§ Order for Second Reading read.
§ 11.6 a.m.
§ Mr. Phillip Whitehead (Derby, North)
I beg to move, That the Bill be now read a Second time.
The Bill is a short one, and it is an amending Measure, but I would not seek to disguise from the House the fact that it touches upon great issues—issues of human relationships, parenthood and family life. It seeks to enlarge one of the most enlightened Measures of the last Parliament—Mr. Edwin Brooks's National Health Service (Family Planning) Act, 1967, which as a Bill received an unopposed Second Reading almost five years ago.
In introducing that Bill, Mr. Brooks drew—I think rightly—a sober picture of the world situation against which the Bill was being considered, a situation in which the fecundity of mankind threatened to outstrip his resources. Almost five years have passed. I do not think that anyone could gainsay that contention of Mr. Brooks's now.
Just two weeks ago 60 of our most eminent medical men signed a joint statement in the Lancet and the British Medical Journal emphasising the Inescapable connection between population, resources and environment. The greatest of these, as they said, is population. We are now taking Professor Ehrlich and others like him more seriously. Last week's Ecologist manifesto "Blue Print for Survival" can no longer be laughed off by sceptics as doomsday propaganda. There can be very few who were not struck by Mr. Jack Parsons's vivid analogy reported in The Times the other day between population growth and the rate at which a waterlily covers a pond, doubling its size each week through a year until the pond is covered; and nine-tenths of all that growth takes place in the last month.
Our leading medical men stressed in their statement in the Lancet and the British Medical Journal that greater publicity for and greater involvement in 827 family planning services, including vasectomy, which is the subject of the Bill, was absolutely vital. That has been welcomed in the Press, even by those newspapers which found the overall tone of the statement by the medical men somewhat alarmist.
When Mr. Brooks introduced his Bill he was also right to stress that what was needed was the interest and support of Governments in family planning, not their intervention to force a population policy upon a frightened people. He said this:The alternative is to give free men and free women the knowledge—the knowledge which is today so indispensible for the exercise of responsible and wise parenthood."—[OFFICIAL REPORT, 17th February, 1967; Vol. 741. c. 937.]That is the position from which I approach the question of vasectomy and family planning.
When the Family Planning Association gave evidence to the Select Committee on Science and Technology in 1970 and 1971, it was emphatic that its main aim was to make life more tolerable, more agreeable, and more enriching, not just for the woman in marriage but for the family unit as a whole, and that should be the prime consideration in family planning. I yield to no one in my reverence for life and for the right to a life which is tolerable and enriching. The House will understand this when I say that I was an adopted child and the circumstances of my birth were such as to make me cherish the gift of life which came to me very much by chance.
The House has legislated a good deal in recent years on medical and social matters. The family planning counselling and treatment now available under the 1967 Act, and more widely so since the Department published Circular 36/71 last year, are mostly used by women. The Abortion Act provides for the most drastic birth control of all, for women.
The House of Commons is still, to some degree, a male institution, "a tawny male paradise", as Sir Henry Channon called it many years ago. That is significantly still the case. It may be for that reason that we have given so little consideration to vasectomy as a form of birth control. As my hon. Friend the Member for Pontypool (Mr. Abse), 828 who I am delighted to see waiting to take part in the debate, said in a powerful intervention during the Second Reading of the Medical Termination of Pregnancy Bill, 1966:I do not understand why, so far, nobody has referred to the fact that the Royal College with all its knowledge, has said that it is a far less dangerous operation—almost a slight operation—for a man to be sterilised"—that is, less dangerous than the operation involved in abortion and the termination of pregnancy. My hon. Friend continued:But I have noticed that if one says to a man, 'Look, if a working class woman has six or seven children and is worn out, and there is every probability that she will have another one, do you agree that she should be sterilised?' he will often agree, but if one puts to him the reverse possibility—the sterilisation of the man, which could end the dilemma of the working class family in such circumstances—he recoils, because he regards it as an assault upon his own masculinity."—[OFFICIAL REPORT, 22nd July, 1966; Vol. 732, c. 1150.]My hon. Friend was right, although, as I hope to show, male attitudes to vasectomy have changed very considerably since 1966. But large numbers of women are sterilised, including the majority of married women who have just had abortions under the National Health Service. The figure for female sterilisations under the National Health Service in the last year for which we have figures from the Department, 1969, was about 20,000 against 2,000 male sterilisations which were possible on strictly defined health grounds. At all times female sterilisation requires a stay in hospital and an internal operation. It is more expensive and carries a greater risk than vasectomy.
