer to make their own private arrangements for their confinements, and to enable them to do so we suggest that further assistance might be given by the provision of more maternity hospitals of the intermediate type, in which these mothers may have all adequate facilities with the right of attendance by their own doctors. Here, too, we believe that proper knowledge of child spacing is most desirable, though we consider that this is a matter for private arrangement.
(2)Removal of Fear of Childbirth.
It has been indicated that whereas the majority of witnesses expressed the opinion that the fear of pregnancy and labour played little part in the demand for abortion, and that the majority of women were satisfied with the help and relief which they received at the time of their confinement, yet there were some witnesses who held very strongly that inadequate pain relief and lack of sympathetic understanding of the individual on the part of the attendants were factors of considerable importance.
We believe that these complaints are, as far as the maternity services in general are concerned, entirely unjustified.
Taken as a whole, there is probably a more general use of pain-relieving measures in New Zealand to-day than anywhere else in the world.
Nevertheless, while commending what has already been done, we trust that every endeavour will be made by the Health Department, the doctors of the Dominion, and those responsible for the management of our maternity hospitals to do everything possible to extend these pain-relieving measures within the limits of safety, and to encourage that sympathetic consideration of the individual which is so desirable.
While deprecating certain attacks which have been made on the St. Helens Hospitals, and appreciating the fact that there are other considerations involved besides the relieving of pain, we feel sure that the Health Department will investigate the possibility of improving the services rendered by these Hospitals by the introduction of resident medical officers.
We agree with one witness who expressed the opinion that too much had been done in the past in the way of publishing the risks of maternity.
We feel that there are real grounds for confidence in the obstetrical services of the Dominion and that any fear of pregnancy which does exist would be largely removed if the public were made aware that New Zealand now has a very low death-rate in actual childbirth, that relief in labour is largely used, and that further developments in this direction are continually being investigated.
(3)Control of Abortion amongst the Unmarried.
The evidence before the Committee indicates that, while this is not the major problem, it is, nevertheless, an important one.
Obviously, the main cause is a looseness of the moral standard, and the remedy must be educational.
It is not the province, nor is it within the capacity of this Committee, to make detailed recommendations on this matter, but we would urge upon all those concerned—the educational authorities, religious bodies, the various youth movements and women's organisations, and individual parents—the importance of enlightened education of the young in the matter of sex problems.
One factor of great importance we believe to be the widespread use of contraceptives amongst the unmarried.
It might, at first thought, seem likely that the use of contraceptives, however reprehensible, would tend to diminish the incidence of abortion.
But we believe that actually this is not the case: there is reason to think that many young women, relying on undependable methods of prevention, are tempted, and then, finding themselves in misfortune, resort to some method of abortion.
It is our opinion that not only is immorality encouraged by the indiscriminate sale of contraceptives, but, indirectly, criminal abortion has increased amongst the young.
For these reasons above all we are convinced that there should be a determined effort to suppress the indiscriminate sale of contraceptives.
While realizing the great practical difficulties, we believe that much could be done.
In particular, we believe that some effective measures could be devised to control the distribution of that type of contraceptive which is mainly used in these circumstances.
We recommend the consideration of the licensing of the importation of certain contraceptive goods.
We urge that the sale or distribution of contraceptives should be restricted entirely to registered practising chemists, doctors, hospital departments or clinics, and that their sale by other persons should be illegal and subject to severe penalty.
Evidence placed before the Committee showed that, a profit up to 300 per cent. was being made on contraceptive appliances.
We recommend that the restriction on the advertisement of contraceptives should be more rigidly enforced, and particularly that the promiscuous advertisement and sale of contraceptives by "mail order" agencies should be made illegal.
We recommend that it should be made unlawful to supply contraceptives to young persons.
Difficulties and possibilities of evasion are of course obvious, but, nevertheless, similar restrictions have been applied with at least some measure of success in other directions.
We would also appeal to the Pharmaceutical Society and to the individual chemists, since the responsibility rests so largely with them, to co-operate most earnestly in this matter.
With regard to abortifacients, the recommendations we later make apply with even greater force to unmarried women.
Several witnesses, speaking on behalf of women's organizations, advocated the introduction of women police for the guidance and protection of the young in places of public resort.
Reference to the effect of alcohol on moral restraint has already been made.
The second big consideration is the care of the unmarried woman who is in trouble.
It has been suggested that if there were a more tolerant attitude towards such girls many who now resort to abortion would be prepared to go forward and face the future.
