A Plowboy Interview with Ira Neiger, the 1972 Director of Public Information for Planned Parenthood's New York City office.
Many of today's environmental problems boil down to one word: people. With no real natural predators or other checks to control our numbers, an increasingly good case can be made for viewing the species "man" as a cancer upon the face of the planet. One United Nations survey has projected that—whereas the earth's population increased about 20,000,000 annually only 40 years ago—it now accelerates by more than 72,000,000 every 12 months. That is, we are not only increasing . . . but we are frightfully increasing the rate at which we increase.
Clearly, when confronted with such numbers, the finite platform (earth) upon which we live must begin to show alarming signs of wear and tear at some point . . . and many concerned individuals believe that point has already been reached. "Something must be done to limit population growth," they say, "especially in the areas of illegitimate and unwanted births. "
And something is being done. Planned Parenthood is just one of the many public and private agencies that currently provide services, information and education about the population problem, contraception, abortion, vasectomy and sexuality in general. The Director of Public Information for P.P.'s New York City office is Ira L. Neiger, and Allan Richards recently visited that office to question Mr. Neiger about Planned Parenthood's work.
How long has family planning and Planned Parenthood been in existence?
Family planning has been practiced in one way or another since man formed the first tribal units. Birth control was known and practiced in ancient African kingdoms and. in this country, among American Indian tribes before Columbus arrived. The diaphragm was developed as a birth control device in the late 19th Century and condoms have been used many, many years.
Our organization, Planned Parenthood, has existed only since the early '50s and Planned Parenthood in New York City is just five years old. Our New York City operation, however — while relatively young in its current form — represents an amalgamation of borough units that were here 50 years ago when Margaret Sanger was active.
Many environmentalists feel that overpopulation is one of the most pressing problems facing the human race today and — depending on the foundation or research group being quoted — project that we'll all be standing shoulder to shoulder by the year 2,000 or 2,040 or whatever. How do you and Planned Parenthood view such projections?
First of all, we like to talk about the situation as being one of "quality of life" as opposed to the simplistic term, "overpopulation". Overpopulation is a problem, but there are varying opinions as to how critical the condition is at present. There are even varying opinions as to how big the problem will be 20 or 30 years from now. There are other factors that contribute to quality of life which are not necessarily related to the birth rate.
I think some people tend to imply that if we can control and stabilize reproduction all the overcrowding, pollution, crime, bad housing and hunger will disappear. We don't believe that. Nonetheless, we do recognize that there is a problem and we are very much involved in trying to control it.
Through the use of Family Planning Programs, whereby we offer aid — educational, medical and clinical — to women and men who need it. We try to educate individuals about themselves and motivate them to use birth control. Our programs are all voluntary and our services are made accessible in convenient and economical ways, either free or at a minimal cost. We deal mostly with low-income groups who can't afford physicians and who can't get this attention elsewhere. Most well-to-do people can go to their own doctor or gynecologist for family planning services. It's the poor women and those with a marginally low income, plus an occasional college girl, with whom we deal throughout the country.
We know that — thanks to the baby boom of the 40's and 50's — there will be a bumper crop of young adults living in this country during the coming decade. We also know that young adults are prime producers of babies of their own. Don't you feel it's vital to reach all-or at least most-of these people with your message . . . and not just an occasional college girl?
Yes, I do agree. We are very much concerned with the young adult . . . and also the teens, the 15 to 19-year-olds. Youths today are very sexually active and it is necessary for them to have effective means of birth control.
And how do you attempt to contact the younger group?
We've been very active in colleges and in special programmed sessions with teenagers. Small group meetings are held in which youths talk to nurses, doctors and social workers. For many women, it is the first time they've had pelvic examinations. We find that the young people respond well to this procedure.
We are also working in two ghetto areas with trained workers who discuss sexuality and contraception. These communities have many social ills, drug addiction, promiscuity, and the kids are grossly misinformed about sex. The ones we're reaching with this effort are responding well and they've finally gained confidence in the program.
Do you feel then, that your efforts are successful?
