§ Order for Second Reading read.
§ 11.7 a.m.
§ Mr. Edwin Brooks (Bebington)
I beg to move, That the Bill be now read a Second time.
It was on 28th April, 1926, during the week that preceded the outbreak of the General Strike, that Lord Buckmaster moved a Resolution in another place which sought to remove all obstac[...] to the introduction of birth control in n [...]nity and child welfare centres. The noble Lords on that occasion passed the Resolution by 57 votes to 44, becoming the first legislative body in the world to define responsible parenthood as a legitimate and essential concern of the public service.
Forty years can put many things afar and asunder, and the year of the General Strike is a fading memory. Yet during that time—1¼ billion seconds—the earth's population has increased by one a second. In a striking phrase, Sir Theodore Fox described this multiplication of man as Noah's new flood, and it is an accelerating flood tide.
Every second today human beings are coming in two by two on to a planet whose natural resources are finite and diminishing fast. Our annual road fatalities appal us; yet humanity increases 936 by an equivalent number every hour. The annihilation of Hiroshima was dreadful beyond words; yet humanity increases by an equivalent number every day. At Auschwitz 4 million people died; yet humanity increases by an equivalent number every three weeks.
My generation has come to hear, in the words of Professor Powell, "the tolling of the great bell of history" in the detonations of the thermonuclear tests. Yet our greatest menace is not the mushrooming cloud released by man's fertile genius, but the mushrooming cloud of humanity released by man's genius for fertility.
I have felt it appropriate to preface my Bill with such thoughts because the great issues of life and death are indivisible by national frontiers. The control of death, the control of the ancient killers by the devices of medical science, has known no such frontiers in recent decades. Equally, the problems of birth control involve deep and universal moral dilemmas. These dilemmas are as old as human history, yet their form and validity are today facing unprecedented pressure and challenge from scientific and medical revolution.
Until recently, for example, man has always had to live with the constant presence of pestilence and famine. We need look back no further than the large Victorian family to remind ourselves of how social values came to correspond to social necessities. The children of whom Charles Dickens wrote were shadowed with the sadness which comes from knowing that they would probably die in childhood.
I remember last summer walking through the old and now overgrown cemetery which lies below Liverpool's rising new Anglican Cathedral. The headstones told of tragedy and grief, of whole families wiped out in epidemics which brought catastrophe less than 100 years ago to those narrow streets.
Nature is always profligate when the future of a species is at stake, and it is understandable that human society should have come to regard fecundity as a blessing in former times. But times change, and the moral and religious teaching which once corresponded to our deepest and finest human instincts must reinterpret the need of human destiny in a world which medical science has largely 937 made safe for our three score years and ten.
The case for birth control is overwhelming when we look to the developing countries. India's people add to their number one million a month. China's population increases by 40,000 a day. When I work out these sums in terms of hospitals, schools, houses, public services and, not least, food, I grow impatient with those who hinder the spread of contraceptive knowledge. But if Britain is to play her full role internationally in advancing the knowledge necessary for planned and dignified parenthood, she must beware of adopting a double standard and of encouraging people of other lands and colours to adopt family planning techniques while remaining deeply ambivalent in her official attitude to those same techniques at home.
Indeed, it is particularly the responsibility of a mature democracy such as ours to show that there is an alternative to the despotic intervention in parental liberties by which frightened Governments might otherwise seek to contain the population explosion.
The alternative is to give free men and free women knowledge—the knowledge which is today indispensable for the exercise of responsible and wise parenthood. This is the essential objective of my Bill.
The history of family planning in Britain is hard to summarise briefly without doing an injustice to the many men and women who have devoted their lives to a cause which does honour to the quality of our civilisation. I will limply say that I regard it as an undeserved privilege to follow pioneers whose vision was matched by their courage and persistence over the long weary years. Because the years have indeed been long and weary. Despite the resolution of the Lords back in 1926, and despite many other false dawns, Governments have a sorry record in this story.
Not until February, 1966, when my right hon. Friend the Minister of Health issued a circular, which can rightly be called historic, was an official silence of 30 years broken. Then the Minister was forced, I have no doubt reluctantly, to accept that further legislation would be necessary to meet, as he put it on that occasion, 938the wider need of advice and prescription for those who wisely desire to achieve the aim of planned parenthood even though no specific danger to health is involved.He went on to say in the same circular:The Minister is advised that the existing family planning powers of local authorities relate to the provision of services for those likely to suffer detriment to their health as a result of pregnancy and to contribution to any voluntary body formed for the purpose of the prevention of illness. …My right hon. Friend referred again to this point in reply to an Adjournment debate on 24th May, 1966, initiated by my hon. Friend the Member for Pontypool (Mr. Abse). He said on that occasion:It was a disappointment for me to discover the statutory limitations on local authorities' powers which confine their activities to those who require family planning services on medical grounds.Meanwhile, I found myself singularly fortunate, as a very new Member of the House, in drawing a relatively high place in the ballot for Private Members' Bills, and my experience in local government on Merseyside was already a powerful stimulant to introducing a Bill such as this Bill. Before continuing this chronology of events, perhaps I may linger on this point because it was my personal experience in local government far more than theoretical analysis which really suggested the Bill.
We are seeing emerging a new and sinister phenomenon in our urbanised society. I would describe it as the obverse of the rise of the meritocracy. We see it in the problem family and in the appearance of what we are prone, and sometimes too glibly, to call the unemployable. It is a phenomenon rooted in bad housing. In turn, it nourishes delinquency, crime and the violence of mindless frustration. Sometimes we watch it on television and call it "Cathy." What seems to be happening is that the submerged one-tenth, or whatever proportion it may be, is losing its power to comprehend and communicate meaningfully with society as a whole.
As social mobility is complemented by geographical mobility, the natural leaders move out and a sort of Gresham's law begins to operate, and we have emerging what I am tempted to call "ghettoes of the under-privileged." The problems are deep-seated and inter-related, but no one today surely can doubt that the 939 characteristically very large families are both a symptom and a cause of social privation. It is among these families that the hoary distinction between medical and social need is so futile. The E.S.N. family is, in a very real sense, ill. Just as the chronic bronchitic needs trained help to live life more fully, so too does the person whose personal capabilities and domestic and social environment hinder the realisation of his or her potential. There are many women on the treadmill of motherhood whom society surely must rescue, not only for their own sakes, but for the well-being of the children already born to them.
A few months ago I was told of a case—I will not identify the place for obvious reasons—in which the mother was expecting her thirteenth child. The first eleven were all in the care of the local authority. The children's committee was expecting the twelfth to be handed over the moment the thirteenth arrived. When the father was asked whether he took contraceptive precautions, he was insulted. "It's me rights", he said. Such cases are the extreme cases, but they are sufficient to cause sadness and alarm—alarm because in this case alone which I have mentioned there will be, a generation from now, at least 13 families with a parent who has never experienced the joys and security of parental life; sadness because such indiscriminate breeding is the result of ignorance, suspicion and fear rather than a positive desire to bring a new life into the warmth of the family circle. These are the families for whom I see my Bill having the most value.
Contraception in our modern society is only a mystery to those who, for whatever reason, choose not to avail themselves of the information and of the appliances which are freely on sale and available to the general public. Magazines display advertisements for family planning under plain wrappers, although the advice despatched is sometimes embroidered with the tendentious claims of the method in which the manufacturer has a financial interest. This, incidentally, is one good reason for ensuring that people should have access to objective and disinterested advice on the efficacy and implications and possible side effects of the numerous and various methods of contraception 940 now available and to which other methods will doubtless be added in time.
Nevertheless, there is clear and accurate information on the market, and the real problem lies in disseminating it among those least able to gain access to it unaided. The decisive test of my Bill's value must be its ability to grapple with this problem. For the past 40 years the problem has been plagued by the distinction between medical and social criteria to which my right hon. Friend drew attention in his circular last February. In Memorandum 153/MCW of July, 1930, the Ministry of Health specified that maternity and child welfare centres could give contraceptive advice onlywhere further pregnancy would be detrimental to health.My Bill would remove that restriction.
Clause 1(1) of the Bill empowers local authorities, with the approval of the Minister of Health, to provide either themselves or through a voluntary body medical examination and advice on contraception and to supply pills and appliances to men and women. The former distinction between medical and social need lapses, and the advice and supplies would be available to any person who needed them on social grounds and not only, as at present, where the woman is deemed to be at medical risk in the event of a further pregnancy.
Once this legal straitjacket is discarded, I have no doubt that many local authorities will be delighted with their new freedom to experiment and to extend their work. This is confirmed in a letter which I have just received from the Association of Municipal Corporations, following their deliberations upon my Bill and its implications. It says:The conclusion reached by the Association's Health Committee is that the Bill will be welcomed by those local authorities anxious to extend the provision of family planning services through their own clinics. The Committee therefore support your Bill, and has expressed the hope that the Association's Vice-Presidents may feel able to assist in securing its passage through Parliament.I am sure that the vast majority of local health authorities, including those who would wish to work through voluntary bodies, will gladly ensure that their arrangements meet the Minister's approval, particularly as local opinion, 941 henceforth freed, I trust, from inhibitions, will not be slow to spur the laggard authority. Nevertheless, in a field of such rapid change in medical science as that of human reproduction, where the pioneers of yesterday, if too complacent, could become the antediluvians of tomorrow, it is clearly right to give the Minister reserve powers, and it will be seen that these have been written into the subsection.
It would, of course, be for the Minister and successive Ministers to interpret this Clause. Personally I would hope that centralised direction proves completely unnecessary, but if it is the will of Parliament that family planning shall henceforth be an integral and respected part of the National Health Service, it is vital that the standards of service provided throughout the nation have no local blemishes due to somnolence and apathy.
It will be seen that my bill does not define the specific arrangements which are to be made. In the early stages of drafting the Bill, I was tempted to produce a very long one which would make reference, say, to the detailed rôle of clinics, the problem of sub-fertility, domiciliary family planning services, and not least, liaison with maternity and gynaecological units in the hospitals. I have come to the conclusion, and I am sure it is the right one, that arrangements are best left to those best qualified in this work and upon whom will fall the responsibility of implementing the Bill.
I hope that it is clear from my earlier remarks about the problem family that I regard the development of a domiciliary family planning service linked to the family services generally provided by local authorities as the single most valuable potential consequence of the Bill.
The Family Planning Association has begun to gain valuable experience in this approach, annd I have been greatly impressed by the result of a pioneering domiciliary birth control service which was embarked upon as long ago as 1961 in Southampton, which was described in The Medical Officer of 16th April, 1965, in very encouraging terms.
This may well be a particularly favourable moment to examine the relationship of family planning to those 942 other local authority personal social services currently under review by an inter-departmental committee which has been asked to seek "an effective family service". There is certainly more than enough duplication and fragmentation of the work in this field already, without having any more.
I am confident that health authorities throughout the country will find my Bill a stimulus to the co-ordination of the work carried out by children's officers, health visitors, welfare officers, directors of education, probation officers, mental health workers and others. The size of family is often so critical to the success of the work undertaken by these various specialists that birth control advice could immensely lighten the burden on these hard-pressed services, and, incidentally, economise in many ways in the time of such hard-pressed qualified people. I trust that the Minister, in the event of my Bill being passed, will issue another circular to local authorities which will spell out such implications and possibilities in some detail. I should also like to think that progress reports would be sought regularly from time to time to enable the Minister to assess the situation and to discover which particular arrangements appear to be proving most helpful.
I would feel it inappropriate therefore, given the unrestricted powers of the Bill, to try to define one rigid pattern of growth. Some authorities will undoutedly prove more adventurous than others, but this is no new phenomenon. Indeed, to the extent that they serve as pacesetters and trail-blazers, such a pattern of contrast is all to the good. That is why I have been content to draft in this core of the Bill a simple wording which provides maximum flexibility.
I am equally eager to ensure that this permissive legal framework should help create and buttress a climate of opinion towards family planning which will ensure a constant levelling-up process.
Before I leave this point, I should say that I have received advice that the Bill should make specific reference to the hospitals. Professor Brian Abel-Smith, for example, states:Increasingly, confinement is taking place in the hospital and it seems to me that the 943 hospital out-patients' services also have an important part to play in providing family planning services.In a later letter he agreed thatthe essential problem is the domiciliary service,but he reiterated the case for including the hospitals. He foresaw that, as hospital confinement became more general, ante-natal and post-natal services might become based upon the hospital rather than the local authority. He went on:It would seem undesirable for there to be no family planning service in an area in which the hospital was doing virtually all the obstetric work.Professor J. C. McClure Browne, of the Institute of Obstetrics and Gynaecology at Hammersmith Hospital, also argues that my Bill should include mention of the hospital services. He states:For far too long, because of the failure of the hospitals to take a leading part in this important measure, contraception has become the province of medical people who have often lacked the specialist knowledge of the gynaecologist.He goes on:I am sure that the speciality of obstetrics and gynaecology should include not only the generally accepted activities, but that family planning should be part and parcel of this field.I certainly do not dissent from the view that the hospitals have an important, and probably increasingly important, potential role to play in family planning. Surely the hospitals are no less part of the National Health Service than are the public health authorities.
I would trust that under my Bill the arrangements to be provided by health authorities would ensure maximum liaison with the ante-natal and post-natal services of the hospitals. My view during the drafting of the Bill was that my essential priority was to eliminate a restriction in the existing law which had curtailed health authorities for decades, and that once family planning was accepted as an integral part of the family services provided by local authorities, there would be an inevitable chain-reaction effect throughout the whole field of health and welfare provision, including the hospital service.
I would emphasise that there is no restriction at the present time upon hospitals giving contraceptive advice on health grounds. I hope that henceforth 944 hospitals will be encouraged, and encouraged directly by the Minister if necessary, to interpret "health" in the widest possible terms of mental as well as physical well-being.
I now turn to the two most controversial aspects of the Bill. Before doing so, I want to qualify the word "controversial". In the course of the last two months, during which my Bill has received publicity in the Press and elsewhere, I have received only four letters—including an anonymous and interesting postcard, which clearly confused my Bill with that introduced by my hon. Friend the Member for Pontypool—which could be regarded as critical and hostile. This would seem to suggest that there is little spontaneous opposition to the essential objective of the Bill, and I am greatly heartened. Nevertheless, from discussions at numerous meetings, including many on Merseyside, I am aware that there is some anxiety felt by citizens whose opinion I value, and I should like to deal briefly with the two issues on which most of the anxiety focuses.
The first of these concerns payment and fees. It will be seen from Clause 1(2) that a local health authority will be empowered, subject to the approval of the Minister, to recover such charges for the provision of advice or the supply of substances or appliances as the authority considers reasonable, having regard to the means of the recipient.
The power to recover charges is wide enough to enable an authority, again with the approval of the Minister, to use its discretion in deciding what charge, if any, should be made, and, of course, to exempt necessitous cases. It might, for example, be decided to make no charge for advice or supplies in medical cases and in non-medical cases to charge for supplies or prescriptions but not for advice.
My personal view is that advice should be at all times free, since the whole object of the exercise is to encourage people to have access to the most up-to-date, accurate and considerate information about the differing contraceptive techniques. I strongly believe that to introduce a financial barrier would be entirely wrong in principle, but where supplies are provided I do not consider it unreasonable to ask for payment, unless the person concerned is under financial 945 stress. Such stress might well be the pattern. It will almost certainly be the pattern among those families whom I foresee a domiciliary service helping most, and it is hardly necessary to say that the object of the Bill would be ruined if the families who needed help most found themselves facing a monetary barrier.
But this is not at issue. The main argument I have heard is that fees are wrong in principle and that contraceptives should simply be given away free.
The analogy is drawn with free medicines on prescription. The difficulty about this parallel is that the quantity of medicine prescribed is strictly related to the disease affecting the patient, which in most cases is only temporary. It is hard to see a similar criterion applying in the case of contraceptives which have a demand curve varying considerably from individual to individual, and rather than have to ask the sort of questions which would make even hardened Ministers blanch, I feel that the simplest way to regulate demand would be by payment. But there is a deeper issue here, and it was well put by Mrs. Helen Brook, who in her work through the Brook Advisory Centres has been one of the notable pioneers. Mrs. Brook described to me the way in whichthe young people who come to Brook pay a fee of £3 a year, which covers any number of visits they may wish to make in 12 months, and they also pay for any contraceptive supplies they may need".She goes on to say:I feel most strongly that in the drafting of the Bill provision should be made for patients to continue to make these payments—in much the same way as the Family Planning Association operates today. The fact that the young people who consult us have to pay a fee and purchase their supplies does, I think, underline the fact that they are persons with some sense of responsibility.While she was specifically referring to the young people for whom the Brook Centres were devised, I feel that her argument has a wider relevance.
I turn now to the second major anxiety, the problem of the unmarried. Strictly, I have found that this should be termed the problem of the unmarried adolescent. It is a problem more specifically felt by the parents of teenage girls who fear that sexual promiscuity will be encouraged unless youngsters are excluded from the terms of the Bill.