As one witness stated:—
"She should be treated with the greatest tenderness. Usually she is more sinned against than sinning; but she carries all the blame which belongs not only to the man but also to society, which has been guilty of supine acquiescence in the surrender of standards of moral conduct."She has to give birth to a child which has the rights of every unborn infant; and she has to re-establish herself in the community.... It is terribly difficult for them afterwards with the child, and they need all the help they can get. It seems to me that some of them must go in sheer dread to the abortionist. My definite opinion is that something more needs to be done."
"She should be treated with the greatest tenderness. Usually she is more sinned against than sinning; but she carries all the blame which belongs not only to the man but also to society, which has been guilty of supine acquiescence in the surrender of standards of moral conduct.
"She has to give birth to a child which has the rights of every unborn infant; and she has to re-establish herself in the community.... It is terribly difficult for them afterwards with the child, and they need all the help they can get. It seems to me that some of them must go in sheer dread to the abortionist. My definite opinion is that something more needs to be done."
In all fairness to the many fine organizations which are helping these girls, the Committee is satisfied that there is no lack of tolerance, sympathy, and helpfulness with them.
If fault there is, it is in the attitude of the general public to this matter.
Some criticism has been directed at the St. Helens Hospitals because they are not freely open to unmarried women, but it is only right that the position should be made clear.
The actual position is that, in the majority of cases, the St. Helens Hospitals, which can only offer accommodation to an expectant mother for the period of her confinement, arenot suitablefor dealing with single women, who require protection and care before and after their confinements as well.
There are, throughout the country, many admirable institutions which are equipped to give this service.
Discussion before this Committee has, however, made it clear that where an unmarried mother can make adequate private arrangements for the care of herself and her infant after confinement, the St. Helens Hospitals are prepared to take her for the actual confinement period.
In regard to the maternity homes which deal with unmarried women, there has also been some criticism of the usual regulations in these homes which call for a period of residence in the home both before and, especially, after confinement.
It should be pointed out, however, that this is a wise and humane provision, entirely in the interests of the mothers and their babies; it ensures for the mother that very period of convalescence which other witnesses have so strongly advocated under other circumstances, it gives the baby protection in the most difficult early months, and it allows the helpers in the home an opportunity to make provision for the baby's future.
Here, again, where the mother is able to make adequate provision for herself and her infant, these regulations are certainly relaxed in some of the homes concerned, and we would commend this practice in suitable cases to those responsible for the management of all these homes.
Regarding the obstetrical care given to the unmarried mothers in these homes, the evidence given indicates clearly that it is of a standard equal to that in our other maternity hospitals.
Indeed, whereas the risks of childbirth amongst unmarried mothers the world over is notoriously high, amongst the women who place themselves in the care of these homes in New Zealand the maternal mortality and the infant mortality are both exceedingly low.
In the homes of which the members of the Committee have personal knowledge the same ante-natal care (indeed, since these patients are resident in the home and under close observation, more complete care) is given and the same methods of pain relief are used.
It is only right that these reassuring facts should be made public.
Regarding the provision for the children in these cases, while we are satisfied that the State and the various organisations responsible for their care deal with them in a kindly and sympathetic manner, we agree that every effort should be made to give them a fair prospect in life, to avoid any stigma, and to keep secret their misfortune.
It has been suggested by one witness that the privacy of an unmarried mother's affairs has been interfered with the present regulations regarding the notification of births. Under the Child Welfare Act as it at present operates there is a duty on the Registrar to inform the Child Welfare Department of every birth, and the register is also open to the Plunket Society for purposes of following up.
Good as the intention of these provisions is in the interests of the babies, the assertion has been made that in certain cases the knowledge of this lack of secrecy has deterred women from allowing their pregnancies to continue, and has constrained them to seek abortion.
The Committee is not prepared to comment on this complaint, but would suggest that it be investigated, and that, if there is any justification in it, the regulations be amended so that, while fully protecting the child, full secrecy is maintained.
(4)To Meet Changes in Social Outlook.
The Committee has concluded that, beyond the economic and domestic considerations already discussed, there are many changes in modern social outlook which are operating in the direction of family limitation, and which, in many cases, lead to the practice of abortion.
Can anything be done to prevent the occurrence of abortion resulting from these tendencies in modern life?
Concerning birth-control the realities of the position must be faced. There can be no doubt that there is a widespread uncontrolled and ill-instructed use of contraceptives.
