§ 2.24 p.m.
§ LORD CASEY rose to ask Her Majesty's Government whether they have considered the consequences of the present rate of population growth in Asia, and in the Commonwealth countries in Asia in particular and, if so, what they propose to do to stimulate scientific research in the United Kingdom towards a socially acceptable solution of the problem applicable to Asian conditions; and to move for Papers. The noble Lord said: My Lords, my reason for bringing the subject matter of my Motion to your Lordships' notice is because I believe that it is of first class importance; otherwise I should not have ventured to take up your Lordships' 602 time by discussing it. I have on previous occasions, in debates on wider topics in your Lordships' House, raised the broad subject of population pressure in Asia, but I must admit to not having received any great encouragement. That could well be due to the fact that I did not put the matter as succinctly or as convincingly to your Lordships as it should have been put.
§ The simple facts of the situation are these. More than half the total population of the world—that is, 1,600 million people out of about 3,000 million—live in Asia. Nothing that I shall venture to say to your Lordships to-day will have reference to the situation in Japan, which is a wholly different case, because they have kept entirely on top of their problem of population pressure; but in respect of the rest of Asia, the factors in the situation in most Asian countries are high population density, a high and rising rate of increase of population, and a low standard of living. It is the combination of high population density with a high and rising rate of population increase in many of the countries in South and South East Asia that creates the problem which I am venturing to lay before your Lordships to-day. A high rate of population growth also exists in Africa and in most of the countries of Latin America. However, these countries cannot be regarded as over-populated; therefore the problem has not the urgency and importance that it has in Asia.
§ Another factor that underlines the importance of this subject so far as we in the Commonwealth are concerned, is that well over 80 per cent. of the total population of the Commonwealth live in Asia—about 550 millions out of a total of about 650 millions—and it so happens that the combination of overpopulation and excessive population growth is most intense in the Asian Commonwealth countries. Also there is the melancholy fact that, according to the United Nations published statistics, the average national income per head in the Asian Commonwealth countries is £23 sterling per year, whereas the average national income in what might be called the older Commonwealth countries is £421 per year.
§ By way of example in particular, let me speak of the case of India, with 603 its immense population of now approaching 450 million people. That is more than the whole of the population of Africa and of Latin America combined. The population growth in Ceylon, Malaya and Singapore is even more intense than that in India, but let me concentrate on India as a large and typical case, though, as I have said, the problem is by no means confined to that country. The figures and statements that I make are applicable almost precisely, in proportion, to Pakistan. The Indian population has grown by 22 per cent. in the ten years between 1951 and 1961. The figure of at least 22 per cent. yearly increase is the accepted present rate of population growth in India. If this rate of population growth is projected into the future it will mean that the population of India will double in about 30 years. I realise well how imprudent it is to project a curve into the future, but this is offset by the fact that the most informed demographers on this subject tend to believe that the rate of increase of population in India, and indeed in Asia, is more likely to increase than it is to decrease.
§ The problem of population pressure at its present and growing rate of intensity in India and elsewhere in Asia is relatively quite a recent one—in fact, it may be said to be a product only of the last fifteen years. In 1947, when India achieved independence under the Crown, it was 310 million. To-day, fifteen years later, it is close to 450 million—an increase in fifteen years of 140 million people. In the same period of fifteen years prior to the independence of India the increase in population was only 33 million, as against 140 million in the past fifteen years. I submit that these two figures are in effect a numerical justification for what I am about to lay before your Lordships. All the figures that I use I have drawn from relevant official sources.
§ As those of your Lordships know who follow the series of Indian five-year plans, a vast effort is being undertaken there to raise the pathetically low standard of living of the vast population by development of all the relevant factors in the Indian economy.
§ It is common knowledge that the Indian Government cannot achieve their 604 developmental objectives on the basis of their own domestic financial resources, but they are relying to an appreciable extent on financial and economic aid from the more highly developed countries, particularly the United States of America, the United Kingdom and the other developed countries of the West. However, as the Indian population is growing at a rate of at least 9 million persons per year, any increases in national production tend to be spread progressively over a constantly and largely increasing number of people. The large amount of effort and finance that is being put into the Indian Government's effort to increase production and to improve the Indian standard of living is now being practically cancelled out by reason of constant and formidable population increases. The unemployment problem in India annually gets more and more acute each year in addition to widespread under-employment. As has been said, they have to run fast in order to stand still This means that the very large amount of developmental money spent by the Government of India itself, by ourselves and by the United States is being largely wasted, in that it is not helping to achieve the primary purpose—that of improving the standard of living of the Indian people.
§ It is widely agreed among demographers, scientists and relevant men in public life that the only possible solution to the problem of growth population in Asia must be some form of family planning, some form of contraceptive that is socially acceptable. As your Lordships know, family planning has been an important part of Government policy in India—and indeed in Pakistan as well—for a great many years. Increasing amounts of money have been devoted to it in successive Indian Five Year Plans. In the third Five-Year Plan, now about a year old, many millions have been allocated to be spent on family planning. There are about 2,000 birth-control clinics in India, and it is planned to increase them by a great many thousands in the course of the present Five-Year Plan, The problem of those in charge of birth control in India is that they have only the methods of family planning of the past to work on, which are by no means adequate, appropriate or effective for Indian conditions. 605 They are waiting impatiently for science to evolve something better and more appropriate to their needs. As your Lordships will know, there is no religious or other prejudice against birth control in India. In fact, no fewer than 125,000 operations for sterilisation have been conducted up to the present in India alone.