946 I hope that I may speak as a parent as well as a Member of Parliament. It is not easy to speak as either on the intractable difficulties of sexual morality in the modern world, but I am bound to say that I cannot regard ignorance as the bastion of virtue. The parent who fails to satisfy his children's natural curiosity, or who regards sex as a three-letter unmentionable, must not be surprised when those children seek to satisfy their curiosity furtively and with consequences which can be tragic.
Our society seems profligate with erotic titillation, yet curiously grudging with sexual instruction. The consequences can be read in the statistics. In 1965, nearly 1,200 illegitimate babies were born in Liverpool alone. This amounted to 8.2 per cent. of all live births, the highest figure for 19 years. The number of illegitimate births per 1,000 unmarried women between 15 and 44 increased from 10.2 in 1950 to 19.9 in 1964, the proportion nearly doubling in 14 years. There is naught for our comfort in such statistics.
In many ways, the position is deteriorating, and I need hardly spell out the consequences. Marriages are founded not on mutual love but on a momentary and, perhaps, bitterly regretted impulse. Children, the innocent victims, are resented and even rejected. Illegal back-street abortions occur in squalor and misery. These are the tragedies of infatuation gone sour, and we see the legacy in divorce and the desolation of the children affected.
I should find it strangely incomprehensible if a society which permitted contraceptives to be readily available in shops, with no questions asked, and in slot machines in public conveniences sought to exclude unmarried people on principle from all access to that advice and help which could be so much more than simple instruction in the techniques of contraception. Perhaps we need rather more pre-marriage counselling, not less.
My Bill, as the saying goes, leaves the options open. It refers simply to "persons". If it were to exclude the unmarried as a matter of principle, it would be a thoroughly retrograde step and would not deserve passage by the House. 947 Already, the Family Planning Association gives help to those couples who are approaching marriage. Nearly 24,000 such pre-maritals were helped in 1965, and I am sure that this is wholly beneficial. If the Bill were to limit help to those about to be married in, say, three months, it would not be difficult to practise fraud; and one could hardly ask for the refund of advice if a bridegroom had cold feet on the day.
As I have said, it will be for the local authority in the first instance, and then for the Minister if he wishes, to interpret the permissive powers under the Bill, but I ask the House to agree that the Bill as it stands, far from being an incitement to promiscuity, is an incentive to loving and responsible parenthood.
Finally, on the question of the unmarried, since payment for supplies will be required, unless there is financial hardship, nothing is being provided that is not already available in the shops or on mail order, nothing, that is, other than the relationship which is inherent in an advisory health service and which I see as an instrument of sex education parallel with that provided in our schools.
I have dealt at some length with this aspect of the Bill, and I come now to the remaining Clauses. The effect of Clause 2(1) is that the services to be provided under the Bill will be treated as local health services, the promotion of which the Minister has a duty to secure under Section 1 of the 1946 Act, and will be subject to a number of other provisions of that Act, including his default powers. Clause 2(1) also makes it necessary for the local health authority, should the power under Clause 1 be converted into a duty, to submit proposals to the Minister for carrying out its duties as required by Section 20(1) of the 1946 Act.
The effect of Clause 2(2), which brings Clause 1 within the scope of Section 46(1, a) of the Local Government Act, 1958, is that a scheme of delegation to a county district council of health and welfare functions of a county council made under Part III of the 1958 Act will operate as though there were a reference to contraceptive services in the delegation scheme.
Clause 3 deals with financial matters, and a Financial Resolution will be neces- 948 sary. Clause 3(1, a) provides that any increase in the expenses which the Minister incurs in the exercise of his functions—that is, his default powers—under the National Health Service Act, 1946 and the Local Government Act, 1958 which arise out of the provisions of the Bill shall be met by the Exchequer.
Clause 3(1,b) provides that any increase in rate support grant to local authorities necessitated by increased local expenditure under the Bill will also be met by the Exchequer. The effect of Clause 3(2) is to require the payment into the Exchequer of any sums received by the Minister through the exercise of his default powers in respect of contraceptive services.
The core of the Bill, however, is Clause 1. In one sense, it is very short and simple, but I accept that it has implications for social and economic as well as family planning. For ten years, our forecasts have had to reckon with an expected increase in the British population of roughly one-third by the end of this century. In housing terms alone, this would mean building the equivalent of a city the size of Bristol every year to house the net increase in numbers.
Such forecasts are, of course, subject to many unforeseen variables. By September, 1966, for example, it was estimated, fairly reliably, I think, that over 800,000 women throughout Great Britain were using the oral contraceptive, the pill. This number has, obviously, increased very rapidly during the 1960s, and it is tempting to speculate on the possible relationship between the cumulative consequences of this extended use and the fall in the birth-rate which has occurred in the past two years. My Bill might well have consequences for the net reproduction rate, although whether it will ever be possible to isolate its effects is doubtful.
Having admitted such implications, may I refute the allegations in some newspapers that this is some sort of State population plan, masquerading as a Private Member's Bill? My Bill is designed to help people exercise choice and to exercise it wisely on the basis of knowledge. If people want to have large families there is nothing in this Bill which will in any way prevent or discourage them from doing so. What my 949 Bill will accomplish is not the curtailment of parental rights, but the extension of parental responsibilities.
Far from asking the State to impose a population policy, my Bill is concerned with parental choice, a choice free from ignorance and superstitution, old wives' tales and passive resignation to fate. In that sense the Bill implies a population policy. But it is a policy based on millions of independent decisions by responsible and mature men and women. I would respectfully suggest, pace The Times, that such an issue whose controversies owe nothing to party polemic is an entirely fitting subject for a Private Member's Bill.
In conclusion may I say how helpful I have found the Family Planning Association and many individuals during the preparation of my Bill. The Association has made immense strides in recent years, and since 1964 its clinics have increased by more than one-third in number to well over 600. If the work of such voluntary dedication is, through my Bill, to be henceforth supported by unequivocal official action and encouragement this would be a fitting reward for years of effort for what can truly be called a labour of love. I commend the Bill to the House.
§ Mr. Speaker
I want, if possible, to secure a balanced debate. If there are any hon. Members on either side of the House who wish to oppose this Bill, I would be grateful if they would let me know.
§ 11.43 a.m.
§ Sir David Renton (Huntingdonshire)
Far from opposing this Bill, I would like to congratulate the hon. Member for Bebington (Mr. Brooks) upon his choice of this vitally important matter. I would also like to congratulate him upon his most interesting, constructive and fearless speech. In my experience, this vital question of over-population, which was one of the factors he urged in favour of the Bill, is one of the most important matters for Government and Parliament to consider, and one which has been the most shirked. The hon. Gentleman has done a most valuable service today in breaking the ice at last.
He put forward a number of reasons for his Bill, the principal reasons being in my opinion human, social and demo- 950 graphic. I wish to deal briefly with those three in that order, but before doing so I ought to say that I agree with the hon. Gentleman that although it will not prevent people who really want to have large families and can manage large families from having them, the Bill will lead to fewer large families being born to women who do not want to have them. In saying this, I would not like to imply any discredit to those valiant women who have produced large families, sometimes unwillingly; one admires them. Generally speaking, those large families develop a sense of pride and loyalty which arouse our admiration. There is, however, another side to the picture which I shall mention. We can all agree that it is lovely for parents to have children; I have three of my own. But the responsibility and burden of bringing up children increases with the size of the family. This is especially so if the children follow each other at short intervals.
It is the mother upon whom the burden mainly rests, and any family doctor with a really general practice like my father had knows of women who wish to avoid having another child soon after the last one. However incredible as it may seem in these sophisticated and unashamed times in which we live, some women do not know how to avoid having another child so soon, and the reason is that they are too shy to discuss this even with their own family doctor. Family planning centres have undoubtedly done much to help, and many women have cause to be grateful to them, but strangely enough this does not apply to those in the lowest income groups, who do not use the family planning centres so much. Unfortunately, one must include in this many of the immigrants, for whom we have some responsibility.
The Bill provides that local health authorities shall take upon themselves the responsibility, which the hon. Gentleman has in mind, of offering advice and help on birth control. He mentioned the opportunity which arose in maternity hospitals, and I believe that these hospitals within the National Health Service offer the best opportunity of birth control, because they provide the opportunity of giving advice at the best time. I hope that in Committee we shall be able to go into this and that the hon. 951 Gentleman, with the Minister's support, will agree to his Bill being strengthened so that something really positive can be done about women in maternity hospitals. Owing to the shortage of maternity accommodation today, a very large number of women entering National Health Service maternity hospitals are the very women needing this advice, because they enter the hospitals for the very reason that their home circumstances are not good enough. These two factors are linked and a great opportunity would be missed if the Bill were not strengthened in the way that I have suggested. I hope that the Minister would agree to it being implemented and strengthened in this way.
As to the social reasons for the Bill, only a very small proportion of the millions of houses and flats in this country are large enough to accommodate a family of more than two parents and four children. There are not enough bedrooms, especially if there are both boys and girls in the family who have to be separated as they grow older. Even in the 13 years of Tory Government, when over 4 million new houses were built, we never really caught up with housing demand. The hon. Gentleman has made it abundantly plain, very candidly, that it would be extremely difficult to catch up with housing demand, even if the present Government reaches their target of 400,000 houses a year. The population is still increasing rapidly.
It could be said that local authorities should build a larger proportion of houses, big enough to house large families, but if they were to do so they would build fewer houses altogether. There is therefore a dilemma. We have to face the fact that large families nearly always mean overcrowding, with a constant lowering of the standard of living, and, worse still, an increase in the psychological pressures on the family.
I think this would be the right moment for me to mention something that I came across only through having judicial experience. Some people think that it is strange that Members of Parliament should have judicial experience, but I think that a breadth of experience can be valuable. I do not know whether one is any better sitting judicially through being a Member of Parliament, 952 though one likes to think that one is. However, what I am about to recount would not have come my way had I not been sitting judicially.
Everyone knows that many delinquents come from broken families, but I have been astonished at the number who come from very large families. I was surprised and sorry to find how often offenders had come from large families of nine children or more, even though the parents had done their very best to hold the family together. So there are strong social reasons for encouraging family planning.
I come finally to the demographic reason for the Bill. I hope that I shall not be introducing a note of controversy—I do not intend to do so—when I say that I consider this the most important Bill introduced in the House since the Commonwealth Immigrants Act, 1962. For the past 20 years, I have felt that this country was over-populated and, as the hon. Gentleman said, over-urbanised. I now find that thinking people are coming increasingly to that point of view, and I hope that Whitehall will do so, too. I do not think that this would be the right occasion for me to deploy the whole of the demographic argument—the hon. Gentleman went into it fully, and I entirely endorse what he said—but I would remind the House that the main reason we put forward in favour of the Commonwealth Immigrants Act was that this country was densely populated and likely to become more so.
There are only three ways to deal with a population problem in practice. One is to limit immigration. Another is to encourage emigration. My hon. Friend the Member for Surbiton (Mr. Fisher) and I years ago joined a very useful body, the Commonwealth Migration Council, whose object is to stimulate emigration. I am glad to say that emigration has been going very well in recent years; I have no hestitation in saying that. It is a separate problem from the brain drain.
The third method is to discourage large families. I think it would be wrong and not human to discourage large families by any financial discrimination or by not giving help with family allowances or Income Tax allowances. That would not be the right way to discourage them, and I do not think that any party 953 in the House would countenance it. But by the means offered by the Bill large families can be discouraged in the right way. That is why I deeply admire what the hon. Gentleman has done in introducing the Bill and the way in which he has done it.
§ 11.54 a.m.
Mr. Bernard Flood (Acton)
I join other hon. Members—I am sure that there will be many more in future—in congratulating my hon. Friend the Member for Bebington (Mr. Brooks) and his co-sponsors on introducing this eminently sensible and humane Measure. I give it my fullest support.
There is no necessity for me to outline again, because it has been done so well, the overwhelming need for such a Measure. All of us, perhaps particularly, but not exclusively, those of us who represent urban constituencies, are constantly aware of the difficulties and pressures that arise as a result of large families, and particularly large families which come into this world unwanted and not through the wish of the parents.
During recent months I have become even more aware of the problem, since I now have a daughter-in-law working as a child care officer in London, and from what she tells me of dealing with cases which come before her—the children who are brought into the care of local authorities—in a very large proportion of cases the initial difficulty arises from large families, over-large families and unwanted families.
I do not propose to go over all the arguments used by my hon. Friend about the need for the Measure, but I want to make reference from my own experience to the support which I believe the Measure has in the country, right across party lines, just as in this House. Not many weeks ago the Secretary of the Acton Residents' Association wrote to me expressing the concern of many of his members that the Government were apparently supporting a Bill which would mean that the ratepayers' money would be used to provide contraceptive advice and appliances to all women whether married or unmarried. I replied to that letter pointing out that while I realised that many people could have moral or religious objections to such a Measure, if one viewed it from a strictly financial 954 point of view there was everything to be said for such a Measure going through because the cost of the provision of contraceptive advice and appliances would be absolutely minimal compared with what must be the vast sums at present spent by local authorities and hospitals on dealing with abortions and the aftermath of abortions which go wrong, in dealing with illegitimate births and in dealing with the whole range of problems, juvenile delinquency and so forth, which come about because of lack of provision of this kind.
Perhaps partly because of the argument that I advanced in my letter, the Executive Committee of the Association—which has shown its concern not only with the narrow financial interests of ratepayers but also with the interests of the community as a whole, and, if I may say so, with the maintenance of high moral standards in the community—has now formally come out in support of the Bill.
I should like to read an extract from a statement issued by the Association, a widely representative body of people in my constituency, regarding the Bill:Whereas it is realised that many people may object on moral and religious grounds to such a venture receiving support from the rates—I believe that some members of the Executive Committee do object on those grounds—it is agreed that proper education, advice and training will lead to a reduction of costs to the medical service now resulting from illegal abortions, disease etc. Members recalled the 'shock methods' adopted by the Services during the last war when personnel attended film shows designed to illustrate the worst effects of sexual promiscuity. Known results today appear to indicate the necessity for more widespread knowledge, and it is hoped that local authorities would ensure that this is included in their future plans, in addition to the dispensing of contraceptives and advice—particularly amongst the young and unmarried.That expression of opinion by a body of this kind is probably representative of sensible and reasonable opinion throughout the country.
How far will the Bill make it possible for hospitals to play their full part in providing contraceptive advice and facilities? One of the biggest problems we face is the reluctance of women to seek help, particularly women who are most in need of help. When considering this 955 problem, one must ask why they are reluctant. There are a variety of reasons. In some cases they may be reluctant to seek help through shyness, a perfectly natural feeling. In other cases it may be the fear of authority. In others there may be a mistaken belief that family planning clinics are middle-class institutions; that many people going there will find themselves out of their normal social range. Then, and this certainly applies in west London, the language barrier arises in many cases.
There is also the general inability of some people, through no fault of their own, to cope with the problems of life. A senior registrar in psychiatry wrote to one of my constituents on this subject. He stated:… among those who need the service most are such who have so little initiative for anything other than immediate emotional needs that they would not walk 10 yards or spend 2s. 6d. a month for effective contraception.How are we to deal with the problem of those who do not at present seek advice and the facilities which they could obtain and which they will be able to obtain much better when this Bill becomes law? I believe that the most fruitful way of ensuring that these needs are met is to make certain that hospitals can provide advice and assistance while patients are still in hospital.
There are an increasing number of first births taking place in hospital and one hopes that in years to come it will become standard practice for all first births to take place in hospital. Confinement in hospital is increasingly the case where home conditions are bad, either through shortage of accommodation or overcrowding. It is also true that many of the women whose abortions go wrong—and there are many thousands of these each year—end up in hospital. These are the people who are most in need of advice, and they could most readily be given it when they are in hospital and through hospital post-natal clinics.
If the opportunity is not taken to give this advice and assistance while women are in hospital, the opportunity will be lost until they return to hospital with their next pregnancy or as a result of an abortion. While women are in 956 hospital, particularly while they are there having a child, the situation for advice of this kind being given is particularly favourable. They will probably have developed a friendly relationship with the staff of the hospital and their personal and medical histories will be known. There is also a good chance of bringing their husbands in on the solution of this problem, since they are likely to be visiting their wives in hospital—and while they are there they will also probably develop a feeling of respect, and in many cases more than respect, for the hospital staff who are looking after their wives.
We must ensure—either through this Measure, possibly amended, through other legislation or yet further steps which the Minister can take—that the provision of contraceptive advice and appliances where necessary becomes normal practice for women who are in hospital for births or as a result of abortions.
I am not for a moment suggesting that advice of this kind should be forced upon people. They may have religious or moral objections to receiving it. On the other hand, they might wish to have large families and be wholly capable of taking care of them. Nevertheless, the advice should be available and only by ensuring that all hospitals are fully brought into this will we deal with the great problem of providing advice and assistance to the women who are most in need of help and who at present, for one reason and another, are probably the last to seek it. I am particularly hopeful that the Minister will comment on this subject.
