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1937.

NEW ZEALAND.




REPORT

OF THE

COMMITTEE OF INQUIRY

INTO

THE VARIOUS ASPECTS OF THE

PROBLEM OF ABORTION

IN NEW ZEALAND.


_Laid on the Table of the House of Representatives by Leave._




CONTENTS.


                                                          PAGE

Historical and Introduction                                  2

Part I.--Incidence of Abortion in New Zealand                3

Part II.--Underlying Causes                                  8

Part III.--Possible Remedial Measures                       12

Part IV.--Medico-legal Aspects                              19

Summary and Conclusions                                     26

Thanks                                                      28




CONSTITUTION AND TERMS OF REFERENCE OF COMMITTEE.


In accordance with the decision of Cabinet, a special Committee was
appointed on 4th August, 1936,--

    (1) To inquire into and report upon the incidence of septic abortion
    in New Zealand, including--

        (_a_) The incidence among married and single women;

        (_b_) Whether the rate of incidence has increased during recent
        years;

        (_c_) How New Zealand compares with other countries in this
        respect;

    (2) To inquire into and report upon the underlying causes for the
    occurrence of septic abortion in New Zealand, including medical,
    economic, social, and any other factors;

    (3) To advise as to the best means of combating and preventing the
    occurrence of septic abortion in New Zealand;

    (4) Generally to make any other observations or recommendations
    that appear appropriate to the Committee on the subject.

    The following were appointed members of the Committee:--

      Dr. D. G. McMillan, M.B., Ch.B. (N.Z.), M.P., Chairman.
      Mrs. Janet Fraser.
      Dr. Sylvia G. Chapman, M.D., D.G.O. (T.C.D.).
      Dr. Thomas F. Corkill, M.D. (Edin.), M.R.C.P. (Edin.), M.C.O.G.
      Dr. Tom L. Paget, L.R.C.P. (Lond.), M.R.C.S. (Eng.).




REPORT.


The Hon. the Minister of Health, Wellington.

SIR,--

The Committee set up by Cabinet to inquire into the various aspects of
the Problem of Abortion in New Zealand has the honour to submit
herewith its report.


HISTORICAL AND INTRODUCTION.

Since the rise in the death-rate from septic abortion in 1930, the
Department of Health, the medical profession, and women's organizations
and societies have shown great concern regarding the problem. The
Obstetrical and Gynæcological Society of the New Zealand Branch of the
British Medical Association conveyed to the Prime Minister a resolution
passed at the meeting of its executive held in Wellington on 12th
March, 1936, wherein it begged the Prime Ministry to consider the
advisability of setting up a Committee of inquiry to investigate this
matter.

This recommendation having been favourably considered, the following
Committee was appointed:--

    Dr. D. G. McMillan, M.B., Ch.B. (N.Z.), M.P., Chairman.
    Mrs. Janet Fraser.
    Dr. Sylvia G. Chapman, M.D. (N.Z.), M.B., Ch.B. (N.Z.).
    Dr. T. F. Corkill, M.D. (Edin.), M.R.C.P. (Edin.).
    Dr. T. L. Paget, M.R.C.S. (Edin.), L.R.C.P. (Lond.).

Although the immediate purpose of this inquiry was to investigate the
problem of septic abortion, it at once became apparent that this matter
was so inextricably bound up with the subject of abortion in general
that all aspects would require consideration.

The Committee has therefore attempted to make this wider survey and to
bring before you as complete a picture as possible.

The Committee has been guided by the Order of Reference, which was as
follows:--

      I. To inquire into and report upon the incidence of abortion in
      New Zealand, including--

         (_a_) The incidence among married and single women;

         (_b_) Whether the rate of incidence has increased during
         recent years;

         (_c_) How New Zealand compares with other countries in this
         respect.

     II. To inquire into and report upon the underlying causes for the
     occurrence of abortion in New Zealand, including medical,
     economic, social, and any other factors.

    III. To advise as to the best means of combating and preventing the
    occurrence of abortion in New Zealand.

     IV. Generally to make any other observations or recommendations
     that appear appropriate to the Committee on the subject.

The preliminary meeting of the Committee was held on the 18th August,
and in all sixteen meetings have been held, of which thirteen meetings
were held in Wellington, one in Dunedin, one in Auckland, and one in
Christchurch.

Evidence was heard from--

    British Medical Association.
    Church of England.
    Crown Solicitor.
    Dominion Federation of Women's Institutes.
    Dominion Federation of Women's Institutes (Auckland Branch).
    Government Statistician.
    Lecturer in Medical Jurisprudence, Otago Medical School.
    Maternity Protection Society.
    Mothers Union.
    National Council of Women.
    National Council of Women (Canterbury Branch).
    New Zealand Labour Party (Auckland Women's Branch).
    New Zealand Registered Nurses Association.
    New Zealand Registered Nurses Association (Auckland Branch).
    New Zealand Registered Nurses Association (Christchurch Branch).
    Obstetrical and Gynæcological Society.
    Obstetricians and Gynæcologists attached to the Public Hospitals in
      Auckland, Wellington, Christchurch, and Dunedin.
    Pharmaceutical Society.
    Police Department.
    Presbyterian Church of New Zealand.
    Roman Catholic Church.
    Royal Society for the Health of Women and Children.
    St. John Ambulance Association Nursing Guild.
    Women's Division of the Farmers Union.
    Women's Division of the Farmers Union (Otago Branch).
    Women's Division of the Farmers Union (South Auckland Branch).
    Women's International League for Peace and Freedom.
    Women's Service Guild.
    Working Women's Movement (Auckland Branch).

In addition to these, evidence was heard from twelve other persons.

The Committee would like to express its thanks to the witnesses, many
of whom have gone to considerable trouble to collect information and
prepare their evidence.




PART I.--INCIDENCE OF ABORTION IN NEW ZEALAND.


All the evidence brought before the Committee indicates that abortion
is exceedingly frequent in New Zealand.

It is quite impossible to assess the incidence with complete accuracy,
for the reason that a very considerable number of these cases do not
come under medical or hospital observation, but some definite
indication of the frequency is given by the statistics obtained from
various hospitals and practices.

In one urban district, for instance, in which the total live births for
a two-year period were 4,000, the number of cases of abortion treated
in the public hospital alone was 400.

When to this number were added the cases treated in the various private
hospitals, those attended by doctors in the patients' homes, and those
not medically attended at all, it was computed that a total of 1,000
abortions was a conservative figure. In other words, roughly twenty
pregnancies in every 100 terminated in abortion.

