Protection of Women and Children in Soviet Russia
Before the Revolution, the Czarist Government took the stand, usual in most countries, that abortion was a moral and physical evil which must be made illegal. As a result laws were put into force which identified abortion with murder and rendered it excusable only in order to save the life of a pregnant woman who was dangerously ill, and it could only be carried out by a physician who had consulted with other licensed doctors and had agreed with them that the operation was necessary. Abortion performed in any other circumstances was illegal, especially in the case of the woman dying. Persons performing illegal abortions received severe punishment: cancellation of any medical license, long periods of imprisonment, and in some cases death as the penalty for having inflicted death.
Such an attitude is generally considered sound, but there was one difficulty, one which affects all poverty-stricken peoples, and therefore one which was particularly prominent in Russia, i. e., many people were too poor to have all the children "God sent them." The masses were not often in contact with doctors anyhow; they cured their own ills or died of them, they delivered their own children, only sometimes with the aid of a doctor or midwife; and they worked out their own salvations, of course under the guidance of the Church.
It was obvious to any woman that, though she might die from an abortion she was most certainly losing her health and strength by repeated pregnancies, and not only did each child cost the family more but while the mother was pregnant, she was a less efficient worker both in her home and in the fields or factories and thereby she and her pregnancies cut down still further the family's finances. It also seemed logical that it would be better that a child not be born than that it should suffer privations all its life. So, in spite of the stand taken by the Church and State, the poor Russian woman protected herself from a physical and her family from an economic breakdown in the only way she knew--by using abortion to prevent too frequent births, exactly as so many working class women have always done, and still do everywhere in the world.
The result of such abortions, which were necessarily done in secret, is obvious. Many times the woman performed the operation herself, or was assisted by an inexperienced friend or midwife. In any case, the instruments used were simple household implements totally unsuited to the purpose, and the conditions could scarcely ever have been hygienic. Those who performed such operations were usually thoroughly ignorant of female anatomy and physiology, and so, in many cases, death or lifelong invaljdism was the result.
There are no adequate or reliable statistics on abortion and deaths resulting from it in Russia before the Revolution, because all such matters were, of necessity, kept as quiet as possible. We can only repeat the general consensus of opinion held by both the doctors and the women of Russia today, namely, that the deaths were an appallingly high percentage of the number of abortions, which in turn were not few in number.
When the working woman became aware that she was living under a Government which claimed that it not only believed that women should share equal rights with men, but would to the best of its ability help women to become men's equals, one of the first things she asked was the right not to give birth to children which she did not want. Because Birth Control was practically unheard of in the Russia of 1917, it was legalised abortion for which the women asked. The question was discussed at great length in all places where women met together and in the newspapers, as is the Russian custom since the October Revolution. The points on both sides were numerous and strong. The women were almost unanimous in the feeling that they never could be socially or economically independent so long as they had to bear continually recurring pregnancies. They were also very decisive in the opinion that as long as they were forced to bear children every time they became pregnant, they could never be strong enough nor have sufficient enthusiasm to bring up a family as they should. Western physicians are most emphatic in endorsing such popular sentiments held by the average woman. The Dutch gynaecologist, Th. H. Van de Velde, states in his book, Ideal Marriage:
Fear of pregnancy often impairs sexual processes and reactions on the psychic side to such a degree that bodily reactions are sympathetically affected and even inhibited or checked. Many marriages are totally ruined by this fear and its consequences.
The doctors in Russia were faced with more difficulties than were the Russian women before committing themselves as to the way of solving the question. As one of the doctors in the maternity hospital which is connected with the Institute for Protection of Motherhood and Childhood in Moscow told me, "The question is one of the most difficult with which any doctor or any human, for that matter, could be faced. Waiving the moral issue, the physicians were under no illusions as to the harm abortion can cause, even when performed under the finest conditions and by the best medical experts. But we were faced with the undeniable fact that Russian women would continue illegal and underhand abortions as long as they were faced with many unwanted pregnancies. At that time there was, and even now there is no absolutely safe and harmless contraceptive. We were convinced that it was not the young healthy women who wanted abortion because the Revolution had banished the illegitimate child, making marriage and cohabitation practically synonymous; it was the poor woman with children who was unable to support more, who wanted and needed relief, and we were still more convinced that if she did not get it from the State, she would do the best she could for herself. It gradually grew to seem logical in the eyes of the medical profession that the best way of fighting abortion was to fight it openly, which meant making it legal; and I do not think we took a false step when we did so, for we now have not only cut down the number of deaths due to underhand abortion but we are also in a position to fight abortion by well-advised birth control."