I should, perhaps, make it clear that while I have spent most of my speech referring to this question of hospitals and the need for these services to be provided by hospitals, I wish to express my strongest possible support for the Bill. It is a great step forward, as far as it goes. I echo the sentiments expressed by the right hon. and learned Member for Huntingdonshire (Sir D. Renton); the promoter and his co-sponsors are to be congratulated on having brought before the House a Bill which, perhaps more than any other introduced in recent times, will go a long way towards averting human misery and promoting human happiness.
§ 12.7 p.m.
§ Sir Stephen McAdden (Southend, East)
Like other hon. Members, I congratulate the hon. Member for Bebington (Mr. Brooks) on his good fortune in the Ballot. I hope that he will excuse me if I do not extend those congratulations to his Bill, since I do not share the view expressed by my right hon. and learned Friend the Member for Huntingdonshire (Sir D. Renton), the hon. Member for Acton (Mr. Floud) and others that this is the most important Bill introduced into Parliament for a number of years. I do not believe that it is of such world-shattering importance or that it will necessarily carry out the purposes which its sponsors hope it will achieve.
The hon. Member for Bebington made an excellent speech, and I congratulate him on that. I assure him that if his Measure were concerned solely with giving advice to parents about how they can best regulate the size of their families, there would be a lot to be said for it. It might then have been described as an excellent Measure. However, it is part of our modern approach to things generally to use language to describe our intentions when that language is often far removed from what we actually have in mind. For example, nobody today calls himself an atheist; he is a humanist—it sounds better.
So also in introducing the Bill the hon. Member for Bebington suggested that by providing universal explanations about the value of contraception and by providing, possibly free, contraceptive appliances to everybody, without restriction, this can be called "family planning". It is nothing of the sort. Nor do I accept that the hon. Gentleman's remarks represented a complete and perfect definition of the various things which the Bill proposes.
The hon. Member for Bebington rightly referred to the enormous population explosion in China and India. But this Bill will not make the slightest difference to the state of affairs in those countries. It is meant to deal with the problems of this country. With that in mind, the hon. Gentleman called in aid an example from his experience in Liverpool, a city which I used to know quite well. He referred to a mother of 12 children who was expecting her thirteenth. 958 Knowing Liverpool as well as he does, and as well as I did, he knows perfectly well that, even had this Measure been on the Statute Book, it is extremely unlikely that it would have made the slightest difference in that case. The hon. Gentleman the Member for Bebington knows as well as I do the attitude of certain of the citizens of Liverpool, and that they deny themselves access to knowledge about birth control has nothing to do with its availability; they simply do not want to know, because, for religious or moral reasons, they think it is wrong.
§ Mr. Leo Abse (Pontypool)
Does not the hon. Member appreciate that in these clinics advice and guidance would be available to Catholics who would be able to receive guidance in methods which are not theologically repugnant to the Church, and that, therefore, his arguments are quite irrelevant?
§ Sir S. McAdden
With great respect, I think they are extremely relevant. When the hon. Member says these clinics may provide that sort of information, let me remind him that that sort of information is available today through the Family Planning Association and the like, if people seek to make use of it.
It seems to me rather unfortunate that though, when in this House something is put forward for which it is claimed that it is forward-looking, revolutionary, a great step forward, people are prepared to listen to the arguments for it, as, indeed, I have listened very patiently, without interrupting, to everything that has been said, as soon as a contrary point of view, perhaps from only one Member of the House, and perhaps not very well, is put forward, that arouses a great deal of excitement, and, in this case, more than I should have thought the modest remarks I have so far passed would have fully justified.
Then we are told we ought to have this Bill because of the housing problems, and that unless we have this Bill the population explosion will go on and therefore we must have this Bill passed in order that we can regulate the number of children by the number of houses we are able to provide to accommodate them. This does not seem to me to be a very enlightened argument either. I should have thought that it ought to be the other way round. If people choose 959 to have families, I should not have thought that in itself a bad thing. After all, most of us would not have been here at all if our parents had not had families, and I should have thought that we would think our parents having had families to have been a good thing. Surely, it might be a good thing to allow other people to have families if they so desire, and to let the State with its resources help to see that the families may be suitably accommodated.
Then I heard the hon. Member for Bebington call in aid the considered judgment of obstetricians and gynaecologists upon this matter. I am glad that he has got their support, but I hope that he and they will heed the advice of other obstetricians and gynaecologists in their opposition to the Bill not so far distantly related from this one and which is also at present being considered by Parliament. It does seem to me that one must not be selective and not call in aid these obstetricians and gynaecologists whose advice and opinions happen to suit us and ignore those of others upon the matters on which they have particular knowledge.
It is suggested that the people of this country do not know very much about methods of contraception, that it comes completely new to them, and that unless these facilities are provided through the local authorities health services they will not know. I should have thought that "Cathy Come Home", which was mentioned by the hon. Member for Bebington, would have drawn attention to the considerable burden under which the local authority health services already work. Whether it is the answer to that, that to the burden being placed upon those services there should be added increased responsibilities, is something which I choose to doubt, and whether this is necessarily the most important priority of the lot.
We are told that unless these facilities are provided these contraceptive methods will not become known. My experience is that as soon as a couple become engaged they are immediately inundated with masses of information about contraceptive methods. Does the hon. Member think that even boys and girls as soon as they leave school know nothing about it? As soon as a couple 960 announce in the newspapers that they are to be married they receive masses of information about contraception.
§ Sir D. Renton
What about the vast majority of couples who do not announce their engagements in the newspapers?
§ Sir S. McAdden
I am very well aware of that. My right hon. and learned Friend must not seek to detract me from the point. I know a lot of people do not announce their engagement in the newspapers, but a lot of people do. A lot of people get married in the registrar's office; their names are put up outside the office in order that interested parties should know; and there are firms which make use of this information through these notices and circularise the couples. If my right hon. and learned Friend does not know that, let me assure him that in fact they do. I have heard it mentioned that this announcing of engagements to marry is something which is reserved to the middle class. Do not believe it. If the hon. Member looks in his local newspaper he will find that all kinds of ordinary working people like to announce to their friends the engagement of their children. It is my experience that working-class families like to take the opportunity of so publicising these events, so important in their lives.
So whilst I accept and support the excellent work which is being done by the Family Planning Association in giving advice to people who go to it for that, and the help it gives married couples so to arrange their lives that they are not over-burdened with families larger than they can manage, I do not believe that the time has come when this Bill is right for the people of this country—at the ratepayers' expense, and irrespective of whether they are married or not. There is not here even a single mention of an age limit, and the Bill could apply even to schoolchildren. It simply says "persons". It does not say how old they should be, but by this Bill people of any age at all will have the right to go to these clinics and seek advice and be supplied with contraceptive equipment. Is this the most urgent priority of the last 50 years? It is certainly not, in my view, and I think we could find some other priority in some other Private Member's Bill more worthy of support.
§ 12.16 p.m.
§ Mr. Leo Abse (Pontypool)
I am bound to say, I hope without disrespect to him, that, having noted the speech and the profound remark of the hon. Member for Southend, East (Sir S. McAdden), that but for our parents we would not be here, I could only wish that his parents had practised family planning.
§ Sir S. McAdden
The hon. Gentleman will, I hope, realise that that crack attempted by him is as old as the hills? And though he may differ from me, he will not in arrogance assume that his own views are always necessarily right?
§ Mr. Abse
I have the good fortune to have come from the hills and valleys of Wales, so it is not surprising that I come with attitudes which differ from those of the hon. Member.
I believe, as does the hon. Member, that for many of us having children can be our greatest blessing, but I support this Bill since my professional experience has exposed me very frequently to the sad and repetitive case histories that emerge in so many divorces, and I know of the tragic impact on marital relations that comes as a result of unwanted pregnancies. The subsequent fears which enter into the relationships, the anxieties, and sometimes the resultant frigidity, can be irreparably destructive of a marriage.
This Bill is essentially one which will enable advice and guidance to be given in a way which can help many more marriages to be lived out harmoniously and free from fear, and, therefore, I certainly congratulate my hon. Friend the Member for Bebington (Mr. Brooks) on sponsoring this Bill and on having brought it in. I am glad that it is as a result of an Adjournment debate which I initiated, and which afforded the Minister of Health, whose support and identification with the family planning movement has been lifelong, the opportunity to articulate inhibitions in the existing law, inhibitions which my hon. Friend is now seeking to remove.
The Bill is so obviously beneficent that I am perplexed why it does not apply to the whole country. Hon. Members who do not represent constituencies in Scotland are naturally diffident about commenting upon legislation which 962 could apply to Scotland, though I have often observed that, quite properly, the same diffidence is not usually displayed by Scottish Members when speaking about legislation touching upon England and Wales.
A curious pattern appears to be establishing itself for Scotland in relation to Bills touching upon human relationships. When progressive Peers in another place passed a Divorce Bill which would have brought divorce law substantially as up to date as divorce law is in England and Wales today—and that is not very up to date—that Bill was savaged in the Scottish Committee without any protest. Before the homosexual law reform Bill was proceeding through the House, I observed there were many influential contributors in the Scotsman and not a few professors of law in Scotland who were calling for Scotland to be included in that Bill, but no initiative came from Scottish Members of this House.
Now that we have an all-party Bill which, rightly, has more than a neutral attitude from the Government, as it should since it conforms with the unanimous demand of the Labour Party conference, I am bound to ask why Scotland is omitted. It cannot be due to any lack of demand in Scotland for such a family planning service. It is interesting to note that the Scottish and Northern Irish figures reveal that it is likely that some 120,000 women in those regions are using the pill. That represents nine out of every 100 women between 15 and 44, which is a far higher percentage than the number of women using the pill in the Greater London area, so there is no sign of a marked prejudice against contraception revealed in figures of that kind.
I wonder why, therefore, this Bill does not apply to Scotland and whether there are not some prim Victorian prejudices lingering round the Scottish Office which have resulted in what I regard as the unfortunate fact that Scotland is omitted from the Bill.
To overcome those views in the Scottish Office, if they exist, it may be useful to remind those who may be afflicted with those prejudices that, at present, the oral contraceptives which are supplied to the Family Planning Association's clinics are supplied at about 5s. per packet. Thus, the cost per annum 963 of providing a woman with protection against pregnancy is 65s., whereas the cost to the State of providing a child allowance is £26. I am bound to say that it is high time that voices were raised in Scotland to ensure that they are not left behind in so much useful social legislation.
Although I am sorry that Scotland is omitted, I am pleased to see that the sponsors of the Bill have had the courage to make certain that the advice proposed to be provided should include the unmarried as well as the married. It is abundantly clear that we have to face the situation realistically that, each year, there are born within marriage some 65,000 children who are conceived pre-maritally. That represents about 7.5 per cent. of the births in the country, and that does not exactly bear out the suggestion made by the hon. Member for Southend, East that birth control information is so well understood and well known amongst all sections of the community. Apart from those 65,000 children, there is a similar number of illegitimate children born outside marriage. Whether we like it or not, it is the fact that something like one in six of children born in the country are conceived outside marriage. Faced with those facts, I cannot believe that benefits are not bound to result from having advice and guidance given on a much wider scale than is at present available.
I was glad to hear my hon. Friend the Member for Bebington refer in his excellent contribution to the necessity of observing the correlation between high fertility, problem families and poverty. What is insufficiently understood is the enormous difficulty in persuading these families to practise birth control. I know that there may be some who scoff at the notion that, from the clinics, family planning patrols should be calling upon these families regularly. Some will believe it to be the utimate folly of a spoon-feeding Welfare State. However, if costs are uppermost in the minds of these critics, let them weigh up the saving to the nation in maternity grants and the cost of keeping children in care against the cost of the type of service proposed. Let them take into account the huge burden of human misery that a domiciliary service may help to alleviate.
964 It is an extraordinarily difficult problem. Domiciliary visitors have to break down ignorance, fear, prejudice and suspicion. They will be needed to visit those who may be regarded as the losers in our society. I refer to the women who have been ground down by it all, and the men who cannot cope with the pressures of an increasingly competitive society. They will find that there are those uncertain men who refuse to let their wives be fitted with a coil because they fear that they will then feel safe to go with other men. There are women who are as primitive in their reactions as any of those in a developing country, who are convinced that the fitting of a contraceptive means some dreadful pain.
The battle to succeed is not only to establish a contraceptive routine but to get these sorts of people to keep it up. If domiciliary visits are to be successful, there will be a need for the clinics to have ample skilled staff.
Perhaps at this point I might draw the attention of the Minister of Health to the fact that there are too few doctors who are able or willing to give contraceptive advice. Unless there is a change of policy at medical schools, this pattern will persist. I am informed that in London there are only two teaching hospitals which include the control of fertility in their curricula. They are University College Hospital and Charing Cross Hospital. Bearing in mind the increased needs which arise from the Bill, I hope that the Minister will, at least draw the attention of the Royal Commission on Medical Education, which he so promptly set up, to the urgent need to deal with the new demand which the community is making for skilled and trained advice in fertility problems.
The last matter with which I want to deal is, in my view, an important one, and it is one which may perhaps be overlooked in this debate. If the Bill is to succeed, it is obvious that it will mean that, more than ever in our history, men and women will be practising family planning. It follows that we can all anticipate that there will be more appliances and pills used than ever before. The other arrangements which the Minister has activated which will enable doctors to obtain a small fee for prescribing contraceptives undoubtedly will add to 965 the greater demand for contraceptives of all kinds. It is quite impossible for us to ignore that the consequences of the Bill are likely to be a huge and growing market for the manufacturers of contraceptives.
What is certain in this country, however, is that it cannot be left to competition between rival manufacturers to ensure that local authorities will obtain contraceptives for their clinics at realistic and reasonable prices, because a sinister monopoly dominates the whole contraceptive manufacturing industry. The millions of men today who in chemists' or in barbers' shops buy the well-known rubber brands of Durex, Prentifs, Prevax, Velsan or Ona protectives are given the illusion of choice, but the truth is that these brands, and many others, like Arloid and Lloyds Grade, are, though it is coyly omitted from all the packets, manufactured by one firm, the London Rubber Company. This company in fact manufactures at least 95 per cent. of the 100 million male contraceptive devices said to be used annually in Britain, and of course the company similarly dominates the female rubber contraceptive industry.
When I drew the attention of the President of the Board of Trade to this position in the House in July, 1965, he indicated that he was giving consideration to a reference being made of this industry to the Monopolies Commission. The Bill, in my view, makes the need for such a reference much more compelling, and I hope that my right hon. Friend the Minister of Health will give some assurances that he will initiate discussions with the President of the Board of Trade now that the Minister of Health's activation is bound otherwise to lead to still greater profits and more excessive profits for this firm.
Already the London Rubber Company, as its hold on the market is increased, makes quite staggering profits.
§ Sir S. McAdden
I have listened to the hon. Gentleman's description of this company and to the fact that it now controls 95 per cent. of the market. Does not he think that it is ripe for nationalisation?
§ Sir S. McAdden
Does the hon. Gentleman realise that he is taking himself back to the pre-war Labour Party conference, and perhaps he will fetch his memory back to what the late Jack Jones, the Member of Parliament for Silvertown said at the time.
§ Mr. Abse
The hon. Gentleman's memory is longer than mine, and if I might pursue the point, since I think it needs to be pursued, if one looks at what is happening in the industry, one sees that the Chairman of the Company, Mr. Reid, or Mr. Durex, as he is sometimes described, at his last annual meeting announced with great pride that he had had another record year, which I found on examination to be the 14th in succession. The profits amounted to more than £3,200,000, and were up by £200,000 over the previous year, and treble those for 1960. In the meantime, in a company which has been prolific in its scrip issues, the six directors in this wage freeze year increased their fees from £52,000 to £74,000. I am not one of those who believe that there is anything necessarily sinful in profits. I do not take that view. Indeed, they often go hand in hand with efficiency, and, I think, service to the public. But we have a right to be on inquiry when monopolistic conditions of this kind prevail, and I think that we have a duty, when passing a Bill such as this leading to the enlargement of consumer demand, to urge price safeguards for the public.
Every analysis of the costs of producing contraceptives points to the fact that the contraceptive for which a man pays 1s. 3d. in the shops costs the manufacturer, after taking into account raw materials, manufacturing, testing, packaging, and advertising, certainly not more than 3d. Judging by the usual margin of profits given to distributors, certainly the manufacturers in this country are making not less than 120 per cent. profit.
It is, of course, not only the price margins which disquiet one in the monopolistic industry in contraceptives. One cannot fail to notice how it was not until the Consumers' Association in 1963 967 brought attention to the holes in so many condoms, and the subsequent creation by the British Standards Institute of testing standards, that the position was substantially improved. Nevertheless, those who have looked at results of the tests carried out by "Which?" in June 1966 know that among many of the products of this monopolistic company, not a few such as Prevax which had a 3.8 per cent. leakage test, and Lloyd's Grade which had a 4.4 per cent. leakage test, failed to pass the B.S.I. standard. A little less profit and a little more money spent on testing is a right which I think those who wish to practise family planning are entitled to expect from this monopolistic concern.