Looked at from a somewhat different angle, figures were presented from
one hospital showing that in a group of 568 unselected women of
child-bearing age, there were 549 abortions in 2,301 pregnancies, or 23
per hundred.


HOW DO THESE CASES ORIGINATE?

It must be explained that a certain number of cases of abortion occur
perfectly innocently as the result of some condition of ill health, or,
occasionally, as the result of accident. These _spontaneous_ cases
constitute an entirely medical problem.

All other cases are artificially produced or _induced_.

A very small number of these are honourably performed by medical
practitioners when the mother's life is seriously endangered.

This procedure is termed "_Therapeutic induction of abortion_."

Certain important questions in relation to therapeutic abortion will be
discussed at a later stage in this report.

The remainder of the induced cases are unlawfully produced by the
person herself or by some other person--_criminal abortion_.

The Committee received much evidence regarding the methods used in the
attempt to procure abortion.

In the first instance it was shown that the use of so-called
abortifacient drugs was extensively practised and was usually a first
resort.

Little need be said about the matter at this stage except to state that
the New Zealand evidence entirely supports the opinions expressed
elsewhere that drug-taking is rarely effective.

Those tempted to use these drugs should realize the futility of the
practice for the purpose intended and the frequency with which
disturbances of health are caused by taking them.

Their only value is as a lucrative source of gain to those people who,
knowing their inefficacy, yet exploit the distress of certain women by
selling them.

It is perfectly clear that the real menace is the instrumentally
produced abortion, either self-induced by the person herself or the
result of an illegal operation performed by some outside person.

These abortionists include a few unprincipled doctors and chemists, a
few women with varying degrees of nursing training, and a number of
unskilled people.

It was a matter of considerable importance for the Committee to attempt
to determine first the extent to which spontaneous abortions contribute
to the total figures: the prevalence of unlawful abortion could then be
better realized.

Here again it was found exceedingly difficult to obtain exact figures,
but the evidence suggests that probably less than seven pregnancies in
every 100 terminate in spontaneous abortion.

Taking the records of one group of 1,095 women where the incentives to
interference were probably at a minimum, it was found that out of a
total of 2,180 pregnancies only 152, or 6·97 per cent., terminated in
abortion, while in a series of 5,337 pregnancies in patients taken from
the records of St. Helens Hospitals, 6 per cent. terminated in
abortion.

Even assuming that _all_ these were spontaneous (which was probably not
the case), the incidence is approximately 6 per cent. to 7 per cent.

If, then, the total abortion rate is 20 per 100, it is clear that the
incidence of criminal abortion is at least 13 in every 100 pregnancies.

The Committee believes that this figure can be accepted as a
conservative estimate of the prevalence of unlawful abortion in New
Zealand. Some of the figures presented suggested a still higher
incidence.

Applying the figures given to the whole of New Zealand it means that
while in the year ending March, 1936, there were 24,395 live births
there were probably 6,066 abortions, of which nearly two-thirds (4,000)
were criminally induced.

The impression of the Committee is that this is an underestimate.

Serious as this is on general grounds, the matter is of particular
importance in regard to the special problem which led to the setting-up
of this Committee of inquiry--the _incidence of septic abortion_.

Septic infection, or blood-poisoning, is the most serious complication
which may follow abortion.

Grave concern has been occasioned by a realization of the frequency of
septic abortion, the most significant indication of which is the number
of women who lose their lives as the result of this complication.

Attention has repeatedly been drawn to this problem by the officers of
the Department of Health, the New Zealand Obstetrical and Gynæcological
Society, and others interested in maternal welfare.

During the five-year period 1931-35, 176 women died from sepsis
following abortion. In the same period there were only 70 deaths from
sepsis following full-time child-birth. Some of the distressing
repercussions from these tragedies have been revealed in the annual
report of the Director-General of Health, 1936, which shows that in
that period 338 children were left motherless by the death of 109
married women.

Another serious fact is that, while, owing to the strenuous efforts of
those engaged in the direction and practice of midwifery, there has
been a most gratifying fall in deaths from post-confinement sepsis from
2.02 per 1,000 live births in 1927 to 0.4 per 1,000 in 1935, deaths
from post-abortion sepsis in the same period rose from 0.50 per 1,000
live births in 1927 to 1.73 per 1,000 in 1934, with a fall to 1 per
1,000 in 1935. These figures are illustrated by the following graph and
accompanying table:--


_Maternal Mortality._

Showing the number of deaths and the death-rate per 1,000 live births
from certain causes, 1927 to 1935.

--------------------------+----+----+----+----+----+----+----+----+-----
                          |1927|1928|1929|1930|1931|1932|1933|1934|1935
--------------------------+----+----+----+----+----+----+----+----+-----
Maternal mortality,       |    |    |    |    |    |    |    |    |
  _including_ septic      |    |    |    |    |    |    |    |    |
  abortion--              |    |    |    |    |    |    |    |    |
   Number                 | 137| 134| 129| 136| 127| 101| 108| 118| 101
   Rate                   |4·91|4·93|4·82|5·08|4·77|4·08|4·44|4·85|4·21
                          |    |    |    |    |    |    |    |    |
Maternal mortality,       |    |    |    |    |    |    |    |    |
  _excluding_ septic      |    |    |    |    |    |    |    |    |
  abortion--              |    |    |    |    |    |    |    |    |
   Number                 | 123| 120| 110| 106|  98|  75|  82|  76|  78
   Rate                   |4·41|4·42|4·11|3·96|3·68|3·02|3·37|3·12|3·25
                          |    |    |    |    |    |    |    |    |
Puerperal septicæmia--    |    |    |    |    |    |    |    |    |
   Number                 |  56|  42|  30|  27|  18|  13|  14|  17|   8
   Rate                   |2·01|1·54|1·12|1·01|0·68|0·52|0·58|0·70|0·33
                          |    |    |    |    |    |    |    |    |
Septic abortion--         |    |    |    |    |    |    |    |    |
   Number--               |    |    |    |    |    |    |    |    |
     Married              |}   |    |   {|  26|  26|  24|  16|  29|  17
                          |} 14|  14| 19{|    |    |    |    |    |
     Single               |}   |    |   {|   4|   3|   2|  10|  13|   6
   Rate                   |0·50|0·51|0·71|1·12|1·09|1·04 1·07|1·73|0·96
--------------------------+----+----+----+----+----+----+----+----+-----

[Illustration: Maternal Mortality.
               Showing the Deathrate per 1,000 Live Births from Certain
               Causes 1927-1935.]

