the development of family planning in canada

The Development of Family Planning in CanadaAuthor(s): IAN BAINSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 55, No.8 (AUGUST 1964), pp. 334-340Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41983579 .

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The Development of Family Planning in Canada1

IAN BAIN,2 B.A., M.S.W.

DURING represented the

in past

the year, International

Canada Planned became the

Parenthood thirty-second

Federation country

- the to

last be

represented in the International Planned Parenthood Federation - the last major world power (apart from China and the Soviet Union) to join the I.P.P.F. This event was significant for two reasons. First, the long delay in Canada's being accepted into the international family planning group reflected the confusion which surrounds the whole subject of planned parenthood in Canada and, second, the admission of a Canadian family planning federation signified the first faint stirrings of a family planning movement in Canada which holds promise of national interest and support.

Attempting to sketch the history of family planning in Canada is both satisfying and frustrating. It is satisfying in revealing a number of different avenues by which the pioneers in this country tried to reach their objectives - and the vision and courage of these pioneers is worthy of note, whether or not one accepts the validity of their cause. It is frustrating because there is no written history of family planning services in Canada and virtually no records upon which to draw for information. There is, in fact, very little history to tell, for the development thus far has consisted of fragmented activities in scattered parts of the country, largely isolated from one another and totally unco-ordinated. There has not been in Canada up to the present time, as there has been elsewhere, an impetus toward a national movement in the field of family planning services.

In dealing with this patchwork kind of picture, however, it is possible to detect a variety of motives which have prompted the formation of birth control groups or organizations. One motivating force has been an interest in and a concern about eugenics . For many years, the proponents of family planning included those who viewed contraception and sterilization as means of preventing the birth of physically and mentally handicapped children. This point of view has been expounded by scientists who are convinced that at least some of the knowledge gained by science and used in the development of better stock in the animal and plant worlds should be drawn upon in the reproduction of mankind.

A second motivation was concern for the health of the mother , and this concern arose naturally among doctors, nurses and social workers in daily contact with women who had borne large numbers of children in rapid succes- sion and whose health had suffered as a result. Evidence of the need for family planning was magnified in the cases of poor families where other factors were

Presented at the Seventh Annual Refresher Course, Division of Postgraduate Medical Education, held at the School of Hygiene, University of Toronto, Toronto 5, Ontario, February 10-14, 1964.

2The Planned Parenthood Association, 26 Neville Park, Toronto. 334



August 1964 FAMILY PLANNING 335

brought to bear upon the health of the mother - poor nutrition, overwork, squalid living conditions, and the absence of proper medical care.

A third motivation was concern for the welfare of the child, and this is perhaps of more recent importance. Children have not always been thought of as individuals, with personal worth and personal rights. Measured in terms of history, these are recent concepts. As we have better understood the development of the child (in the psycho-social as well as in the physical sense), and as we have appreciated the fact that the child resembles a sponge in his capacity to absorb endless quantities of mother-love, we have begun to reason that unless the child receives his full share of the love he so obviously needs, his development is likely in some way to be incomplete. A logical concomitant of this is that there should be a space between children in a family to permit each child to absorb the life-giving elements he needs and to sink firm roots into the family complex before a sibling arrives to demand his or her share of the available love. All of us have seen the distortions to children, youth and adults - distortions of delinquency, promiscuity, neurosis or mental illness - which can at least in part be traced to what Dr. John Bowlby has called "maternal deprivation" in infancy. And we have recently had forced upon our attention and our conscience the growing incidence of child-beating and child-killing by parents, which are further manifestations of the hazards to children resulting from unplanned and unwanted pregnancy.

A fourth motivation has been concern for the stability of the family unit , and this is perhaps of even more recent origin. It stems from observation of the effects of economic, social, emotional and physical stress upon the partners in the marital relationship and upon the family as a unit. These stresses may be imposed by low income, unemployment, poor housing, illness, immaturity or instability of the marital partners, or a multitude of other factors. The effect of these stresses, many caused by or aggravated by the arrival of too many unplanned and unwanted children, is well known to everyone in the public health or welfare fields.