§ The steady increase in net population growth in India and other Asian countries over the last fifteen years, has been due very largely to the increasing effectiveness of public health measures and preventive medicine, which can be said to have started to be put into effect only in 1945 and which have resulted in a constantly declining death rate. The birth rate has not significantly increased, but the declining death rate has had the effect of a steady increase in the net rate of population growth, and this situation may be expected to become more pronounced and acute as the years go on.
§ Scientific research into biological methods of contraception have been going on for a number of years in this country and more particularly in the United States of America. Appreciable success has been achieved in certain directions, in particular, the pill developed by Dr. Pincus, known as Enovid in the United States, and as Conovid in the United Kingdom. In the United Kingdom it is now available on doctor's prescription, for medical purposes under the National Health Service, but it is not in use for what may be called general social purposes. However, the biological contraceptives developed so far are almost certainly not suitable for Asian conditions, by reason of the fact that they have to be taken no fewer than 20 times a month, which is a practice that is most unlikely to be observed by illiterate women in Asian villages. A great deal more research is needed into the whole of the male and femal reproductive machinery, before the ideal and socially acceptable contraceptive is likely to be evolved for use in Asia. Compared with other forms of medical research, the amount of work being done on population control is very small, and in the ordinary course of events the appearance of the final answer is likely to be long-delayed. Such research can be effectively done only in countries with large resources of scien- 606 tific personnel and of money, notably the United Kingdom and the United States. The resources of the Asian countries in this regard are relatively small.
§ That brings me to the point of what I am endeavouring to say to your Lord ships, that a major direction, possibly the major direction, in which the United Kingdom can help India (and the other Asian countries similarly afflicted with excessive growth population) is to encourage the pursuit of scientific research directed towards the discovery of a socially acceptable contraceptive suitable for Asian conditions. I know very well that the United Kingdom by reason of the foreign exchange position and the problem of our balance of payments, is limited in the amount of economic aid that can be given to overseas countries; but scientific research that I speak of, in an effort to evolve a practical and acceptable contraceptive suitable to Asian conditions would have no impact whatsoever on the United Kingdom's foreign exchange position or on her balance of payments. And the same thing can be said of similar accelerated research in the United States.
§ THE EARL OF LONGFORD
My Lords, may I ask the noble Lord one question? When he refers to "a socially acceptable contraceptive", does he mean a contraceptive that would be socially acceptable in India, or a contraceptive that would be socially acceptable in India and in this country?
§ LORD CASEY
My Lords, I am speaking solely of India and other Asian countries similarly afflicted with population problems, not of contraception in the United Kingdom.
The end-point of such research, if it were to be successful, might be some form of contraceptive (it is not for me to say what that form would be) that would put into the hands of the Governments of India and of the other Asian countries the means of curbing their high and growing population pressures. They would, of course, have to take the normal prudent steps to assure themselves of its efficacy and suitability, and that it did not produce unwelcome side effects. They would be under no obligation to accept and use it unless they were satisfied as to its value. Once the scientific work is done and a successful 607 result achieved, as I have no doubt it will be, the rest is up to the Governments of India and the other countries concerned to take advantage of it, to manufacture it and put it into use. That aspect of things is entirely within the "say-so" of the Government of India.
When I speak of Her Majesty's Government encouraging such scientific research, I am not speaking solely of such research being done in Governmentally sponsored scientific research establishments. There is a great deal of scientific research potential in this country under the aegis of foundations, in the universities, by the pharmaceutical companies and in other directions that are not dependent on Government sponsorship or funds. If Her Majesty's Government were to be convinced of the importance of the matter of which I speak it would not be difficult for encouragement to be given in many ways, publicly or privately, to let it be known that the matter might be given the necessary priority. I believe that something between £100 million and £200 million a year is currently being provided by Her Majesty's Government, in the form of aid of various kinds to overseas countries that are in need of it. Might I suggest that a million or two out of this substantial amount might be devoted by, or in, the United Kingdom, to the encouragement of scientific research in the direction of which I am speaking?
It is reasonable to expect that scientific research in this direction will be successful in due course, but at the present rate at which such research is being conducted, the successful result is likely to be rather long delayed. Meanwhile, population pressure in India, and in Asia more generally, is mounting year by year—by nine million persons at least in India each year, and by a great many more in Asia as a whole. I find it difficult to believe that Her Majesty's Government can be indifferent to the economic, social and political consequences, particularly when the means of seeking to shorten Asia's period of dangerous travail is in their hands.