One of the unfortunate features of this matter from the public health
point of view is the extent to which this increase in deaths from
abortion sepsis is counterbalancing and masking the very real
improvement which has been achieved by the obstetrical services in the
work for which they may justly be held responsible.

According to the international system of recording, these cases are
included in the total maternal mortality.

Actually in New Zealand in the five-year period mentioned, abortion
sepsis was responsible for one-quarter of the total maternal deaths.

In the larger urban areas the position is even more unfortunate, as the
following instance will indicate:--

_Maternal Mortality in Urban Areas for the Five-year Period, 1930-34._

---------------------------------------------------------------------------
            |       |       |        |         |Maternal |        | Death-
            |       |       |        |         | Death-  |        |  rate
            |       | Total |Maternal|Maternal |rate per | Deaths |  from
            |       | Mater-| Death- | Deaths  | 1,000   |  from  | Septic
 Urban Area | Live  |  nal  |rate per|excluding| Live    | Septic |Abortion
            |Births.|Deaths.| 1,000  | Septic  | Births  |Abortion|  per
            |       |       | Live   |Abortion.|excluding|        | 1,000
            |       |       |Births. |         | Septic  |        | Live
            |       |       |        |         |Abortion.|        | Births.
------------+-------+-------+--------+---------+---------+--------+--------
Auckland    |14,290 |   81  |  5·67  |    55   |   3·85  |    26  |  1·82
Wellington  |11,690 |   61  |  5·22  |    32   |   2·74  |    29  |  2·48
Christchurch| 9,599 |   51  |  5·31  |    29   |   3·02  |    22  |  2·29
Dunedin     | 5,960 |   24  |  4·03  |    17   |   2·96  |     7  |  1·17
            |       |       |        |         |         |        |
Total, four |41,539 |  217  |  5·22  |   133   |   3·20  |    84  |  2·02
 urban areas|       |       |        |         |         |        |
            |       |       |        |         |         |        |
Total,      |58,623 |  273  |  4·66  |   204   |   3·48  |    69  |  1·18
 remainder  |       |       |        |         |         |        |
 of Dominion|       |       |        |         |         |        |
---------------------------------------------------------------------------

In the case of the four urban areas deaths from septic abortion account
for approximately two-fifths of the total maternal mortality.

With these cases excluded, the maternal mortality associated with
child-birth proper was 3.20 per 1,000 live births.

Clearly, any comparison between different maternity services should be
made on the basis of these latter figures alone.


WHAT IS THE CAUSE OF THIS HIGH INCIDENCE OF DEATHS FROM SEPTIC
ABORTION.

The evidence offered to the Committee by medical witnesses indicates
conclusively that sepsis, and death from sepsis particularly, is almost
entirely due to illegal instrumental interference.

Spontaneous abortion, provided that proper medical care is given,
rarely results in sepsis. Therapeutic abortion, done with all the
safeguards of modern surgical practice, is associated with very little
acute sepsis.

But criminal abortion is associated with an extremely high sepsis rate.

The reasons are not far to seek: the surreptitious nature of the
operation and the lack of skill and surgical cleanliness so frequently
shown by the operator make this result almost inevitable.


HAS THE PRACTICE OF ABORTION INCREASED IN RECENT YEARS?

In so far as the deaths from septic abortion can be taken as a
comparative indication of the occurrence of abortion generally--and the
Committee believes this is a fair index--there seems little doubt that
there has been a marked increase.

A reference to the graph already given will indicate this rise.

There is reason to hope that the fall in 1935 means an improvement in
the general situation.

Professor Dawson, giving evidence regarding admissions to the Dunedin
Hospital, showed that in the five-year period 1931-35 there was an
increase of 23.7 per cent. in the cases of abortion as compared with
the previous five-year period.

The evidence of other medical witnesses was practically unanimous on
this point.


HOW DOES NEW ZEALAND COMPARE WITH OTHER COUNTRIES IN THIS MATTER?

According to the report of the British Medical Association Committee on
the Medical Aspects of Abortion (1936), the position in Great Britain
would appear to be very similar to that existing in New Zealand.

In that report it is stated that the incidence of abortion is generally
reckoned at from 16 per cent. to 20 per cent. of all pregnancies.

The spontaneous-abortion rate is suggested as probably about 5 per
cent. of all pregnancies.

The evidence set before that Committee suggested that there has been an
increase in criminal abortion in the last decade.

In England and Wales 13·4 per cent. of the total maternal deaths were
due to abortion.

That Committee concludes that "illegal instrumentation contributes to
an overwhelming degree to the mortality from abortion."

One of the most interesting investigations into this aspect of the
subject is reported by Parish[1] in a study of 1,000 cases of abortion
treated as in-patients in St. Giles's Hospital, Camberwell, during the
years 1930 to 1934.

      [1] "The Journal of Obstetrics and Gynæcology of the British
      Empire," December, 1935, p, 1107. T. M. Parish.

In 374 of these cases where instrumentation was admitted the febrile
rate was 88·2 per cent., and the death rate 3·7 per cent., while in 246
cases with no history of interference and presumably spontaneous the
febrile rate was 5·7 per cent. and the mortality rate _nil_.

The following table compiled by the Government Statistician shows New
Zealand's position in comparison with eleven other countries:--

_Puerperal Mortality per 1,000 Live Births in Eleven Countries, 1934._

-------------------------------------------------------------------
                        |         |            |  Total Puerperal
                        |         |            |    Mortality.
                        |         | Puerperal  |-------------------
     Country.           | Septic  | Sepsis     |Including|Excluding
                        |Abortion.| following  | Septic  | Septic
                        |         |Child-birth.|Abortion.|Abortion.
------------------------+---------+------------+---------+---------
Norway                  |   0·47  |    0·57    |   2·75  |   2·28
Netherlands             |   0·30  |    0·73    |   3·20  |   2·90
New Zealand             |   1·73  |    0·70    |   4·85  |   3·12
Switzerland             |   0·73  |    0·82    |   4·58  |   3·85
England and Wales       |   0·49  |    1·53    |   4·60  |   4·11
Australia               |   1·45  |    0·90    |   5·76  |   4·31
Irish Free State        |   0·07  |    1·73    |   4·68  |   4·61
Canada                  |   0·58  |    1·23    |   5·26  |   4·68
United States of America|   1·02  |    1·30    |   5·93  |   4·91
Union of South Africa   |   0·67  |    2·03    |   5·99  |   5·32
Scotland                |   0·38  |    2·30    |   6·20  |   5·82
Northern Ireland        |   0·32  |    1·85    |   6·27  |   5·95
-------------------------------------------------------------------




PART II.--THE UNDERLYING CAUSES OF ABORTION IN NEW ZEALAND.