Well, not as successful as we would like them to be, of course . . . but we have definitely made enormous strides, considering the many legal, religious and medical obstacles. We are becoming well known by the young people and more openly accepted. And this is essential.
In the beginning we had to go out after the teenagers. Now we have many of them coming to us for help and advice. They want to protect themselves against unwanted pregnancies, which is a vital factor if we're going to stop the growing population. Last year alone, in 1971, there were more than 400,000 births out of wedlock in the United States.
There's a lack of knowledge among young people and even many older married couples. There's a remarkable degree — an appalling degree — of ignorance regarding the simplest question of physiology and reproduction. Many youths come here with questions about promiscuity and sex relations. Girls who are going away to college come to us wanting to know about sexual involvement and how to protect themselves. The problem we try to combat is the lack of knowledge.
You say there were 400,000 babies born out of wedlock in 1971. How many additional unwanted births do you estimate take place every year?
The number of normal unwanted births each year is tremendous. And they're not restricted to young people. In the decade between 1960 and 1970, nearly 50 percent of all deliveries were either out of wedlock, unplanned or otherwise unwanted.
Looking at just one year — 1969 — we estimate that there were certainly no less than 950,000 unwanted births in the United States. If we subtract this figure from the total deliveries3,571,000 — we arrive at a figure of 2,621,000. Then, subtracting that year's deaths — 1,919,000 — we would be left with a net natural increase of 705,000, instead of the actual 1,655,000. We would have cut our population growth that year by nearly one million just by reducing the unwanted children. With greater planning and knowledge about family life, this figure might have been lowered even more.
What about the legal ramifications of providing birth control information and/or devices to minors? Have you encountered difficulties in that area?
There are conflicting laws throughout the country regarding the legal rights of minors to receive health services without parental consent. The problem of law suits is terrible, confusing and complex. In most cases — on a national level — there are restrictions on health services, clinics, private hospitals . . . and even on the rights of private physicians to treat minors without parental consent. Here at Planned Parenthood we have taken a very liberal, perhaps radical, position of serving minors down to age 16. Sometimes even younger if, in the opinion of the social worker or physician, the individual's health and well-being would be in danger if methods of birth control were not provided to her. The question of pregnancy risk is a grave concern.
How do you rate the various voluntary services? Are they poor, adequate, excellent?
They vary. Some are first-rate . . . some facilities aren't that good. There is also the problem, as I said before, about discriminatory practices against the young.
There is no uniform standard then?
Well, Planned Parenthood has basic standards which are set by the national organization and to which all chapters adhere. In general, the P.P. affiliates offer the best birth control help available. As for other organizations . . . it's hard to make an evaluation. Some hospitals have excellent facilities and others are extremely poor . . . especially in the boondocks.
But isn't it those in the boondock and ghetto areas who must be cared for? The people living there are often in the dark about many problems and no doubt are not even aware of the newer or — perhaps —any birth control methods.
The biggest increase in population in this country is in the white middle-class suburbs. I don't disagree that the poor and ignorant must be taught, but the white middle class is the one which has procreated the most. It's the people who have the house, an acre, two cars, etc. and who say we'll have three, four, five kids. Sure, right on. That's bad.
The people in the ghettos are always told to have less children, but they know that the middle-class whites are having THREE, FOUR, FIVE kids. They resent this tremendously. They're told to have fewer children because of overcrowding . . . while the middle class continues to reproduce the most. If people really care about the population problem, they should consider it a personal matter, and not leave it up to the organizations to hand out birth control to the poor.
Obviously, the white middle class also includes the Sunday churchgoers.
Well, of course, the Roman Catholic Church is the one organization that has provided us with the most opposition. They have a very strong prohibition against birth control, reiterated once again by Pope Paul in his encyclical back in 1968. Many Catholics practice birth control anyway, however, and I think the prohibition is very medieval. I found it absolutely revolting when Pope Paul went to Manila and visited the people in their tar paper shacks — people who've barely enough to eat — and said, "We love you" and "God cares," and then gave them $500 for food or furniture and walked away saying: "Don't practice birth control." I think it's outrageous.
