A Catholic Paediatrician on Family Planning
by Thomas F. Draper, M.D.
in The Catholic Case for Contraception, Ed. D. Callahan, Macmillan, pp.128-135,1969.
Until 1800 the practice of medicine was largely a mixture of superstition, sorcery, and primitive surgery. However, in the nineteenth century man made his first great strides in the control of disease, first providing sanitary services in the management of his environment, then in the discovery of bacteria as a cause of infection. Since that time the profession of medicine has matured in its understanding of the scope and meaning of disease, and society at large has come to expect remedies for the ills that it suffers. In the United States today it is expected that if a child can be paralyzed by poliomyelitis, the disease should be prevented, if a premature infant can suffer blindness, the cause should be found, and if a child cannot learn in school, the causative factors should be identified and dealt with. In short, [p.129] medicine has come to measure its effectiveness by the level of capability at which its patients can function in society.
As control of infectious disease has improved by more efficient sanitation, immunizing agents and antibiotics, the physician has broadened his concern from mere survival of his patients to an acceptance of responsibility for the kind and quality of human life in his care. Infirmity, physical or emotional, that impairs the optimal function of a child is recognized by the paediatrician as proper subject for his effort and study. The fundamental role of the environment in the manifestation of disease has caused the paediatrician to be concerned at once with the community and the child in the community, the school and the child in the school, the family and the child in the family.
In appraising the ills of society, social scientists are fond of pointing to “gaps,” rich-poor, black-white, old- young, as symptoms of social sickness. Fragmentation is viewed as a measure of social decay. The physician to the family, be he G.P., paediatrician, or internist, sees the family as the unit cell of society; he understands that fragmentation within the family may manifest itself in the children by school failure, deviant behaviour, or delinquency.
It is common for physicians to participate with families in seeking solutions to marriage problems. In reviewing the histories of twelve fragmenting Catholic families with whom I was associated, I found that there were sixty-six children involved, that no family had less than four children, and that as of this writing, two of the marriages terminated in divorce (eleven children). The causes of the conflicts confronted by [p.130] families in which the presence of multiple children was associated not with an increase in family love, but with hostility, resentment and anger, has been the source of continuing speculation. Do children not have a right to parental love, a right to be wanted? Can parents who do not love each other provide an environment favourable to child rearing? In the absence of a climate of love ought there not be an obligation for parents to cease having additional children? If inter-parent distrust, disharmony and disrespect compromise the growth and functioning of the offspring, ought not the family physician to seek the causes of the psychological and emotional handicap to the child and pursue its therapy and prevention?
It is not possible to typify the “problem” family. However, certain themes emerge as characteristic of this small group. Most commonly the marriage was between two Catholics, the girl in her early twenties, the boy a few years older. The spouses anticipated families of four or more children and were anxious for the early occurrence of the first pregnancy. After the arrival of the first baby, the parents tried to delay the second and subsequent pregnancies by the rhythm method (periodic continence). Among all of these families, rhythm was unsuccessful and considered by them as a major contributor to their friction. The words of one such mother recently interviewed are revealing:
I had five children in six years. We had wanted the first baby right away and I do love all of my children. But when the last one was born, our fifth, I had “that terrible feeling” that I couldn’t take care of any of the children. I couldn’t take care of the house; I couldn’t cook the meals; [p.131] I couldn’t even change the baby. I didn’t want to look at any of the children. I couldn’t leave the room; I just stayed there and cried. I think I should have been in the hospital. For almost a year my husband, neighbours, and friends took care of everything. Life seemed hopeless, babies would keep coming and I would be unable to take care of them. I think I wanted to die. Then a doctor prescribed some birth control pills, but two priests told me I wasn’t allowed to take them. Someone told me of a priest who would give permission. I went to him and he told me that it was like taking aspirin. I didn’t believe him, but I took the pills.
I asked this woman what effect taking these pills actually had on her life. Her own words are apt:
“The first six years of my married life were torment. I wasn’t a wife. I was afraid to give myself to my husband. I was afraid of intercourse because it meant pregnancy. I resented my husband coming home at night. I was afraid to smile at him, to show affection, even to hold his hand lest it lead to something more. Now I can smile again. I think all I ever want to do is make my husband happy. When he’s happy, I’m happy and the children are happy.