As seen by the Committee, the reasons which lead to a resort to
abortion may be set out under the following broad headings:--

    (1) Economic and domestic hardship.

    (2) Fear of labour and its sequelæ.

    (3) Pregnancy in the unmarried.

    (4) Changes in social outlook.

    (5) Ignorance of effective methods of contraception and of the
        dangers of abortion.

    (6) Influence of advertising.


(1) ECONOMIC AND DOMESTIC HARDSHIP.

(_a_) _Poverty._--Cases arise where the parents are on the bread-line
and have no means of supporting a child, but the Committee is of
opinion that such extreme poverty is rare in New Zealand.

More common are the cases in which income is sufficient for a small
family but a larger one would constitute hardship, or, alternatively,
in which income is sufficient to support several small children but not
to provide education, &c., in later life. The view, formerly widely
accepted, that membership of a large family is in itself a valuable
contribution to education and to the training of responsible citizens,
appears to be at a discount, and many parents now consider that
advantages which can be _given_ to a child as a result of family
limitation outweigh the natural advantages of a large family in which
the children develop initiative through companionship.

(_b_) _Housing._--This constitutes an acute problem in crowded city
areas. In many cases houses which are past repair and already condemned
form the only shelter for a growing family. Ordinary domestic and
hygienic conveniences are often lacking. Where a family is able to pay
for better accommodation, difficulties frequently arise owing to the
unwillingness of landlords to accept tenants with children, and, as the
demand for houses exceeds the supply, landlords are able to pick and
choose. The lack also of suitable cottages on farms for married couples
with children probably has a considerable influence on the limitation
or avoidance of families and leads to a premium being placed on
childlessness because married couples without "encumbrances" can more
easily obtain employment. This is an aspect of the problem that should
receive earnest consideration.

(_c_) _Domestic._--Lack of help in the home even by those who can
afford it is a factor of very great importance. This applies especially
to country life, where a woman's whole physical energy is taken up by
attention to domestic matters and often also to farm-work, to the
detriment of family life. The following is an account given to one
witness by a farmer's wife, describing an average day's work:--

    "Rise 4.30, have cup of tea--wife to shed, set machines, hubby to
    bring cows--start milking 5 a.m., hard going to 8 o'clock; wife
    returns house to get breakfast, also see to children and cut
    lunches for them to take to school. Hubby feeds calves, fowls, and
    ducks, then breakfast. Load milk on express, harness horse, away to
    factory mile away--get whey return. Now 9 o'clock, wife has
    machines down and washes, hubby hose down shed. Drive whey down to
    paddocks and feed 40 pigs, returns, unharness horse, wash cart
    down, yoke team to plough, disk, &c. Wife to start housework about
    10 o'clock, dinner at 12.30 to be ready, or taken down to paddocks
    (if harvesting 3 or 4 men are working). Usual times fencing,
    repairing sheds, fixing yards, besides other farm duties till
    3.30--afternoon tea--children given something to eat on returning
    from school. Husband and wife to sheds again 4 till 7. Hubby washes
    machines, feeds calves, &c., wife in meantime has returned house,
    washed children and put to bed before sitting down to her tea at 8
    o'clock--by time washed up is 9 o'clock--too tired to do anything
    else but crawl into bed."

The lack of adequate playing-areas, kindergartens, and other means of
employing the time of the pre-school child outside the home is a matter
that was brought before the notice of the Committee as another of the
domestic difficulties. This is one of the factors preventing that
amount of leisure which is necessary for the well-being of the mother.

(_d_) _Cost of Confinement._--This was stressed particularly by country
witnesses. Where a woman is beyond the reach of medical attendance and
has to travel a considerable distance to hospital this adds materially
to the cost of the confinement. To some women even moderate hospital
and medical fees are prohibitive, and the problem is rendered more
difficult still by the necessity for providing extra help in the home
or on the farm during the wife's absence. It was, however, rightly
pointed out by one witness that the fees paid to an abortionist and the
economic waste due to subsequent ill health would in many cases more
than pay the expenses of an ordinary confinement.


(2) FEAR OF LABOUR AND ITS SEQUELÆ.

This was referred to by several witnesses, some of who cited cases from
their own experience. An erroneous idea seems to be prevalent among
certain sections of the laity that the total abolition of pain during
labour is possible for every patient. The fear that such relief will be
withheld has been suggested as a cause for women seeking the
abortionist. It would seem, however, that, with the increasing
knowledge of methods of pain-relief in labour, more extensive
ante-natal and post-natal care, and the cultivation of a more normal
psychological outlook among pregnant women, the fear complex will in
future assume progressively less importance. The Committee believes
that increasing attention is being paid to these aspects by the medical
profession.

As to the bearing of this matter on the subject of abortion, several
witnesses, among whom were two obstetricians of wide experience,
expressed the opinion that, while fear of pregnancy and labour is rare,
fear of infection following abortion is a factor the recognition of
which is becoming more general.

The Committee is of opinion that fear of labour is not a major factor,
and this opinion is supported by many witnesses.

Ill health was alleged as a cause in a few instances, but it would
appear that, in spite of the ambiguous state of the law, no genuine
ease of ill health need resort to abortion by clandestine methods. This
is referred to in greater detail elsewhere.


(3) PREGNANCY IN THE UNMARRIED.

While this constitutes only a small part of the general problem of
abortion, it is, nevertheless, a matter of great importance, and one
which merits the closest study. Undoubtedly the general attitude
towards the unmarried mother to-day is kinder and more tolerant than
was formerly the case, but the fact remains that the single girl who
determines to face the world with her child may find herself subject to
unreasonable and unnecessary cruelty and injustice. Excellent work in
assisting the single mother is done by various religious and charitable
organizations, and where a girl is driven to the abortionist this is
more likely to be due to fear of social ostracism than to lack of ways
and means of caring for the child.

Several witnesses mentioned ignorance of matters relating to sex as
being frequently responsible for pregnancy in the unmarried. This is
undoubtedly the case, and the responsibility of parents, guardians, and
teachers in this matter is evident. The evil influence of drinking on
young people was also stressed, medical and social workers being well
aware of the importance of this factor. Alcohol consumption need not be
excessive to undermine self-control and dull the moral sense.