It is quite true that every gynaecologist I met was trying to reduce the number of abortions, but it is equally true that they all felt that State sanction of abortion, if performed by surgeons in State hospitals, was the best way to control the problem. Everywhere one can see propaganda posters used in the fight against abortion:
"Abortion carried on even under the best conditions can damage the health."
"It is less dangerous to prevent conception than to have an abortion."
"Abortion is a great evil! It must die out! The destroying of it is the most important social problem of the immediate future."
"The struggle with abortion, by means of suppressing it, is not only useless but pernicious, for legalising the operation has greatly lessened the number of underhand abortions performed by incompetent persons in unsanitary environments, and thereby has lessened the large percentage of deaths from such operations," etc., etc.
In those museums which deal with the care of women and children, there are, as well as the above posters, elaborate charts and colourful illustrations regarding abortion and its consequences when performed in a hospital and when performed in an underhand manner. There are also wax figures showing how abortion used to be done by inexperienced people and how the peritoneum was so easily punctured, resulting in blood poisoning and death. Beside such figures, are ones showing how the surgeons operate and how little risk there is when they perform abortions. A film has been made and widely circulated throughout the U. S. S. R. showing, in story form, why some women desire abortion and the evil effect of that operation, especially if it is performed by an inexperienced person in an unsanitary environment. Included in the picture are drawings showing the right and wrong ways of performing the operation of abortion. There is always a chart in every one of these museums showing the decrease in underhand abortions since 1920, when abortion in State hospitals was legalised. The only way to discover underhand abortion is by keeping track of the deaths it causes, according to the Moscow Bureau of Statistics. In State hospitals 0.79% of abortions result in death. In U. S. S. R. in 1923, 42% of abortions resulted in death which means that more than 41% of abortions were not performed in a State hospital. In 1927, the amount had been decreased to about 14%. That is why doctors feel that legalised abortion has been a good thing--and that it is the best possible means of combating the evil.
The law of 1920 which legalised abortion did so under the following conditions:
a) The operation known as abortion can only be performed by licensed surgeons.
b) Save in very exceptional circumstances, abortion must be the result of a surgical operation and not the result of medicines or drugs.
c) After every abortion performed, the woman concerned must stay in bed in the hospital, or other place of operation, for three full days.
d) After every abortion or miscarriage, the woman concerned must not be allowed to go to work for two weeks after said operation or illness.
e) An abortion must not be performed for the first pregnancy unless childbirth would seriously endanger the woman's life.
f) Abortion must not be performed if the pregnancy has been continued for more than two and one-half months.
g) Except as stated in paragraphs "e" and "f," no qualified doctor has the right to refuse abortion, although he is at liberty to discourage it in every way he thinks fit.
h) The State recommends that all abortions be performed in those State hospitals where there is a section definitely for that purpose. All women who carry social insurance or whose husbands are socially insured can receive abortion free of charge in a State hospital, (Paid for by socialinsurance. All others must pay the usual medical fees and residence fees for the time they are in the hospital. These are very small.)
i) All midwives, and any other persons who are not licensed doctors, are strictly prohibited from performing abortions.
j) Private doctors or any other individuals who perform an abortion which results in death of the woman can be tried for manslaughter. Women who perform abortions on themselves are not subject to punishment. (This seldom occurs since abortion is so easily obtained.)
k) It is recommended that abortions be discouraged if the woman concerned has had less than three children; if she has adequate means for supporting another child; if her health would not be impaired by another pregnancy; if her living conditions make a good enough environment for children; and, if, in general, there is no social, physical, or economic reason for the abortion.
Since this law legalising abortion went into effect in 1920, accurate statistics on all such operations in State hospitals have been kept and it has been found, as mentioned before, that only 0.79% of abortions performed in these resulted in death.