A mother of six observed of her family life:
I think that marriage ought to be based on love, you ought to love the one you marry. I think that love is communication, understanding, compassion. I think my principal responsibility is to raise my children in a proper way—to respect others—to understand the works of God—to meet their responsibilities to their fellow man. I think that families should eat together because that helps them to love each other. I think that family problems have to be settled privately. But I honestly feel now I’ve reached my capacity. Our oldest is eight and the youngest only two. I don’t seem able to communicate with all of the children as individuals. There doesn’t seem to be enough time. I can’t love them the way I want to. I can’t find the privacy to deal with their personal problems. I seem to lack patience. I’m always [p.132] fatigued. I can’t discipline them. We practiced rhythm for the last four children. It was a nightmare. It bred distrust and hate of the very one you love. You live by the calendar, under the constant threat that the whole world will collapse if there’s another pregnancy. I know the pills aren’t the answer, but at least they’ve given me a chance to breathe.
What is the answer? Or indeed is there an answer at all. The problem that seems to be recurrent is this: That love is fundamental to the successful maturation of the family. That love is dynamic and must grow to survive. That somehow it is measured by communication and understanding and compassion. That its growth within the family is dependent upon its growth between the parents and propagated among the children and that by this love mutual confidence and respect is bred among the members of the family. That in the environment of love, mutual respect, and confidence, the education of all the members of the family occurs. Any factor that diminishes or destroys this love compromises the intellectual, emotional, and social development of the family and moves them in the direction of fragmentation.
In medicine, it is recognized that the same disease may manifest itself in different ways in different people. So too in the fragmenting family, the manifest symptom may be the delinquent child rather than the problem marriage. Whether the initiative arise from law enforcement agencies, school authorities, or the parents, children manifesting deviant or delinquent behaviour are frequently referred to the family physician for appraisal.
The Committee on Juvenile Delinquency of the [p.132] American Paediatric Society has characterized the families of delinquent children as (i) lacking warm parent- child relationship; (2) lacking maternal supervision; (3) lacking completely or partially presence of the father. In discussing problems of delinquency the Gluecks suggested five criteria of family life that they utilize to forecast juvenile delinquency with considerable accuracy. These criteria are: discipline of boy by father; supervision by mother; affection by father; affection by mother; cohesiveness of family. In so far as delinquent behaviour is symptomatic of family malaise, the causes of delinquency are important to the physician concerned with family well-being. Parents find no difficulty in comprehending the Glueck criteria. But the father who requires a second job to support a growing number of children often lacks time and energy to discipline his son, or show affection for his children. An unlimited number of children may well exceed the capacity of a mother to supervise the individual care of each of the children.
The change from rural living in this country to urban industrial life has profoundly affected the family. The parents of earlier generations raised their children with or near their ancestors. At an early age on the farm these children contributed to its productivity. Today’s family has become a “single cell” unit, often remote from collaterals and ancestors. The care and raising of these children has become a task for the man and wife alone with little help from other kin. And these children remain in a dependent status in the home pursuing formal education often for twenty years or more. The 1968 mother cannot ask her mother to care for an infant while she attempts to unravel the problems of a [p.134]high school or college age offspring. The mother of today must be prepared to deal at once with infant, school child, or teenager. Today’s father cannot share his occupation in support of his family with a son as did his farming ancestor. He must support that son for a far longer and costlier time. In meeting these complex responsibilities the parents find there comes a time when increasing the family compromises their capacity to meet their responsibilities to the existing children. When that moment is reached, additional babies introduce strain and tension and serve to diminish the cohesion of the family unit.
A thirty-five-year-old mother of four small children was convinced that her husband no longer loved her. They had not had conjugal relations for months; he was spending far more time at work than before and when not working seemed to find endless reasons for being out of the home. On rare occasions when they would be out socially he would find excuses to leave her and visit with others. In addition he had established a favourite among the children and lavished most of his attention on this one child to the jealousy of the others. He was critical of every effort expended by the mother in the care of home and children. The mother felt she was a failure, rejected, and that their marriage was threatened by decay. After discussion with the father it was revealed that he was so fearful of being unable to care for additional children that he became resentful of his wife’s affection and repulsed her every effort to please him. Intercourse meant another baby: His wife became a threat to his security. Hate was replacing love, only this time it was the man who feared showing any affection to his wife. As a consequence, the fatherly [p.135] love for the other children was distorted, his presence in the home diminished, and the cohesion of the family was threatened.
The American Catholic family of today shares the strain of all family life in our society but in addition bears a burden that is unique. In a worldly environment of hostility, anger, crime, and war, the family recognizes the special obligation to nurture love. In meeting this responsibility some families have found that this love may be threatened or destroyed by further increase in family size. In ministering to the ills of families it has been my experience that when responsibilities become excessive, the warm parent-child relationship is threatened, the love between the spouses is devoured by fear and the cohesion of the family may succumb to separation or divorce. As one particularly concerned with the community, I recognize family love as the bedrock upon which society must build. Therefore, I conclude that in those instances where family planning may contribute to the preservation of family life, this service must be provided.