The tactics which the monopoly is prepared to resort to in order to maintain its position shows its capacity to behave in an utterly irresponsible manner. It was revealed, as a consequence of investigation by some highly intelligent journalists in 1965, that the London Rubber Company clandestinely created and endowed a unit known as the Genetic Study Group with the object of disseminating to medical officers of health, the Women's Institute, and Members of Parliament, misleading and alarming propaganda concerning contraceptive pills. With the aid of doubtful public relations practitioners, attempts were made fraudulently to induce medical officers of health to act as patrons to this unit. The unit was created to mislead and alarm women and so dissuade them from using contraceptive pills, and to use instead the rubber products of this company. It was a disgraceful episode, and the fact that newspaper reports and Questions which I put in the House led to this unit being hurriedly wound up with the comment from the company, "It was only a very small affair anyway", in no way allays alarm at the contemptuous way in which the company treated the public.
Therefore, since an unintended consequence of the passage of the Bill must surely not be a widening of the area of exploitation by this monopoly, I trust that one of the things which will come out of this will be a renewed demand that the industry should be referred to the Monopolies Commission. With a 968 very good heart I give my full support to this excellent Bill.
§ 12.37 p.m.
§ Sir Clive Bossom (Leominster)
I, too, congratulate the hon. Member for Bebington (Mr. Brooks) on introducing this long overdue Bill. He put his case most sensibly and clearly. I am not going to follow the case put by the hon. Member for Pontypool (Mr. Abse) about the business side of contraceptives or about their standards. I think that it was well worth raising that issue but I am sure that the hon. Gentleman will excuse me if I do not follow him.
On 6th January, there was a leading article in The Times, with which I agreed, that this very important Bill should not have had to be introduced by a private Member. Nevertheless, I felt so strongly that family planning could no longer be left entirely in the hands of charity that I willingly became a sponsor of it. The timing of the Bill is perhaps unfortunate, because many people would have preferred to have seen the Bill introduced before the Termination of Pregnancy Bill, because the better the contraceptive devices available to the population, the less need there will be for abortion. But if the abortion Bill is to be on the Statute Book, it is vital that this Bill too should be there.
The Times article of 6th January went on to imply that a Bill such as this was the beginning of a population policy. I assure the House that this is not what prompted me to sponsor this long overdue Measure. I agree with the views put forward by the hon. Member for Bebington. My aim is not to interfere with the number of wanted babies but to try to help stem the increasing number of unwanted babies. I am not trying to force birth control on anyone. Today we do not hesitate to immunise the population against smallpox, diphtheria, polio and measles, though the incidence of these diseases in very serious form never approached the epidemic proportions of our teen-age pregnancies.
It is argued that contraception is not natural. Equally, the use of penicillin to prevent a mother dying of infection is not natural. Nowadays the question is not whether a thing is natural but whether it is desirable. A great many people are capable of exercising responsibility in planning their families, but 969 there are appallingly wide areas of the population in which, although its members would like to plan, knowledge is limited, and help and advice are urgently needed. In our major towns and cities there are 622 voluntarily run family planning clinics, which are doing a magnificent job.
Regardless of where people live they should be able as their right to obtain family planning advice as and when they desire it. At the moment the country is not adequately covered. Surrey is well, if not entirely adequately, covered, whereas the centre of Wales has only just opened its first clinic. The branch area in which I live covers Shropshire, Herefordshire and Worcestershire. It has nine family planning clinics, which are hardly enough for this vast area, of approximately 2,890 square miles, with a population of approximately 1,045,000. Not long ago my wife, who is a member of the executive of that branch, was appalled to find herself seconding a proposal not to open any new clinics in our area for the time being. This went right against her feelings, because she knew how desperately these clinics are needed, but she felt that the branch could not afford to provide any more clinics without more concrete financial backing from the Government.
I have been encouraged by the pronouncements of the Minister in the past. He is obviously a believer in family planning and a strong supporter of it. On 23rd November, 1964, in answer to a Question, he said:I want to make it quite clear that I regard family planning advice as an important part of health education."—[OFFICIAL REPORT, 23rd November, 1964; Vol. 702, c. 905.]On 9th May, 1966, also in answer to a Question, he said:I believe that certain steps could be taken by many authorities—and in my view authorities should take them. … —[OFFICIAL REPORT, 9th May, 1966; Vol. 728, c. 5.]This was borne out by the excellent circular, mentioned already, sent by the Ministry to local authorities on 27th February, 1966.
I should also like the Minister, in intervening, to comment on certain points which are worrying many of us. One concerns charges. I am not against a small charge being made. It is reason- 970 able and logical, as it is for a private prescription or an appliance. A reasonable charge for the pill or an appliance will not discourage people from asking for advice. People who suffer with their eyes have to pay no charge for advice or examination if they are in trouble. The person pays only for the appliance. If a person has trouble with his teeth he is charged £1 for a course of treatment. If a doctor feels that a certain service is required on purely medical grounds no charge should be made. I should like to hear the Minister's views on this matter.
I live in a rural area and I therefore want to touch upon the question of transport. How does the Minister envisage the provision of adequate facilities in remote rural areas? Could full-time mobile teams go round, visiting clinics, covering a wide area? I am sure that a mobile van parked on a village green is not the answer, because people would be too shy to go. The clinic must be held in a proper building. In my area of Herefordshire we are keen for local authorities to finance the transport of patients for long distances, either by reimbursing them for the use of public transport or transporting them in existing welfare service vehicles.
Another most important point on which I should like the Minister's views is the subject of training. In most cases family planning machinery has a good liaison with various local authorities. As soon as the Bill becomes law we must anticipate a rapidly increasing demand for contraceptive advice. I am afraid that we shall then find there is a shortage of trained doctors and nurses, especially, to cope with the increased demand.
This situation was very evident when the cervical smear test was first introduced in my area. We did not have enough testers in the laboratories. The Family Planning Association is ready and willing to take on this training. In my view it could be financed by central Government more easily than through local authorities. We have heard today that there are only two training hospitals which can do this type of work at the moment. The Association has 80 training clinics, as well as a theoretical training course in London and in some other major cities. I hope that the Minister 971 can explain how he proposes to set up training facilities.
In general terms the Bill is permissive and not mandatory. In these circumstances. I hope that the Minister will make his follow-up directives to local authorities and medical officers of health as strong in terms as was his first circullar, on 27th February, 1966.
In this great step forward there are lessons to be learned from other countries. In Denmark, by law, every woman must be offered birth control advice at her six weeks post-natal check. When the Bill becomes law I hope that the Minister will be able to consider this question and make arrangements to see that some advice is offered—I stress the word "offered"—at this time. I have always maintained that family planning is one of the most important aspects of our community services. Nearly every speaker has said that it can greatly contribute to the dispersal of ignorance and fear, while increasing the joys of happy family life.
One cannot begin to measure this happiness by money. Nevertheless, it is worth examining the cost. I do not propose to argue my case on these lines, but it is worth pointing out that to supply the pill on the National Health Service, I understand, would cost about £3 5s. a year per head. On the other hand, the cost keeping a child in a Dr. Barnardo's Home is approximately £500 a year and of keeping a child in a State adoption home in the region of £600 a year. The cost of family allowances for the third and subsequent children amounts to £26 16s. per child per year. Furthermore, maternity grant amounts to £22. Unfortunately many high fertility families are problem families. They periodically have to apply for National Assistance. Then we have to add the cost of education and welfare, and this adds up to a substantial amount. But the cost of human unhappiness is immeasurable.
This is an excellent Bill. All that it aims to do is to make available the latest medical advice to those who want it and to ensure that this advice is not left, as it is now, available in some areas and not in others. All of us who are engaged in pressing for family planning to come 972 under the wing of the National Health Service have found almost no resistance to the idea, even in areas with large Roman Catholic populations. I sincerely believe that public opinion is definitely ready for this overdue Bill.
§ 12.50 p.m.
§ Mr. Douglas Houghton (Sowerby)
One of the compensations of returning to the back benches is that one can once again speak one's mind in public, a form of liberation which I am sure I will enjoy when I get more used to it. I give my warm support to my hon. Friend the Member for Bebington (Mr. Brooks), whose political courage we must all admire. Until I heard the speech of the hon. Member for Southend, East (Sir S. McAdden), I thought that my hon. Friend was pushing at an open door. I wondered why it had remained closed for so long.
The mixture of cynicism and frivolity of the hon. Member for Southend, East was no contribution to the debate. The door has remained closed for so long because successive Governments have left to the luck of the Ballot and the hazards of Private Members' Bill procedure issues of profound social and individual importance. It is regrettable that this should happen.
I thought that, in his history of this matter, my hon. Friend would refer to the last occasion—so far as I can trace—on which a Bill of this kind came before the House. It was in February, 1926, introduced by the late Mr. Ernest Thurtle, M.P. for Shoreditch whose widow, is, happily, still among us and is the daughter of George Lansbury, a figure revered in the history of the Labour movement. But that was 40 years ago. Why not since?
The reason is that this is left to the private Member's luck in the Ballot and to his choice of subject. I wonder what would have happened if my hon. Friend had not chosen a Bill on this subject. Would the door have remained closed? Should we have had to wait longer still for a private Member to have luck in the Ballot and to select this subject?
I believe that successive Governments bear a heavy responsibility for much poverty, misery, suffering and squalor, through having shirked this issue over the years. We could have been spared much 973 in child poverty today and for years past, had Governments recognised this to be a form of health service and preventive medicine against families with which parents cannot cope and which have thrust suffering and deprived children on community care. The circular issued by my right hon. Friend in February, 1966, has been mentioned. It has been described as historic, but what was historic about it was the warmth and enthusiasm with which my right hon. Friend embraced the concept of family planning as a contribution to family welfare and social health.
When he had done it all, he had to stop short of this Bill, because he had to emphasise that he was advised that legislation would be required to enable local authorities to extend family planning advice and facilities beyond the boundaries prescribed in the circular of 1930, which restricted this facility to women for whom a further pregnancy would be detrimental to health. Beyond that, the Minister could not and did not go. It is this Bill which will take him beyond the confines of a circular issued so long ago as to seem to belong to a past age when people were thinking differently.
Yet nothing has been done in all the intervening years. We have spent millions on curative and remedial action and treatment, but have shrunk from providing this facility, which would prevent a good deal of the need for social welfare services, particularly in the case of large families. One of the principal causes of child poverty, about which we hear a good deal just now, is the combination of low wages and large families. Whatever is done in social provision, by increased family allowances or other means recently discussed freely in the Press, this support for the family will not wholly meet the needs of many families.
The significance of the large family has been brought out in a good deal of the publicity given to the plight of children deprived of the fulness of family life, whose parents have an income just below what used to be called National Assistance level. On a television programme recently, the plight of several women was brought before us—the first with 12 children, the next with six and another with five. The first quarterly newsletter of the Child Poverty Action Group only a few weeks ago described the pre- 974 Christmas agonies of a mother of nine children who could not buy all the things that her children wanted for the festive season.
Travelling the country since then, I have discovered that this kind of publicity is building up a resentment against improved family allowances and additional support for the larger family. People are becoming increasingly critical of people who are too feckless or ignorant or indifferent to their family and social responsibilities.
It needs to be stressed that the bearing of children is not purely a personal matter. We are all agreed, I think, that, just as marriage is not only a private contract but important to the moral welfare of the community, so the procreation of children is not wholly a private matter either.
The more the community accepts responsibility for the health, housing, education, financial support and general welfare of the family, the greater become the social responsibilities of parents. This needs to be brought home to many people. This Bill will provide the facilities but it will not, by itself, provide the social and family education necessary to encourage people to take advantage of the facilities.
This is why the point made by the hon. Member for Acton (Mr. Floud) is most important. It is perhaps in the maternity hospitals, when women are going in to have their third, fourth, fifth of sixth child and the authorities know their home circumstances, that education and persuasion should be used to impress upon them the need to avoid more additions to the family.
By a realistic and progressive approach to sex education, marriage guidance, family planning and care of children we can reduce some of the squalor, poverty and cruelty which still exist in all our constituencies.
There is a good deal of enlightened opinion behind the Bill. I think that religious objections have either been withdrawn or are under serious reconsideration. Indeed, many church authorities are supporting the Measure. In the past there have been religious objections to policies which have been designed to alleviate suffering and to improve personal and social health. We have seen in 975 retrospect how unenlightened the resistance was to measures which are now fully accepted. I believe that the debate will appear to have been almost a ludicrous event 30 or 40 years from now when people will have accepted the idea of a family planning service freely given as part of the health services of the community.
The number of families with four or more children is increasing. We must be on our guard against having more and more families of a size which may become synonymous with child poverty. One-third of the homeless families in London have three or more children. To give family planning advice on medical grounds only is, I think, totally unacceptable today.
The Bill has a limited objective. It merely removes the limitation put on the local health and welfare services by the circular of 1930. I hope that we shall get assurances about the part that the hospitals can play. I hope that we shall be encouraged to believe in the future of a more widely available family planning service where the resources of all our social, health and welfare services can be placed at the disposal of those who want them.
I fully support the extension of these facilities to unmarried people. This is discussed in an interesting article in New Society this week. It seems to me wrong to distinguish between married people whom we want to inform and single people whom we want to keep ignorant. I know that it is a dilemma and that the argument on both sides can be close, but I am sure that if we do not offer these facilities to unmarried persons we shall have to face a rising rate of illegitimacy, and it is rising now. The figures for illegitimacy in London are, unhappily, twice as high as those for Liverpool which have been mentioned in the debate. I believe that London has the highest illegitimacy rate and Manchester the second at present. We must face the fact that if we do not provide these facilities for unmarried persons we shall have an increasing illegitimacy problem.
It is knowledge that we want to provide. A wise use of knowledge, of the social and personal problems and the risks of promiscuity—all these are part 976 of education. We do not educate people by withholding things from them; we do it only by enlightenment and by free discussion of all the pitfalls of freedom and uninhibited behaviour.
I hope that the House will today add to the history of our social services by passing the Bill without a Division, that it will be given a swift passage through Committee, and that the Minister will be encouraged in what I know he has in his mind—a more radical policy on these matters for the Government. Then I think that we shall have justified the steps that my hon. Friend has taken and the political courage that he has shown in introducing the Bill.
§ 1.5 p.m.
§ Dame Joan Vickers (Plymouth, Devonport)
I am very glad to add my congratulations to the hon. Member for Bebington (Mr. Brooks). I thank him for giving me the honour of being one of the sponsors of his Bill. Also, I am delighted to see the right hon. Member for Sowerby (Mr. Houghton) here, taking his usual interest in these social problems. I am sure that we are all intensely grateful, also, to the Minister of Health for coming here personally today. It shows his interest in the subject, and I think it augurs well for the Bill. The hon. Member for Bebington must be very grateful that he has such strong support.
It has been pointed out already that this is a permissive Bill. This must be borne in mind, particularly when we are replying to our critics.
It is extremely important that the Bill should be introduced this year. The United Nations General Assembly made a historic decision which has ended the struggle over giving support for a programme of training, research, information and advisory services in the population field within the limits of available resources. The Secretary-General now has the decision of the appropriate committee to outline priorities for the work for two-year and five-year programmes. He has to consult various agencies and specialised persons to ensure the effective co-ordination of activities. Britain was one of the 24 signatories of the resolution. Therefore, I think that the hon. Member for Bebington has been very fortunate in bringing his Bill forward at this moment. 977 As has been said, the Bill will remove a great deal of the fear and apprehension on the part of women. I was particularly impressed by his point in regard to what men in many sections of the community still regard as "their rights." It is also very acceptable that the Bill should come before the House when plans are being made for Human Rights Year. This is another great human right which I hope we shall confer upon, particularly, women this year. I have for many years been interested in this subject and, with the right hon. Member for Sowerby, I sincerely hope that the Bill will be given a Second Reading.
I want to put forward some reasons for the Bill which have not yet been mentioned. For example, girls are maturing at a very much earlier age. This in itself is a problem. I understand that we are facing a new social pattern, which appears to be the custom for a steady relationship between young people of opposite sexes. I do not mean to imply that people are more promiscuous than they were in previous generations, but I think that many, and more of them, have this relationship which has not been so obvious in the past. It is regrettable to find, too, that many girls have become pregnant by what is known as their "steadies". This is something with which the Bill may help.
In April last year I attended a conference arranged by the Family Planning Association, and was very impressed by a lecture given by S. E. Finlay, who gave the following figures. Between 2 and 3 per cent. of unmarried women students in British universities become pregnant each year. Therefore, a university with 2,000 women students will have between 40 and 60 unmarried pregnancies a year, or two each week of the academic term. He also gave an example. Of 600 girls entering a university in October to read for a three-year degree, he stated that between 40 and 50 will become pregnant—while unmarried—during the course—about 1 in 12.