Methods employed in the struggle with abortion are many and vary with the doctor or social worker using them. However, they are based on several definite ideas held by the Soviet medical profession, the social workers, and the State itself. They are admirably put before the public in poster form, as well as in meetings and in the actual consultations themselves and without doubt they express to a certain degree the attitude taken towards the problem of women's rights as a whole, since they reveal those methods used by the Soviets in attacking all such social questions. They are:
1. Raising of the cultural and physical level of the population as a whole.
2. Development of an institutional system for the protection of women and children.
3. Insurance for mothers, vacations for working women before and after giving birth.
4. Defense of deserted women, alimony from husband and State, court trials of fathers who do not fulfil their social obligations.
5. The crushing of the concept expressed by the words, "Illegal children," as stated in 1918 by the law concerning marital and family relations.
6. Bettering the living conditions of all people and the working conditions of all labouring women.
7. General medical care of public health, special medical care for pregnant women, maternity hospitals and medical care for women who feed their babies from the breast.
8. The law of 1920 which made abortion legal under certain conditions; which insured that in all probability the operation would be carried out in a State hospital, since private medical institutions are too expensive in their maintenance, due to the terrific taxes on all private business concerns.
9. By acquainting the population with adequate means of birth control, through clinics and all other medical and social institutions.
This last method of fighting abortion is, to my mind, the most important positive weapon they are using although some of the other methods are more profound and have, therefore, a greater effect in a passive way; for example, generally speaking, when the cultural and financial level of a group of persons is raised, there ceases to be so much need for abortion and consequently abortion ceases to flourish. However, the raising of the cultural and economic level of the people residing in the U. S. S. R. is the one great and important task of the whole Soviet Government. They know it and remind themselves and others of it continually and so to analyse that phase of Soviet life would mean analysing the ideas, tactics, failures, and achievements of the entire Soviet regime, a task which, I think, at present impossible. But the one definite weapon against abortion, i.e., birth control, is something tangible and something which expresses in the main not only their methods of work but also the attitude they adopt towards such social problems.
Out of every hundred pregnant women who come to the Moscow clinics, from eighteen to twenty ask for abortions. If the woman asking for the abortion is healthy, economically up to standard, living in good social conditions, is not burdened by a large family and is not mentally deficient (when she would probably not ask for the abortion), the doctors and social workers all try to prove to her that she does not need the abortion and that it would be a social crime if she did not bring her child into the world, and that she would be endangering her own good health by such a step. If they cannot persuade her, the abortion is performed and it is considered important to do so, since a woman who will stand out against all such persuasion really does not want a child and is therefore unfit to have one. In fact, in the year 1927 [there were no later figures in the spring of 1931] in Moscow almost twenty per cent more abortions were due rather to social than to medical reasons. In that year, in Moscow, 40.8% of abortions were due to medical causes of which tuberculosis was 15.4%, heart trouble, 4.60%, venereal disease, 1.1%, anemia, 0.8%, structural difficulties which could not be corrected, 0.6%, constant vomiting during pregnancy, 0.3%, and miscellaneous, 18%. (Some of these reasons, such as vomiting during pregnancy, would not always be considered medical reasons for abortion in England or in the United States, but, in the Russian sense, they do not come under the category of social reasons.) Fifty-nine and two one-hundredths per cent of the abortions performed that year were carried out for social reasons. These were made up of the following: lack of financial means for supporting the mother during pregnancy, 44.3%; lack of material means to wean and support new baby, 5.8%; possible loss of employment due to pregnancy, 2.9%; miscellaneous, 2.1%. This is fairly good evidence that there are few women who are simply lazy and request abortions without sufficient social or medical reasons.
It is obvious, therefore, that as the law now stands, the woman is free to do almost as she pleases regarding the continuation of her pregnancies. And, from the number of abortions performed in the cities, it is equally obvious that she takes advantage of the opportunities thus offered her.
