Causes of infertility

1. Kill or Cure
Reproduction in the 20th century

2. Aims
• To introduce the theme of reproduction and
reproductive health in the 20th century.
• To think about reproduction in terms of biology
and the broad social constructs in which we all
reside.
• Through focusing on the subject of reproduction,
we will see how look at the history of health and
medicine with a gender-sensitive lens.
• To explore three aspects of reproductive health –
maternity, fertility control and assisted
reproduction.

3. Part one
• Reproductive health

4. Introduction to reproductive health
• Reproductive health is defined as a state of physical,
mental, and social well-being in all matters relating to
the reproductive system, at all stages of life.
• Good reproductive health implies that people are able
to have a satisfying and safe sex life, the capability to
reproduce and the freedom to decide if, when, and
how often to do so.
• Men and women should be informed about and have
access to safe, effective, affordable, and acceptable
methods of family planning of their choice.
• Women should have the right to appropriate health-
care services that enable women to safely go through
pregnancy and childbirth.

5. Part two
• Maternity

6. ‘A Plea for a Pro-Maternity Hospital’
• Ballyntine was a staunch advocate
for prenatal care at a time when
there was no space for such care
within the medical system.
• In Ballantyne’s vision, a hospital
dedicated to prenatal care would
have 2 main purposes:
• First, to treat cases of pathological
pregnancy in which the mother’s
health is at risk.
• Second, to practice ‘antenatal
therapeutics’ (treating the fetus
through the mother), especially in
cases where the mother’s behavior
might be endangering the fetus.

7. Mortality rates
Infant mortality
per thousand
births 1900-1990
Annual death rate per 1000 total
births from maternal mortality
in England and Wales (1850-
1970)

8. The medicalization of birth
• In the 20th century childbirth in
the developed world moved from
the home to the hospital.
• Associated with this new birthing
space were childbirth
technologies. Hospitals provided a
hi-tech, highly medicalised birthing
experience.
• Obstetricians began defining
‘normal’ standards for childbirth.
The epitome was Friedman’s curve,
developed by Emanuel Friedman, a
graphic representation of a
‘normal’ labour. Deviations from
normality were seen as reasons for
medical intervention.

9. Part three
• Fertility control

10. Reasons for the fertility decline I
• 1. As the infant death rate declined more babies survived into adulthood, thus
fewer pregnancies produced surviving offspring, so it was not necessary for
parents to have more children than they expected to survive into adulthood.
• 2. As methods of efficient birth control improved, access to contraception
became easier and knowledge of them spread.
• 3. There was a greater willingness to use contraceptives.
• 4. Men’s attitudes towards women have softened so that they have been more
willing to use contraceptives in order to help relieve women of the health risks
of frequent and closely spaced pregnancies, and the hard work associated with
a large family.
• 5. Simon Szreter argues that abstinence was the English way of adjusting
fertility in response to the perceived relative costs of having children. The
perception of the escalating ‘costs’ of childrearing provided the conscious
motivation to control births. The anti-sexual culture was both conducive to the
use of abstinence as the method to achieve that goal and provided married
men and women with a legitimating, anti-sexual rationale.

11. Reasons for the fertility decline 2
• 6. In Britain,
Joseph Banks has
argued that the
economic
depression of the
1870s and 1880s
undermined
middle-class
confidence in the
future and
encouraged the
use of birth
control to
maintain living
standards.
• 7. In America, Daniel Scott-Smith has argued that the decline in
middle-class fertility offers an indication of ‘domestic feminism’ (the
power and autonomy exercised by women within the family).

12. Population control movement
• In the 20th century, population control
proponents have drawn from the insights of the
British clergyman Thomas Malthus who
published An Essay on the Principle of
Population in 1798.
• Malthus argued that, ‘Population, when
unchecked, increases in a geometrical ratio.
Subsistence increases only in an arithmetical
ratio.’
• He also outlined the idea of ‘positive checks’
and ‘preventative checks’.
• ‘Positive checks,’ such as diseases, war, disaster
and famine, are factors that Malthus considered
to increase the death rate.’
• ‘Preventative checks’ were factors that Malthus
believed to affect the birth rate such as moral
restraint, abstinence and birth control.
Thomas
Malthus, 13
February 1766 –
23 December
1834

13. Eugenics
• Eugenics, meaning "well born,"
was introduced in the 1880s by
Sir Francis Galton, a cousin of
Charles Darwin and the father
of modern statistics.
• Galton pioneered the use of
pedigrees, twin studies, and
statistical correlation for the
purpose of using that
knowledge to improve "the
breed of man."
• During the early 1900s,
eugenics became a serious
scientific study pursued by both
biologists and social scientists.