In the United States and, I am glad to see, in certain areas in this country anonymous advice is given to girls in difficulty who inquire by telephone. We have this service in a very small way in Plymouth, and it has proved very bene- 978 ficial. I mention this to show the anxiety there is among young people. They need the knowledge, and they do not know where to turn happily, some are turning to the anonymous advice service.
So I want particularly to ensure that this knowledge is given to the unmarrieds, either in the schools or in special classes. It is very desirable that various women's organisations should have this information, too. It has already been mentioned that there is considerable shyness on the part of women in discussing the matter; I agree. Therefore, if organisations like the Townswomen's Guilds and the Women's Institutes could have this knowledge given to them, and if demonstrations could be arranged of what can be done, it would help many mothers to face the question openly, which is what we want to achieve.
My hon. Friend the Member for Leominster (Sir Clive Bossom) mentioned that the Family Planning Association has 80 clinics on a regional basis and that a little financial help would be advantageous to them in helping them to carry on their work. It is essential, as has been said today, that more people should be trained in this work. This is important for a domiciliary service.
I should like to quote from a letter which recently appeared in the Press. It read:I am a university graduate and teacher, presumably of fair intelligence, with a husband in a secure financial position and our own house. Yet none of these assets were enough to prevent me from being utterly swamped and paralysed by two non-sleeping babies. Not until the second baby was over six months could I summon sufficient physical and emotional energy to attend the family planning clinic.She added:To condemn the domiciliary contraceptive service"—according to a general practitioner she was quoting from an article by Shirley Lewisas too much welfare spoon-feeding is tantamount to insisting that a crippled man transport himself to hospital to obtain crutches".I should like to support this very heartfelt cry.
I hope that it will be possible for health visitors to take a part in any future action. I wish to refer briefly to the Cheshire plan, which has already started, under which clinic services will be provided and domiciliary visiting will be undertaken. 979 This is proven work and I hope that it will prove very advantageous.
It has been drawn to my attention—and I agree with the hon. Member who mentioned this point—that the Bill would be of even greater benefit to those needing it if a service could be provided by the hospitals. I have had a letter saying that many women would welcome these facilities as part of their post-natal care. It is often difficult to get women to attend clinics, especially those in problem families.
I will not go into the question of charges because it has been dealt with very well by my hon. Friend the Member for Leominster, but I think that there would be no objection to certain charges being made, particularly on social grounds. In the City of Plymouth we needed cytology clinics. It was some considerable time before they got going. Together with a committee, I started two cytology clinics. We are keeping one on, despite the local authorities' now very good work, because we find that there are people who are willing to pay and who perhaps do not want to wait months until it is convenient for the doctor to see them. It has been proved that there is a wish, by some people, to make some contribution.
The Bill will make many women feel very much happier. In Plymouth there is a watch kept in a F.P.A. clinic on women fitted with the coil. It is amazing how much less nervy they are and how much more easily they face life. I do not agree with the hon. Member for Pontypool (Mr. Abse) who said that husbands fear that this might make women more promiscuous. Women who take advantage of any form of contraception and wish to safeguard the future are seldom the promiscuous. Others perhaps do not mind if they have a number of children, and they do not take adequate precautions.
I always remember something which happened when I was nursing in a London hospital which is probably known to the Minister—the Margaret MacDonald and Mary Middleton Infants' Hospital in Notting Hill. It was named after the wife of the Labour Prime Minister, Ramsay MacDonald. I was on night duty. A baby was very sick and I was 980 told by the sister how to lay it out because it was expected to die that night. I was determined that it should live and, besides nursing it, I used something in which I believe very much—my prayers—and the baby survived. I was very joyful when next evening I met the mother. She came from what was a poverty-stricken part of London in those days. She used very unparliamentary language about the fact that I had saved her baby. She said, "Why did you not let him go to your God? He would have given him a good home. My man has just given me my seventeenth child". This impressed me immensely, and from that time onwards I have always been very anxious to do something to help women in this state.
The hon. Member for Bebington mentioned the question of subfertility. This is equally important because there are women who cannot conceive who are just as distressed as those who have too many children. Family planning units have done tremendous service in bringing happiness to women who are frustrated because they cannot have children and perhaps go to the length of adopting children. Here I pay particular tribute to the voluntary workers.
I suggest to the Minister that in future much more use might be made of part-time women doctors. There are many women doctors with family commitments who cannot work full-time. There are many local authorities, and, I regret to say, hospitals, which do not like employing part-time doctors. I should have thought that it would be very advantageous to draw up a list of women doctors willing to work part-time who could give very great assistance. In most of these cases, advice is taken more easily from a woman doctor than, perhaps, it is from a man doctor. The woman perhaps feels a little less embarrassed unless the man doctor is used to dealing with the family and he has the woman's confidence—then it is all right. Much more use could be made of part-time women doctors.
It may not be considered surprising that I support the Bill. In 1932, the Plymouth Health Authority was the first local authority to offer premises for family planning purposes. I think that this was largely brought about by the very energetic and enterprising Lady Astor. 981 I hope that the House will support the Bill. I say this from the depths of my heart, because I know the difficulties of trying to pilot through the House Bills designed predominantly to help women. I know this from my experience with the Maintenance Orders Act. I was very sad about what happened to the Guardianship of Infants Bill, which I got to Committee but which was defeated on Report. Yet there is the extraordinary fact that the homosexuality Bill gets priority from the Government. I am not particularly against that Bill, but I wish to get over my point that the Bill we are debating will primarily help women. For some unknown reason—perhaps it is because of the small number of women Members of Parliament—so many Bills designed to help women seem to be shelved or voted against.
There is another reason why the Bill is needed. The Registrar-General has stated that in his opinion there are likely to be 1,700,000 more men than women in the working groups in 1983. In the past the situation has been different. In my age-group there are more women than men. If the spate of 10-minute Rule Bills continues, we are likely to have one to legalise polyandry.
We should consider, particularly for the younger generation and the unmarried people, educational classes in schools or evening classes to which they can go for lessons on how to plan, not just their families, but their future life. It is for this reason that I support the Bill. If this Bill goes through, it will get away from the opinion that there is one law for the rich. We know perfectly well that the rich can have all these advantages if they so wish.
I am sorry that my hon. Friend the Member for Southend, East (Sir S. McAdden) is not here. We all know that there is no perfect contraceptive, but this Bill may have an additional value. It may encourage people to research for a contraceptive which will be really efficacious. We all know that at present the only really safe oral contraceptive is the word "No". It is no good deceiving ourselves about this. But the Bill will be a great step forward in helping many people whose point of view has been put forward today, and for this reason I am very grateful to the hon. Gentleman for 982 allowing me to sponsor his Bill. I will do my very best to support it during the Committee stage, and I hope that he will have the satisfaction of seeing it enacted before too long.
§ 1.21 p.m.
§ Mrs. Renée Short (Wolverhampton, North-East)
It is a pleasure for me to follow the hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers), for she has spent a great deal of her Parliamentary life in championing the causes of women. I agree with her that we have not enough women in the House who are prepared to stand up and fight these battles. I am delighted that we have been able to find some male champions in the House, not only for the Medical Termination of Pregnancy Bill, on which the hon. Lady and I have the pleasure of sitting in Committee, but also a champion through this Bill in my hon. Friend the Member for Bebington (Mr. Brooks).
I should like to add my congratulations to those of other hon. Members who have spoken on both sides of the House both for the fact that he took up the Bill when he was lucky in the Private Members' Ballot, and for the way in which he moved it today. All hon. Members who have championed these causes have done a service to the House and to the nation. We are an awful lot of hypocrites in this country about matters sexual. Those hon. Members who are prepared to bring forward Bills of this kind, and to bring forward Adjournment debates on these important matters, are helping to create a reasonable, rational and sensible public opinion, a climate in this country where these matters can be discussed in a sensible and open way.
My hon. Friend is now striking a blow to relieve women of uncontrolled maternity or the tyranny of their own fertility which has bound women ever since life began. We know that so many babies who are born today and who were born in generations past were never planned for and were never wanted.
As the hon. Lady the Member for Devonport said, we need research into new methods of contraception. I hope that we shall have an antinidation pill which could be a substitute for some of the other processes and methods that are being used today, but 983 until that time comes this Bill will provide great help.
I must cross swords with the hon. Gentleman the Member for Leominster (Sir Clive Bossom), who is no longer in the Chamber, who said that this Bill ought to have come before the Medical Termination of Pregnancy Bill. This was not something that we could arrange. It was the luck of the Ballot, as hon. Members know. We all accept that as long as contraceptives can fail and as long as families are unwilling to take precautions, there will be the need for termination of pregnancies in certain circumstances.
My right hon. Friend, the Member for Sowerby (Mr. Houghton), who made an excellent contribution to the debate, pointed out how long ago it was since a Bill was introduced on the lines of my hon. Friend's Bill. It is not all that long ago, as Parliamentary time goes, that Sir William Beveridge made his Report. That was some twenty years ago. He showed clearly that the greatest single cause of poverty in this country was children, the large family. Despite two generations of family planning and propaganda on this matter, the situation is unchanged. We have seen in recent reports that the position is precisely the same today. We have seen, from the work of Professor Abel Smith and Peter Townsend, that one child in six—that is, 2¼ million children—is classified as "poor", and one child in 20 is classified as "poorest". The word "poor" in these terms means families whose total income is below our National Assistance rates, and the incomes of the "poorest" are very much below those rates. Most of the hazards for the children of large families arise from the poverty that results from this tyranny of fertility or uncontrolled maternity, whichever way hon. Members like to look at it.
Various hon. Members have made reference to the growth in the illegitimate birth rate. My hon. Friend the Member for Pontypool (Mr. Abse) was a few thousand out in the figures he quoted, because I believe the figure for 1965 is 68,000 illegitimate births, an increase of many thousands over the 1964 figure. What is alarming about the illegitimate 984 birthrate is not only the increase in numbers, but the fact that the mothers bearing illegitimate babies are going down the age scale. It bears a very similar pattern to the problem of drug addiction. One finds that little girls of 11 and 12 are capable of becoming mothers and are, in fact, becoming mothers. Several local authorities have, in fact, opened mother and baby homes in their areas, and girls of this age are being taken in and are giving birth to unwanted babies.
The hazards to the child that is born in these circumstances start, of course, before birth, when it is still a foetus. Research has shown that the children in these overlarge families are generally smaller and of poorer physique, and so the girls who develop and grow and become adult women, and who, in turn, give birth to large numbers of babies are also at a disadvantage as mothers, and their babies are, of course, at a considerable disadvantage before birth because of the poor physique and the lower standard of life of the mother-to-be.
The National Birthday Trust survey, which was published in 1963, showed that infant loss is 12 per cent. above the average in mothers who are having their fourth baby, while in mothers who have had four babies or more, the increased risk to the baby rose to 54 per cent. above the average. We know that with the increased number of births there is a correspondingly greater risk to the mother, too, from the additional number of babies, and the older she is there is also greater risk from childbirth.
It is very clear that these women and these unborn foetuses are also very much at risk from the attention of the illegal abortionist. I must say quite clearly that my sympathy is all with the women. I run the risk of getting another lot of letters from Catholics who believe I am the "mass murderess of the 1960s"—that is what I have been called by some of my Catholic correspondents because of my active support for the other Bill—but I will say again that we cannot mourn the loss of these foetuses. Our sympathy should be with the mother. The foetuses should never have been conceived, and the pregnancies are rightly terminated in such cases. 985 Those hon. Members who are not too far removed from childhood will remember the nursery rhyme which begins,There was an old woman who lived in a shoe,She had so many children she didn't know what to do.That puts the problem very well. The mother with too many children is old before her time. She becomes prematurely aged. Generally, she lives in overcrowded and very difficult circumstances. She brings up her enormous family on a shoe-string. She often gives up the unequal struggle and subsides in a morass of apathy and carelessness because she is so disheartened. This is the situation which we want to change.
I have in mind particularly the state of affairs in our large towns and cities—my constituency is one such in the Midlands, very near Birmingham—where there are great problems affecting large families. In the Birmingham area, for example, an excellent report recently published by Professor Rex at the university showed that there is a high percentage of overcrowded homes. Very many of these homes are inhabited by immigrant families, West Indians, Indians and Pakistanis. I have this problem in my constituency, too. At my "surgeries", quite a lot of Indian families come to see me about the problem of family planning. Hitherto, my experience has been that many Indians have been ignorant of family planning methods, and they have religious taboos about it as well. But this is gradually being overcome. Sterilisation, of course, is a very drastic solution because it is irreversible in a woman, but quite a large number of women are being sterilised, and a good many men—those who come to see me are certainly given the right sort of advice—are being advised about contraceptive methods which they can use.
Large families perpetuate their own difficulties. For instance, they are never able to drag themselves out of the appalling houses in which it is their lot to live. The families who really need better housing cannot get it because they cannot afford to pay. Both the rates and the rent for the larger houses they need are too high for them.
In the Birmingham city area, the infant mortality rate is 24 per 1,000 live births. In the overcrowded parts of the city 986 where the situation is at its worst, the infant mortality rate is about 30 per 1,000 live births. It is interesting to compare the infant mortality rate for illegitimate births with that for legitimate births. Whereas in the country as a whole the infant mortality rate in 1964 was 20 per 1,000 live births, the rate for illegitimate births was 26 per 1,000. The increase in the illegitimate birth rate creates a greater hazard for babies during their first few months of life.
There is also the worrying increase in what are called "cot deaths" those often unexplained deaths of babies during the first months of life. In overcrowded conditions, there is a higher incidence of this sort of assault—I think that is the right word—on the new born baby. It has been found that 66 per cent. of these cases were of children living in overcrowded conditions and 30 per cent. came from families with four or more children.
The National Society for the Prevention of Cruelty to Children has evidence of some 80,000 children brought to its attention during a year. The N.S.P.C.C. knows a good deal about the battered baby syndrome—there is an analogy here with the cot deaths—the babies which in the first few months of life are so maltreated, so assaulted, so cruelly handled that they either die or are taken to hospital with unexplained injuries—unexplained, at least, in the past, though now it is understood that these babies are assaulted by their parents.
An enormous number of children are treated cruelly in this inhuman way by parents who really ought not to have children at all. Thus, uncontrolled maternity not only causes damage to the mother and aggravates the difficulties for the existing children in the family but it causes ill health among the children and is liable even to affect their mortality.
Overcrowding does other damage to children as they grow to adolescence. As the hon. Lady said, adolescence seems to come earlier all the time, and when I speak of adolescence I have in mind a child from the age of 10 upwards. Serious psychological harm can be done to children brought up in these circumstances. They lack the privacy which they ought to have. The parents, too, lack the privacy which they ought to have. A good deal of future delinquency is created by children being brought up 987 in overcrowded conditions, without privacy, where they see and hear a great deal more than is good for them at an early age.
The National Food Survey in 1962 showed that in large families with four or more children diets were generally inadequate. Surprisingly, this state of affairs spreads right across the social spectrum. It is not only the children of large families in the poorer section of the community who are badly fed or undernourished. The problem is found among better-off families, too. One wonders about this. Why are some middle-class families, apparently, not able to feed this children properly? One is inclined to think that, in their circumstances, perhaps, there is a good deal of "keeping up with the Joneses" at the expense of the children's diet. They are anxious to have holidays abroad and to run one car or two, so something has to give. Apparently, it is the feeding of the family which gives.
A fairly recent London County Council survey showed that there were physical disabilities evident in the children of large families, but there is evidence that such children are at a disadvantage educationally, too. The Crowther Report showed that the probability of children leaving school at the minimum age of 15 rises progressively as the size of the family increases. All these factors militate against the welfare of the large family, putting the children very much at a disadvantage.
Several hon. Members have commented on the fact that the Bill is designed not only to bring help and relief to married women but to bring help to single women as well. I earnestly ask my right hon. Friend to join forces with the Secretary of State for Education and Science and have a thorough examination of what is going on in our schools, or what is not going on in a large number of them. I am a member of a local education authority and a member of the Hertfordshire education committee. Recently, I asked the education authority to do precisely that, and I should like to think that education authorities throughout the country would now examine the nature and level of sex education being given in our schools. I believe it to be grossly inadequate in many parts of the country.
988 Social workers, who are the people most concerned, next to the doctors who deliver the women who give birth to illegitimate babies, will confirm that in innumerable cases the mother, whatever her age, will say that she had no idea of how easy it was to become pregnant. They do not understand the basic facts of life and not understanding these, it is not surprising that they do not know what precautions to take.
When one appreciates that the last published figure by the Department of Education and Science about the number of schoolgirls under the age of 15 who have become pregnant is in the region of 1,300 in a year—and that local authorities have been moved to set up mother and baby homes for girls in this age group—then it is quite clear that there is something fundamentally lacking in the education and guidance given to our young people.
I am not only talking about knowledge of the mechanical means of avoiding pregnancy. I mean the whole picture, the question of the moral education of our boys and girls, and the need for regarding this as something which is of fundamental importance in our schools. It is primarily a responsibility of parents, but with so many parents ignorant and ill-informed it is not surprising that they are not able to help their children. I would support everything that has been said about the need to look at the medical training of our medical students, but I will not elaborate on this, because I think that my right hon. Friend has taken the point.