"How often is this privilege abused?" is the question which arises in the minds of those persons who know only that abortion is sanctioned in the U. S. S. R. This, of course, is a question that is hard to answer, since no one can really reply to it except the women concerned, and they can always make adequate excuses for their actions. There is one thing, however, on which all doctors are agreed, i. e., there are very few abortions performed on women who merely want to hide the fact that they have had relations with men. The very fact that an abortion is not performed for the first pregnancy makes it almost a certainty that this privilege cannot be abused by women who merely wish to conceal their private actions. Even after twelve years, a great deal of opinion and counter-opinion finds expression as to when a child should be permitted to come into the world and when it should not. Promiscuity is sanctioned neither by the Russian Government nor by the Russian temperament. If, on the other hand, "abuse" is understood to mean the wilful harming of the human body, and perhaps mind, it is certain that the privilege is abused, since the operation occurs so frequently; and, because of its frequency, it must necessarily harm women physically and psychically.
No one realises this more keenly than the doctors. They have often told me that there are times when they have been obliged to perform an abortion for a woman when they know she is ruining her health by the practice; and so, to them there is only one thing to do and that is to provide adequate preventive means. This task is by no means easy since to begin with there is no really safe contraceptive, either from the point of view of absolutely preventing conception or from a psychic point of view; because, as all medical persons and social workers know (as well as every individual who practices contraception), with the present known means, either the man or the woman, or both, are subject to a very definite psychic disturbance by merely applying the simplest of methods. The fear of having children and the means of preventing them is an important factor in many cases of neurosis, and has been dealt with at great length by many doctors and psychologists. Although the theories of Jung, Adler, Stopes, and especially Freud are now frowned upon by many authorities, there is certainly no doubt that they opened up a question and presented to the medical profession a problem which has not vet been solved, i. e., "How can a man and a woman--especially a woman--be free from the fear of pregnancies, so that they can enjoy a normal physical life?" The obvious answer, if the question be looked at superficially is that birth control offers a very good solution and that the small amount of uncertainty attached (because no perfect method has as yet been found) is in reality a benefit in disguise since it adds an adventure to sexual relations which, if lacking, as in the case of sterility, can easily deaden almost all but the pure animal pleasure of the sexual act. It is also a question whether the physical side does not suffer too, not only because a sterile person is necessarily not so alive as a normal person but because the physical and psychic are so bound up in one another, especially in intercourse, that it is difficult to distinguish between the two and what can deter the one has almost always the same effect upon the other. But all doctors know and some (as in the case of the American physicians) claim that the psychic effect of being bothered by contraceptives is so harmful that in itself it can cause nervousness and even, in some cases, neurosis. It is, therefore, up to the medical profession to discover a way, or rather several ways, which will prevent conception and which will eliminate psychic irritation since it is highly improbable that all men and women would react equally to a given contraceptive, no matter how sure it might be any more than to any other given factor in their lives. Care must be taken that birth control does not have the same psychic effect, but in a milder degree, as abortion.
None of this is new although it is retold us by the Russian doctors. It only goes to prove that they do not want to be forced into inadequate means of contraception as they were into abortion. And so, at all costs, they are making researches in contraception in order not only to kill abortion but also to save themselves when the Russian women find out that the abortion which they now demand is really only harming them and is not at all the proper solution to their problem. The Russian people are going then to ask the doctors (and I think that in some especially enlightened places they have already begun to do so) for means of prevention which will not only be safe hut which will not ruin their physical and psychic well-being as did the old method of abortion. Such a demand on the part of the layman and woman is normal but it is extremely hard to gratify and, at present impossible although the Soviet doctors' methods of attempting a solution are as yet the most modern ways to solve the problem.
The Institute for Protection of Motherhood and Childhood is sponsoring the major part of the research which they hope will result in the perfect contraceptives and all application of their results is being done by the doctors in the clinics. Their methods are simple with the simplicity of beginners and as such have a tremendous scientific value, since they are in no way hampered by social tradition; and the very fact that they allow abortion shows that in one of the essentials, at least, they are not hampered to any great extent by medical tradition. Neither is there any sex consciousness either in the literature for or in the meetings of the lay population. As Maurice Hindus says in his book, Humanity Uprooted: "....physicians, nurses, will go into minute explanations in language audaciously frank, of the function, physiology, hygiene, technique of sex, and again the audience invariably is mixed."
