COUNTING THE DAYS:

THE HISTORY OF NATURAL FAMILY PLANNING IN AMERICA

Paula Viterbo

BROWN BAG SERIES IN SCIENCE AND SOCIETY

BRYN MAWR COLLEGE, OCTOBER 6, 2003

During the first two decades of the twentieth century, many women believed they could avoid pregnancy if they restricted sexual intercourse to the two weeks after menstruation (the so-called safe period). This unfortunate rule constituted authoritative advice since the nineteenth century, based on studies by such luminaries as the French physiologist Felix Pouchet, and the German physician Carl Capelmann.

Pouchet, Capelmann, and many physicians well into the twentieth century still followed the Aristotelian model that equated menstruation, ovulation, and sexual desire. Although an increasing number of studies challenged the old paradigms from the 1880s onwards, by the end of the 1920s a new model of human reproduction had not yet emerged. Reproductive scientists attempted to define the fertility curve in the woman’s cycle, using various methods, such as macroscopic and histological analyses of ovaries and uteruses, embryo dating, and patient histories. But different methods yielded different outcomes. Each research group had its own theory of time of ovulation. Especially disconcerting were a series of demographic surveys that suggested ovulation could occur at any time of the cycle. The field was in chaos. In 1927, the American gynecologist and birth control advocate Robert Latou Dickinson described the time of ovulation as "the chief puzzle in human reproduction."

Then, as now, the difficulty predicting ovulation had important implications for fertility control. In the 1920s, urbanization, rapid economic change and a climate propitious to new ideas fostered the American birth control movement, led by Margaret Sanger. The concept of family limitation became widely accepted, even if often for eugenic reasons. But whilst birth control was deemed desirable or necessary, the means to achieve it were very controversial. The available contraceptives (douches, jellies, suppositories, sponges, vaginal and cervical cups, intrauterine stems) were considered dangerous, immoral or, at best, inefficient. Contrary to what we may think today, contraception was not an obvious or easy choice in the first decades of the twentieth century. But it was undoubtedly a choice many people made. The problem was especially acute for Roman Catholics, whose Church prohibited any form of birth control except abstinence. "If contraceptives are wrong, give us something better," pleaded Marion McNeely in The Outlook, a family magazine from New York.

A few years later, many scientists and moralists became convinced that they had found something better. In 1928, the Austrian gynecologist Hermann Knaus used an innovative method to determine time of ovulation, by studying the influence of ovarian hormones on the rhythmic movements of the uterine muscle. Knaus’s conclusions corroborated previous histological studies by the Japanese Kyusaku Ogino. The determination of time of ovulation led to the redefinition of periodic abstinence as a scientific method of birth control, and the demise of previous safe-period concepts. Advertised with the jazzy name "rhythm method," it played an important social role in America, especially among Roman Catholics.

The following scenes, reconstructed from archival documents, articles in popular magazines, and historical studies, allow us to imagine the experience of American Catholics with birth control in the 1930s.

(December of 1930. Marion and her sister Nora are having coffee in the kitchen of Marion’s apartment in Brooklyn. Christmas decorations brighten the walls. A few household appliances – an electric iron, a radio set, a brand new Hoover standing on a corner – reveal a modest middle-class existence.) [POINT TO APPLIANCES]

NORA, ironically, pointing to the vacuum cleaner -- More work for mother…

(MARION) – And one more debt for father!

(NORA) – What’s a family to do? Everybody has debts these days. It’s not easy to raise a family on a workman’s tight budget.

(MARION) – We can count ourselves lucky that our men haven’t been laid off yet! Sometimes I think I should get myself a job a few hours a day, while the children are in school. But my Patrick won’t hear any of it. He tells me good Catholic wives stay at home.

(NORA) – Vincent says the same, though I wonder if he won’t change his mind once we move to Chicago, next year. His boss told him the transfer would mean a lower salary. Well, that’s better than being laid off... I just pray I won’t get pregnant again!

(MARION, agreeing) – It’s not that we don’t love children. But even before last year’s crash, it was already difficult to keep up with all the expenses… Life used to be simpler when we were kids. Everything now seems to happen at such a fast rhythm! There isn’t enough time or money to keep up with it.