My Lords, I realise very well that the importance of any statement tends to lie in the individual who makes it. I have said a number of things, in the course of what I have ventured to lay before your Lordships' House to-day. 608 but it may be said that I am no expert in these matters, although I do claim to have given an appreciable amount of attention to them over a number of years. However, let me now quote some individuals whose names and standing will be well known to you, and who have expressed themselves with authority and force about the problem of population pressure in India. I have on past occasions quoted to your Lordships. Mr. Nehru, the Prime Minister of India, and President Ayub Khan of Pakistan, in each of whose countries family planning is an important matter of Government policy. Each of them has spoken in the most serious terms of the need for effective family planning in each of their great countries. I will not repeat the quotations I have made of each of these highly placed individuals, in what I have said in your Lordships' House in 1960 and 1961.
I have also quoted Mr. Chagla, the late Indian Ambassador to the United States, now the Indian High Commissioner in London. I have quoted his words in the fervent and moving public appeal that he made in the United States two years ago, addressed to the Government and people of the United States, to press on with scientific research directed towards the evolving of an acceptable contraceptive appropriate to the conditions of India and of Asia. I personally have reason to believe that Mr. Chagla's views are even more strongly held now than when he expressed himself so pungently two years ago.
Now let me quote, if I may, from what Mr. Eugene Black, the distinguished President of the International Bank, said in an address to the Economic and Social Council of the United Nations in April last year. He said this:Population growth threatens to nullify all our efforts to raise living standards in many of the poorer countries. We are coming to a situation in which the optimist will be the man who thinks that present living standards can be maintained. The pessimist will not look even for that. Unless population growth can be restrained, we may have to abandon for this generation our hopes of economic progress in the crowded lands of Asia and the Middle East. This is not a field in which international agencies can do much. But there is scope for Governments to act: it is time that they gave earnest attention to this threat to their aspirations.Senator Fulbright, Chairman of the Foreign Affairs Committee of the United 609 States Congress, speaking of population pressure in Asia, has said this:The Indians and the Pakistanis have both very frankly said that something has to be done about it. Their Finance Ministers came to see me and said that something had to be done about this. This is fundamental to the success of the economic programme. I do not see why the Government should be so reluctant about it.The noble Lord, Lord Brain, who has a long and distinguished record of concern with this subject, is I believe, here to-day and I will not attempt to take words out of his mouth, but I have no doubt that he will let your Lordships know his views in his own terms. Professor A. S. Parkes, lately of the National Institute for Medical Research in London, now Professor of Reproductive Physiology at Cambridge, has said, speaking of scientific research directed towards the finding of an effective contraceptive:Work must be pushed on at top speed, both ad hoc investigation into possible applications of existing knowledge and fundamental researches to broaden the basis of existing knowledge and therefore of possibilities of practical application. More research workers and more facilities are needed but they will take time to produce.Sir Henry Dale, who is distinguished in the fields of medicine and public health, has said, speaking on this same subject:We ought to begin to ask ourselves what we are going to do about it. … There is much to be gained by removing this subject of birth control from whatever remains of its furtive associations . … I think that the time has come when we should advocate, insistently, if need be, that the whole subject should be, as it were, brought out from under the counter, discussed at the highest levels and raised to the full dignity of a proper and important objective, for all that the best of medical and pharmaceutical research might be able to offer towards its eventual solution.My Lords, I have picked out these few distinguished individuals to quote almost by chance. There are a great many others—Sir Julian Huxley, Sir Solly Zuckerman and others, whose names are household words in the scientific world. Let me end by quoting Mr. James Reston, the well known representative of the New York Times in Washington, who said not long ago in this same connection:Probably never in history has so obvious and significant a fact as the present population explosion been so widely evaded or minimised by the Governments of men.610 If any further authority for the seriousness of this subject is needed, I would refer your Lordships to the United Nations Report on "The Future Growth of World Population". I do not believe that what has been said, by the highly placed and responsible individuals whom I have quoted, can be lightly set aside.
I may say that, in what I have said I am not speaking in any way of contraception in the United Kingdom, which from the strictly national point of view is less urgent, however important it may be to individuals. There is a great deal to be said with truth about contraception in the United Kingdom in this context, but this afternoon I am speaking particularly and only about the situation in Asia and in India. The population of the United Kingdom is growing only at the very small rate of about one half of 1 per cent. per year.
Whilst I have spoken of the need to curb the excessive population growth of India and of other Asian countries, in order to enable the pathetically low standard of living to be raised, this is not on the rather longer view the only consideration, or even perhaps the principal consideration. In India itself, continued Jack of success in the task of improving the standard of living will have unfortunate political repercussions. In the larger context, the ideological competition between democratic India and Communist China is well known. If mainland China can get ahead significantly faster than democratic India over the next ten or twenty years, then the people of India may well come to the conclusion that Communism is a more fruitful form of Government and of social system than is Democracy—with appalling consequences for democracy, for Asia and for the world.