There is no birth control advice at the marriage registry, which many of the Russian doctors think is a fault, but since the Government is still on a very unstable financial level, it is at present all they can do to support adequately the Institute for Motherhood and Childhood, and so they are naturally the ones to whom the problem of Women's Rights in all matters, as well as in birth control, must fall. It is interesting to trace the history of a given and, as I think, typical woman, since I had the opportunity of observing many cases, through the abortion and birth control clinics. Let us take a woman who wants an abortion and see how she is handled since it is from abortion that birth control grows, at least in Soviet Russia.
Moscow and all other cities and some towns, as well as co-operative farms, have a number of general health clinics for women and children which are known as Points of Consultation. Any woman who is socially insured, or whose husband carries social insurance, is entitled to free care and advice from the Point of Consultation in her residential district. All others can obtain treatment and advice for nominal fees, if they can pay. Whether they can pay or not is decided by the visiting nurse. It is, therefore, logical that a woman who is pregnant and who does not want a child should first go to her local Point of Consultation, in order, in the first place, to verify her pregnancy and then to obtain the abortion or, at least, advice on abortion.
When the woman calls and it is found that it is the first time she has visited the Point of Consultation, she states her name and address, her business and that of her husband, as well as her education, if any, to one of the nurses in the Reception Department. Unless the case is urgent, she is given an appointment at some other convenient time. Before that time the Point of Consultation sends a visiting nurse to her home, who talks to the woman and tries to make friends with her in the ordinary ways used by most social workers in making home visits. After the visit, the nurse fills out as full a form (see Chapter 22) regarding the woman's history, environment and present mental and psychic condition, as can be seen by a first and necessarily superficial visit. Then, when the woman comes to the clinic, she is taken to the Section for Consultation of Pregnant Women and the doctor who examines her has the visitor's report and can thus, even at first, know a little of the case.
The consulting rooms in all the clinics which I have seen are very pleasant, and do not look like the ordinary clinic room but rather like the room of a good private physician, as most Americans and English know them. All persons in the consulting room, including the patients, wear white medical aprons, and in all other respects the room is fitted with every modern convenience. The doctor, if he has found that the woman is pregnant, will then refer to the report made by the visiting nurse, or if she is there, as she usually is during consulting hours, he will talk to her and find out something of the history of the case (we are taking it for granted that the woman wants an abortion). As has been stated before, if it is the first pregnancy, he will in no wise consent to the abortion unless the woman's life would be endangered by childbirth, which, of course, is rare enough in all countries and especially so in Russia where the women are very strong.
If it is not the first pregnancy, the doctor finds out from the visiting nurse or from her report how many children, or miscarriages the woman has had, and also makes inquiries concerning her economic and social circumstances. In case she has had a fair-sized family (three or four children), is very poor, and her pregnancy has not advanced more than two and a half months, he will, without much hesitation (only warning her as to the effect abortion has on the health, telling her that even now there are ten times the number of deaths from abortion as from birth) give her an order to the State Hospital where the operation may be performed. If, however, she has only one or two children and there is no reason why, socially, economically, or medically she should not have a child, the doctor does all in his power to persuade her not to have the operation. If, however, she insists, as they often do, with no real reason except that abortion is a part of Women's Rights, although she usually says that in spite of all the help given to mothers with new babies, she cannot see her way clear to go through another birth, she is sent to the State Hospital. In such a Point of Consultation they receive pregnant women from seven to nine hours a day, during which time about ninety women are examined, fifteen to eighteen of whom want abortions. Of the number desiring abortion, they are usually able to persuade about half not to have it. The other half, who still think that they want abortion, are then sent to the State Hospital where they are again examined, this time much more thoroughly so that in reality the examination done in the Point of Consultation serves only as a preliminary one. However, the same methods used in the Point of Consultation are followed in the Hospital, i.e., home visits and medical examination as well as talks with the doctors and nurses. In the State Hospital they usually succeed in persuading five to ten out of twenty not to go through with it which means that in the long run the number of abortions is quite low considering the number of pregnancies.