(4) CHANGES IN THE SOCIAL OUTLOOK.

The Committee believes that, in the altered social outlook,
particularly towards the rearing of large families, lies a very
important cause for the present situation. This aspect of the matter is
intimately interwoven with the economic considerations already set
forth, but extends far beyond them.

The point of view of what we believe to be a very large body of women
is illustrated by the following evidence, which is but one of many
similar expressions of opinion heard by the Committee. This witness,
speaking on behalf of a group with incomes of £300 to £400 per annum,
stated:--

    "On present incomes, not more than two or three children at the
    outside can be given educational and economic opportunities. It may
    be said that it is quite possible to mitigate to a quite tolerable
    degree the strain put upon the parents by the provision of (1)
    adequate wages for husbands, and (2) a system of domestic help for
    wives. With regard to (1) it is not probable within our lifetime
    that everybody will be guaranteed an income adequate to the needs
    of a family of, say, three children--'needs' as viewed by educated
    parents. The most sympathetic administration would have its hands
    full for many a year coping with the problem of helping those
    thousands of our people who have been just on or very near the
    bread-line. Those worst off hitherto need help first. A man earning
    between three and four hundred a year should not claim Government
    help to breed children, when there are such numbers of people
    living on a much lower wage. But it must be perfectly clear to each
    member of the Commission who figures the matter out that a salary
    of less than £400 will not enable more than two children to be
    given such chance of development as every parent reasonably
    desires. It is pertinent to ask here what is the average number of
    children in the families of the British middle class--which is
    mainly the stratum from which our legislators, rulers, and
    magistrates have been drawn. Do such people breed freely?
    Self-respecting parents prefer to do without such Government help
    as family allowances; but knowing the cost of training a child they
    claim the rights first, to decide how many children they will
    breed, and, secondly, to live themselves normally satisfied married
    lives. Few women, moreover, of average intelligence are to-day
    content to be breeding-machines, and their husbands support them in
    that attitude. With regard to domestic help, even were this, or
    nursing schools, or both, provided by the State, the responsibility
    for her children's well-being would be still all-absorbing, at
    least during the first four years of each one's growth. Students of
    child psychology are insistent that the pre-school period is the
    most important in the life of the individual and requires the most
    skilful attention. Natural affection is not enough; it must be
    wedded to care for the child's mind. Now, willy-nilly, modern life
    itself takes such toll of nervous energy that there are few
    educated women today who go through all the child-bearing period
    and have sufficient nerve force to welcome each child that may
    'come along' and rear it happily. Yet without adequate nervous
    energy in the mother what family can develop into healthy and
    well-balanced useful citizens? It necessarily follows that the
    output of children will be limited if the parents are to do their
    part adequately. Quantity, the mass production of the past, must
    give way to quality. That involves birth-control. How is it to be
    achieved?"

Without necessarily assenting to the sentiments expressed in the above
quotation, the Committee considers that such opinions cannot but demand
thoughtful consideration. Dread of large families or of close-interval
pregnancies under modern conditions is undoubtedly a common reason for
attempting to limit the family.

But having made all allowances for the more difficult circumstances of
modern times, the more thoughtful consideration of some husbands for
their wives and of some parents for their children, and a legitimate
intention to maintain a higher standard of living, it seems clear that
amongst a considerable section of the community the demand for the
limitation of families has passed beyond these motives into regions of
thoughtlessness and selfishness.

Furthermore, an attitude of pitying superiority towards the woman with
many children appears to be a current fashion. Many witnesses expressed
the opinion that a young and sensitive mother was frequently deterred
from a further pregnancy, for which she would in other circumstances be
quite prepared, or tempted to seek abortion, because of the fear of
ridicule by current public opinion.

Still other women, it has been explained, are influenced by
comparisons. Seeing their neighbours leading less burdensome and more
pleasure-full lives, they decide to follow suit.

The modern desire for pleasure and freedom from responsibility has led
many to lose sight of the ideal of the family as a service to the State
and the unit of social life.

Unwillingness on the part of the wife to give up remunerative work is a
factor that operates in certain cases; this may be due to the position
of the wife as the support of an invalid husband and family, but in
other cases the reason is obviously selfish.

While dealing with this question of social outlook, it will not be out
of place to refer to an aspect which, though mentioned by only a few
witnesses, is known to all social workers as a factor of increasing
importance. This is the fear of war. It may take the form of (_a_)
conscious visualization of the horrors of war, or (_b_) sub-conscious
fear evidenced by excessive anxiety regarding the future. In either
case it acts as a powerful deterrent from child-bearing, although it is
doubtful whether those who are influenced by this fear would resort to
abortion where contraception had failed.

Speaking of social conditions, some witnesses, under the impression
that the average age at marriage was rising, attribute the increasing
abortion-rate among the unmarried partly to this cause.

The actual fact is that the age at marriage has decreased of late
years, but is still probably higher than would be the case if economic
conditions were more favourable.

It is clear that, whether the motives be worthy or selfish, women of
all classes are demanding the right to decide how many children they
will have. Methods which depend on self-control are ruled out as
impracticable. Contraceptives are largely used, and, judging by the
marked decline in the birth-rate in recent years, are in many cases
successful. In other cases, however, they are not so, and there is then
frequently a resort to abortion.


(5) IGNORANCE OF EFFECTIVE METHODS OF CONTRACEPTION AND OF THE DANGERS
OF ABORTION.

The public as a whole is ignorant of the physiology of reproduction.
This results in attempts being made to prevent conception by methods
which are doomed to failure at the outset. The use of defective methods
owing to their comparative cheapness and the unnecessarily high cost of
effective appliances are undoubtedly among the causes of such failure.

While it is not the function of this Committee to report upon the wider
aspect of contraception, but to deal with it only in relation to the
abortion problem, yet we would point out that the evidence given showed
that, though contraception is widely practised, many of the methods
used are unreliable and not founded upon physiological knowledge, and
that when they fail abortion is resorted to. Abortion is a delayed,
dangerous, and unsatisfactory form of birth-control. It was stressed by
some witnesses that many women have no idea of the risks to life and
health involved in the procuring of abortion, a medical witness
mentioning, among other evils, the tendency to spontaneous abortion
arising from damage to the generative organs sustained at an initial
induced abortion. Other witnesses, on the contrary, maintained that
these risks are well known to the majority of women, but that when
faced with an unwanted pregnancy they are willing to incur any risk.
Fuller reference to these dangers appears in another section of the
report.