Dr. Potts, of the International Planned Parenthood Federation, giving evidence to the Select Committee in 1970 stated:We have probably over-used female sterilisationin family planning. That is the main reason why my Bill deals with vasectomy only and why I ask this largely male assembly to consider, when it next sends its womenfolk along that road where pills its women folk along that road where can have side effects or be forgotten, where caps do not always fit and intrauterine devices can come out, to consider the possibility of male sterilisation. It is cheap, simple and, properly carried out and checked, 100 per cent. reliable. These are strong recommendations not 829 merely in cases of medical need but wherever mature people responsibly decide that their families are complete.
Vasectomy is not castration. It has no effect on a man's desire or capacity for sexual relations. It is done by opening the scrotal sac under local or general anaesthetic, locating the duct which carries sperm from the testicles into the seminal fluid, the vas deferens, and making a small cut in it. This interrupts the passage of sperm, which continue to be produced but are reabsorbed into the body. The operation takes about 15 minutes and, although the patient may experience discomfort for days, or occasionally weeks, in its order of risk and difficulty the operation is like the extraction of a tooth.
Although vasectomy has been known since the end of the last century, its early advocates stressed eugenic considerations. We all realise today that those eugenic considerations tended to be misapplied and that the thinking behind them was not such that many of us would subscribe to it. Mr. Stedman Jones, in a profound recent study of the problem of the outcast poor in London, has drawn attention to the extent to which many social thinkers of the time, including the Webbs and William Beveridge, believed that one could sterilise the "remnant" of the casual poor of London. This would not commend itself to us today or to the non-eugenic considerations which are behind the campaign with which I am proud to be associated for greater knowledge of and wider facilities for vasectomy.
There was for some time doubt about the legality of this operation. In 1934, the Brock Committee recommended that the operation for sterilisation for men should be legalised. For the next 20 years the argument hung on whether the Offences against the Person Act, 1861, passed long before any sterilisation operation had taken place, or even the medieval law of mayhem rendered the operation illegal. In 1960 the medical defence organisations obtained counsel's opinion that:an operation for sterilisation is not unlawful whether it is performed on therapeutic or eugenic grounds, or for other reasons, provided there is full and valid consent for the operation by the patient concerned.In Written Parliamentary Answers on 23rd February and 30th April, 1970, my 830 right hon. Friend the Member for Coventry, East (Mr. Crossman), the former Minister of Health, made it clear that the operation was regarded as legal where regard was had to the health of either the husband or wife, given the valid consent of both parties. We owe an enormous debt to the Simon Population Trust and to associated bodies for the increased knowledge of vasectomy over the past few years. The Simon Trust launched its sterilisation project in May, 1966, and we already have its follow-up report on 1,012 case histories where vasectomy was performed on applicants after full consultation between both marriage partners, family doctors and surgeons.
Nearly 90 per cent. of the men had been married for more than 70 years and over 90 per cent. of them were more than 30 years old.
§ Mr. Anthony Fell (Yarmouth)
Did the hon. Gentleman say that the men had been married for over 70 years?
§ Mr. Whitehead
If I did, I was somewhat exaggerating the need and desire for this operation.
Nearly 90 per cent. of the men had been married for over seven years and over 90 per cent. of them were more than 30 years old. Their predominant reason for applying had been a distaste for the daily round of contraceptive precautions and a desire to spare their wives either operations or the risk of further pregnancy.
It is interesting that only two of the 1,012 reported that their health had deteriorated, and 115 of them claimed improvement. Only 15 out of the sample reported any deterioration in their sex life. Remarkably, 740 of them—almost three-quarters of the sample—said that their six life had improved. Over half the sample reported that marital harmony had much improved and less than 1 per cent. reported less harmonious relations. This report is closely followed by Canadian surveys carried out by Livingston and Alderman.