A fifth motivation, and one which runs throughout the history of family planning, is concern for women's rights. A number of the pioneering souls in the birth control movement have been at least as concerned (and perhaps more concerned) about the right of women to determine if and when they will become pregnant, as they have been to protect the health and well-being of mothers and children. These advocates of birth control have been most vocal in condemning the view that the entire family planning needs of every couple can be met by either abstinence or employment of the "rhythm method". Neither of these methods, it is pointed out, is satisfactory to women themselves since neither is under their control and neither method offers any protection whatever to wives whose husbands choose not to abstain, or choose not to observe the restrictions inherent in the rhythm method.

Finally, the grim facts of the world population explosion have given an added impetus to the planned parenthood movement. An increasing number of leaders in the fields of medicine, science, religion, economics, political science, and other disciplines have added their distinguished voices to the demand that action be taken to relieve the pressure of population growth, particularly in the impov-



336 CANADIAN JOURNAL OF PUBLIC HEALTH Vol. 55

erished countries, by providing birth control aid to nations wanting this kind of help. For those in the public health field whose aim it is to maintain health and eradicate illness, premature death, and disability, the impact of the world population explosion must have special meaning. Public health workers have provided sickness control and death control in many impoverished countries only to find that human misery was compounded because more people lived longer and continued to reproduce, and added more mouths to those already inadequately fed from a limited food supply.

The Family Planning Movement in Canada There is perhaps no more logical place to start a consideration of family

planning in Canada than with the work of Mr. A. R. Kaufman, of Kitchener. More than any other Canadian, this dynamic businessman has been the prime mover of family planning services in Canada, and not the smallest part of his contribution has been in underwriting a large part of the cost of all family planning services apart from those provided by the medical profession to their patients.

A. R. Kaufman has been involved in family planning as a costly sideline to his other interests since 1929, and in the intervening years his service has grown to meet an increasing need. In the beginning he undertook to serve only employees and former employees in financial distress as a result of the depres- sion. The services provided by Mr. Kaufman were later extended to other families in the Kitchener area. As word spread that family planning help was available, the service was requested across Ontario and eventually throughout Canada. To meet the increasing demand Mr. Kaufman set up the Parents' Information Bureau at 410 King Street West, Kitchener.

The Bureau reports that since its inception in 1930, more than 200,000 mothers have been registered, and about 2,000 sterilizations have been arranged. Close to 3,000 unsolicited new applications for contraceptive materials are received each year, and mail orders exceeding 25,000 a year are sent out to mothers registered with the Bureau.

From the outset, the Bureau employed part-time agents in many cities across Canada to visit the homes of persons writing to the Bureau for help. As many as 50 of these agents were employed at one time. This method of reaching personally the families wanting birth control proved to be highly satisfactory but in 1933 Mr. Kaufman tried another approach by setting up a birth control clinic in Toronto. The supervisor of nursing at the Wellesley Hospital was persuaded to take over management of the clinic, and the services of three doctors, on a part-time basis, and a social worker were also obtained.

The Toronto birth control clinic operated for the five years 1933-1938, and during that time served about 10,000 women. A break-down of applicants according to economic circumstances showed that 55% were on relief, 25% had incomes of from $60-75 a month, 10-15% had incomes of up to $100 a month, and 5% had incomes about $100 a month. With the necessary adjustments in figures, it seems likely that we might find a roughly comparable break-down of patients at a birth control clinic in 1964.

One newspaper referring to the Toronto birth control clinic stated that the




medical profession in Canada . . . "must take the lead in bringing proper and safe birth control information to women in need of such advice . . . Birth control clinics should not be considered as entities apart from other organized medical services but should be included in all maternal welfare programs under the direction of the medical profession. The organization and operation of these clinics should not be the responsibility of lay workers, and every effort must be expended to remove this question from the field of personal controversy."

By 1938, Mr. Kaufman was convinced that the cost (estimated at $25,000 a

year) of the Toronto clinic was not justified in view of the lower cost and

approximately equivalent case-finding ability of the visiting workers. Before he closed the Toronto clinic, Mr. Kaufman, his staff and various women's groups which had supported the idea of a birth control clinic, tried to persuade the

municipality to take over administration and financing of the clinic. This idea was strongly opposed by the Medical Officer of Health and, although it gained some support in Board of Control, it was turned down and the clinic disappeared from the Toronto scene.