(6) INFLUENCE OF ADVERTISING.

The attention of the Committee was drawn to advertisements appearing in
certain periodicals which, while openly advocating the use of various
contraceptives, referred to restraint and self-control in deprecatory
terms. Abortifacients were advertised in terms which, while equally
offensive, were less obvious. Other advertisements set forth the
contents of certain books on sex matters of a very undesirable nature.
The language of these advertisements can only be described as obscene,
and their possible effects on immature and inexperienced minds can well
be imagined.

A reprehensible practice is that of certain so-called "mail order
chemists," who send out price-lists of contraceptives and
abortifacients indiscriminately through the post. In some cases these
advertisements were shown to be of a definitely misleading and
fraudulent character.




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
assistance _directly related to the encouragement of the family_
is 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."

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, are _not suitable_ for 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 well cause 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 read _ejusdem generis_ with "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. In _R._
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
things _ejusdem generis_ with 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
the _life_ of the mother.

It is a fact that the law is _interpreted_ liberally, 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 possible dangers 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."

This is the view of Miss Stella Browne in her essay on "The Right to
Abortion"[2] and of others who hold similar opinions.

      [2] "Abortion Spontaneous and Induced." Taussig.

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]

      [3] "Abortion Spontaneous and Induced." Taussig.

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"[4] he
writes:--

    "If only the disingenuous propaganda in favour of legalized
    abortion would cease, and if only those who carried it on refrained
    from dinning into the ears of an uninformed gallery of women the
    alleged safety and harmlessness of abortion carried out under the
    best hospital conditions, there would be less eagerness to face the
    ordeal of criminal abortion.

    "So long as ignorant women are led to believe that abortion, when
    skilfully performed, is as easy and harmless as having a corn
    extracted, they will naturally infer that it can be done just as
    harmlessly in secret as in public, especially if they are assured
    that the surreptitious abortionist is skilled, as presumably they
    always are, and are, moreover, kept in total darkness concerning
    the kind of operation that is necessary for the interruption of
    pregnancy.

    "If, however, they knew the truth, which is that artificial
    abortion, even under the best hospital conditions, is a precarious
    undertaking, so frequently leading to invalidism as never to be
    'safe'; if, moreover, we spread the truth about Russia's legalized
    abortions, and put a stop to the false reports circulated by
    ill-informed enthusiasts regarding the ease and safety of skilled
    induced abortion, we should be going a long way towards reducing
    criminal or surreptitious abortion to vanishing-point."

      [4] "Abortion," by Stella Browne. Ludovici and Roberts.

_Sterilization._--Brief mention must be made of _sterilization_--an
operation whereby further pregnancy is prevented--which has been put
forward by certain witnesses as a method of preventing abortion.

Just as therapeutic abortion is, in certain cases, legitimately
performed by medical practitioners, so has the operation of
sterilization a recognized place in medical treatment of exceptional
cases in which a woman's life is likely to be endangered or her health
gravely impaired by further pregnancy.

It can, indeed, be reasonably argued that in such cases sterilization
is very definitely to be preferred to the very unsatisfactory
alternative of repeated therapeutic abortion.

Nevertheless, any general extension of this practice would, in the
opinion of the Committee, be open to serious abuse.

The Committee sees a tendency in some quarters to extend the
indications for this operation far beyond the bounds of generally
accepted medical opinion.

The attitude of the Committee towards this matter is therefore the same
as towards more specific legalization of therapeutic abortion.

_The Prosecution of the Criminal Abortionist._--A very disquieting
aspect of this problem is the relative immunity of the criminal
abortionist from punishment. Conviction for the crime is rare, even in
cases where guilt appears to be proved beyond all reasonable doubt.

The Committee has sought to discover the reasons for the failure to
obtain conviction.

It is apparent that the police authorities are faced with many
difficulties. In the first instance conviction is largely dependent on
the evidence of a woman who, in the eyes of the law, is an accomplice
to the offence, and corroboration of her evidence may be demanded.

It has been suggested by certain witnesses that, if the woman were
legally exempt from penalty, there would be less reticence about giving
evidence and a greater fear on the part of the abortionist.

On the other hand, it has been stated to the Committee that where such
an indemnity is actually given, this very fact operates against
conviction.

The Commissioner of Police gave information that--

    "Juries are loth to convict in such cases and appear to be
    impressed by the argument usually advanced by counsel for the
    defence that, as it was at the solicitation of the woman that the
    offence was convicted, she is the principal offender, and they
    adopt the view that unless she also is charged it would be unfair
    to convict the abortionist. The fact that if the woman was charged
    she could not be called as a witness, and that, without her
    evidence, there would be no case, does not appear to weigh with
    them."

It would therefore appear that legalized exemption of the woman would
not be a remedy.

The very serious statement has been made that--

    "In many cases professional abortionists have the assistance of one
    particular doctor who attends their patients when medical skill
    becomes necessary. The doctor either treats the patient
    successfully or sends her to hospital on his own personal note, and
    in neither case does the identity of the abortionist come to light.
    There is reason to believe that in many such cases the assistance
    of the doctor is given knowingly and in collaboration with the
    abortionist contrary to the rule laid down in Sydney Smith's
    'Forensic Medicine,' 3rd edition, page 362, that 'It is no part of
    a doctor's duty to act as a detective, but it is equally certain
    that it is no part of his duty to act as a screen for the
    professional abortionist.'"

The Committee would earnestly draw the attention of the responsible
medical authorities to the suggestion that there are even a few members
of the profession who are prepared to "cover" the abortionist when
difficulties arise.

It is quite well realized that there are many occasions on which the
general practitioner quite innocently comes in contact with these
cases: that is an entirely different matter.

It is a further complaint of the police that they are hampered by the
fact that rarely are they notified of a case of criminal abortion until
the woman's condition is so critical that it is impossible to obtain a
statement from her, and if she dies the evidence she might have given
is lost. Without such evidence there is little chance of successfully
prosecuting the abortionist.

To overcome this difficulty it has been advocated that, where a patient
is admitted to hospital and is suspected to be suffering from the
effects of criminal abortion, it should be the duty of the responsible
medical officer of the hospital to notify the police forthwith and
supply all the information in his possession.

This suggestion, however, involving as it does the confidential
relationship between doctor and patient, is open to serious objections.

It is proposed to consider the position of the medical practitioner in
relation to criminal abortion more fully in a subsequent section.

Finally, it is evident that the general public as represented by some
members of juries do not regard this crime with the same seriousness as
does the law.