As one witness put it, "New Zealand is saturated with birth-control."
Owing to this extensive half-knowledge there is in many cases an entirely unwarranted dependence on their reliability to the exclusion of any measure of self-discipline whatever.
The Committee is under no illusion in this matter.
With this attitude prevailing in the community and provided with such a weapon—even though it is likely to explode in their own hands—women will continue to limit their families. No social legislation, however generous, will prevent it, nor, as far as the Committee can see, will legal prohibitions do much to restrict it.
Two lines of action are suggested:—
(1) To direct the knowledge of birth-control through more responsible channels, where, while the methods advised would be more reliable, the responsibilities and privileges of motherhood, the advisability of self-discipline in certain directions, and other aspects of the question could be discussed.
It is this view which has led the Committee to the recommendations it has made in the discussion of birth-control.
(2) To appeal to the womanhood of New Zealand in so far as selfish and unworthy motives have entered into our family life, to consider the grave physical and moral dangers, not to speak of the dangers of race suicide which are involved.
We can but urge all those who have to do with the education of our youth and the moulding of women's opinion to give these matters earnest consideration, and the Committee is of the opinion that it is necessary to develop the education of young people in biology and physiology in our primary and secondary schools as a foundation for a more rational and wholesome outlook on sex matters.
(5)Contraception.
The practice of contraception is a debatable question, and one on which the most varied evidence has been given.
Witnesses opposed this practice, some on moral grounds, some with the plea for a greater natural increase in the population of New Zealand.
Others again, particularly the representatives of women's organizations, advocated the establishment of clinics for the general instruction of married women in the practice of reliable methods of contraception. They expressed the opinion, and some of them supported their opinions with sound argument and overseas experience, that the instruction of the mothers of New Zealand in the practice of child-spacing rather than resulting in a diminution of the birth-rate might wellcause an increase in the size of many families, for, in addition to enabling mothers to plan their families, such clinics also specialize in propaganda calculated to awaken women to an appreciation of the privileges and responsibilities of motherhood.
The Committee agrees that the possession of reliable contraceptive knowledge by the married women of New Zealand would tend to augment rather than to diminish further the natural rate of increase of our population, for an additional factor to those given above lies in the large amount of sterility which follows induced abortion, that most unsatisfactory of all forms of birth-control.
The evidence laid before the Committee shows that in New Zealand every year thousands of women imperil, and indeed negate, their future prospects of motherhood by submitting to the induction of abortion.
It has been shown that abortion is a delayed, dangerous, and unsatisfactory form of birth-control, and it can quite logically be argued that if a reliable and simple method of contraception was known to all married people the abortion problem would assume very small proportions.
This is, to a large extent, true, but it must not be forgotten that both abortion and contraception have various aspects, and that apart from other objections there are practical difficulties which are not easily surmounted. There is no known contraceptive which is simple, inexpensive, and 100 per cent. reliable for the thoughtless, the careless, and the stupid.
Contraception may be considered under three headings:—
(1) The practice of contraception extramaritially, which only needs to be mentioned to be deprecated.
(2) The practice of contraception by married people irrespective of their circumstances.
Evidence was given by responsible and representative women in support of a mother's right to say when she will bear her children, and although we agree that this privilege might well be conceded her, we are of the opinion that it is not the function of the State to undertake the dissemination of the knowledge and give the practical instruction necessary to enable the general adoption of this principle.
This general instruction can well be left to the medical profession, who should also undertake the responsibility of impressing the privileges of motherhood upon young women seeking such advice.
In recommending that such general instruction should be left to the medical practitioners, we are cognizant of the fact that many members of that profession are at a loss to know what methods of contraception can be reliably recommended to lay persons.
A sub-committee of the Obstetrical Society, consisting of members who have made a special study of this problem, has been set up, and the presentation of their report will doubtless clarify the position in the minds of the medical profession.
(3) The practice of contraception by married women who, in the opinion of their medical attendant, should have temporary or permanent freedom from the fact or fear of pregnancy.
Not only are there cases in which severe illness exists making further pregnancies dangerous, but there is also a heterogenous group including all gradations of health and economic reasons.
Here we have the mother with health undermined and reserve vitality reduced to a minimum by the strain of bearing and rearing a large family. She approaches the menopausal stresses with anxiety and apprehension, having done her duty to family and race, often having lived an exemplary self-sacrificing life, the intolerable contemplation of a late pregnancy drives her to desperate measures often for the first time in her life.