(NORA, in a small voice, while pouring some more coffee) – Say, Marion, what did Father Belford tell you about avoiding pregnancy?

(MARION) – Ah, you know, the usual! "Restrain yourself, my child, be strong..." (Upset) "Raise children, raise children," that’s all they tell you. But how to feed the little ones, that they don’t know. I’m a good Catholic, I don’t like this birth control craze, but total abstinence is for saints, and mother’s safe period, a joke! There has to be another solution for the problem!

(NORA) – What about those suppositories they sell at the drug store? Our Polish neighbor told me they cost only a dollar. They aren’t real contraceptives, they’re… you know… for feminine hygiene.

(MARION) – Could be… But Dr. Pascual says they are dangerous, one can get infections from them. He doesn’t think they work either.

(NORA) – And what works, did he tell you?

(MARION) – Of course not. I wonder why we hear so much about birth control, and doctors really don’t seem to know anything about it! I’ve used Lysol and sometimes a jelly, but I feel so ashamed I don’t even tell Patrick. And he hates the rubber. Most of the times he just tries to be careful… you know what I mean… but that’s how our last two babies happened. Maybe it was God’s punishment.

(NORA, sighing) – I wish doctors would get together with people in the Church and the government, and would agree on some remedy for family control. Because if contraceptives are wrong, they should give us something better!

(MARION) – Ah, Nora, come on, let’s change the subject!

(She gets up and turns the radio on. Gershwin’s song "I Got Rhythm" fills the air.) [TURN RADIO ON]

(MARION, excitedly) – That’s Ethel Merman in that Broadway show, Girl Crazy! It has been sold out since it opened in October. They say Merman is a sensation. She certainly looks naughty in the pictures… [SLIDE 6 – Merman] And the way she holds that note in "I Got Rhythm"! Have you read what they say on Time magazine? I have it here.

(NORA, reading from the magazine) – "Ethel Merman… Her baby stare belies knowing anatomical curves… She approaches sex in song with the cold fury of a philosopher…" (She giggles, and looks out the window.) The kids will be here in a minute. Marion, I must convince my Vincent to take me to the Alvin Theater before I move to Chicago.

(MARION) – Count me in!

(A doctor’s office. Women sit on sofas and armchairs, chatting and browsing through magazines. A calendar on the wall indicates the year 1935. Nora arrives, accompanied by her next-door neighbor Sylvia. They sit down.) [ENACT]

(NORA, in a low voice) – You know, Sylvia, it was awfully kind of you to accompany me here, to Dr. Latz’s office. I doubt I would have the courage to come alone.

(SYLVIA) – No need to thank me, Nora. I know you don’t have many friends in Chicago yet. I’m sure Dr. Latz will give you good advice. I’ve heard wonders about his rhythm method.

(NORA) – Vincent and I really didn’t want to have another baby so soon, but life has its own ways. I cannot believe it wasn’t even a year since we moved to Chicago when little Tony was born.

(SYLVIA) – He’s a jolly baby, the poor dear, but in your situation I too would take care from now on. (She opens a magazine from the coffee table) Have you seen this article in the News-Week? It says Dr. Ogino in Japan and Dr. Knaus in Austria made amazing discoveries, which prove that women can only conceive during a short period each month. And, look, it even talks about Dr. Latz!

(NORA) – Really? What does it say about him?

(SYLVIA) – Well, it seems that his rhythm method is based on the theories of two foreign doctors. They call it the Ogino-Knaus method in Europe, O-K for short.

(NORA) – And is it true what Father Flannagan told me? Is it no sin?

(SYLVIA) – Seems so. Listen to this. (Reading from the article) "The O-K method … finds little opposition from the Catholic Church. It has the approval of Cardinal Hayes, and the Reverend Joseph Reiner, former dean of Loyola University."

(NORA) – And is it safe?

(SYLVIA) – I suppose so. The article says that several known doctors vouch for it: Dr. Morris Fishbein, of the American Medical Association, Dr. Fred Adair, of the University of Chicago… These people count… My cousin, who lives in Hobart, Indiana, goes to Dr. Miller’s rhythm clinic, and it seems to work for her.