Before venturing to address your Lord-ships this afternoon, I reminded myself of a great debate that took place in your Lordships' House, and in another place, on the Indian Independence Bill in July, 1947. Much was said—and very movingly said—about good will and help to the two great nations, India and Pakistan, that were in the course of emerging as independent countries under the Crown. Among the many contributions to this great debate, the noble Earl, 611 the late Lord Halifax, said this OFFICIAL REPORT, Vol. 150, col. 834]:… they"—that is, the people of the then undivided India—will know that in the British Government and people they have friends who will be prepared to place … a measure of unstinted help at the service of the new Indias which are now emerging.I realise very well that the pledges of help that were given in that great debate have been appreciably redeemed by way of economic and financial aid by successive Governments in this country, to the extent that conditions have made possible; and this can also be said of other Commonwealth countries by way of aid to India and Asia.
The interdependence of Commonwealth countries was also stressed in that great debate. I venture to say to your Lordships that if "interdependence" has a meaning—even, I might say, if the word "Commonwealth" has a meaning—it surely means that India and the rest of the Commonwealth countries in Asia should be able to count on the work of a few score, or a few hundred, additional scientific workers, in an effort to cure the most intractable problem of which I have been speaking, with its almost incalculable social, economic and political consequences, and for which the Commonwealth Asian countries do not happen to have the scientific and other wherewithal to do fox themselves. It has been said—and I tend to agree—that, short of preventing another great wax from breaking out, there is no more important matter than to curb the excessive population growth in Asia, with the devastating effects that will follow if it is not coped with.
I have some realisation, I think, of the problems at home and abroad that Her Majesty's Government face and with which they are so valiantly endeavouring to cope. What I have ventured to suggest will not add appreciably—I might even say it will add microscopically—to these burdens, but if the Government were to be successful I believe it would represent the greatest boon that the United Kingdom could provide for the overburdened, underprivileged and underfed countries of the Commonwealth in Asia. Those of your Lordships who take comfort 612 in the belief that population pressure is not one of the great problems of the world that demand attention will no doubt take added comfort in the fact that, in any current assessment of world problems, high place is given, and very properly given, to the limitation of armaments, East-West relationships and, a little closer to home, to the European Common Market and British-American relations, with practically never a mention of population pressure. Holding the belief in the importance of this subject that I do, I ask myself: Why is this so? It is no doubt because it is not happening here, but to a large section of mankind half the world away. It may be because it is regarded as a problem for those countries which suffer from it and not for us; it may be because it is not an immediate menace of to-day or to-morrow but is a gradual, creeping, relatively slow-motion menace; and perhaps it is because one of the great churches has so far been antagonistic to its consideration.
As against this, I submit that those people of consequence in India and elsewhere who know the facts and the inevitable trend believe that the need for action now to cope with it is urgent, as it is approaching the point of no return. Every year that goes by makes the problem more intractable, with its devastating economic and political consequences if nothing is done about it. It is also the fact that the remedy for it is in the hands of the West and not in the hands of those who suffer from it. My Lords, I end with a plea to Her Majesty's Government, and perhaps, in particular, to the Secretary of State for Commonwealth Relations and to the noble Viscount the Minister for Science, to give heed to this great problem—heed and sympathetic understanding. I beg to move for Papers.
§ 2.52 p.m.
§ BARONESS SUMMERSKILL
My Lords, the noble Lord, Lord Casey, has on other occasions drawn the attention of this House to the rapidly-growing population of South-East Asia and to the abysmal poverty which is the common lot of millions of families in those regions. In his opening remarks he said we had not reacted favourably. I can only say to him, as I took part in the debate last year, that if this House has 613 failed to provide a solution to these vast problems, at least the noble Lord has always had a sympathetic response.
We must all appreciate the anxieties of small countries like Australia and New Zealand as they watch the rising population in South-East Asia. Nevertheless, I believe we must welcome the fact that the Malthusian doctrine has not prevailed in Asia or India—a high degree of malnutrition, perhaps, but the gloomy predictions of Malthus have been disproved, and hunger has not decimated those densely populated regions. The West have learnt that a high birth-rate, which is always associated with poverty, ignorance and fatalism, can be effectively reduced by raising the standard of living and introducing compulsory education. It is significant that in those countries where there has been compulsory education for two generations the birth-rate has been stabilised. However, I recognise that this is a long-term solution in regions with a high population density; and, of course, this is not the occasion to examine the economic and fiscal problems of these countries. I say, with all due deference to the noble Lord, that perhaps it is not the time to examine the racial policy of Australia, either.
My concern with the noble Lord's speech is not that I view the situation with complacency: I share his apprehensions, but I dissent very strongly from his specific short-term solution—namely, the use of oral contraceptives.
§ LORD CASEY
My Lords, may I venture to correct the noble Lady? I did not pretend to say what particular type of contraceptive: nor, I think, did I mention oral contraceptives.
§ BARONESS SUMMERSKILL
If the noble Lord examines his speech of last year, he will see that he referred to oral contraceptives and mentioned the kind that were being used in America, and if he examines Hansard to-morrow he will discover that he actually mentioned Conovid. I listened to the noble Lord very carefully. He will surely recall that just before my noble friend intervened and asked him what he meant by "socially acceptable" he said to this House to-day that the oral contraceptive which was acceptable in this country could not be used in Asia because 614 twenty pills had to be taken every month. I think the noble Lord said that. I understand my hearing was accurate.