Again, there is the relatively young, tired, anæmic, debilitated mother, with a number of young children born at very close intervals, often denied even a half-holiday, let alone an adequate one, unable to afford suitable domestic assistance, often with poor housing or domestic arrangements, and completely exhausted with the incessant round of cleaning, cooking, and the strain of the inevitable fretfulness of a number of young children.
The Committee is of the opinion that it is the State's duty to ensure that mothers within this group should obtain the respite that the health of themselves and their present and future families demands.
The economic aspects of these problems are dealt with in our general recommendations, but we also recommend that departments should be established, preferably in conjunction with the out-patients' departments of our public hospitals, whither medical practitioners could refer for instruction and equipment with contraceptive appliances mothers who in their opinion should be assured of temporary or permanent freedom from child-bearing.
It might be desirable that the certifying doctor's recommendation should be endorsed by the officer in charge of the department before admission, but that is a practical point which could be discussed at a later date with members of the Obstetrical Society and medical profession.
Though the Committee discounts the exaggerated statements that have been made at intervals about the sale of contraceptives to juveniles, and though no first-hand information on such matters was laid before the Committee, yet we are of the opinion that the sale of contraceptives to young persons should be prohibited.
(6)The Control of the Advertisement and Sale of Abortifacient Drugs and Appliances.
The Committee recommends the advertising and sale (except by doctor's prescription) of drugs euphemistically described as for the "correction of women's ailments" or "correction of irregularities" should be forbidded. For their alleged purpose of correcting functional menstrual irregularities they have no value; as abortifacients though usually ineffective their unrestricted sale should be forbidden. As stated previously, "their only value is as a lucrative source of gain to those people who, knowing their inefficiency, yet exploit the distress of certain women by selling them." An example of this exploitation was obtained by the Committee. The drugs were advertised as "corrective pills, ordinary strength, 7s. 6d.; extra strong, 12s. 6d.; special strength, 20s." A supply of the last was obtained, and analysis showed that they consisted of (1) a capsule containing about 12 drops of oil of savin, value about 6d., dangerous to health but usually useless for the purpose sold; (2) 9 tablets of quinine, worth about 4s., and quite ineffective; (3) 24 iron and aloes pills, worth about 6d., and equally ineffective. The gross profit on this 2s. worth of rubbish was at least 900 per cent. If it is possible to legislate to stop such fraudulent exploitation of people we recommend that it be done.
The Committee also recommends that the sale of surgical instruments which can be used for the purpose of procuring abortions, such as catheters, Bougies, and sea-tangle tents, be prohibited, except on the prescription of a medical practitioner, and that if possible their importation be placed under control.
PART IV.—QUESTIONS RELATING TO THE MEDICO-LEGAL ASPECTS OF ABORTION.
At the present time there is in many countries much criticism of the existing laws regarding abortion, and various suggestions have been made for the alteration of the law.
Such representations have, indeed, been made to this Committee.
A consideration of these matters, therefore, could not escape our attention.
The New Zealand Law regarding Abortion.
The law in regard to abortion as set down in sections 221, 222, and 223 of the Crimes Act, 1908, is as follows:—
Procuring Abortion.
"221. (1). Every one is liable to imprisonment with hard labour for life who, with intent to procure the miscarriage of any woman or girl, whether with child or not, unlawfully administers to or causes to be taken by her any poison or other noxious thing, or unlawfully uses any instrument or other means whatsoever with the like intent.
"(2) The woman or girl herself is not indictable under this section."
This section re-enacts s. 201 of the Criminal Code Act, 1893.Cf.s. 223,infra.
"Other means" must be readejusdem generiswith "instrument." (R.v.Skellon[1913] 33 N.Z.L.R. 102.)
"Procuring her own Miscarriage.
"222. Every woman or girl is liable to seven years' imprisonment with hard labour who, whether with child or not, unlawfully administers to herself, or permits to be administered to her, any poison or other noxious thing, or unlawfully uses on herself, or permits to be used on her, any instrument or other means whatsoever with intent to procure miscarriage."
This section re-enacts s. 202 of the Criminal Code Act, 1893.
"Supplying the Means of Procuring Abortion.
"223. (1) Every one is liable to three years' imprisonment with hard labour who unlawfully supplies or procures any poison or other noxious thing, or any instrument or thing whatsoever, knowing that the same is intended to be unlawfully used or employed with intent to procure the miscarriage of any woman or girl, whether with child or not.