A heavy responsibility rests on the public in allowing the present
position to continue.

The Committee cannot but take a serious view of the repeatedly
demonstrated difficulties in securing convictions, even in the face of
apparently conclusive evidence, of persons charged with inducing
abortion, and consider that the time has arrived when careful
consideration should be given to the condition of the law relating to
such crimes and to what steps are necessary to discourage effectively
their practice. With that object in view the Committee respectfully and
earnestly directs the attention of the Government to the position that
has arisen, and the serious social, physical, and moral consequences
which are likely to follow if effective steps are not taken to enforce
the clear intention of the law.

_The Position of the Medical Practitioner in Relation to Criminal
Abortion._--The duties and responsibilities of medical practitioners
in connection with cases in which the performance of an illegal
operation is suspected or known to have occurred are of great public
importance.

Two main questions arise--(1) The duty of a doctor before the death of
a patient or in a case where a fatal result is not expected, and (2)
his duty in a case where the patient has died.

Concerning the first issue there are very conflicting opinions.

As already pointed out, it has been urged by the Police Department that
in every case where a patient is admitted to a hospital and is
suspected to be suffering from the effects of induced abortion or
attempted abortion it should be the duty of the Medical Superintendent
or Senior Medical Officer of the hospital to notify the police
forthwith, and supply all information in his possession which would
assist in establishing the identity of the offender and bringing him to
justice.

The widely accepted view of the medical profession, supported by high
legal authority, is that the bond of professional secrecy as between
doctor and patient is so important that it would be entirely wrong for
a doctor, without the patient's consent, to give information to the
police before her death.

It has been insisted that, were it to be compulsory for the doctor to
notify the police on the strength of information obtained in his
professional capacity, patients would refrain from obtaining the
necessary medical help under these circumstances, thus accentuating the
problem of deaths from abortion rather than limiting it.

It has been stated that already in one centre a disinclination to enter
hospital has been expressed by patients because they feared that the
police would be informed.

It is agreed, however, that the doctor should attempt to persuade the
patient, especially if her condition is serious, to make a statement to
the police.

The actual legal position in New Zealand was made quite clear by the
law officer of the Crown when asked by the New Zealand Obstetrical
Society in 1932 for an opinion.

This opinion, as published in the _New Zealand Medical Journal_
(Obstetrical Section), 29th October, 1932, was as follows:--

    "A doctor is under no legal obligation to inform the police as to
    the cause of the illness of a person which has been due to an
    illegal operation, either in a case where the patient recovers or
    in a case where the patient dies. He is, of course, under an
    obligation to insert in the certificate of death which he furnishes
    under the Births and Deaths Registration Act, 1924, the cause of
    death, both primary and secondary. In that certificate, where the
    death was the consequence of an illegal operation, he should insert
    the nature of the operation as the primary cause of death. He need
    not, of course, describe it as an illegal operation, but he would
    describe the type of operation and the reason why such operation
    was the primary cause of death--_e.g._, owing to incompetence or
    ignorance, if that be the case.

    "In giving this ruling I am, of course, referring merely to the
    legal obligation--_i.e._, the duties imposed according to law.
    Speaking generally, there is a moral duty on every person having
    knowledge of a serious crime which is an offence against morality
    as well as against law, to assist the police as far as possible in
    its detection and suppression. The confidence of a patient may be a
    legitimate ground for excluding that duty in some, or even in most,
    of the cases of this kind. But no doubt there are certain cases
    where the duty is clear. Instances are the case of a young and
    inexperienced woman who has reluctantly submitted to the operation
    at the hands of a person who is known as a practised abortionist,
    or where the operation has been done by violence and against the
    will of the subject. These, however, are questions of morality upon
    which varying opinions may be held, and upon which I do not desire
    to be taken as expressing a final opinion."

This legal opinion has not been challenged, though it has been
criticised.

Although the Committee appreciates the difficulties under which the
police are working, the evidence of other witnesses has led them to
agree that any extension in the direction of compulsory notification to
the police before death, and against the patient's wish, is open to
serious objections and is therefore not advisable.

Regarding the second issue, there is general agreement that there is a
duty on the doctor to assist the police, and that this should be done
by withholding a certificate of death and informing the Coroner.

The position has been more clearly defined as a result of a recent
amendment to section 41 of the Births and Deaths Registration Act, as
contained in section 12 of the Statutes Amendment Act, 1936:--

    "12. (1) On the death of any person who has been attended during
    his last illness by a registered medical practitioner, that
    practitioner shall forthwith sign and deliver to the Registrar of
    the district in which the death occurred a certificate, on the
    printed form to be supplied for that purpose by the
    Registrar-General, stating to the best of his knowledge and belief
    the causes of death, both primary and secondary, the duration of
    the last illness of the deceased, the date on which he last saw the
    deceased alive, and such other particulars as may be required by
    the Registrar-General, and the particulars stated therein shall be
    entered in the register together with the name of the certifying
    medical practitioner.

    "(2) The medical practitioner shall at the same time sign and
    deliver to the undertaker or other person having charge of the
    burial a notice on the printed form to be supplied for that purpose
    by the Registrar-General to the effect that he has furnished a
    certificate under the last preceding subsection to the Registrar.

    "(3) In any case where, in the opinion of the medical practitioner,
    the death has occurred under any circumstances of suspicion, the
    practitioner shall forthwith report the case to the Coroner.

    "(4) Every medical practitioner required to give a certificate and
    a notice as aforesaid, or to report to the Coroner as provided by
    the last preceding subsection, who refuses or neglects to do so is
    liable to a fine not exceeding five pounds."

Recently a consultation on this matter was held between the Minister of
Health and members of the Council of the New Zealand Branch of the
British Medical Association.

The Association expressed the opinion that the resolutions of the Royal
College of Physicians (England), which were laid down as a result of a
similar controversy in Great Britain, constituted the most satisfactory
guide in these difficult and responsible situations, and informed the
Minister that steps would be taken to make the position clear to all
its members. The resolutions are as follows:--

    "The College is of opinion--

    "1. That a moral obligation rests upon every medical practitioner
    to respect the confidence of his patient; and that without her
    consent he is not justified in disclosing information obtained in
    the course of his professional attendance on her.

    "2. That every medical practitioner who is convinced that criminal
    abortion has been practised on his patient should urge her,
    especially when she is likely to die, to make a statement which may
    be taken as evidence against the person who has performed the
    operation, provided always that her chances of recovery are not
    thereby prejudiced.