The doctors are more or less at liberty to try to persuade the women against abortion as they like; and, as can be seen, they really have a surprising amount of success. Usually they only try to talk to the woman and show her, if they think necessary, that she is only hurting herself; and it is easy enough for a doctor in a district to pick out women patients of the clinic who are known to any particular patient who may come to the clinic, and to show how such and such a woman has ruined her health and finally her earning capacity by repeated abortions. With the average woman who comes to the clinic this is sufficient to show her that it would be better if she had a child instead. However, with some of the women, especially those who are in the habit of asking for and consequently receiving repeated abortions the doctors are forced to more strenuous measures. For example, I met one doctor at the Institute for Mother and Child, in Moscow, who is in the habit of having quiet talks with his patients, and if nothing can persuade them that they should not have the operation, he will say, "All right, you shall have your abortion as soon as possible (which is usually in a few days), but I am afraid that most women think that abortion is a simple, painless operation, and therefore, when they lie on the operating table we have a little difficulty with them; so I suggest that it would be much better for you to come tomorrow when I shall be operating, and you can observe two or three abortions which will help not only you but also me, as your doctor." If the woman is wise she will not come, if she really wants the abortion, because in nine cases out of ten, the doctor assured me, this cured them and they were very glad they did not have to go through with it. Such a treatment of individuals would seem, at first sight, almost impossible to use, and I have heard some Europeans say, "Only Russians could stand such treatment." This, however, as any medical student or social worker can tell you, though a little harsh on the observing woman, is after all about the same kind of care as is given in all charity and free hospitals in England and the United States where medical students and from time to time others can go into the operating rooms or delivery rooms of charity patients and hear a professor lecturing on the delivery or operation, even when the patient is conscious and can only be hurt by hearing what the lecturer is telling his class. It is our manner of dealing with charity patients which is really cruel, for it is not nearly so necessary as using any means possible to prevent ruining a woman's health by abortion. In addition, there is no reason why women should not know what is ahead of them, especially as such knowledge might be of great help to them, so long as their presence is not allowed to harm the patient who is undergoing the operation. If anything, the Russians are even more humane than the Europeans and Americans because they do not allow in their hospitals any patient to be disturbed by talking or lectures, while he or she is suffering.
If the woman is persuaded not to have the abortion, she is then given regular care in the Department for Pregnant Women in her local Point of Consultation. This and the Maternity Hospital are, however, dealt with in another chapter. Only after she has had her child does she come into active contact with the Department of Abortion and Birth Control advice. The woman who, on the other hand, goes through with the abortion is told that she must go to the Point of Consultation again, and this time to the Birth Control Advice Department since it would be much easier for her to find a way to prevent further abortions than to have to go through with another such operation. As a rule, the normal woman is quite willing at least to try preventive methods. The difficulty, as all women know, even those who are well informed about birth control, is to keep on applying the contraceptives; it gets tiresome, and it is easy to grow careless. This is especially true of the working People who are, after all, very tired at night and simple fatigue can make people run all sorts of risks. Lack of education is another factor, as is lack of sanitation and inadequate knowledge concerning the care of the sexual organs; and so, on the whole, the advocates of birth control in Soviet Russia have a very hard time for there are so many chances (even more than in most countries) of their advice not working or even causing actual harm for the above-mentioned reason. I do not mean to say that the Russian is not clean; he is perhaps the cleanest working man in the world, for even long before the Revolution every Peasant in most localities took a bath once a week, and the first thing that I myself remarked was that no matter how poor and ragged a person might look, his face, neck, and ears were invariably clean. But simple cleanliness in the sense of washing daily is not enough when caring for the sexual organs and it is hard to convince most people of this fact.
There is not much use in going into the necessity for birth control; many others have done so to the satisfaction of all thinking people; and the Russians agree with them that a woman has the right to her own body and she must, therefore, be helped in every possible way to use it to the best advantage. But in Soviet Russia, contraception is not only considered a social necessity but it is the direct result of, and the cure of, a recognised evil, abortion; and its development is due mainly to the intense desire on the part of all Soviet physicians to do away with abortion. Because the Soviet State is working so hard to solve this problem which inevitably faces the adult population of any group, (how many children should we have, how frequently, and what kind?) it has placed itself far beyond the arguments for practical eugenics with which we are so familiar; because our birth control advocates can only attempt to improve existing conditions, they cannot go to the root of the matter without making radical social changes which would be promptly stopped with the brand "Revolutionary." Such a woman as Mrs. Sanger, in her pamphlet, Family Limitation, pointed that out when she wrote: "Society is generous in doling out pittances for the unfit and diseased, thus encouraging their multiplication and perpetuation, while it prevents and discourages the use of scientific knowledge which would enable women to avoid bringing into the world children they cannot feed, clothe, or care for." The fight which Mrs. Sanger and others are waging with organised society in the Western World has been won in Russia where the State recognises the value of eugenics and is doing its best to arrive at a practical solution and to educate public opinion.