§ BARONESS SUMMERSKILL
He said last year that that would not be suitable for Asia; that the ideal thing would be to find an oral contraceptive which functioned in the same way but which called for the illiterate women of Asia to take only two pills a month. If the noble Lord examines his speeches, he will find that I am absolutely correct.
Unfortunately, last year I had spoken before the noble Lord did; otherwise, I would have advanced some of these views then: but I must say that, in view of certain statements by eminent doctors in this country during the last year, I am in a much stronger position to review his suggestions than I was last year. I believe that the noble Lord has shown a genuine concern for the vast, under-nourished populations of South-East Asia. One does not question his sincerity, but his solution of the problem may well aggravate, not alleviate, the misery and wretchedness of millions of illiterate, inarticulate women. I am not opposed to birth control. As a woman doctor, I have always regarded it as a most important form of preventive medicine. The mechanical forms of birth control are widely used in this country, and the planned family is a concept which is now accepted by all income-groups—and that is precisely why the noble Lord, in his final remarks, quite rightly reminded this House that the population increase in this country was very small. By all means allow people in overcrowded countries to obtain means of using harmless methods of birth control, but we must not further encourage some members of the pharmaceutical industry hastily to produce new products which can be effective only by inhibiting the ovulatory process.
The noble Lord has quoted a number of eminent men (most of them, I think, big businessmen), who approve of the principle of birth control; but among them he did not mention one endocrinologist—that is, an authority 615 on the ductless glands—who whole heartedly approved of the oral contraceptive. Nevertheless, again he advances the same argument as he advanced last year: that this is the answer to the population problem. He mentioned the names of some of the oral contraceptives on the market last year, as I have said, and to-day he mentioned Conovid, which so many doctors in this country—and this is a very good test of any drug—refuse to prescribe for their patients. There have been only limited trials of this American preparation, some in this country but mostly in other countries; and in view of the opinions expressed by eminent authorities I doubt whether any doctor would prescribe the pill for his own wife and subject her delicate pituitary gland to the bombardment of this compound.
Professor Sir Charles Dodds is one of the foremost endocrinologists in this country, and therefore an authority on this subject. In fact, he is now the President of the Royal College of Physicians. In a lecture to the Society for Endocrinology—whose members were men and women Who devote their lives to the study of this subject—this is what he said; and I ask noble Lords to forgive me if I quote his words in some detail, because it is a highly technical subject and has a tremendous importance to-day to this country, and, indeed, to the whole world. He said:The continuous or cyclical use of these compounds may foreseeably have other undesirable effects which the trials conducted to date have not resolved. Such effects, for instance, when their use is continued throughout the reproductive period of a woman, might involve the pituitary, mammary glands or ovary.He went on:The fact that in a relatively short period nothing has been found does not really indicate very much. Whilst everything might appear all right on the surface, there may be deep-seated changes going on in the body. It would seem very unlikely to me that the abolition of a cyclical process such as ovulation can be accomplished over a long time without profoundly affecting other processes, and the fact that there appears to be no change for a period is not, I suggest, reassuring.He then said:Even if you thoroughly understand the mechanism of a clock, provided it is going well it is very much better to leave it alone; but to interfere with its mechanism if you do not understand it can be disastrous.616 He expressed his fears to the Family Planning Association in October of last year, and warned them of the dangers, particularly if the treatment is prolonged.
Later on, no doubt, other doctors may be quoted; but I think that the noble Lord, Lord Casey, should hear what the British Medical Journal said, because they are there to assist both sides who express opinions on this matter. On September 16, 1961, in an editorial on the contraceptive pill, the British Medical Journal said this:The mechanism by which these drugs inhibit ovulation is not precisely understood, but they are believed to block the synthesis of certain hormones in the anterior pituitary gland. In the present state of knowledge, based first on animal experiments, and later on clinical trials, no certain answer seems possible to several important questions. One is whether the endocrine system will become permanently impaired, and perhaps fertility reduced or destroyed. Another question is whether these substances could be carcinogenic. Though the likelihood of these oral contraceptives being carcinogenic is probably extremely remote, and though fears that they might cause congenital defects in babies born subsequently are probably groundless, it still remains to be shown that the suppression of ovulation over long periods is harmless to the endocrine system and to ovario-uterine relations.May I now ask noble Lords to go into the Library this week and to look at the Lancet? An editorial in the Lancet, which is a paper that tries to collect the voices of the medical profession, and to approach matters objectively, is devoted to the danger of oral contraceptives, and echoes the warnings of the British Medical Journal. It says:The use of oral contraceptives cannot be contemplated without considerable trepidation. … Twenty years may go by before we can be sure about the safety of the present oral contraceptives.These are words of wisdom. I believe that when the American company originally responsible for the oral contraceptive practice conducted their trials, they used Puerto Rican women as the guinea pigs for these tests. I say, let twenty years elapse, and let us see what happens to these women, and whether these fears of one of the finest endrocrinologists in the country are realised, before we enter into more trials or before we take these drugs to densely populated areas.