    "3. That in the event of her refusal to make such a statement he is
    under no legal obligation (so the college is advised) to take
    further action, but he should continue to attend the patient to the
    best of his ability.

    "4. That before taking any action which may lead to legal
    proceedings, a medical practitioner will be wise to obtain the best
    medical and legal advice available, both to ensure that the
    patient's statement may have value as legal evidence and to
    safeguard his own interest since in the present state of the law
    there is no certainty that he will be protected against subsequent
    litigation.

    "5. That if the patient should die he should refuse to give a
    certificate of the cause of death, and should communicate with the
    Coroner.

    "The college has been advised to the following effect:--

    "1. That the medical practitioner is under no legal obligation
    either to urge the patient to make a statement, or, if she refuses
    to do so, to take any further action.

    "2. That when a patient who is dangerously ill consents to give
    evidence, her statement may be taken in any of the following ways."
    [The procedure employed in taking this statement is then
    specified.]

The Committee is also of the opinion that if the medical profession
closely follows this guidance and that of the amended section 41 of the
Births and Deaths Registration Act, the public interests will best be
served.




SUMMARY AND CONCLUSIONS.


  I. The Committee is convinced that the induction of abortion is
exceedingly common in New Zealand, and that it has definitely increased
in recent years.

It has been estimated that at least one pregnancy in every five ends in
abortion; in other words that some 6,000 abortions occur in New Zealand
every year.

Of these, it is believed that 4,000, at a conservative estimate, are
criminally induced either through the agency of criminal abortionists
or by self-induction, either of which is equally dangerous.

It is clear that death from septic abortion occurs almost entirely in
such cases.

Such deaths have greatly increased in recent years, and now constitute
one-quarter of the total maternal mortality: in some urban districts it
amounts to nearly half of the total maternal mortality.

New Zealand has, according to comparative international statistics, one
of the highest death-rates from abortion in the world.

 II. The Committee, after taking evidence from witnesses representing
all sections of the community, has formed the conclusion that the main
causes for this resort to abortion are:--(1)Economic and domestic
hardship; (2)changes in social and moral outlook; (3) pregnancy amongst
the unmarried; and (4) in a small proportion of cases, fears of
childbirth.

These matters are fully discussed.

III. Consideration has been given to the possible remedying of these
causes.

    (_a_) In so far as economic hardship is the primary factor, certain
    recommendations have been made regarding financial, domestic, and
    obstetrical help by the State.

    (_b_) To lessen any fear of childbirth where this exists, it has
    been recommended that the public should be informed that New
    Zealand now has a very low death-rate in actual childbirth and that
    relief of pain in labour is largely used. At the same time the
    Committee has advocated that further efforts in the direction of
    pain relief should be explored.

    (_c_) For dealing with the problem of the unmarried mother, the
    Committee considers that the attack must be along the lines of more
    careful education of the young in matters of sex, prohibition of
    the advertisement and sale of contraceptives to the young, and a
    more tolerant attitude on the part of society towards these girls
    and their children.

    (_d_) The Committee believes, however, that the most important
    cause of all is a change in the outlook of women which expresses
    itself in a demand of the right to limit--or avoid--the family,
    coupled with a widespread half-knowledge and use of birth-control
    methods--often ineffective. These failing, the temptation to
    abortion follows.

The Committee can see only two directions in which abortion resulting
from these tendencies can be controlled:--

    (1) By the direction of birth-control knowledge through more
    responsible channels, where, while the methods would be more
    reliable, the responsibilities and privileges of motherhood, the
    advisability of self-discipline in certain directions, and other
    aspects of the matter would be discussed.

The Committee believes that it is through the agency of well-informed
doctors, and, to a certain extent, through clinics associated with our
hospitals, that this advice should be given.

It is not, however, considered that this is a matter for the State
except to a limited degree.

    (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.

This, it is considered, is a matter for all women's social
organizations to take up seriously.

 IV. Certain further measures of a more general nature came under the
examination of the Committee.

The prohibition of the promiscuous advertisement of contraceptives, and
of their sale to the young; the licensing of the importation of certain
types of contraceptives; the restriction of the sale or distribution of
contraceptives to practising chemists, doctors, hospitals, and clinics;
the prohibition of the advertisement, or of the sale, except on medical
prescription, of certain drugs and appliances which might be used for
abortion purposes; these measures are recommended.

The specific legalization of therapeutic abortion (by doctors for
health reasons) as a safeguard to doctors was fully examined but is not
recommended.

The Committee is satisfied that the present interpretation of the law
is such that, where the reasons for the operation are valid, the doctor
runs no risk of prosecution.

The risks of an alteration in the law are great.

Legalization of abortion for social and economic reasons was also put
forward. The Committee has discussed the matter, and strongly condemns
any countenancing of this measure.

Though it may be conceded that legalized performance of the operation
by doctors in hospitals might reduce the incidence of surreptitious
abortion and deaths from septic abortion, we do not accept this as any
justification of a procedure which is associated with grave moral and
physical dangers.

With regard to sterilization, the Committee adopts the same view as
towards the specific legalization of therapeutic abortion.

It is believed that, where the reasons for the operation are in accord
with generally accepted medical opinion, there is no bar to its
performance.

We see, however, tendencies in the direction of extending this
operation far beyond the bounds of this accepted medical opinion.

For this reason we do not recommend any alteration in the present
position.

The failure to obtain the conviction of the criminal abortionist, even
in cases where the guilt seems beyond all doubt, has been discussed as
a matter of serious concern, and the Committee can only bring before
the public its responsibility, as represented by members of juries, for
the virtual encouragement of this evil practice.

Finally, the Committee, while fully conscious of its inability to place
before you a complete and certain solution of this grave problem, or
one which will satisfy all shades of opinion, believes that a definite
service will have been done through this investigation if full
publicity is given to the facts of the situation as here revealed, and
if the public conscience is awakened to the fact that, although State
aid and legal prohibitions may do something to remove causes and to
deter crime, the ultimate issue rests with the attitude and action of
the people themselves.




THANKS.

To Mr. C. Stubley, of the staff of the Department of Health, we extend
our thanks for the efficient manner in which he carried out his duties
as Secretary to the Committee, and also to Misses B. Frost and O. Clist
who, as stenographers to the Committee, had a very arduous task, and
whose excellent reports materially assisted the members of the
Committee in their final deliberations.

    D. G. McMILLAN, CHAIRMAN.
    JANET FRASER.
    SYLVIA G. CHAPMAN.
    T. F. CORKILL.
    T. L. PAGET.


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