An event occurred in 1936 which brought the whole birth control question before the Canadian people as never before and made the names of Kaufman and Eastview known to everyone who had access to a newspaper. The event was the arrest of Dorothea Palmer, an agent of the Parents' Information Bureau in Eastview, a suburb of Ottawa. Miss Palmer was tried on one of three charges originally brought against her. This charge was that she advertised to persons in Eastview by means of a pamphlet instructions intended as a means of preventing conception. The section of the Criminal Code under which this charge was laid contained a clause which stated in effect that if the accused person could prove he served the public good by the acts which were charged against him, he should not be convicted. It was on this clause that the defence, underwritten by Mr. Kaufman, was based.

The trial lasted 19 court days over a period of six months and on March 17, 1937, Miss Palmer was acquitted. The Attorney General on April 12, 1937, appealed the acquittal of Miss Palmer to the Court of Appeal of Ontario, and when the appeal was heard in June, 1937, the Court dismissed the appeal without even asking defence counsel to reply. The acquittal of Miss Palmer thus stood.

Hamilton Canada's only birth control clinic operates in a suite of offices at 80/2 James

Street North in Hamilton, under the auspices of the Planned Parenthood Society of Hamilton. Major support of the Hamilton clinic originally rested with a group of socially prominent women of that city. One of the original founding members, Dr. Elizabeth Bagshaw, has been medical director of the clinic since its inception 32 years ago. The clinic is endorsed by the Hamilton Council of Churches and by the Hamilton Council of Women.

Patients are interviewed privately by the senior nurse and examined by the medical director. Contraceptive materials are prescribed and the patient is able to buy these at reasonable cost at the clinic. Those unable to pay are given their supplies but are encouraged to try to make some reimbursement, even if over a period of time. If medical examination reveals any condition which requires



338 CANADIAN JOURNAL OF PUBLIC HEALTH Vol 55

medical treatment, the patient is informed and advised to see her own physician as no medical treatment is given at the clinic.

It is a policy of the Hamilton clinic to require a medical referral but this does not mean that a private physician must always refer. Women who are in receipt of welfare assistance may be referred by doctors serving official or private welfare agencies. Where a woman does not have a family physician or has a physician who will not prescribe contraception, the medical director of the clinic uses her discretion in accepting these women.

The clinic estimates it has more than 5,000 patients on its case records of the past 30 years.

Winnipeg The Family Planning Association of Winnipeg has a different approach to the

provision of family planning services. Established on January 28, 1934, the Winnipeg association does not maintain a clinic but offers a home visiting service. About 150 new patients are seen each year by the volunteer visitor who makes two home visits to each new patient to ensure that the instructions for use of the prescribed method are fully understood.

The Winnipeg association believes that there are real advantages in going into the homes of persons needing family planning advice since in no other way can a true understanding be obtained of the living conditions and the problems facing the family. Commenting on some of the conditions found by the visitor, a recent report of the Winnipeg association stated: "This family planning advice should be included within the medical services available to the needy, thus helping very effectively to check the spread of slums and the disgraceful housing conditions which are one of society's very grave and most pressing population problems today."

Brantford During the 1930's the late Dr. William L. Hutton, medical officer of health for

Brant County, actively supported the cause of planned parenthood. Dr. Hutton was a prolific writer and broadcaster on the subject of family planning and sterilization and, although no official records are available to show the extent to which he incorporated family planning services with other public health work in Brant County, the copies of his articles and scripts provide clear evidence of Dr. Hutton's conviction that contraception was a legitimate service of the public health authority.

Vancouver In 1961 a group of people met in Vancouver to discuss their mutual anxiety

about the world population explosion and ways in which Canadians might take part in a program to extend birth control to the underdeveloped countries. This group subsequently formed the Society for Population Planning which during the past year was granted incorporation in British Columbia, the first planned parenthood group in Canada to achieve this mark of respectability.

In recent months the Vancouver group has been exploring the possibility of setting up a family planning service in Vancouver. Another resource on the




West Coast is the Vancouver General Hospital which through its Outpatients Department has been willing to give information on contraception to its outpatients, and is now willing to extend this service to any family of limited means.

Ottawa About two years ago the Ottawa Society on Population Problems was formed

in Ottawa for the purpose of studying the world population crisis and of bringing about the changes needed in Canada's legislation to permit free dissemination of information about birth control and the establishment of birth control services.