I hope that he will also give some thought to those local authorities who are at the moment unwilling to give any help, even through the limited powers that now exist, by supporting family planning clinics, and who are refusing to give the help enjoyed in very many other parts of the country. This is a problem, and it would be quite unacceptable to Parliament and the nation, and certainly to all the women of the country, if any local authority were to be able to contract out of its responsibilities when this Bill is passed.
If we can have the joint co-operation of the two Ministries, Health and Education, we can make a very valuable contribution, after this Bill is introduced, towards educating our children at school and this will inevitably bring in the need to educate our teachers as to the proper 989 way in which they can help young people. There is a need for the rehabilitation of mothers after the birth of the child. I support what has been said about the need to give mothers contraceptive advice after the birth of a baby in hospital or in their own home. I particularly want this advice to be followed through when mothers are confined after the birth of an illegitimate child. The rehabilitation of mothers who give birth to illegitimate babies is non-existent, and I would urge my right hon. Friend to study this matter carefully.
I hope that we will go through this Bill very quickly and that it will be unopposed today. When we reach Committee stage I trust that we will find less of the mischievous and ill-informed opposition which the other Bill is receiving in Committee. I hope, too, that we shall find that the suggestions made for looking at the whole question of the monopoly of contraceptive appliances will be examined, so that by this means we can create the sort of social climate which will make it possible for a woman to discuss this urgent and intimate problem with her doctor without inhibitions. My hon. Friend has made a very great contribution to the emancipation and freedom of women by bringing this Bill forward.
§ 1.45 p.m.
§ Mr. Nigel Fisher (Surbiton)
I hope that the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) will forgive me if I do not follow her directly on the points that she has made, partly because I have some regard for other hon. Members opposite who have been waiting patiently for a long time to intervene in the debate, and partly because at this stage practically everything that needed to be said has already been said very well by other hon. Members and especially by the sponsor of the Bill, whom I congratulate as everyone else has, for bringing in the Bill, and for his wide-ranging and comprehensive speech. I shall be brief also because I know that my hon. Friend the Member for Harrow, Central (Mr. Grant) has an uncontroversial Bill for which he would like a little time, if we can get through this debate before Four o'clock.
In congratulating the sponsor of the Bill. I should also like to congratulate the right hon. Gentleman the Minister 990 of Health on his very helpful attitude towards the Bill, and for the help that his Department has given in drafting it. I would also like to pay a small personal tribute, perhaps unusually coming from a member of the Opposition, that in my view he is a good and humane Minister of Health.
The distinction hitherto made between medical and social grounds for family planning was one that I have always thought unreal, and in some cases almost inhuman. Everyone, with the possible exception of my hon. Friend the Member for Southend, East (Sir S. McAdden), would agree with the Royal Commission of 1949, that the provision of advice should be the duty of the National Health Service. If we leave these things to voluntary effort, then we shall almost always come up against a shortage of funds and an uneven distribution of the service in different parts of the country.
Legislation was needed to bring the social considerations within the scope of the service, and we might have had to wait a very long time in the Government's legislative queue, despite the goodwill of the right hon. Gentleman, if this Private Member's Bill had not been introduced. In some areas this would not have mattered very greatly, in my own constituency, for example, we have a very active and successful family planning clinic, which has over double the number of patients now compared to its first year of operation and which carries out a very wide range of work from cervical smears to the training of doctors and nurses in family planning work, many of whom later take up positions overseas.
Although as my hon. Friend the Member for Southend, East pointed out the overseas aspect is not strictly relevant to the provisions of the Bill the hon. Member for Bebington (Mr. Brooks) referred to this aspect in his opening speech, and I should like very briefly to say something about it. The need for family planning in the developing countries is very great. I had a little experience of this in office, and the case for it is overwhelming. The hon. Gentleman mentioned India and China, where the need is clearly greatest of all, but even in the little territories for which I was responsible as a Minister in the 991 Colonial Office in the last Government, the need is very great. In the West Indies, the Indian Ocean Colonies, such as Mauritius and the Seychelles, in some of the Pacific Ocean Colonies, and in many other areas, even including the Mediterranean, the growth in population far outstrips the resources of the territory concerned. However much aid is received, it cannot create enough employment to give the people who live in those countries the work, dignity and self-respect to which they are entitled.
Family planning lies at the root of all these things—employment, immigration, higher living standards and so on. It is indeed the only long term solution and the only long-term hope for countries like India. It is a very difficult issue, as we all know, in Roman Catholic communities and I do not minimise the problem of conscience involved. But equally, I do not understand the attitude of mind which opposes both abortion law reform and family planning at the same time. Surely prevention is better than cure. It must be better to encourage birth control than to be forced to legislate about abortion—and I say that as a supporter in principle of the abortion Bill now in Committee upstairs.
Of course, the hon. Member for Bebington is right in saying that we should give the lead here at home in Britain, where there are many many families which, through ignorance or apathy or poverty, do not now avail themselves of the existing facilities; and it is now for the Ministry of Health to take the initiative made possible by this Bill and to make this service part of the National Health Service.
The seal of official approval is important in creating a better climate of opinion in this respect and it could be of very real value, quite apart from the impetus which will be achieved by removing the financial inhibitions for the less well-off. I stress the word "less" because I agree with the hon. Gentleman that, although advice should be free, and supplies also should be free to those who cannot afford to pay for them, supplies should not be free to those who can afford to pay for them.
We should not always demand Government economy in principle and at the 992 same time greater Government expenditure in practice for the particular causes in which we ourselves are interested, but I am afraid that such a tendency is a besetting sin of politicians. It particularly applies to politicians who happen at the time to be in opposition but it also applies to hon. Members who have never held office in Government and who have not therefore, been as it were, at the receiving end of the requests. It is not wrong in my view to regulate demand by payment provided the payment is within the financial capacity of the payer.
I do not want to introduce a discordant note but by the same token I think it was wrong to abolish indiscriminately and universally the prescription charges. This has added many millions of pounds, quite unnecessarily, to the nation's drug bill but that is a different and rather more controversial issue and I will not go further into it, except to say that, as a director of a group of pharmaceutical companies, I cannot really complain, however much, as a taxpayer, I feel it to be wrong. As my hon. Friend the Member for Leominster (Sir Clive Bossom) pointed out, we can have our eyes tested free but we have to pay for our glasses. So, here, one can have the advice on family planning free but I think that one should pay for the supplies if one can afford to do so.
I hope that one result of the Bill will be to increase the demand for help. If so, more trained doctors and nurses will be needed and I would expect there to be a requirement for some financial assistance from the Government for their training. I do not think this need be on a very large scale. I believe that the Family Planning Association could cope with this training with the help of a small Government subsidy, possibly of about £10,000 a year.
A number of hon. Members have also mentioned the problem of the unmarried girl. I understand the fears about encouraging promiscuity in the young. The hon. Gentleman the Member for Bebington gave the figures of illegitimate births and I need not repeat them. To understate it, they are very disturbing. Young people are very much more grown up nowadays in this as in other ways than they were in my generation at the same age. My son tells me that a boy or 993 girl of 17 or 18 is equivalent to someone aged 21 or 22 when I was young, and I believe this to be true.
Marriages take place, which really should never have taken place, in order to legitimise unwanted children, and that is one of the seeds of divorce. Abortions take place to prevent the birth of illegitimate children and that is the seed of squalor and misery and sometimes even of death or suicide. The Bill does not exclude unmarried girls and it is absolutely right that it should not do so. But if family planning instruction is given to unmarried girls at the same clinic as to married women, it might be wise to give it to them at different sessions, so that if the married women do not want to be bracketed with the unmarried girls, they need not be.
This is a good Bill, a progressive Bill and a necessary Bill. It is a nonpolitical and non-party Bill dealing with a human problem in a humane and imaginative way. I hope that it will receive a speedy passage to the Statute Book.
§ 1.57 p.m.
§ Mrs. Gwyneth Dunwoody (Exeter)
I am delighted to take part in the debate and I should like to join in the congratulations to my hon. Friend the Member for Bebington (Mr. Brooks) on choosing this subject for his Bill. However, having said that, and having thanked him for allowing me to be one of the sponsors, I hope that he will not feel me ungracious if I criticise one or two aspects of it which have occurred to me and which I do not think have been altogether brought out in the debate.
We might be misled by the almost universal praise in the speeches into believing that the whole battle of the Family Planning Association has been won, but I think that it will be felt in some areas that the Association is still fighting very hard even for rudimentary recognition. If I have any reservations about the Bill, one is that local authorities are still to be given a certain amount of leeway in deciding whether or not they will provide these facilities.
I come from a part of the country which has difficulties over some of its local authorities and I hope that my right hon. Friend will be quite strict in his application of the Bill and will urge forward those local authorities which 994 might drag their feet to ensure the provision of these facilities to women who live in rural areas as well as to women living, in large urban centres. In the country, although perhaps we do not provide as many statistics, we have quite as frightening problem families as those in urban constituencies.
I hope that no one will consider me to be ironic when I say that I welcomed the intervention by the hon. Member for Southend, East (Sir S. McAdden) because I believe that his rather bewildered indignation was indicative of the sort of dual standards we quite frequently find in this country. We live in a society which has elevated hypocrisy almost to a way of life and it is difficult to get through to people the fact that we cannot, on the one hand, subject our young people to all the enormous pressures of advertising, the so-called "permissive society" and the rest, leading them to believe that they can lead on open sexual life, and in the next breath condemn them bitterly when they produce illegitimate children, make them suffer enormous stigma and refuse them the practical assistance they require.
If I am asked whether it is better that a 16-year-old girl should go through the traumatic experience of producing a child, keeping it with her for a few weeks and then having to go back to lead a normal sort of life, or that she should have been offered the sort of contraception advice suggested in the Bill long before that, then I answer that no problem of morals is involved. She must be offered contraception advice long before it is too late.
A difficulty in this, above all other matters, is that this is a human problem. One cannot stress too strongly the black despair felt by a young mother, perhaps living in furnished accommodation without sufficient money to go round, with two or three small children, suddenly finding that she is pregnant again. The Bill seeks to help her.
I hope that we will be able to insist on proper and decent premises being provided for clinics. People tend to underestimate the enormous nervous decision which many women must take before finally deciding to go to a family planning clinic. In many cases women must steel themselves to go there for the first time and seek the advice which they 995 desperately need. If, when a woman arrives at a clinic, she finds that she must discuss very intimate details when seated behind a small screen in a room in which lots of other people are waiting, possibly able to hear what she is saying, she may turn tail and run away. I hope, therefore, that local authorities will be obliged to provide decent premises for clinics.
As hon. Members have pointed out, the woman who most needs this advice is the one least likely to seek it. The middle-class woman who is fairly articulate—and has at her command a reasonable relationship between herself and her local general practitioner or welfare authorities—is not so in need of this sort of encouragement. It is the very simple woman, who is unable in some cases to even understand what the word "contraception" means, who is most in need of encouragement. This was brought home to me forcibly not long ago when speaking to a lady with a large family. She said, "The doctor is keen on this conception business, isn't he, Madam?" and, after thinking about it a little longer, she asked, "What does it mean?". It is this sort of person we seek to help. The provision of these services by hospitals is essential, because in many cases speed is all-important, particularly when dealing with the problem family. When a mother has just produced an addition to her family is the time when she should be given this advice.
I hope that when we discuss this Measure in Committee we will be able to debate it in the informed and cool way that has been a feature of this debate. This is a highly important piece of legislation and it is to be hoped that it will rapidly go on to the Statute Book and that, when it becomes law, it will receive the sort of publicity that will make its provisions clear to those who do not normally read such things as local authority handouts.
I greatly welcome the Bill, not least because one of the reasons why there are so few married women with children in this House is because women have not until recently been able to plan their future with the degree of certainty that is given to males. I again give the Bill my warmest support and can only add that the sooner it becomes law the better.
§ 2.4 p.m.
§ Miss Mervyn Pike (Melton)
I intervene briefly to welcome the Bill and to add my congratulations to those of other hon. Members to the hon. Member for Bebington (Mr. Brooks) not only for introducing the Bill but for the excellent way in which he addressed the House.
In welcoming the Bill I must express some regret that it is not a Government Measure. This is probably one of the most important social questions we are facing today and it is regrettable that more and more Governments are using the device of helping the private Member to bring forward such Measures. I speak rather as a gamekeeper turned poacher because I recall from my experience at the Home Office that this is one of the favourite methods of proceeding. This is an important matter and I wish that the Government had themselves introduced the Bill.
I frequently find opportunities to criticise the Minister. I dearly wish on this occasion that I could have congratulated him on being the first Minister to have the political courage to bring forward a Bill of this nature. As has been said, the right hon. Gentleman has certainly made social history in giving official approval to the practice of birth control. I will keep calling it "birth control"—further to the remarks of the hon. Lady the Member for Exeter (Mrs. Gwyneth Dunwoody)—because many people still do not understand what the word "contraception" means. I have trained myself to use simple words because when talking about this matter it is usually those who do not understand long and complicated words whom one is trying to assist. The Minister is moving forward in this matter and I hope and believe that he will give all possible support to the Bill. Nevertheless, it would have been valuable to have had all the steam that is given to a Government-sponsored Measure behind the Bill.
No significant opposition to the Bill has been expressed today, and this is probably indicative of the mood for the country as a whole. This leads one to the conclusion that the Measure may be coming forward rather too late. We in Government—and I say "we" because I accept responsibility for the years when the Conservative Party was in office, I do that as well as to some event censuring hon. Gentlemen opposite—who 997 have a responsibility for social matters should be well ahead of public opinion in these rapidly changing times. It is not enough to be going along with public opinion and to act just when public opinion has reached acceptance of these difficult and often controversial questions.
One of the main reasons why I wish this could have been a Government Bill is because the medical profession must be given every possible encouragement in this matter. A great many G.P.s do a tremendous amount to help, but there are still far too many who leave this work to somebody else to do. This is a problem in the solution of which we need the positive involvement of the medical profession as a whole.
One must recognise—and I have a particular responsibility to voice these views—that a great many people do not agree or approve of this Measure, although very little of their objection has been heard in this debate. A great many people, particularly in my constituency, still hold very strong religious objections to birth control and that is why we particularly welcome the fact that the Bill allows local authorities to give advice on those means of contraception which are endorsed particularly by the Roman Catholic Church.
Many people are asking why family planning facilities and advice should be provided through the State. The answer is simple. It is because, fundamentally, only the State can give the necessary universal service that is required. Although it is a universal service, like other hon. Members I do not believe that it should necessarily be a free one. It is the sort of service to which people should make their own contribution. As hon. Members know, I advocate more and more personal contribution to the services we receive. Nevertheless, I hope that the charges will be kept minimal because in these matters we are often dealing with young married people whose financial burden is at its height when advice of this sort is most needed. I appreciate that there will be income-testing and that those who cannot afford to pay will not be called on to do so. Nevertheless, when we talk about testing incomes we may sometimes forget those who are just on the margin—those who are, at it were, hit for absolutely everything. It is only the State which can 998 provide a universal, but not necessarily a free, service.
But, most particularly, this is related to one of the most serious and worrying social problems which we are facing at the present time. I shall not repeat many points which have been made by hon. Members in their speechs today, but the aspect of this Bill which most concerns me personally is the aspect of the domiciliary service, because it is here, I think, that we can bring the greatest social benefit to the people of this country. I have had some opportunities of going round with doctors who are operating the domiciliary service, and I know from the little experience that I have had that not only are they able to give very welcome advice on contraception but that they can also give so much emotional reassurance to families, and particularly to women, needing this advice.
So although the Bill is in very vague and broad terms—of necessity, no doubt—I hope that one of its main outcomes will be a great strengthening of the domiciliary service, because it is in that respect that we need to put a great deal of steam behind this type of social service, and particularly—and this has been touched on by only one or two hon. Members—the services which we give to many immigrant families. They have added disadvantages. They have the language disadvantage; very often they do not understand our customs; they do not like going to our clinics; they are very often people who can be reached only through the domiciliary service.
The Bill provides that there should be charges. G.P.s at present can charge 10s. 6d. for prescriptions for social reasons. I would suggest looking at some of the other charges. Five guineas for some advice seems to me a particularly high fee. As I said earlier, I hope that we shall see that these charges are kept as low as possible. This is a matter not only related to social problems; it is related to medical problems. Medical care is a responsibility of the State, and, therefore, this needs all the resources of the National Health Service behind it.
The main part of the debate has focussed on the need to help the problem family and the large family. On both sides of the House we have talked a tremendous amount about the burden on the mother having children she has not 999 wished to have and, very often, does not wish to bring up. Equally, however, there is the burden on families where the mother and the father are good parents. We sometimes forget the burdens on the children in large families. Statistics show that even where the incomes may be quite reasonable and sometimes even quite high, the children in large families are often stunted in growth, very often find greater difficulty at school, do not stay on as long at school.