It's God's wish to be fruitful and to multiply, isn't it?
We've multiplied! The answer is that we have multi plied! We can't use the Bible as a precept for how we must live today. We must shape our environment to suit our need, and to relate what's happening in an intelligent way. I've seen the unwanted pregnancies, the self-induced abortion girls who come bleeding to death to Harlem Hospital. It's a disaster, and it's disgraceful!
How does Planned Parenthood feel about the abortion laws as a means of controlling population?
We are very much in favor of liberalizing the laws. Planned Parenthood is pro-abortion as are many other groups. We are in favor of keeping the New York law intact, and not having it weakened and eroded by legislators who want to make it impossible for out-of-town women to obtain an abortion or to reduce the time in which they can get it. We don't want to see any dilutions. The law hasn't been perfect, but it has improved and it is working quite effectively.
Of course, we don't consider abortion a substitute for birth control. It is not a substitute, but rather a supplement. For women who experience contraception failure, it is terribly important that they have the option of terminating an unwanted pregnancy. We feel it is very important to make safe, economical abortions available to people who, through ignorance, don't use contraceptives. A woman should have full control over fertility.
Based upon the figures of unwanted births, it would seem that abortion is a very necessary supplement to birth control. And if it is that vital, shouldn't there be a uniform abortion law throughout the country, instead of on a state-to-state level?
We think there should be, yes. We would like to see this liberalization throughout the country. It does seem absurd to have spotty, disparate laws. I mean, a woman in Illinois has to come to New York for an abortion, or a woman in Texas has to go to the state of Washington. It doesn't make any more sense than it would for someone from Texas to come to New York to have a baby or a tonsillectomy.
There is a movement in various states to rewrite the laws. Some states already have — Washington, New York, Hawaii, Alaska and Colorado — and California, to a lesser degree. I really feel, and so does Planned Parenthood, that the answer isn't in individual statutes, but in a movement by the Supreme Court to declare anti-abortion laws — such as those in Wisconsin — unconstitutional. If that were done, every state with similar legislation would have, to revise its code. We hope this will happen in the next several years and, with this accomplished, we'd have reasonably uniform statutes. A woman would not have to have that child or suffer unbearable traveling to obtain a safe, legal operation.
Do you have any figures on the out-of-state women who've come to New York for abortions?
Since July 1, 1970, forty percent of the women who've come here to terminate pregnancies have been from out-of-state or out-of-country. They've come from Mexico, Canada, Australia . . . it's unbelievable.
It would seem then, that abortion is actually being used as much more than a birth control supplement. The fact that women are coming to New York State from all over the country and the world for this service indicates that the induced miscarriage has become a necessary weapon in the battle to control population.
Our approach is not acutely population oriented, as much as it is individual oriented. I don't look upon abortion as a way of reducing the population . . . although it does, of course. Abortion is a one-time cure, not a long-term or widely effective preventive measure. It isn't like 30 days in the country. An abortion is not pleasant. What we'd like to see happen and what is written into the law here in the state of New York is that a woman who has had an unwanted child or who has terminated a pregnancy . . . such a woman must he exposed to education so that she won't repeat the occurrence
There are better ways than abortion to prevent or deter people from having more than, say, two children: tax laws that discriminate against large families, incentive programs that motivate individuals and couples to limit the number of their children, widespread availability and education in the use of contraceptives. Perhaps in 20 years the government will ever say, "We don't care if you do want another child you can have only two."
Are there any countries that use abortion as a prime birth control weapon?
Yes. Japan uses it as its chief means of birth control. But it seems to make more sense and to be more reliable to use contraception to prevent pregnancy. Nonetheless, we feel that abortions should be available.
In discussing the family planning concept, you stress the point that, in order to deter population growth, there must be a fully effective fertility control program. Has such a plan been proposed?