By making the Government solely responsible to the people it follows that birth control or anything else which aids in gaining freedom for individuals and health for society should and must be fostered not only by a small group of scientists but by the State itself. Therefore the Russians do not talk much about contraception as it is related to Women's Rights, that relationship and its accompanying arguments for birth control are taken for granted, but they are very actively concerned with contraception as a weapon against abortion.
Therefore, mainly in order to avoid abortion, when a woman has had either an abortion or the last child she can afford, either physically or economically, she is recommended to her local Point of Consultation, where she may receive advice on birth control. (Some Points of Consultation do not have a birth control section, but this only means that the woman has to go to the nearest clinic which can serve her.) There, also, are sent all women who are ill or diseased: all those suffering from nerve troubles or mental deficiency, or any other mental or physical disorder which would keep her from being a good mother or from producing first-rate children.
When the woman first comes to the birth control section of a Point of Consultation (the only place where such advice can be had in Russia), she is again given an appointment for some later date in order that one of the visiting nurses of that department can learn to know something of her in her home. The visiting nurse follows much the same routine as the one sent to the homes of women who are anxious to have an abortion. Above all, they try to find out if the woman is unhappy in her home life and if so, why. This, of course, is most difficult for such a discovery can scarcely be expected to be the result of a first visit. The nurses however seem to know the kind of people with whom they come in contact and so are able to turn in a fairly comprehensive report on each home visited. The actual work of knowing and pleasing the women, however, belongs to the doctors in the clinic. At her first appointment, the woman has a long conversation with the doctor, during which the physician tries to ascertain something of her temperament and to advise her accordingly. It is quite obvious that they cannot deal with an educated woman in the same manner as they do with the ordinary run of illiterate or half-literate women who come to the clinics. As long as there is no universally satisfactory contraceptive, much of the effect of any method prescribed is in the hands of the doctor who prescribes it, and for this reason I was very impressed with the fine type of men and women (usually women) physicians who were in charge of the birth control clinics.
During the doctor's conversation with the women applying for contraceptive means, a very definite attempt is made to find out how happy the woman is in her sex life and what she thinks would improve it. As is the case with most women, in no matter what walk of life they may be placed, the one thing which comes between them and their husbands is the fear of pregnancy, which after all is why they have come or been brought to the clinic. A complete, but brief, physical examination is made by the doctor, who, if the woman is normal in her physical formation, can prescribe contraceptives according to her temperament and not according to her physical build, which, if abnormal, needs special treatment. [It is impossible to publish the book as it was originally written because it contained descriptions of certain contraceptive methods used in Russia and these are not allowed to be published for lay consumption in the United States.]
About fifty per cent of the women who seek advice on birth control in the Russian clinics can be fitted with a particular mechanical contraceptive, which, as far as I know is used only in Russia. The rest are treated according to their individual physical and social needs with methods which are commonly known in other countries. In addition the Institute maintains experimental laboratories for research in the field of new and more satisfactory birth control methods. Some of their experiments have met with noteworthy success and the results will doubtless be published in the near future.
No matter what method is advised, the information is always obtained in a clinic from a qualified nurse or doctor. A still more important feature of Russian technique in this matter is the obligation on the part of each woman receiving contraceptive information that she return to the clinic every ten days for a brief examination and cleansing. All contraceptives when not in use are kept at the clinic. This system of regular examinations allows the doctors to keep in touch with the general health of the patients and renders it possible to detect any cases of venereal diseases almost immediately and see that each woman receives proper care. The hygienic value such frequent visiting of the clinic has upon the community cannot be underestimated.