It is only fair to add that, in a study of men who had undergone vasectomy through the Simon Trust at Swindon, Helen Wolfers found that 10 out of 82 indicated physical or psychological problems, mostly with a history of psychosexual problems before the operation.
831 This is where the importance of psychiatric counselling comes in. Professor Pond, Professor of Psychiatry at London Medical School, puts it in this way:If you ask questions all the time then you only get answers all the time. The answers may not be at all about what the person really wants to tell you.I cannot stress too strongly that time, care, and the ability to listen are crucial when preliminary counselling is carried out.
The Family Planning Association with 17 clinics which have been opened for vasectomy operations and which would be largely integrated with the local authority family planning service if the Bill became law is scrupulously careful in its screening of cases. General support for the Bill has come from the Royal College of Psychiatrists, which has sent me a strong letter of support for the Bill, indicating its view that it should be passed into law. One of the first Family Planning Association clinics, run in collaboration with a surgeon at Cardiff Royal Infirmary, reported on its first 123 cases in 1969. Of that number 15 people did not, or were counselled not to, have the operation. All these people were counselled by Family Planning Association doctors in the light of their family background and contraceptive history. They were told, as all people who go to the Family Planning Association or the Simon Trust are told, that the operation must be considered irreversible and the implications of this if a child or perhaps the wife dies. They both sign consent forms and their family doctor is asked to do so, too. For this, the operation and the checking of seminal specimens over a period of several months to see whether the operation has been a success the total fee charged by the Family Planning Association is £15.50.
Local authorities cannot pay this, except in very rare cases where medical need qualifies a man for a National Health Service operation, usually genetic defects, or the mental health of either partner. or the obstetrical reason, that a further pregnancy would actually threaten the life of the woman. Many local authorities would like to be able to meet the cost of this operation. They are uneasy at a situation where the well-off can get vasectomy on demand from 832 private surgeons for anything from a £30 to £70 fee without any waiting period, whilst a huge waiting list is building up known to the Family Planning Association and the Simon Trust.
In my own constituency there are two family planning clinics operated by the local authority. The Medical Officer of Health for Derby tells me that he estimates there may be around 600 people who would like a vasectomy. He can see they get free contraceptive equipment if necessary, but he cannot pay for vasectomies. Apart from recourse to private surgeons the nearest Family Planning Association clinic equipped for vasectomy is at Nottingham where the branch administrator tells me there is a 600 waiting list and a five month delay before a patient can be seen.
I am not surprised, therefore, that I have had a very heavy mail in support of this Bill from local authorities, for example, from Camden, where I live during the week, and which is taking the lead in introducing the free comprehensive family planning service which should be our target in this field. The Medical Officer of Health at Camden expresses the view that my Bill does not go far enough and to him it is only an interim Measure and nothing else. I agree. He tells me in a letter:I have had some success"—in setting up a free hospital service—in one of our local hospitals which will accept cases for vasectomy provided they are screened by family planning clinics or general practitioners. Another hospital is considering the possibility of arranging for an F.P.A.-sponsored vasectomy clinic to be held in the hospital for cases which have no medical or social grounds; and a third has informed me that they will undertake vasectomies on medical grounds only. In this absurd situation your Bill will act as a most useful though, I hope, temporary expedient, and you probably know that my borough has asked for such legislation to be introduced.Similarly, I have had letters from throughout the country—from Newcastle, Brighton, Cambridgeshire, Staffordshire—and there has also been a considerable amount of support by the Junior Hospital Doctors' Association, by distinguished neurologists such as Professor Blandy of Charing Cross Hospital and Mr. Grant Williams, by Dr. John Fry of the General Medical Council, by Mr. Anthony Storr, and by every single letter I have received 833 in my very considerable mail about this matter.