Yes, the program that we feel would be most feasible and most necessary is a ten-point plan that we have designed here. It's not in operation yet, of course, but I'd like to read to you what it includes:
1. Development of a new, medically safe, 100% effective contraceptive that is inexpensive and long-lasting, that requires no medical prescription and is not coitus-related;
2. Development of a medically safe abortifacient that can be simply administered with minimal medical supervision and, pending this, a provision of medically safe abortions on request to any woman of any age who desires to terminate a pregnancy;
3. Expansion of existing family planning clinic services, including sterilization and abortion;
4. Stimulation of more effective participation in family planning by physicians in private practice, an increase in the emphasis on family planning in medical training programs, active support by doctors of the efforts to repeal abortion laws, and the promotion of greater physician interest in the development of improved birth control methods;
5. Expansion of contraceptive information and education programs for professionals and para-professionals and the encouragement of new or expanded family planning promotion activities by the agencies employing them;
6. Development of more widespread and more effective patient information and education programs, providing facts for intelligent decisions about child spacing and family size limitation, and for utilization of available birth control resources;
7. Establishment of comprehensive sex education programs, including factual information on contraception as well as conception in all public and private schools, churches, community centers and other youth-serving agencies, whose staffs would be trained and authorized to refer sexually active adolescents for counseling and related medical care;
8. Enactment of legislation specifically enabling adolescents to obtain contraceptive devices and abortion on request;
9. Creation of a variety of programs such as courses in schools, colleges and universities, discussions and workshops in local civic and social organizations, churches and community centers to educate all Americans in population dynamics, so that they can understand more fully the impact of population growth and distribution in the U.S. and the world;
10. Repeal of existing legislation that restricts interfaith adoptions, the establishment of financial incentives for adoption through tax-credits or cash subsidy payment, the facilitation of adoption by single individuals and the stimulation of interracial adoption.
Could this program be implemented now?
Yes. We have the financial resources, the technical competence and the legislative capacity.
But can this plan, which relies solely on voluntary fertility limitation, really influence future population growth significantly and soon?
I don't really know. Time and experience alone can answer that. But this is surely a better plan and a more rational proposal than others now being advocated. Simply to suggest that all American families will limit themselves to two children is unworkable . . . not without free access to optimally effective contraception, backed up by the ability to terminate pregnancies easily and cheaply. As long as absolutely effective fertility control measures are not easily and fully available to all, it is simplistic to suggest that tax laws be passed to encourage two-child families and/or penalize larger ones.
Do you foresee government action with tax laws, incentive programs or even an outright ban on more than two children per family in the near future?
I can't foresee it, no. Our present tax laws are an incentive to have children. One gets deductions and exemptions for every addition to his family. I can visualize this the other way around, though, and there have been efforts by some congressmen to, say, penalize an individual for every child in excess of one or two. I truly don't know if this will occur, although it is a possibility. I think it will depend on how successful the current efforts of volunteer groups and the government prove to be.
The government, you know, committed itself very heavily when it passed Nixon's bill to give money to health services and it is now behind the family planning concept. The largest amount of Federal funds ever granted for the purpose is currently going into research projects and medical aid designed to deal with the population problem in a voluntary, family planning way.
If present efforts work well enough to raise the quality of life noticeably, I think the need for coercive measures will be reduced. If they don't work . . . there will obviously be added impetus for the government to step in and dictate a national population policy.
Do you think it's possible — or even desirable — for our system to reach a zero population growth rate through either voluntary action or government control?
We must remember that the idea of zero population growth is advocated by only some of the individuals and authorities who've studied the situation. Others want some increase in our numbers and still others believe we must immediately decrease the number of humans inhabiting the world. The issue, in short, is both crucial and complicated and it may well be too early to know which expert or group is right.
Until we do know which leader to follow, however, I think it's extremely important to inform every citizen about the population problem and about sex. We must educate and motivate people to use birth control. Then, when we are certain of the course we want to pursue, we'll know how to do it. That, to me and to Planned Parenthood, is the primary concern. In the final analysis only education and motivation can do what must be done . . . and it's time we got on with that education and motivation.