In very large families there are compensatory advantages, no doubt. I always wanted to be a member of a large family. I had only one brother, and I always thought how wonderful it would be to be part of a large family. However, statistics show that great burdens are put on the children in large families, and very often the parents, in planning the future of themselves and their families, do not necessarily pay sufficient regard to the battle which, sometimes, their children will have.
So when we are looking at this problem do not let us look at it only from the point of view of the parents, important though that may be, and not only from the point of view of children in large families where there is a low income, but let us remember the burden on large families as a whole. If parents wish to have large families, if they plan for large families, if they are willing to take on the responsibilities of large families, well and good; but we must make certain they have the facilities for planning the size of the family according to their own ability to discharge the whole of their responsibilities.
There is, of course, as we have said, the problem as well of ignorance and shyness, and this, I think, is a certain kind of false modesty or personal modesty which people have. This again is one of the reasons I am sorry that this is not a Government Bill, that we are not seen as a State to be saying that this is something which we think good in itself, that it may be only a psychological mood or attitude of society as a whole, but it is recognised here now, at this stage in our development as a society, that we believe these facilities should be provided universally for everybody, so that all can have the treatment and the advice and the 1000 facilities. I think that to some extent this does break down the problem of shyness and personal modesty.
If this is shown to be something which the State takes on as its responsibility, then I believe that we shall get more and better sex education throughout the whole of our society. Surely the extension of good sex education can do more than anything else for the physical and mental health and well being of the great majority of our society as a whole.
I said I was going to welcome this Bill very briefly, and I know that there are yet some hon. Members who want to speak, and also that there are other Measures to come before the House today, but I would like to ask the Minister one or two questions.
In the first place, he will ensure, I am certain—but I should like a reassurance—that no doctor who has moral or religious objections to it will be forced to lend his assistance.
Again, there is the question of parental authority. There are parents, maybe misguided parents, who do not wish their young unmarried children to have this type of advice. Much as we may disagree with their outlook, we must have regard to the rights of parental authority.
We have mentioned the difficulties of giving this advice to unmarried adolescents, and there is no doubt that this is a very difficult problem which is fraught with different contradictory arguments. The article this week in the New Statesman, to which reference has been made, posed those problems, and certainly we cannot say, if we have more family planning advice, we are going to cut down promiscuity, we are going to cut down illegitimacy. Statistics do not prove this at all. They may show that we are going to increase promiscuity, we are going to increase illegitimacy, and, of course, there are those people who, properly, fear that we are getting too permissive in our society as a whole, and we must have regard to those fears.
Nevertheless, I am sure that the majority of us, particularly those of us who have had experience in this field, recognise that it is those adolescent unmarried people who probably would benefit as much as anybody from wise advice on family planning. It is not only 1001 the advice on contraception itself; it is the advice upon the whole attitude towards sex, and it is that advice which is so important for these young people. Nevertheless we must have regard to parental authority.
Then again, there is the burden that this could place on the National Health Service. That, of course, can be overestimated, because if we can cut down the births of unwanted children we release so much of the pressure on the Service as a whole. I think the suggestion made about part-time women doctors is a very useful one. There are a lot of women doctors now who are anxious to come back, but who can give only a small part of their time, and who ideally could be used for this side of the service. If that is to be done properly—and, if it is to be done at all, it must be done properly—it will mean more cost and a heavy demand upon the National Health Service. In that context, the hon. Member for Exeter made a valid point in saying that these clinics must be adequate in every sense of the word. If we are to get people to come along who are diffident about coming and who in the past have not taken steps to come, we must be certain that we have the sort of facilities which will encourage them to accept the advice which is offered.
Will the Minister also give us an assurance that the omission of the hospital service in the Bill will not cause a fundamental weakness in it? The point has been made and re-emphasised, and it does not need making again by me. It is in the hospital service that possibly we have the most fruitful source of really good advice on the problem. It is in the immediate post-natal period that one can give advice in a form which will not only be acceptable but will be remembered by so many women.
Normally, the general practitioner is the person to go to for advice on the subject, because it is all part of a much greater problem of personal, married and family life. The general practitioner has a tremendous part to play in this service.
There are arguments on both sides, but the debate has shown that the balance of argument is in favour of the Bill. We on this side, like all hon. Members who have spoken so far, wish to see the Bill improved and strengthened. In Committee, we hope that we shall be able to 1002 give the Bill the strength which it needs, so that it can go some way towards meeting a very serious social problem and all the other problems which have been so eloquently outlined by hon. Members during the debate.
§ 2.22 p.m.
§ The Minister of Health (Mr. Kenneth Robinson)
Perhaps it would be for the convenience of the House if I were to intervene at this stage to give the Government's view, without wishing in any way to conclude the debate.
First of all, I wish to pay my tribute to my hon. Friend the Member for Bebington (Mr. Brooks) for the eloquent and humane speech with which he introduced the Bill. It has set the tone for what has been an unusually thoughtful and constructive debate. The subject matter has a considerable bearing on the health and happiness of our people, and my hon. Friend is to be commended for his public spirit and enterprise in promoting so important a piece of legislation.
Although the Bill relates to England and Wales, I think that my hon. Friend was right to set the problem against the world background. In so doing, he mentioned the name of Sir Theodore Fox, the Director of the Family Planning Association. I would like to call the attention of hon. Members to a lecture which Sir Theodore delivered, the sub-title of which was mentioned by my hon. Friend. It was published in the Lancet under the title "The Multiplication of Man, or Noah's New Flood". I should like to quote to the House one brief passage from that lecture, in which he said:What is alarming is the gathering speed with which population is rising. To work up to the present total of about 3,400 million men, women and children has taken hundreds of thousands of years; but, as we are going, a second 3,400 million will be added in only 35 years. This would give us nearly 7,000 million by the end of the century—which is not unlikely. After that, if today's birth and death rates were to persist, our race would go on doubling itself at shorter and shorter intervals until the earth could offer standing-room only.It is worth just pondering those thoughts.
May I say at the outset that this is a Bill which has the support of the Government and one which I am happy to commend to the House. To judge from the discussion that we have had on it so far today, apart perhaps from the single 1003 contribution of the hon. Member for Southend, East (Sir S. McAdden), there appears to be general agreement on the need to extend the existing powers of local health authorities in the way proposed in Clause 1(1) of the Bill so that they will be able to make arrangements for the provision of advice and treatment in connection with contraception to any persons who seek them. By the word "treatment" I mean the prescription and supply of drugs or appliances for that purpose.
It seems to me wholly appropriate that the front line in this campaign of enlightenment should be the local health authority, with its special responsibility for community care, for health education and for preventive health services. That is why my hon. Friend rightly, in my view, has concentrated on the extension of local authority powers in respect of family planning.
As the law now stands, local health authorities are empowered to provide family planning advice and treatment only to those women for whom pregnancy would be likely to be detrimental to health. The limited extent of their powers was a fact of which I became aware when reviewing the subject of family planning shortly after taking up my present office. I must confess that this limitation in local authority powers came not only as a surprise to me but also as a disappointment, because there is a large body of opinion, growing all the time, that would like to see family planning advice and treatment made more widely available through local authority arrangements to all who need it, on social as well as strictly medical grounds.
As many hon. Members have pointed out, it is correct that no distinction is drawn in the Bill between the married and the unmarried and, as drafted, the Bill would be wide enough to enable local authorities to give advice and treatment to unmarried persons. In that, the Bill merely repeats the position existing in relation to advice and treatment given on medical grounds under the present law to unmarried as well as to married women. This is a matter which this House can leave to the discretion of individual local authorities, who will no doubt have regard to local public opinion.
1004 It is generally accepted today that voluntary parenthood is an important factor in strengthening family life. I am convinced that it is an essential aspect of family welfare. It is on that account that I sent my circular on family planning to local health authorities just a year ago, encouraging them to make the fullest use of their limited powers. As I said then, in my view, planned parenthood promotes happiness. It is lack of planning, often due to ignorance of effective methods of contraception, which may lead to misery, ill-health, social breakdown and, in extreme cases, even to criminal abortion and death. We all know that unhappy homes and strained family relationships can be as destructive to the full life of the individual and, indeed, of the community as the ravages of physical disease. The provisions of the Bill, when it reaches the Statute Book, will enable local health authorities to do far more to prevent the emergence of these social problems.
As I have said, a year ago I invited local authorities to review their present arrangements for education and advice in family planning, and I indicated some ways in which they might extend and improve them. My Department has recently made some inquiries about the action taken locally in response to that approach. From the information so far collected about the present practice of local authorities, I find that, almost without exception, they provide a family planning service for women to whom pregnancy would be detrimental to health, either directly or by supporting a voluntary body—usually the Family Planning Association—or by a combination of both. The impression which I get of the local authority activity is of continuing expansion and of a readiness to do still more.
§ Mr. Peter M. Jackson (The High Peak)
Can my right hon. Friend say whether his comments regarding the provisions of the local authorities apply to the county borough of Bootle?
§ Mr. Robinson
I was speaking generally and, offhand, I have not any statistics relating to the county borough of Bootle.
Perhaps I should say a few words about the part played by general practitioners and the hospital service in the provision 1005 of family planning services. Both these matters have been taken up by several hon. Members. A general practitioner in the National Health Service is free to decide whether or not he will give family planning advice in cases where there is no medical need, and this I think answers one of the points raised by the hon. Lady. If he decides not to do so, he may well refer his patient to the local authority service, and of course his patient is free to change to another National Health Service doctor who is willing to advise her. Advice is free, and in cases of medical need, that is where a woman is likely to suffer detriment to her health as a result of pregnancy, a drug may be prescribed and supplied free. In cases where no specific danger to health is involved, the doctor may charge for prescribing drugs and the prescribing and fitting of appliances, and the chemist will charge for their supply.
I noted what the hon. Lady said about certain charges, but I must point out to her that these are within the realm of private practice, and consequently I have no standing in this matter, although I have told the medical profession that I shall watch what happens as a result of these new arrangements.
As regards the hospital service, which has been mentioned by my hon. Friend the Member for Bebington, and by many other hon. Members, under existing arrangements it is open to hospital authorities to provide family planning facilities free of charge through their gynaecological departments if needed on medical grounds. Some hospitals provide a service direct, while others make use of Family Planning Association clinics which are sometimes on hospital premises, and I will gladly consider the possibility of giving fresh guidance to hospital authorities in the context of this Bill if it reaches the Statute Book.
If cases are referred by a hospital gynaecological department to the Association's clinics, it is customary for a per capita payment to be made to the Family Planning Association by the hospital authority. Attractive as it may be in some ways to place additional duties on hospital authorities in this regard, I would ask hon. Members to recall that our gynaecological departments are 1006 already among the hardest pressed sectors of the National Health Service.
It might, I think, assist the House if I were to comment very briefly on two points in the Bill which provide for action by me, and give some indication of the course which I would propose to follow if the Bill became law.
The first point is that of directing local authorities to make arrangements. Clause 1(1) is drafted so as to enable the Minister to give a direction converting the powers of a local authority to make arrangements into a duty to do so. Whether and in what circumstances this power of direction should be invoked must remain open. I have similar powers in relation to arrangements for providing other services, and it is always a matter of judgment, in the light of events, whether it should be exercised. I certainly would not contemplate exercising it under the Bill at present.
As I have said, local authorities have responded very well to the encouragement given a year ago to develop their services to the fullest extent possible under existing powers. There is plenty of evidence that many authorities regard this proposed extension of their powers as long overdue, and there seems little doubt that the enactment of my hon. Friend's Bill would provide a considerable stimulus to further action on their part. I should expect to give guidance to authorities in due course about making arrangements under the Bill for providing services, and I should watch their progress and call for reports on it.
The second point to which I wish to refer is that of charges, a matter which was referred to particularly by the hon. Member for Leominster (Sir Clive Bossom), and some others. Clause 1(2) empowers a local authority, subject to my approval, to recover such charges for the provision, advice, or supply of substances or appliances as the authority considers reasonable having regard to the means of the recipient. This again is a power which I have under the National Health Service Act in relation to similar services, and it is important to note its precise form.
There is no power under the Bill to require a local authority to make a charge. A local authority could decide to make no charge at all. It is my view 1007 that no charge should be made where advice and treatment are given on medical grounds, and this is already the position. If, however, they are given on social grounds, my view is that local authorities should be able to make a charge, except to those who cannot afford it. It follows, therefore, that if the Bill is enacted I should envisage giving approval to local authorities to charge on the basis that advice, prescription, and supply should be free in medical cases, but that a charge could at the discretion of the authority, be made for prescriptions or supplies in non-medical cases. Local authorities are well accustomed to deciding whether or what to charge for services which they provide, and in deciding whether the service should be received free of charge they normally apply the scales used by the Supplementary Benefits Commission.
§ Sir D. Renton
Would the right hon. Gentleman go back to a point with which he dealt only very briefly? When he was dealing with the maternity services within the National Health Service, he merely said that the gynaecological services were so hard-pressed that we could not ask them to do any more. But if we asked them to do this work, would not it mean that they would become less hard-pressed?
§ Mr. Robinson
That is a possibility, but I am thinking of the immediate present. They are under great pressure, and I think that I would hesitate to put additional duties on them. There is no question but that they are currently giving contraceptive advice on medical grounds, which is their primary function, and I think that for this service the primary authority should be the local health authority, for the reasons which I gave earlier.
§ Mr. Floud
Does not my right hon. Friend agree that a considerable amount of time is spent by gynaecologists in hospitals in dealing with the aftermath of abortions, and that if they could spend that time more fruitfully in giving contraceptive advice a substantial part of that work would not be necessary? My right hon. Friend seems to be looking at the matter the wrong way round.
§ Mr. Robinson
It may be that if one takes the long-term view that could be so, but I can only repeat that at the 1008 moment I would hesitate to place additional duties on gynaecological departments. It is a somewhat academic exercise to discuss this, because I am advised that it would be outside the long title of the Bill.
§ Dr. David Owen (Plymouth, Sutton)
Will my right hon. Friend consider giving guidance to general practitioners and hospital doctors that when they undertake post-natal examinations six weeks after birth they might introduce the subject of birth control?
§ Mr. Robinson
I think that that kind of guidance from a Minister to members of the medical profession would probably be somewhat resented, but I take note of what my hon. Friend has said. Perhaps I should mention at this point that the person who regularly sees the mother who has recently had a child is the health visitor, and I think that the health visitor is the appropriate person to give advice and introduce this subject to mothers with young children.
As I have indicated, the proposals in the Bill for reforming the present law have the Government's support. My colleagues and I agree that the existing powers of local health authorities in England and Wales to provide family planning services need strengthening. These present powers make no provision for advice and treatment on other than medical grounds. Social attitudes have changed very considerably, and public opinion has moved far since this policy was first expounded in Departmental circulars in the 'thirties, which, as my hon. Friend mentioned, were the only official guidance on this subject until my circular of last year. I am confident that there is now widespread support for making family planning services available, whether or not a doctor is satisfied that ill-health would result to the woman concerned if, in the absence of advice and treatment, she became pregnant. The debate that we have had suggests that the Bill is widely welcomed and informal consultation with the associations representing local authorities who will have to carry out its provisions confirm that it will be generally acceptable to them.
I should like to quote from my earlier circular:An adequate family planning service, fully integrated with other community services, will 1009 not only contribute to the dispersal of ignorance and fear and to the increase of happy family life, but will also relieve the burdens placed on other local authority services by the physical ill-health and mental distress which so frequently arise from lack of knowledge and advice.
§ Sir S. McAdden
The right hon. Gentleman has been kind enough to give guidance on a number of points that have been raised. Will he deal with the point raised by the hon. Member for Pontypool (Mr. Abse) and let us know whether the Government's view is that the London Rubber Company should be nationalised?
§ Mr. Robinson
As the hon. Member knows, that is a matter entirely for my right hon. Friend the President of the Board of Trade.
The hon. Member for Leominster and the hon. Member for Melton (Miss Pike) said that they were disappointed that this was not a Government measure. An hon. Member said that he wondered whether, if my hon. Friend had not been fortunate in the Ballot, we would have had this legislation. I can assure that hon. Member and the House that it is not on account of the controversial nature of the Bill—if it is any longer controversial—that it is a Private Members' Bill rather than a Government Bill. I can assure the House that if my hon. Friend had not been fortunate in drawing an early place in the Ballot, legislation on these lines would have been sponsored by the Government. It is a question of timing more than anything else. The hon. Lady the Member for Melton knows that one of the most precious commodities of a Government is legislative time. I was satisfied that we would have had to wait for this legislation if my hon. Friend had not brought it forward. Therefore, I welcomed his initiative and I have given my hon. Friend every encouragement over the Bill. The important thing, surely, from all our points of view, is that this legislation should get on to the Statute Book at the earliest possible moment.
Towards the objective that I have just outlined my hon. Friend's Bill represents a significant step forward. He is to be congratulated on making such excellent use of his good fortune in the Ballot and in bringing forward a valuable and progressive Measure, which I can warmly commend to the House.