My Lords, I want to be constructive. I favour the view of Mr. Linton Snaith. 617 Mr. Linton Snaith is the senior obstetrician and gynæcologist of the Newcastle General Hospital. He has written considerably on gynæcology and obstetrics. He has expressed concern about oral contraceptives in family planning association clinics, and he says:It is best to limit the contraceptive pill to experiments already in progress, to hospital clinics, and to patients suffering from gynæcological conditions which justify this treatment.That, I believe, is the sane and the reasonable approach. Many of us deplore the fact that the Family Planning Association, with its splendid record, has not shown greater caution. I realise that the noble Lord, Lord Brain, was chosen as the President of the Family Planning Association, and his well-known name has been very useful to them. But he, of course, as a neurologist, can look at this matter objectively.
The noble Lord, Lord Casey, discussed various means whereby further progress could be made. I can assure the noble Lord that the pharmaceutical firms producing oral contraceptives are not waiting for encouragement from the Government to investigate a cheaper pill for the Asian market. Indeed, they are showing a reckless haste, in this country and abroad. Last week I read that a conference on birth control is being held in the Near East with the co-operation of a pharmaceutical manufacturiing firm concerned with the use of oral contraceptives. Surely, to say the least, this is premature, having regard to the illiteracy existing in the Near East and the shortage of doctors, which would preclude careful supervision.
Doctors who oppose the new oral contraceptives have been called "fuddy-duddies" and "old-fashioned" by the London organiser of the Family Planning Association. I have never in the past been called a "fuddy-duddy" or been accused of being "old-fashioned" but I am quite prepared to accept that label because I feel that I am in very good company in this matter. A British Medical Association spokesman said last week that he was very surprised at the tone of these remarks. He said:I think it is rather unwise to sneer at the caution felt by a lot of doctors towards these pills. The pills, to my knowledge, have only been tested for about five years. There are 618 many things we still do not know about their side effects.I was further astonished by the noble Lord when he suggested that £1 million or £2 million should be taken from the quite inadequate aid given to underdeveloped countries for research into these oral contraceptives; and, indeed, that some of this money could be directed towards the pharmaceutical companies. I can assure him that the pharmaceutical companies are making colossal profits. If he cares to read the Report of the Public Accounts Committee, he will see that the profits which they make out of the National Health Service are such that there is an ample margin for research, without supplementing their profits with some of the money now sent to underdeveloped countries for food and social services. Unfortunately, my Lords, powerful new drugs are marketed to-day by some men who are not moved by human compassion or guided by high ethical standards. They adopt the same methods in selling their wares as the producers of detergents. Doctors are deluged every day with their highly-coloured advertisements, and a constant stream of smooth tongued commercial travellers waste the doctors' precious time.
This modern menace of the drug purveyors has become a social problem in the United States. I would remind noble Lords of the recent glaring case in this country, which I raised in this House and which was raised in another place—the"example of the distribution of Distaval, a so-called tranquilliser, which, when taken by the expectant mother, causes severe abnormalities in the foetus. It will shock the House when they hear that on May 14 of this year Professor Graham Wilson, Professor of Pharmacology and Therapeutics at Sheffield University, stated that in the last year more than half the drugs issued had not been clinically tested.
Of course, there has been no shortage of customers for cheap oral contraceptives. A woman's happiness depends primarily upon happy personal relations in the home. The fact that an oral contraceptive might have most serious long-term ill-effects will not deter some women, desperately anxious to establish short-term personal happiness. The woman who has had a number of unwanted pregnancies will consume 619 contraceptive pills reckless of the consequences, just as she will resort to an abortionist at the risk of her life. The marketing of oral contraceptives promises a colossal margin of profit, for there is no frontier and no limit to the market. The sex instinct is universal. The consumption of this pill would not be limited to a group suffering from a specific disease. All the powerful media of advertising and propaganda would be directed at the healthy, with a promise of enjoyment without fear of the consequences. Even if the doctors could exercise control or afford any protection, they are in such tiny minorities in the Asian countries that their protection would be negligible. The ignorant and illiterate would be the victims of some unscrupulous purveyor of drugs. For all these reasons, I would ask the noble Lord sincerely to reconsider, between now and next year, his immediate solution to the problem of over-population.
§ 3.13 p.m.
LORD MIL VERTON
My Lords, until yesterday I had no intention of taking part in this debate, but it occurred to me then that perhaps it would be no bad thing if somebody spoke on the subject who looked at this problem from the point of view of an administrator and was not a political idealist or a medical expert. The Motion starts by asking Her Majesty's Governmentif they have considered the consequences of the present rate of population growth in Asia".However blind or deaf one might think the British Government are, they cannot avoid being conscious of this, because they are still responsible for Hong Kong, and the normal population of Hong Kong, which was about 600,000, has risen since 1949 to about 3,250,000, and Hong Kong is now bursting at the seams with refugees from China. Conditions there are inevitably appalling. Hong Kong has been left to bear this terrible burden alone. If ever the conscience of the world ought to have been awakened, it surely should have been over a situation like this. The refugees from Europe, the Arab refugees from Israel, and refugees from other parts of the world have had funds collected and generously distributed to help them, 620 but apparently the world is blind to this appalling Asian problem.
