Margaret Sanger, "Birth and Death Rates," N.d..

Source: "Margaret Sanger Papers, Sophia Smith Collection Margaret Sanger Microfilm, Smith College Collections S73:0015."

The best approximate guide to the progress of the general health of a community or country is the variation of the death rate. In the annual report of the Registrar-General of births, deaths and marriages of England and Wales, tables are given which show the birth and death rate and the infant mortality rates in no less than twenty-nine countries over the world. The statistics used in these tables include twentieth century statistics, through the year 1911.

If artificial limitation of births were productive of either direct physical or even moral injury to the community, the result would be recorded certainly by a rise of the death rate. It will be noticed, however, that although the announcement has been made with monotonous regularity for years that each successive birth rate was the lowest on record, it has been followed no less monotonously by the statement that the death rate was also the lowest recorded. It should perhaps be stated that facts concerning the birth and death rates are more accurately known than any other social phenomena. The figures which follow are government statistics and it is necessary to make allowances for only trifling inaccuracies.

Let us first take the case of England. In the year 1861 the birth rate was 34 per 1,000, the death rate 21 1/2, which gives an increase in population of about 13 per 1,000. The birth rate in England rose steadily from the year 1853 up to the year 1876 when it was more than 36 per 1,000. In 1876, however, the famous trial of Charles Bradlaugh and Annie Besant took place. This trial attracted enormous attention to the question and means of family limitation and undoubtedly had a very great affect on the birth rate which began at that time a rapid and steady decline. In 1910 the birth rate had fallen to 25 per 1,000 but the death rate in the same period fell to less than 14 per 1,000 so that the population of the country is now increasing almost as fast as it did before the fall of the birth rate set in. Something like 400,000 fewer births now take place every year in England and something like 400,000 fewer deaths.

In the case of the Germany Empire we have no statisticians over as long a period, but before the year 1876 the birth rate was rising very rapidly and since that year it has declined nearly as rapidly as that of England. At its highest the birth rate of Germany was nearly 41 per 1,000 in 1876, but with the birth rate of 41 per 1,000 went a death rate of nearly 26 so that the increase per 1,000 was only 13. In 1910 the birth rate had fallen to about 31 per 1,000 but the death rate had fallen to 17 which gives a slightly higher rate of increase, and while the German birth rate is higher than that of England, its death rate, it will be noted, is higher and its infant mortality rate is very much higher.

France is one of the most interesting countries in this connection because France is continually held up to us as a dying nation owing to the fact that it has the lowest birth rate known and that it occasionally has had fewer births than deaths in a year. In 1881-84 the birth rate of France was 38.9 per 1,000, nearly as high as the highest recorded in Germany. By 1910-06 the birth rate had fallen to 21.1, but observe what happened to the death rate; in the period when the birth rate was the highest the death rate was no less than 37 per 1,000 and it has since fallen to 19.6. In other words, with the highest birth rate, the rate of increase was only 1.9 per 1,000. With the lowest birth rate the rate of increase was 1.5, a difference so slight that it is almost negligible. There is no doubt that the health of the French people has enormously improved during the whole period of the falling birth rate.

Holland is another example of a European country with a falling birth rate. The essential point about Holland is that it is the only country in which artificial restriction has been extended to the poor to any great degree. In Holland, the birth rate rose as usual up to the year 1876 when it was about 37 per 1,000. By the year 1910 it had fallen to about 29. The death rate in Holland in 1876 was about 26 per 1,000 which would give a rate of increase of about 11. In 1910 the death rate had fallen to 34 which gives an increase of about 15 per 1,000, as against 11 in 1876. The infant mortality rate in Holland is lower than that of any other European country and it was stated at a recent Eugenics Congress that the stature of the Dutch people had increased by no less than four inches within the last fifty years.

A general summing up of the twenty-nine countries given in the report of the Registrar-General shows:

1. There are eighteen countries in which the birth rate has fallen. In fifteen of these the death rate has fallen by an amount nearly corresponding to the fall in the birth rate; in two--New Zealand and Australia--the death rate has only fallen slightly, but their death rate is already the lowest in the world.

2. There are four countries in which the birth rate has remained approximately stationary (Russia, Roumania, Jamaica and Ireland). In these four countries the death rates and infant mortality have remained practically stationary (except that there may be a small fall of the death rate in Russia). Russia with the highest birth rate in Europe (nearly 50 per 1,000) has the highest death rate, about 36 per 1,000, and the highest infant mortality, 26 per cent, that is, 260 babies out of every 1,000 die before the age of one year. The infant mortality rate of Holland is only about 70 per 1,000. That of the United States is about 140. In the other three countries the general and infant mortalities are lower, the lower their birth rates.

3. There are four countries only in which the birth rate has risen (Bulgaria, Ceylon, Japan and Ontario (Canada). In every one of the four the death rate and infant mortality have risen, and in close correspondence with the rise of the birth rate. Is it not most remarkable that even in Canada, (a new and promising country) a rise in the birth rate has not increased numbers--except in the grave-yards?

4. When we compare different countries or towns, or different parts of the same country or town, we find as a whole that high birth rates are accompanied by high rates of general and infant mortality, which low birth rates are accompanied by lower mortality rates.

5. The two extreme variations of the birth rate which have been shown among the great towns, are in the case of Berlin, where it has risen from 32 to 45 per 1,000 between 1841 and 1876, and has since fallen to 21 per 1,000. The death rate and infant mortality have risen with the rising birth rate and have fallen with its fall in almost exact correspondence, except for occasional irregularities due to war and epidemics.

Toronto, on the other hand, is the only example of a town in which the counsels of the moralists appear to have been taken seriously to heart, and which has returned to a high birth rate after joining in the general fall. The death rate fell step by step as the birth rate declined--and to practically the same extent, but rose again immediately the birth rate began to go up, and in 1909 was higher than in 1880-85.

What do we learn from these incontrovertible facts? Not only that medical science has succeeded in bringing down the death rate when family restriction has been practised, but that it has utterly failed to do so when the birth rate has been maintained. Worse still, in every case where the command to increase and multiply has been obeyed by more rapid reproduction, the whole power of medical science has failed to prevent the death rate from rising. And in Toronto, where for some reason the people have stopped in their downward path and have restored their birth rate to its former high value, they have been rewarded not by greater health, but by a steady increase of the death rate. In face of this it is difficult to find words adequate to deal with the attempt of the medical profession to stem the tide of the declining birth rate. If the aim of the medical profession is to allay suffering and to prolong life, the facts show that the whole profession is practically incompetent to effect this for the community as a whole, unless helped by family restriction.

There are these who will attempt to escape from this conclusion by appealing to “corrected” statistics, so it may be well to repeat that although the question is rendered more complicated by such modifications, the general conclusion is unaffected, or indeed strengthened, that family limitation is a decided advantage for the health of the community. France, for example, which is always held up as such a dreadful object lesson, comes out much better when its corrected death rate is given.

Havelock Ellis adds that every country without exception which has a progressive or educated population and a fairly high state of social well-being present a birth rate below 30 per 1,000, and that every country in Europe in which the mass of the people are primitive, ignorant or in a socially unsatisfactory condition, shows a birth rate above 30 per 1,000. France, Great Britain, Germany, Belgium, Holland, the Scandinavian countries and Switzerland are in the first group. Further, that the eight countries with the highest birth rate have the highest death rate and that the eight countries with the lowest birth rate have the lowest death rate.

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