The Institute for the Protection of Motherhood and Childhood, through its birth control clinics and its experimental laboratories, is constantly trying to verify the effect that their prescribed contraceptives have on the woman concerned as well as on their husbands. For this reason, especially in birth control work, they stress the importance of quiet and individual talks with the women who come to the clinics: talks which not only immediately benefit the women but which are infinitely valuable to the research workers of the clinics and Institute. The Institute and all factories encourage meetings and discussions for large and small groups sometimes made up of only women or only men, but usually mixed, where all matters of health are discussed. There is also an abundance of literature which is both scientific and simple to be had on the subject: so that even the person who is only learning to read can understand it. The women especially are encouraged to read such books, since these give them something of vital interest to themselves and keep them from wasting their time by pursuing subjects which have no immediate practical value to themselves. Posters also play a great part in advertising birth control and sex hygiene, but these are used mostly as a means of spreading propaganda to prevent abortion.
During the receiving hours each clinic usually has about three doctors at work, each in a separate room with an assistant. The women enter one at a time, and those who have been there before go right to the table and lie down with no apparent shyness. I was surprised to see how quickly and simply it was all managed. There is never any fuss over anyone, except when a woman first comes and even then she is taken into a reception room where the doctor can talk to her privately. About four new women come a day to each of these clinics in addition to the large number of women who have regular appointments every ten days, and they spend as much time as is needed with the doctor, who talks with them and fits them. Although in most places this care and advice is free to all, even non-insured women, the contraceptives must be bought, but the prices asked for them are so low that even the poorest person is not kept from buying what she needs. The whole clinic, of course, is scrupulously clean, as are the doctors and nurses and their instruments. The impression is quickly gained that these birth control advisers are very serious in their work, and are putting all they can into the struggle against abortion, and into the even greater struggle for the right of women to use their own bodies as they see fit.
When a woman who comes regularly to the Birth Control clinic wishes to have a child, she talks it over with one of the doctors, who sends her to the Department of Pregnant Women (usually in the clinic too) to have a medical examination so that she can know she is in sound enough condition to stand a pregnancy with the minimum of discomfort and risk. (See section on Pregnant Women.)
The study of the history and practice of abortion and the development of birth control in Soviet Russia reveals the type of technique employed, as well as the history and achievements of that Government in dealing with one phase of the problems regarding the Rights of Women, as expressed by Karl Marx. We cannot so much judge them by their achievements, though they are many, as we can by the way they are maintaining and improving, even now, after the first flush of enthusiasm has died down, their early plans and endeavours to make women in every respect equal to men. The fact, as most sociologists conceive it, that such changes in the status of women are inevitable, rather adds to than detracts from the credit due to the Soviet regime for the work it has done and is doing in this line. Certainly they could go ahead with other matters and leave the "woman problem" to care for itself; and no one will dispute that they could use the money and energy they dispense in the protection of women and children in many other ways, some of which might make the Bolsheviki more popular with other Governments. Every member of the Communist Party in Russia has a right to be proud of the way in which his Government is attacking the problems which affect the very heart of society, even though, superficially, they may not seem to be more than the flourishes in which only a very prosperous regime could afford to indulge. As a result not only could many other countries take advantage of the scientific research being made in Russia, but they could also learn an even greater lesson from the way in which it is tackling the real problems which are confronting its society.
I understand that in Belgium and Czecho-Slovakia the laws regarding abortion and birth control are somewhat similar to those in the U. S. S. R. Germany, France, England and the United States have few modern laws concerning these problems, but stick to time-honoured traditions, especially regarding abortion. However, in Germany big efforts are being made on the part of the Left Wing Social Democrats to change the abortion laws so that they function as do those of Soviet Russia. Whether one agrees or not with the present Soviet methods of applying abortion and birth control, we must admit that their experiments are attracting the attention and approval of the men and women of the medical profession and of the social workers of the world. Should the rest of the world react against the Soviets in these matters, that very negative reaction will be a force which cannot help being important to the sociologist. If the reaction is positive, and it is probable that it will be, the Russian social experiments will have even more far-reaching effects. Any serious experiment, honestly carried out, always affects general scientific thought, even should it be a failure. This in itself justifies the most detailed research into the social and economic life (successes and failures) of the. U. S. S. R.