Many of these letters have contained personal case histories of the difficulties of securing a vasectomy. It is when one realises the extent to which really serious cases on medical and social grounds are currently turned down by the National Health Service that the modest proposals of this Bill grow in stature. Dr. Caroline Deys, of the Marie Stopes Foundation, who runs a clinic in collaboration with domiciliary family planning services, mentioned even cases of muscular dystrophy where vasectomy on the National Health Service was refused. In cases where five or more children have been born and where the wife is told by her doctor that her medical condition rules out the pill or an inter-uterine device, the husband's request for a vasectomy has still been refused. Having watched Dr. Deys operating, and having studied some of the case histories in process of counselling, all I can say is that I am astonished and ashamed that vasectomy is not included among local authority family planning facilities.
§ Mr. Whitehead
I am very grateful to the hon. Member for telling me. I am sure she died all the happier for having an illustrious grandson who comes to the House to say that he sees no reason whatsoever for family planning services being available for those who have 16 or 17 children—
§ Mr. Whitehead
It is not a magic number at all. I could mention cases of parents of 6, 7, 8, 9 or 10 children, and the operation has been refused. I mentioned five children simply because it seemed to me that at that number or beyond it is quite reasonable, in many cases, for people to have this operation if they want it and to be able to demand it on the National Health Service.
§ Mr. Fell
I am very grateful to the hon. Member for giving way again, but he keeps mentioning this number of five —or six or seven. My chairman would never have been born if that sort of thing had been happening then. There are many figures in history who have been the tenth or fifteenth children. Who shall decide who shall and who shall not be born?
§ Mr. Whitehead
I cannot express too strongly that it is the parents who should decide—and if the parents decide that their seventh child will be the chairman of the Conservative constituency association, of course they will go flat out to have him.
§ Dr. Tom Stuttaford (Norwich, South)
Is it not the case that a survey by the Department of Health and Social Security showed that the care which children receive gets less and less as the family gets greater and greater?
§ Mr. Whitehead
Of course I would accept that point, and I am grateful for that intervention by the hon. Gentleman who is one of the sponsors of the Bill. There is a correlation between the size of family and adequate care, varying directly with the number of children. I did not for a moment expect that the hon. Member for Yarmouth (Mr. Fell) would agree. He, no doubt, agrees that there should be families of 17 children without regard to the resources of the family concerned and the family's environment round about. All I can say is that the hon. Member is wholly deluded on the subject. However, what I am not saying is that the parents should be ordered or compelled to cease to produce children. It is for them as parents to decide whether they should limit their families or not, and we should not stand in their way.
To come back to my Bill, Clause 1 includes vasectomy among the local authorities' family planning clinic services and domiciliary services which may be set up and which have been increasingly set up under the 1967 Act. I am glad that the figures published in the OFFICIAL REPORT on Tuesday last show for local authority expenditure how rapidly this has risen over the last three years, though 835 it also shows some deplorable local exceptions.
It will be seen that Section 1(2) of the 1967 Act remains exactly the same in my Bill, so that the local health authority will be empowered, subject to the approval of the Minister, to recover such charges as are considered reasonable for the vasectomy counselling and operation having regard to the means of the patient. I personally look forward to the day when all family planning services will be provided free on the National Health Service so that we have a comprehensive service like the one the five London boroughs wish to introduce. That time is not yet, although that is my hope and intention, and this is an amending Bill. It is my hope that the payment of fees by local authorities will not come to be seen by surgeons as a sort of additional remuneration, but rather that vasectomy, where it is advised, should be regarded as a social service, and when it is widely available the lucrative fees which at the moment are paid to some private surgeons should shrink as this becomes an accepted National Health Service operation in the same process of counselling and consultation, and because the acceptance of the operation and its availability on the National Health Service will become more widely known.
Clause 2 (1) simply amends Clause 3 of the principal Act to include among the increases in expenditure incurred by the Minister, or in rate support grant to local authorities, additional expenditure attributable to the provisions of this Act. A Financial Resolution will be necessary. Clause 2(2) amends the payment into the Exchequer of sums received by the Minister under the principal Act in precisely the same way.
I have deliberately left the Bill somewhat general in its drafting, and I welcome hon. Members' suggestions for amendment, and those of the Government should they accept the Bill in principle. It is to this central issue of principle that I now want to address myself. Should vasectomy be supported as a form of birth control, as well as a preventive operation carried out where there may be a threat to life?