The way I am trying to look at this question this afternoon is that birth control can be only an adjunct, not the final solution. I am not denying the value of increased knowledge of birth control, but even if the miracle which the noble Lord, Lord Casey, seems to have dreamed of, a new method of birth control, which could suddenly be used and would be socially acceptable, were found, it would not have its effect now. The problem before the world to-day, a problem which has caused wars in the past and may yet cause something like a world war in the future, is what is going to be done with these millions of surplus people who are craving some outlet and some means of a better and higher standard of living. One has only to read the First Report of the Colombo Plan Committee, in which they detailed how they had poured millions of pounds into India to help the people there, and the net result was merely to cause scores of millions who would probably otherwise have died to go on living on the margin of subsistence.
This is an administrative problem of the highest order and, whatever way one may look at it, there is no possible short-terms solution; it is bound to be a long educational, cultural and economic solution and it lies with the Governments concerned. The countries we are speaking of are independent countries. How can we approach them with the idea that we have perfected a scientific method for curtailing the growth of their race—one which, I understand, we are not prepared to apply in this country? We have been assured this afternoon that this is not for England. I have had experience in countries abroad where birth control is not socially acceptable and the cry arises that this is a new trick of the European in order to stop the growth of races whose increase he does not desire to see. The accusation that we are engaged in genocide is so easy to raise and so difficult to combat or disprove. As your Lordships will gather, I am a pessimist in relation to the immediate solution of this problem. I do not think that there is any scientific solution which can be other than an adjunct to education and economic and cultural influences, and these must be long-term influences.
621 If your Lordships will pardon a reminiscence of mine, some years ago, when I was in Jamaica, I had the opportunity of spending a day in the company of President: Roosevelt. He talked to me about these problems and asked what we were doing about them in the West Indies. I said: "Mr. President, I have devoted a great deal of thought to this and I do not know of any short-term solution. The opposition one creates by trying through Government sources to promote birth control, as any administrator will tell you, is grave and serious. It is apt to defeat its own purpose. "The President said to me:"In my opinion there is only one solution, and it is this. First of all, we must make children a liability and not an asset, which means that you get people to the stage where they do not allow child labour and things of that kind." Then he said: "You must teach people, through education and so forth, to want things that only money can buy, and by this means you will slowly get them to restrict their families voluntarily, because otherwise they cannot live the sort of life they would wish to live". That may sound very material; but, again speaking as an administrator, one has to consider these material things.
It is no good being too lofty-minded; one is dealing with human nature. I suggest that that is precisely what we shall have to look forward to doing, with the assistance, of course, which the doctors can give and which I do not decry for one moment although it is only a secondary thing. Finally, I should like to emphasise the fact that the problem before us now is this: what are we going to do about these millions of people who are spilling over? It is no good thinking too far ahead. That is a problem that will upset all our plans unless we deal with it at an early date. For that reason I feel that, while I could not agree more with the eloquent way in which the noble Lord, Lord Casey, has described the situation which has arisen, I could not possibly concur with what he suggests is the solution.
§ 3.22 p.m.
§ LORD BEVERIDGE
My Lords, I return to-day for the first time, after a month or more in the hands of doctors, to active action in this House, and I am glad to have the chance of doing so on 622 a Motion such as that moved by the noble Lord, Lord Casey. I congratulate him on raising a problem common to all the world—namely, the size of population in relation to the standard of living. I heard the noble Lord on this occasion making much the same general observations as he did on a previous one. I want to urge that this is a problem that must be left to each country to decide for itself. The density of population of each country is for its own decision, as also is the question of any steps to be taken to give effect to that decision. It is not, I think, for an outside nation to take any action to influence the decision of another nation on this point. It is not for us to adopt a policy designed to force the people of another nation to accept a plan of contraception which they do not want, or to say that we will not help them financially in some way or another unless they do what we want them to do.
But while it is for each nation to decide on the density of population of their own country, it is most important to point out what effect the density of population may have on the standard of living. I happen to be studying the history of this country. I think I can say quite certainly that when, in the sixteenth century, we set out to industrialise the country much more, and increase its population, we also raised its standard of living. There was unquestionably a large increase of population in Britain, although we have no definite figures; and there is no question that what happened in the sixteenth century was the beginning of a new life in this country and of an improvement in the standard of living.
I want to suggest that this problem of the relation between the total population and the standard of living is a question for each country to decide for itself. It is not a question for any one country to decide for another, or to use its power to enforce on others its own policy. I do not think it is the business of any one country to interfere in this matttr with another country. It is not our business, because there is no reason to-day to fear the power of other countries in war, in so far as population is concerned. War to-day does not depend simply on numbers. Success in war, as we all know, has come to depend upon the 623 strange, unusual powers which we have learned to use in nuclear war and on our devotion to killing people, irrespective of the risk to ourselves. I would say, therefore, that it is not right to make the question of economic co-operation with other countries depend in any way upon their numbers, and least of all on their attitude to contraception. I hope that we shall make known the facts in regard to the growth of population. I am thankful for what the noble Lord, Lord Casey, has done to bring these facts before us, and I hope that what he has said here will lead to their being brought before others. But I repeat that, having the facts before it, each country must decide for itself.