"(2) Every one who commits this offence after a previous conviction for a like offence is liable to imprisonment with hard labour for life."
This section re-enacts s. 203 of the Criminal Code Act, 1893. InR.v.Thompson[1911] 30 N.Z.L.R. 690, a person was convicted of an attempt (s. 93. p. 209,ante) to procure a noxious thing although the thing actually procured was innoxious.
"Knowing" has the meaning of "believing," and a person supplying "a noxious thing" is guilty even when the person supplied, who states that he required it for procuring abortion, had no intention of using it and did not use it for that purpose (R.v.Nosworthy[1907] 36 N.Z.L.R. 536).
If the evidence shows that prisoner intended the instrument to be used for the purpose stated, it is sufficient without evidence of intention on the part of the woman to use it or allow it to be used (R.v.Scully[1903] 23 N.Z.L.R. 380).
The word "thing" where secondly used in this section includes only thingsejusdem generiswith instrument and capable of being used to produce miscarriage (R.v.Austin[1905] 24 N.Z.L.R. 893).
Therapeutic Abortion.—In New Zealand, as in Great Britain and other countries, the medical profession has always held that when the mother's life is seriously endangered by a continuation of the pregnancy the termination of the pregnancy is justifiable and right.
This the law allows, not specifically but by inference.
It is probably a correct statement of the position to say that, with advances in medical knowledge and thought, even the most conservative medical opinion, apart from that which is influenced by certain religious views, holds that the indications for the termination of pregnancy have been extended somewhat to include not only cases in which the mother's life is immediately jeopardized, but also certain cases in which her life is more remotely endangered.
This view is supported by the social thought of to-day.
This is not to say that the occasions for this operation are frequent; they are, indeed, infrequent.
The general standards which guide the medical profession in this matter are very strict, and are conscientiously conformed to by the majority of its members.
It is also a well-recognized rule of the profession that such operations should only be performed after consultation between two medical practitioners.
With this change in medical outlook, however, there has been no corresponding alteration in the law, which, as it stands, is as uncompromising as ever, and allows of no interference except to save thelifeof the mother.
It is a fact that the law isinterpretedliberally, and no doctor who has acted honestly in the belief that the mother's health was seriously endangered has ever been challenged.
Nevertheless, it has been urged by a large body of the medical profession, especially of those most intimately affected by the question, that there are possibledangers in the situation, and that the law should be altered to indicate more specifically the rightful position of the doctor in this matter; in other words, it is advocated that the present interpretation of the law should be incorporated in the law itself.
Much is made of the fact that an honourable practitioner occasionally finds himself in the unsatisfactory position of having actually to break the letter of the law in doing what according to accepted medical standards is in the best interests of the patient.
As safeguards against the possible dangers of a widening of the law, it has been suggested that new regulations should be introduced governing the practice of therapeutic abortion.
It has been recommended that operations should only be performed after adequate consultation, and that written certificates should be given by both parties to the consultation; that in certain cases the consultant should be a specialist; that all operations should be performed in public or licensed hospitals; that every therapeutic abortion should be notified to the Medical Officer of Health, to whom also the two certificates should be forwarded; and that every operation not performed under these conditions should be subject to strict investigation.
It has also been recommended by some that there should be a general notification of all abortions.
Those who are opposed to any alteration of the present state argue that any specific legalization of therapeutic abortion to save the serious impairment of health as well as to save life might lead to abuses of this sanction. They point out that even at the present time doctors differ considerably in their views and in their practice, and they fear that such divergences in thought and practice might be seriously exaggerated.
As to the suggested safeguarding regulations, there is by no means general agreement in the medical profession concerning their advisability or their value.
The Committee, having investigated the matter very fully, is satisfied that any disability under which the doctor rests in terminating a pregnancy for genuine, accepted therapeutic reasons is only theoretical.
No actual instance was brought before the Committee in which a doctor had been penalized or even subject to question when acting in good faith, nor was any evidence presented to show that any patient had suffered by reason of a doctor refraining from operating through fear of possible legal consequences.
Both medical and legal witnesses competent to speak on these medico-legal aspects were definite in their assurance that, under the existing law, no doctor acting in accordance with the accepted standards of the profession was in any danger.
The only person who need have any fear was one who ignored guidance of the existing standards of his profession, and to this extent the law was, at least in part, a deterrent against laxity of practice.