Those who ask themselves this question and find that it is perhaps distasteful tend to argue that the irreversibility of 836 vasectomy separates it from other forms of contraception. It is true that every couple who are counselled for vasectomy are told, quite rightly, that they are to assume that the operation is irreversible. It would be foolish to have it done on any other basis. But if, say, a man's wife and children were all killed in a car crash and he re-married, no surgeon would refuse to operate to reverse the condition if possible. The chances of producing viable sperm may be no better than 50/50, although in the United States of America there has been evidence of greater success in reversing the vasectomy operation. Experiments are now going on with the insertion of a plug into the vas deferens rather than the cutting of the duct itself. But it is always best to remember the likelihood of irreversibility.
As the Church Assembly inquiry into sterilisation put it:Irrevocable decisions are part of life—marriage is, in the Christian view, one of them —and so are risks.Those who work in this field all agree on the level of sober assessment and mature judgment among the couples who seek advice about vasectomy.
The men are first and foremost family men.…",writes Dr. Pauline Jackson of the Cardiff Family Planning Association Clinic—…concerned primarily for the welfare of their wives and children…one gets a tiny but vivid picture of a deep and shared marital happiness and devotion.No F.P.A. Clinic would counsel vasectomy for a single man, or for one enmashed in a troubled and unstable relationship, but for the couple who regard their family as completed vasectomy can be as appropriate as the range of contraceptive devices for younger people.
There remains the nagging fear in some minds that, if vasectomy is supported by public funds, a rise in demand will drag down the high level of counselling. When in 1970 the Hackney Borough Council decided that it would subsidise vasectomies for men in certain social conditions, the Daily Telegraph sympathised loudly with ratepayers who would—…feel the gravest moral scruples about financing an operation which deprives a man, even by his own momentary consent, of the power to engender children.837 It envisaged "wistful young libertines" queueing up to get immunity from parenthood on the rates.
This kind of attack wilfully misunderstands how vasectomy is controlled. When my Bill talks of voluntary vasectomy it means the full process of counselling and consent by both parties, after consultation with their general practitioner and a second doctor's opinion, an opinion which the Royal College of Psychiatrists recommends should be that of a psychiatrist.
I hope that the medical grounds will be interpreted as widely as possible to include the social conditions of the family. Everything we have learned about the correlation of large, overcrowded families with instability and delinquency makes this a medical imperative. For the couple who present themselves, calmly and rationally, for vasectomy but with no medical indication that it is needed, the only additional check required would be a lower age limit for the man, which the Bill fixes at 30. By that time society can say it has protected for a long period a man's right to have a family, even though he wishes to abdicate that right. In the vast majority of vasectomies done outside cases of extreme medical need the man is already 30 or considerably more.
Everything I have heard from the Simon Trust, the Family Planning Association and the Marie Stopes foundation, to all of whom I and the whole community owe an immense debt of gratitude, convinces me that vasectomy is a sure and simple method of family planning in certain cases. If more widely used it would almost certainly reduce the number of abortions among married women—
§ Mr. Whitehead
As always, the hon. Member's intervention speaks for itself. The operation will help many families to enjoy each other to the full in the plenitude of their resources. What is true of the family unit is true, too, for the society of which it forms part and to which that society in turn brings its burdens and its blessings. The family unit, the micro-unit, in its environment is matched by the macro-unit of society in its environment. The Bill is saying 838 that no man is an island, but we can equally say of society that no island is an island now. We are looking at this against the background of the world's resources and the way in which they must be shared and used.
I hope the House will agree that this modest Bill widens choice for those who seek to exercise it in the matter of family limitation, and frees them from financial limitations. It also preserves that sense of individual responsibility with which the choice must be made by the individual, and not by society for the individual. In that spirit I commend my Bill to the House.
§ 11.36 a.m.
§ Dr. Tom Stuttaford (Norwich, South)
I congratulate the hon. Member for Derby, North (Mr. Whitehead) on introducing the Bill on introducing it so completely and thoroughly and on the extremely comprehensive review he has given of the whole subject of family planning. The Bill is a step forward, an amending Bill, and we must realise that it is not a great revolutionary move but a useful Measure to increase the scope of the Family Planning Act, 1967. It takes account of the fact that vasectomy has now found a place in the spectrum of contraceptive measures available to doctors since 1968 to help their patients.