14. Pro-natalism
• Ann Oakley argues that the Boer War 1899-1902 revealed a
shockingly low standard of health among the male population
recruited to fight in that war, forcing political attention on the
actual condition of the Empire’s citizens and infant welfare was
included in the campaign to improve physical efficiency.
• Jane Lewis posits that the concern to stop the wastage of infant life
‘became even more explicit during World War I’ as the loss of
population during the war increased awareness of the importance
of infant mortality.
• Denise Riley defines pronatalism as ‘despondency and alarm over
the low birth rate, both past and as anticipated by demographers,
which took the solution to the problem to be encouraging women
to have more children.’ Both the concern and the proposed remedy
had been building up throughout the 1930s and became more
generally diffused towards the end of World War Two.

15. Contraceptive pill
• Developed by American
biologist Dr Gregory Pincus,
the pill works by suppressing
ovulation.
• It was tested in the 1950s on
Puerto Rican and Haitian
women and launched in the
USA in 1960.
• In the USA, around 1.2 million
women used the pill within
two years of its launch. Now
the number of users is around
11 million.
• Worldwide, around 100
million women take the pill.

16. Pharmaceuticals and foreign aid
• The dictates of the market play a major part in family planning and
population control.
• About $5 billion is spent each year on family planning by developing
countries; $1 billion of this is donated by Northern governments,
multilateral agencies and private organizations.
• Pharmaceutical companies have global contraceptive sales of $2.6
billion to $2.9 billion per year.
• This huge economic power of pharmaceuticals enables them to
influence the policies of Southern governments and the priorities of
the medical establishment.
• According to the UN, contraceptive use in the southern hemisphere
has increased five-fold in the past quarter century because of the
intervention of foreign-aid donors and international institutions.

17. International Conference on
Population and Development (1994)
• The ICDP brought to
international recognition two
important guiding principles of
reproductive and sexual health:
• 1) that empowering women and
improving their status are
important ends in themselves
and essential for achieving
sustainable development;
• 2) that reproductive rights are
inextricable from basic human
rights, rather than something
belonging to the realm of family
planning.

18. Move to reproductive health
• Three developments were of particular importance to the
reappraisal of reproductive health in the 1990s:
• Firstly, the growing strength of the women’s movement and their
criticism of the over-emphasis on the control of female fertility - and
by extension, their sexuality - to the exclusion of their other needs.
• Secondly, the advent of the HIV/AIDS pandemic; suddenly it became
imperative to respond to the consequences of sexual activity other
than pregnancy, in particular sexually transmitted diseases. But
perhaps more important, it became possible (and essential) to talk
about sex, about sexual relations outside of marriage as well as
within it, and about the sexuality of young people.
• Thirdly, the articulation of the concept of reproductive rights. An
interpretation of international human rights treaties in terms of
women’s health in general and reproductive health in particular
gradually gained acceptance during the 1990s.

19. Part four
• Assisted reproduction

20. Artificial insemination
• Artificial insemination
was first performed in
humans by the famous
English surgeon John
Hunter.
• It was reported by
Everett Home, his
nephew in 1799.
• The procedure was
performed by Hunter, in
approximately 1790, for
a linen draper who had
hypospadias.
John Hunter, 13 February
1728 – 16 October 1793

21. IVF and Louise Brown

22. Criticisms and concerns
• Ann Oakley has noted how infertility treatments are often
unpleasant and their success rates remain relatively low.
• Gillian Tindall has demonstrated how babies created through
assisted reproduction are at excess risk at every stage in their
development.
• In the British context, the issue of cost to the NHS has also been an
issue.
• In the development of ever more powerful techniques of assisted
reproduction a number of new ethical questions have emerged.
They lie at the heart of what it means to reproduce, to be a parent,
to be a human being.
• Since 1990 many countries have been setting out to establish
ethical guidelines and laws for reproductive technologies.

23. Warnock Report
• In 1982 a committee was established to inquire into the technologies of in
vitro fertilisation (IVF) and embryology.
• This was in response both to concern at the speed with which these
technologies were developing, and also to the 1978 birth of Louise Brown
in 1978, the first baby to be born using this technology.
• The role of the committee was to develop principles for the regulation of
IVF and embryology. The committee was chaired by the philosopher Mary
Warnock, who would later become Baroness Warnock.
• The committee concluded that the human embryo should be protected,
but that research on embryos and IVF would be permissible, given
appropriate safeguards.
• The committee proposed the establishment of a regulatory authority with
the remit of licensing the use in treatment, storage and research of human
embryos outside the body. This body would later become the Human
Fertilisation and Embryology Authority.
• The findings of the committee were published in what is now referred to
as the Warnock Report in 1984. In many ways, the Warnock report formed
the basis for the Human Fertilisation and Embryology Act.

24. Conclusions
• Reproduction and the family are central elements in the lives
of people.
• In the 20th C obstetricians began defining ‘normal’ standards
for childbirth.
• There was a move away from ideas of population control and
demographic targets towards a more holistic approach to
reproductive health.
• With new reproductive technologies new ethical questions
have emerged.
• Perceptions of sexuality have shaped medical practices, public
policy, legal rights, technology and the contours of everyday
experiences.