The Committee considers that, as it stands, the law has shown itself adaptable in practice to all reasonable changes in medical thought.
Further, the Committee was impressed by the possible dangers which might be associated with any alteration in the existing law.
While it is undoubtedly true that the majority of doctors are straightforward and honest in their interpretation of the indications for therapeutic abortion, it was made clear that even at the present time there are some who are inclined to terminate pregnancy for reasons which would not be accepted by most.
It would be quite impossible to lay down a hard-and-fast list of indications.
There are definite grounds for fearing that any alteration in the law would lead, in certain quarters, to a widening of the interpretations far beyond the intention of the alteration.
Under any alteration it would be exceedingly difficult to control the merging of the therapeutic into the social and economic reasons.
For these reasons, then, the Committee is not prepared to suggest any alteration in the law regarding therapeutic abortion; the Committee believes, however, that some benefit might accrue from the compulsory notification of all abortions to the Medical Officer of Health.
Abortion for Social and Economic Reasons.—Having received certain representations in favour of this practice, and having examined a large mass of evidence on this subject, the Committee is utterly opposed to any consideration of the legalization of abortion for social and economic reasons.
The Committee does not hesitate to state its first objection on moral grounds.
That the deliberate destruction of embryo human lives should be allowed for all the varying and indeterminate reasons suggested by different advocates would lead the way to intolerable license.
We would draw your attention and that of the public to the extreme views which are held by some of the most active advocates of legalized abortion.
In its most blatant form this advocacy is based on the argument of woman's right to determine for herself whether a pregnancy shall continue or not.
"The right to abortion should be taken quite away from legal technicality and legal controversy. Up to the viability of her child it is as much a woman's right as the removal of a dangerously diseased appendix."
"The right to abortion should be taken quite away from legal technicality and legal controversy. Up to the viability of her child it is as much a woman's right as the removal of a dangerously diseased appendix."
This is the view of Miss Stella Browne in her essay on "The Right to Abortion"2and of others who hold similar opinions.
Is any comment necessary?
The representative of one of the largest women's organizations in New Zealand who gave evidence before the Committee advocated the introduction of legislation permitting abortion under certain circumstances after a woman had had two children, subsequently qualifying the suggestion by the words "if contraceptives fail."
In the case of such ill-considered opinions, the Committee believes that it would be impossible to limit the practice if the law were in any way relaxed.
Of course there are others who confine their advocacy of legalized abortion to cases in which there are elements of real tragedy and which appeal to public sympathy, but, granting that there are many cases in which social and economic conditions create situations of great hardship, nevertheless the Committee is fairly convinced that abortion is not justifiable; the remedies lie in the removal of the causes and the alleviation of these difficult situations by social legislation and other measures, and in the education of the public conscience.
The Committee is also opposed to the legalization of abortion for social reasons on account of the very considerable risks to health which are associated with the practice.
Medical witnesses were agreed that, while the immediate risk to life in surgically performed termination of pregnancy was slight, there were very definite possibilities of more remote disabilities, and that such sequelæ occurred in a considerable proportion of cases.
In the case of a genuine therapeutic abortion these risks are outweighed by the dangers of the condition calling for the termination of pregnancy, but were the operation to be performed freely for social reasons the effect in the community might be very serious.
World-wide interest has been aroused in the matter through the experience on Soviet Russia, where, for a number of years, abortion for social and economic reasons was legalized and extensively practised.
The operations were performed in special hospitals and by skilled operators.
At first it was claimed that when the operation was done openly and carefully the risk to life was exceedingly small. It was stated, for instance, that in 1926 artificial abortion was carried out on 29,306 women in Moscow with no mortality, and that in a total of 175,000 operations in Moscow there were only nine deaths.
But now come most significant reports of the after-effects to these operations, which state that 43 per cent. of these women suffered from some definite illness as a result of the operation, and that "the most enthusiastic Russian advocates of legalized abortion are appalled at the growing evidence of serious pelvic disturbances, endocrine dysfunctions, sterility, ectopic pregnancy, and other complications following in the wake of artificial abortions."3
A recognition of these remoter dangers has undoubtedly been an important factor in bringing about the complete reversal of the previous policy in Russia, where abortion for social and economic reasons is now illegal.
The opinion of A. M. Ludovici, admittedly an extreme exponent, may well be considered when, in "The Case against Legalized Abortion"4he writes:—