There are some countries to which any form of contraception would be most unacceptable, while there are others who would find it more acceptable, or might find some method which they could use with safety without destroying any of the traditions of their country. This is not an international problem; it is a purely national one. I think that, subject to all countries having taken any necessary steps to put an end to war, within that limit, every country should be free to manage its own domestic arrangements, and all will be helped towards doing that by having put before them the kind of facts which the noble Lord, Lord Casey, has tried to put, and others may also try to put, of the relation between the size and density of a population and the growth of a population in relation to the standard of living. My Lords, that is all I have to say. I hope that I may have other occasions of listening to addresses as interesting and as important as those of the noble Lord, Lord Casey, and of learning by them.
§ 3.30 p.m.
THE LORD BISHOP OF LONDON
My Lords, many of us would agree with the noble Lord, Lord Beveridge—whom we are glad to see back in this House restored from the clutches of the doctors and, we hope, to many years of participation with us—that this question is one which ultimately can be determined only by the nations concerned. In the previous debates on this general subject, a good deal has been said from these Benches to indicate that on the side of the Christian Churches we would per- 624 haps wish to take that limitation even further. In the debate last year the right reverend Prelates, the Lord Bishop of St. Albans and the Lord Bishop of St. Edmundsbury and Ipswich, expounded the general position which was taken up by the Lambeth Conference of 1958. I would not wish to traverse again the ground which they covered so adequately. In brief, our belief then was and, I believe, still is, so strongly in the importance of personal relationships that we would wish to put the responsibility for the regulation of birth directly upon the parents, without any interference by anyone else.
If I may remind your Lordships, in Resolution 115 of the Lambeth Conference we stated our belief thatthe responsibility for deciding upon the number and frequency of children has been laid by God upon the consciences of parents everywhere and that this planning, in such ways as are mutually acceptable to husband and wife in Christian conscience, is a right and important factor in Christian family life.To those general principles, I think we in the Church of England, by and large, would still adhere.
The noble Lord, Lord Casey, in his moving speech, has shown again his deep concern for the problems of overpopulation, and we all need to remember this as essentially a human problem. Behind the statistics lie vast numbers of persons and children who are suffering from malnutrition, of youths and adults frustrated by the inability to find land to till or jobs to perform. The Christian conscience must be deeply concerned with their needs, and there can be no shadow of doubt that those needs claim the compassion and such assistance as can be given of the whole world. In the long-term, I would agree wholeheartedly with what has already been said, that the solution of the problem lies in the education of the people so that they can make better use of the resources which they have, and so to assist them with capital, machinery and the technical skills that they can increasingly help themselves to meet their own needs.
Perhaps, too, we need to pay more attention to securing a better distribution of peoples, so that the rapid increase of population is not only centred in areas where national resources are depleted and the soil already exhausted. We need education in the responsibility 625 of parenthood and family life. I am perhaps more optimistic in these matters than the noble Lord, Lord Milverton, appeared to be, but I have no illusions about the length of time which will be needed to establish, through education and economic development, a balance between the increase of population and the increase in productivity. So we feel a need for short-term measures. Among them, the limitation of population by the regulation of birth is most certainly something which must be considered by those who are responsible for the decision in other lands.
But there is a very deep division upon the proper means of regulation. I was disappointed that the noble Lord, Lord Casey, emphasised the need for research to produce a socially acceptable solution in terms of what he called a biological contraceptive which would be simple and effective. Christian opinion is deeply divided upon the moral legitimacy of birth regulation by the use of contraceptives of any kind. Whatever one's own personal views on that may be, it is to be hoped that there will be research not confined to only one method of family planning. We need more scientific inquiry into all the possible and effective methods of birth regulation which do not remove from parents the responsibility for choice, which rightly belongs to them, and to them alone.
Under the mounting pressure of hunger—the certainty that if another child is born other children will have less to eat—people resort to means of control such as infanticide and abortion, which are so cruel, so insensitive and contrary to moral law that we must rule them out of our calculations. Is sterilisation an acceptable means of controlling population? Here again, the medical evidence is conflicting, and the question whether male sterilisation is reversible seems in doubt. The ethical arguments involved are extraordinarily difficult for the Christian conscience. Are there other alternatives which can be socially acceptable and which will not offend the conscience? If so, we need to know them, and it is to that I would hope that such research as goes on may be increasingly directed. Whatever its results, there remain problems of ethics and conscience for the Christian Church. But as was said in a recent report of 626 an inquiry fey a group acting on behalf of the Church Assembly Board for Social Responsibility:Traditional moral theology has not been called upon to consider the extent of the obligations of parenthood under the threat of over-population as we are to-day.We who believe that the Holy Spirit guides us into all truth must be prepared for modifications of former attitudes. But it is truth in its fullness which is promised us in Holy Scripture, and what we need more and more is what scientific research can tell us about the whole truth connected with population regulation.