NURSE, opening a door and calling into the room – Nora Kelly!

(Nora follows the nurse into Dr. Latz’s office.) [ENACT]

(SYLVIA) – I’ll wait here for you, Nora. Good luck! (She picks up a book advertisement from the coffee table, and reads aloud) "Thurston Scott Welton, The Modern Method of Birth Control. The greatest problem in marriage has now been solved! At last science offers birth control without contraceptives!"

WOMAN, sitting opposite Sylvia – It’s a very good book. It explains all you need. And if you have one of those ovulation dials, you can count your safe days.

(SYLVIA) – Ovulation dial?

(WOMAN) – Yes, like this one advertised here.

(SYLVIA, reading) – "Scientific prediction dial, R.N. Specialty Company, New York City."

(WOMAN) – And, of course, there’s also Dr. Latz’s book, The Rhythm of Fertility and Sterility in Women. I heard it has been selling more than 100 copies a day. You know, Dr. Latz once told me that he learned about the new scientific discoveries while traveling in Europe, a few years ago. He decided to bring the method to the States, and gave it a much better name too.

(SYLVIA) – So, how was it?

(NORA) – It went very well. Dr. Latz is so nice and so young too! You should see his eyes, shiny as shoe buttons… (Showing a calendar to Sylvia) He helped me fill a menstrual calendar. He marked the date of my last period with an M, and then crossed the days when ovulation might take place, plus a few extra days for safety. (Pointing to the calendar) See, in the end I’m left with these safe days. Dr. Latz says I must count my safe days for at least eight months before counting on the rhythm method completely. He gave me this special calendar.

(SYLVIA, taking it) – The Concip calendar?

(NORA) – Yes. Dr. Latz told me this is the calendar used by that European physician who discovered ovulation. I hope it works!

FATHER BURKE, pacing back and forth – Ah, Ward, this rhythm method has proved a total embarrassment! The enthusiasm among liberal Catholics, some of our young priests advising it in the confessionary… Of course Margaret Sanger and her friends couldn’t pass this opportunity. Last year in the House hearings, she argued that there was no longer any reason not to legalize birth control, since even the Roman Catholic opposition seemed to rest on methods, not on principles.

(WARD, protesting) – But the Catholic Church has never reversed her age-long position! It has always considered procreation to be the primary function of marriage, and always condemned artificial contraception! Even though we may close our eyes when it comes to the safe period, Rome has never made any official pronouncement on the subject!

(FATHER BURKE, sitting down) – Of course, of course… And this was what Father John Ryan told the Senate Judiciary Committee. His response to the Sangerites was magisterial, as usual. He was able to reconcile a consequentialist line of argument (you know, race-suicide, economic decline, widespread immorality) with the Church’s formalist, natural law position. So far, we’ve been able to block Sanger’s bills, but the situation is delicate." (He waves a letter in his hand) And now this!

(WARD) – And if you permit, Father, what is that?

(FATHER BURKE) – Ah, a real nuisance! Remember the instructions we sent recently to all dioceses, warning our priests not to encourage any publicity to the rhythm method? Well, Bishop Gerald Shaughnessy of Seattle writes me that in accordance with our directions, he has refused the imprimatur to a piece written by one of his priests, a pamphlet to accompany a so-called Wheel of Life, which is an aid to the Ogino-Knaus method. But the pamphlet’s author, a certain Msgr. Theodore Ryan, went ahead and published it nevertheless!

(WARD, exclaiming) – Shameless! And what are you going to do?

(FATHER BURKE) – Bishop Shaughnessy asks the NCWC to help him locate his priest. He fears Ryan is heading to Washington DC, to propose that the Federal Relief Administration distribute the Wheel of Life among countless Catholic poor.

(WARD) – I wouldn’t be surprised. The government is anxious to remove people from the Federal Relief rolls. I’m sure Msgr. Ryan would be able to make a patriotic appeal to the government…

(FATHER BURKE) – Yes. And at the same time assure handsome revenue for his brother who, the bishop tells me, is in charge of the article’s distribution.

(WARD, crying) – Outrageous!