Quebec It has been reported in the press that centers called Serena clinics are operating

in Montreal, Lafleche, Joliette, Sherbrooke, Forestville, Ottawa, St. Jerome, Granby, and Drummondville and a birth control clinic, believed to be the only one in Montreal, has been established at Notre Dame Hospital. The founding of the Serena movement has been attributed to a Montreal couple who are said to have given instruction in the rhythm method to about 4,000 persons in Montreal. The word Serena comes from the first two letters of Service de la Regulation des Naissances.

Information is spread through the use of trained "monitor couples" who have learned to interpret the temperature graphs and are willing to help another couple learn the method. Two of the medical advisers for the Serena clinics are Dr. Roland Simard, professor of gynaecology at the University of Montreal and chief gynaecologist at Notre Dame Hospital, and Dr. Michel Bedard, obstetrician- gynaecologist at Notre Dame Hospital. These doctors are quoted as saying that they have been teaching the rhythm method of birth control to about 100 fourth year medical students at the University of Montreal for the past five years.

Toronto The Planned Parenthood Association in Toronto had its inception in a public

meeting held in Toronto late in 1961. This meeting brought together a group of about 100 residents of Toronto with a common concern about population problems. Many of those who attended this first meeting had a latent interest in the subject of family planning. They were motivated toward attending a meeting on the subject largely because of the leadership provided by Mr. and Mrs. George Cadbury, of Toronto, both of whom had held high offices in the International Planned Parenthood Federation and had through personal observation and experience witnessed both the need for family planning in many different countries and the ways in which various countries had attempted to cope with their fertility problems.

The objectives of the Toronto organization were stated as follows: 1. To promote the understanding and adoption of family planning and to

encourage good citizenship through responsible family life, 2. To promote research and education on population problems, 3. To inform the public on the problems arising from uncontrolled popula-

tion growth, 4. To insure that information and technical assistance on matters of birth

control are available to those who want this help,



340 CANADIAN JOURNAL OF PUBLIC HEALTH Vol. 55

5. To assist and co-operate with other jurisdictions in their population control problems,

6. To help infertile married couples obtain the medical treatment which may overcome their infertility and help them have the children they want.

The formation of the Planned Parenthood Association coincided with the announcement of the hearings of the Royal Commission on Health Services in Toronto in the Spring of 1962, and one of the first projects of the Association following its formation was the preparation of a Brief to the Royal Commission.

The Planned Parenthood Association recommended to the Royal Commission that the enquiries and studies conducted by the Royal Commission give consideration to the place of contraceptive services among the other personal health needs of the Canadian people, that consideration also be given to the need for dissemination of information about contraception in hospitals, clinics and through public health units and departments, and that, as a necessary first step, the Royal Commission recommend to the Government that Section 150 of the Criminal Code be amended and any reference to contraception eliminated.

From the earliest days of the Toronto association, enquiries came into the honorary secretary. Information spread by word-of-mouth as one woman told another that there was someone in Toronto who was not afraid to talk about how not to have more babies. A number of calls were in regard to infertility and others pleaded for help in finding an abortionist - calls from desperate women for whom birth control help had been either too little or too late.

It has been a policy of the Association to refer enquiries only to professional sources of help and callers are asked first if they have discussed their questions with their family doctor. Only when women do not have a family physician or for cogent reasons are unable or unwilling to obtain contraceptive guidance from the family doctor is the case accepted for referral to one of the Association's panel of doctors or to a hospital clinic. The Association has explored the willing- ness of hospitals in the Toronto area to accept as clinic patients women who

require contraceptive guidance and do not have or cannot afford private medical care. Four hospitals in Toronto, including two teaching hospitals, have agreed to co-operate with the Association and a fifth is pending.

Another major project of the Association has been in the field of public education. A newsletter goes out four times a year. Circulation of the Newsletter reaches across Canada and steps have been taken recently to create a national co-ordinating body to bring the scattered family planning groups into a more closely-knit organization. As a result, there has been created the Canadian Federation of Societies for Population Planning with representatives across Canada.

Although early efforts to provide family planning services in Canada date back 30 years, it is only within the past two years that a concentrated effort has been made to remove the legal barriers and to establish a national organization for family planning. Supporters of this movement believe that family planning has much to contribute to the health and well-being of Canadian mothers and children if these services can be developed with the full support of public health workers and in a manner which will respect cultural and spiritual differences in our population.



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