§ 2.44 p.m.
§ Mr. Peter M. Jackson (The High Peak)
I, too, add my congratulations to my hon. Friend the Member for Bebington (Mr. Brooks) on his fortune in being able to bring forward this Bill. I know that other hon. Members wish to speak and that other matters are before the House, so I shall be brief.
I want first to comment on the point raised by many hon. Members, that the Bill is very limited in scope in referring purely to local authorities and not to hospitals. In view of the almost unanimous voices of criticism of the Bill in this respect, I had hoped that the Minister's reply would be more helpful than it appears to be. I want to draw my right hon. Friend's attention to a recent Act passed in Denmark on 8th June of last year. The operative section provided:In connection with the examination the doctor or the midwife should give necessary guidance regarding maternity hygiene, and at the first examination after pregnancy the doctor should inform the woman of any health problems in connection with a possible new pregnancy. The doctor should offer advice concerning contraceptive methods or if the doctor does not wish to give such information himself or if the woman does not want to receive such information from the doctor in question, he should refer the woman to a Maternity Aid Institution or other Medical guidance.Other hon. Members would join with me in hoping that this kind of legislation would be brought forward today.
There is a clear need for this kind of service. I draw my right hon. Friend's attention to a recent survey undertaken by the Department of Obstetrics and Gynaecology at the University of Sheffield. It was a limited study of 100 newly-delivered mothers. Thirty-one did not want contraceptive advice but 69 wanted such advice. The significant fact is that 56 of those 69—a clear majority—wanted this advice to be given by the hospital. It is not enough to say that this is primarily the responsibility of the local authority and that the local authority will undertake to service adequately.
There are reserve powers in the Bill. I am pleased to hear what the Minister had to say. He clearly intends to chase local authorities in this matter and to 1011 see that they are undertaking their obligations under the Bill. I suggest that this is very needful. I would draw the Minister's attention to the situation in Bootle. Following his recent excellent circular, the health committee of the county borough made a recommendation to the general council that a grant should be given to the local family planning association. We all know that this local authority is controlled by Labour. This matter was considered in the Labour group, and it decided against accepting the recommendation. The whips were put on, and when the matter came into the open council it was rejected. Theology won, I suggest.
I would also draw my right hon. Friend's attention to an interesting speech made by my hon. Friend the Member for Bootle (Mr. Simon Mahon) on that occasion. In justifying the action which had been taken by the local authority he said that it was "not an ethical or religious argument". One wonders quite what is was if it was not ethical or religious. He insisted that the intervention of a local authority in the field of birth control at this time would be mistaken and untimely.
§ Mr. Jackson
The hon. Gentleman said that those who wished to have family planning advice could get it under the National Health Service. It seems that we are wasting our time today, because my hon. Friend assures us that we already have an adequate service under the National Health Service.
§ Mr. Jackson
Yes, indeed. I hope that in cases such as Bootle the Minister will use the reserve powers at his disposal.
The question of a domiciliary birth control contraceptive service has been touched upon adequately and I shall not refer to it in detail.
I echo the comments made about inadequate birth control and contraceptive information given to medical students and nurses. My hon. Friend the Member for Pontypool (Mr. Abse) referred briefly to a study recently undertaken at 11 London 1012 teaching hospitals, indicating that only one gave anything other than a perfunctory lecture and the odd demonstration. A Royal Commission is considering medical education at the moment, and I very much hope that my right hon. Friend's Department will make a representation to that Royal Commission suggesting that the medical profession should take much more seriously than it has in the past the question of birth control education.
I want to quote a comment which I gather is quite typical among gynaecologists and obstetricians. One of them said, "I cannot imagine anything more boring than to spend all day fitting women with contraceptive devices." This is typical of many members of the medical profession. The quotation goes on:Like a lion which has tasted blood, I enjoy operating".He had 400 patients awaiting operations and this was where the excitement lay. He concluded, rather condescendingly:I dare say family planning is all right for women who qualify, are married and then get tired of housework.I do not think, therefore, that we shall get much assistance from gynaecologists and obstetricians in this matter——
§ Dr. David Kerr (Wandsworth, Central)
Will my hon. Friend accept my personal assurance that this is not a widespread point of view among my colleagues?
§ Mr. Jackson
I am grateful for that information, but I am sure that my hon. Friend will agree that it is a view prevalent among at least some of the members of his profession.
Family planning and contraception should be regarded as an aspect of preventive medicine and I hope that this view will be accepted by our teaching hospitals.
The occasion is appropriate to some reference to the pioneer work by people like Francis Place, Richard Carlile and Richard Dale Owen. Many people suffered in the cause which we are now debating. Many people, Richard Carlile in particular, spent time in prison for issuing a tract giving advice to the working classes in the 19th century on how to regulate their families. 1013 Francis Place also played a leading part in this campaign. In his "Illustrations and Proofs of the Principle of Population", published in 1822, he said:If … it were once clearly understood, that it was disreputable for married persons to avail themselves of such precautionary means as would, without being injurious to health or destructive of female delicacy, prevent conception, a sufficient check might at once be given to the increase of population beyond the means of subsistence; vice and misery, to a prodigious extent, might he removed from society, and the object of … every philanthropic person, be promoted, by the increase of comfort, or intelligence, and of moral conduct, in the mass of population.It was for this purpose that we were elected and it is in this spirit that I hope that the Bill will be given a Second Reading.
§ 2.52 p.m.
§ Mr. Donald Dewar (Aberdeen, South)
I hesitate to add my congratulations to my hon. Friend the Member for Bebington (Mr. Brooks), as he may be becoming a little blasé, but he deserves them for a Bill which, although not as important or earth-shaking as some hon. Members claimed, is still an extremely useful extension of local authority powers in their unfailing fight against poverty and disorganisation in society. The most outstanding feature of the debate has been its unanimity. With one rather disorganised exception, hon. Member after hon. Member has risen to commend the Bill.
Everyone has, I think, now accepted that there is an unanswerable case for family planning and for the dissemination of the ideas and information which must make up any effective programme. The case was well put indeed it has never been more eloquently or concisely put than in the Ministry of Health circular which has been quoted in the debate, in which, lucidly and simply, and strengthened by the dry official context in which it appeared, the Minister stated his own faith in the value of such services.
It is also right that the weight of the debate has been put upon the unfortunate social consequences of large families in certain circumstances. There has been no suggestion—as my hon. Friend stressed—that this is an effort to deprive people of the right to have a large family if they want it. I would 1014 never say that there was anything wrong in having a large number of children if the decision were consciously taken, and all the social and economic factors had been weighed. The trouble is that a large number of parents cannot take that decision; owing to lack of knowledge or lack of resolution, they bear the burden of an increasing clutter of children and do not know how to prevent this happening.
We all know that it is in families like this, in depressing social circumstances, that one finds the human tragedies and the raw material behind the serious statistics of family poverty which are of increasing concern to the House. It is common ground that the situation as it existed was an untidy halfway-house, an unsatisfactory compromise, as my right hon. Friend made all too clear in his circular.
My hon. Friend the Member for Pontypool (Mr. Abse), in the Adjournment debate which has also been quoted today, described the circular and the argument in which the Minister, with the best of intentions, had used as "tortuous." We now have a Bill to fill the gap. I am happy to welcome it to the House.
In a speech so able and comprehensive, my hon. Friend the Member for Bebington ensured that there would be a certain amount of repetition in the debate. I thought that I at least would be unique in my concern that the Bill applies only to England and Wales, but I am glad that the point was made forcefully by my hon. Friend the Member for Pontypool, who does not come from Scotland. I can see no justification for this important Measure not extending to the whole of the United Kingdom.
We have referred to Circular 5 of 1966, the Minister of Health's first pronouncements on the subject. The very same circular, the same arguments, the same phrases down to the last dot and comma, were repeated, of course, in the Health and Welfare Services circular 10/66 produced by the Scottish Home and Health Department. The only difference was that the former referred to a Section of the National Health Service Act of 1946, whereas the latter referred to the National Health Service (Scotland) Act 1947. I know that it is easier to amend one Act in a Bill than to amend two, but it would surely not have been beyond the 1015 ingenuity of the draftsmen to amend the Scottish Act at the same time and to give equality in the whole United Kingdom.
There seems to be some residual suspicion, as my hon. Friend the Member for Pontypool said, that this exclusion of Scotland is attributable to the persistent refusal to face the need for social change and to consider problems of this nature, the great temptation—which has afflicted some parts of Scottish society for far too long and which is based on an obstructive tradition left over from past ages—to say that subjects like this are a little offensive and unpleasant, and that, therefore, irrespective of the social cost, they should be buried and pushed to one side. I hope that that has not happened on this occasion.
At the beginning of the debate an appeal was made from the Chair for those who wished to oppose the Bill to make themselves known. One of the outstanding features has been that there are no opponents, or only a negligible number, in the House at the moment. I sincerely hope that the exclusion of Scotland in this way does not suggest that we have hidden enemies in the Scottish Office. If we have, we shall most hopelessly handicap a very large number of local authorities in Scotland which have an admirable record in this field.
I think of my own City of Aberdeen, where we have had since the late forties what was first known as a Gynaecological Advisory Clinic, run by the Health and Welfare Department of the Corporation, which has set a tremendous example. It is in the forefront of local authority activity on these lines. One could get free advice from the unit in Aberdeen if referred to it by a general practitioner, health visitor or midwife, and obtain appliances at cost price. Recently this organisation has been translated into the Family Planning Clinic, and there one can get appliances and advice completely free if referred through one of the approved channels. Under the influence of an enlightened and energetic medical officer of health, we in Aberdeen have made immense strides, and the pace so set we wish to maintain.
I do not want to become involved in the argument whether one should charge for appliances or not. There is, I think, a strong case for making them free. We 1016 want to give the people at whom we are aiming every incentive to use the service. We should take every opportunity of tempting them to expose themselves to good, adequate advice. I hope that local authorities will not rush into charging, for that might act as a disincentive, and also because free advice and free appliances would go some way to overcome the problem that the general practitioner now charges for such advice, something to which my hon. Friend the Member for Pontypool objected in an Adjournment debate, and whose reservations I largely share.
If there is an institution or clinic like the one in Aberdeen that I have described, with a staff struggling to give a most comprehensive and adequate service to the population that they are serving, it is unfair to leave them in a situation which the Minister and the House have, almost unanimously condemned as anomalous and unsatisfactory in England and Wales. It means that the staff must continue to struggle to justify every patient on medical grounds and not social grounds. Everyone knows that these two justifications are enmeshed and fused and cannot readily be distinguished.
The staff keep themselves in the clear by ensuring that all patients are referred to them through the proper medical channels. However, if one puts it bluntly, this is merely passing the buck and putting, if not the staff, those referring patients in an equally invidious situation. If the law is left in this state, it becomes unworkable. Consciences will be strained or clinics will be placed in a situation where they cannot be wholly effective.
We all accept that there should be widespread knowledge in this field, that barriers of ignorance should be flattened and that people should be allowed to make a free choice about how many children they want and not be forced into having ever-escalating families because they are feckless, untutored or ignorant and have not the necessary resources available.
If that is accepted in England and Wales, it must be accepted in Scotland. While I give my very warm support to this Bill for England and Wales, I hope that once it is on the Statute Book prompt legislation will be brought forward for Scotland so that local authorities there 1017 which are anxious to continue a fine tradition and give a valuable service will not find their work hindered and hampered by an unjustifiable legislative omission.
§ 3.3 p.m.
§ Mr. Gerry Fowler (The Wrekin)
In a recent debate on the tax system, I said that I would not talk about family allowances because I was an unmarried man. I am still unmarried, but I hope that I shall be forgiven for taking part in this debate.
I am delighted that my hon. Friend the Member for Bebington (Mr. Brooks), in the congratulations to whom I join, has seen fit to include in the Bill the unmarried as well as the married. He made the case for doing this in splendid fashion, and there is little that can be added to what he said.
However, I want to make a contribution about advice for the unmarried. We have been proceeding on the assumption, stated by one or two hon. Members, that we have a choice between giving advice or leaving the unmarried in ignorance. I do not think that most unmarried people today are in a state of total ignorance because advice is available to them, but, unhappily, it comes, whether oral or written, from unofficial sources and may well be unreliable.
I quote an instance from my own experience. I have on at least three occasions received circulars from a contraceptives distributing firm. On two occasions the literature was sent when I was resident at a college of Oxford University. Those colleges are notoriously monastic establishments, and it was a reasonable assumption that I was an unmarried person. It was suggested that I might like to avail myself of certain tree samples or cheap offers. Some of those cheap offers were for products which, as my hon. Friend the Member for Pontypool rightly said, do not appear to be totally reliable. Objective tests indicate that they are far from totally reliable. Yet there was no indication of this in the literature sent to me.
I have also been sent booklets purporting to give advice on the most reliable methods of contraception. From my inexpert knowledge, I can only say that some of the advice in the booklets appeared to be sound—that is, what was 1018 said about various types of contraception was accurate. Some of it was much less accurate. Some of it was really concealed advertising for the type of quite unreliable product so ably described by my hon. Friend the Member for Pontypool (Mr. Abse). I see no reason to assume that my experience is unique. I imagine that there are many unmarried people who have received circulars containing information which is far from wholly reliable.
Therefore, it would be a mistake to believe that if we do not provide advice through the Bill, unmarried people will receive no advice, and will be in a state of blissful ignorance. To believe that people will not be tempted to indulge in premarital sexual activity because they know nothing of contraception and therefore fear the consequences is patently wrong.
The hon. Lady the Member for Plymouth, Devonport (Dame Joan Vickers) said that the only effective oral contraceptive was to say "No." Experience in recent years seems to indicate that this is a very tricky and difficult contraceptive method. The technique of saying "No" seems to be dying. Clearly we are operating in a situation in which unmarried people need advice and help on contraceptive problems no less than married people. We should be living in a fool's paradise and deluding ourselves were we to think that we can prevent premarital activity if we deprive, or attempt to deprive, unmarried people of knowledge about contraceptives.
I add a brief word of support to what was said by the hon. Member for Leominster (Sir Clive Bossom) about the needs of rural areas. I represent a rural area, and I can certainly testify to the fact that ignorance is no less a danger in rural areas than it is in urban areas. Hon. Members have spoken about the problems of large cities. Ignorance is just as prevalent in rural areas, and one problem. namely. transportation, is worse in rural areas. I hope that when my right hon. Friend puts the Bill into effect he will ensure that special attention is paid to the needs of rural areas.
I should like to say a few words about the economic argument, as my hon. Friend the Member for Bebington called it, not because I consider it the most important or the central argument, but 1019 merely because I have little to add to the social argument which he and other hon. Members have stated so well. When I refer to "the economic argument" I mean the trend of population in the country and the likely expenditure which it will involve us in as a nation if we do not take steps to halt it.
I do not suggest that we should indulge in State population planning, but by making advice available as will be done by the Bill, we may at least ameliorate some of the problems which we shall have to face in the next 30 years. As has been said, the Government Actuary's forecast is that the population of this country will rise by about one-third, or 20 million, by the end of the century. Alas, most of this increase is bound to take place simply because of the high birth rate since 1956. This means that there will be far more people of marriageable age when we reach the mid-1970s and for at least a decade after that than there are today. It is therefore inevitable that more children will be born in that period than are born even today. The social expenditure in which this will involve the nation is the greater because at the same time the average size of households is falling, and has been falling steadily for many years, housing standards are becoming higher and it will cost us more today to house this increased population than it would have done in the past.
A particularly serious problem is the one which we will face in the 1970s. We shall find that a much higher proportion of our population than has been normal in the past is not contributing by its labour to the revenue of the nation, because a large proportion of the population will be above retirement age or will consist of young people.
Far be it for me to suggest that we should plan any reduction in the rate at which our population will grow in the long term, but if we are sensible we must, as a nation, face the fact that the short-term problems which we shall face, particularly in the 1970s, when we have a rapidly rising population but not a rapidly rising work force, will be very great, and anything we can do to spread that rise in the population over a longer period will be for the good of us all.
1020 So this is an additional reason why I associate myself with what has been said, almost unanimously, today—that this is a splendid Measure which might well have been introduced by the Government and which might well have been introduced many years ago. I wish the Bill well.
§ Miss Pike
Before the hon. Gentleman sits down, may I refer to one point, on which I did not really wish to intervene in his argument, about helping people in rural areas. Would he agree with me that one of the best ways to help would be to get fuller co-operation with the maternity and hospital services, because so many people in the rural areas have their children in hospitals and maternity homes because of bad housing conditions and transport difficulties? This strengthens the argument, I hope he will agree, for involving the maternity and hospital services.
§ Mr. Fowler
I agree entirely with what the hon. Lady said. I might, however, make one brief comment, namely, that while what she said is perfectly true, there are many rural areas where, alas, hospital provision is inadequate, and my constituency is one of them. Here, therefore, we need an attack on more than one front to solve the problems of the rural areas.
§ Question put and agreed to.
§ Bill accordingly read a Second time.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).