(FATHER BURKE) – Indeed. I am afraid I will agree to the bishop’s request. I will hire a detective to bring Ryan before the Apostolic Delegate.

(WARD) – Do we have any information about him?

(FATHER BURKE) – The bishop has included a description. (Reading from the letter) "About 45 years of age, 5 feet. 10 inches in height, with a somewhat luxuriant head of completely gray hair." (He stands up, determined) Ward, the NCWC must act immediately! We will contact the Federal Relief Administration and some key publishing houses to make sure that this subversive activity is stopped. I will demand that all copies of the Wheel of Life be removed from bookstores and prevented from further distribution!

"Rhythm is everywhere," claimed an article in The Musician, in April of 1932.

"Everything has rhythm, and back of everything is rhythm… On a big scale the earth moves in rhythm with the moon, the stars – all are in rhythm with each other, or we would have chaos… On the boulevard … the rhythm of the incessant flow of the automobiles … sometimes … in these modern times, syncopated, but rhythmic nevertheless…"

Musicals, motion pictures, and especially the radio helped Americans cope with the harsh realities of the Depression. Ethel Merman’s voice offered rhythm and love as a substitute for money, in radio features such as the Bond Program and the RKO Hour. As musicologists have pointed out, the hope of an underlying rhythm among continuous change is brilliantly evoked in Gershwin’s I Got Rhythm. Four of the five notes of the pentatonic scale rise and fall throughout the song, suggesting life’s ups and downs. The three first syllables, "I got rhy…," begin off-beat, in the characteristically syncopated manner of Charleston, but the music steps back into time with the phrase "Who could ask for anything more?"

This search for order was also apparent in reproductive physiology. In the 1930s, Knaus’s and Ogino’s ovulation theory finally offered a model to understand women’s menstrual cycles, and opened the way to further advancements in reproductive science. Fostered by the belief that social ills could be solved with scientific tools, the new model was promptly applied to birth control. Roman Catholic physicians attuned to the American context promoted the revamped rules of periodic abstinence with the catchy name "rhythm method." Liberal priests tipped-off their parishioners, despite the Church’s official disagreement. Opportunistic entrepreneurs quickly inundated the market with books and devices to teach natural birth control.

For a short period of time, women could join Ethel Merman in the refrain "I got rhythm, I got my man, who could ask for anything more?" But, as we know, the rhythm method did not stand to its promise. By 1940, criticism was already mounting against its high failure rate. Rhythm variations – temperature, hormonal, and mucus methods – were developed in an attempt to predict ovulation more accurately. The use of natural birth control declined sharply with the advent of oral contraceptives, but resurfaced in the 1970s as the public became aware of the pill’s side effects. Scientists, feminist activists, consumer groups, and policy makers have reworked the medical, religious and moral arguments of the 1930s to fit their interests.

Recent events suggest that scientific research will continue to play a role in the social history of natural contraception. A study done by Roger Pierson and colleagues at the University of Saskatchewan, Canada, has challenged the established understanding of ovulation. According to the current model, during each menstrual cycle, ovarian follicles grow only during a certain phase (the follicular phase), leading to the release of an ovum (ovulation) from the largest follicle. But based on daily uterine ultrasounds of 50 women, Pierson et al showed that women experience, not one, but two or more waves of follicular growth in a single menstrual cycle.

Contrary to the media sensationalist conclusions, no woman in the Canadian study was found to ovulate more than once in a cycle. For each woman, only one of the follicular waves resulted in ovulation each month. However, one cannot help but speculate that given certain physical or psychological stimuli, the other follicular waves may also produce viable ova. Maybe scientists were right to be confused in the 1920s. Maybe women ovulate much more often than what we’ve thought. If proved, a multiple-ovulation model would lead to the revising of infertility treatments and contraceptive posology. No wonder natural birth control doesn’t work, many have already concluded. Not so, its advocates respond – women using modern fertility awareness techniques have known since long that there are several waves of follicular activity in a cycle, and have learned "to navigate the waves to either achieve or avoid pregnancy." The play goes on, in different historical contexts, featuring different social actors with different agendas, but a common denominator persists – the strong appeal of the idea of the natural as a contraceptive strategy.