I stress that before vasectomy can be done, consent is required not only of the doctor doing the operation but also of the family practitioner. This is most important because where doubts have been expressed—and there have not been many—they have been expressed on the point that, although this Measure is introduced by responsible people for responsible people, there might in time be a slide so that it becomes irresponsibly used. This fear will be eliminated by the double check of the doctor doing the operation and the general practitioner.
§ Mr. Leo Abse (Pontypool)
Will the hon. Gentleman permit me to intervene, since he is a doctor as well as being an hon. Member?
My hon. Friend the Member for Derby, North (Mr. Whitehead) said that the term "medical grounds" should include social factors. In view of the objections and difficulties that have been 839 suffered by the medical profession on the question of abortion, I question the advisability of doctors also having social strains on them. Will the hon. Gentleman direct his attention particularly to that matter?
§ Dr. Stuttaford
I shall come to that later. We must think carefully about who are the people on whom this operation will be carried out. Who are the people who want to have it? Who is the average man? The average man appears to be very similar to the grandfather of my hon. Friend the Member for Yarmouth (Mr. Fell), or his former chairman—
§ Dr. Stuttaford
That displays extraordinary ignorance, and I will come later to that point. According to the Simon Trust, the average man who wishes to have the operation is middle-aged, in the middle income group, has three children and has been married for more than 10 years. If my hon. Friend is looking for a future chairman of the Conservative Party Association, what better recruiting ground could there be for the Conservative Party than middle-aged men in the middle income group, happily married for 10 years, with three children?
§ Dr. Stuttaford
It was my hon. Friend who introduced the subject of the chairman of the Tory Party and I think the matter is entirely irrelevant, except to show that the people who want this operation are responsible, middle-aged and sensible.
This is not a Measure introduced so that lustful youth can carry on in whatever way they may care to and enjoy their pleasures without the slightest risk of retribution or payment of paternity costs. It is not that sort of person for whom this Bill is being introduced and for whom it would enable this operation to be performed.
840 The motives given by people to the Simon Trust for wanting this operation can be seen to be quite unselfish. They are not doing this for themselves but for their wives and families. There is no selfish element in desiring this form of contraception; they are doing it to preserve and enhance the marital happiness of their families. This is a very important point and this is why there has been so little opposition to this Measure. There may have been some opposition from my hon. Friend the Member for Yarmouth, but it has been very limited. There has been very little opposition in this House.
My hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), whose views on abortion law reform and on many matters of family life are very well known in this House, sent me a letter saying that she is sorry she cannot be here today. I believe that my hon. Friend the Member for Chelmsford (Mr. St. John-Stevas) has seen the hon. Member for Derby, North and has said that he has no objections in principle to the Measure. There can be no objections in principle to a Measure which will improve family life and not destroy it.
§ Mr. John Biggs-Davison (Chigwell)
Did my hon. Friend say that the hon. Member for Chelmsford (Mr. St. John-Stevas) had no objection to this Bill?
§ Dr. Stuttaford
I gathered from the hon. Member for Derby, North that he had seen him and he had said that he raised no objection in principle—is that so?
§ Mr. Biggs-Davison
I think that it is an important matter that hon. Members in this House should not by hearsay be quoted without their authority as either supporting or opposing any Measure. My own conversation with my hon. Friend yesterday rather indicated the contrary.
§ Dr. Stuttaford
I am quite happy to withdraw my statement. I learned it in conversation, so it is hearsay evidence. I should have thought that it was a reasonable assumption since my hon. Friend seems a very reasonable man.
841 I will mention one or two of the medical fears which have been raised. My hon. Friend the Member for Yarmouth raised the old fear of castration. This merely displays extreme ignorance. There is no question of a man who undergoes a vasectomy operation experiencing any degree of feminisation. The man is as virile as he was before. In fact, 10 per cent. of the men who have had the operation find they are more rather than less virile. Unfortunately, there is an extraordinary inability to understand the difference between castration and vasectomy. It is difficult to understand why. One can only pity those who have not grasped the basic anatomical details so late in life.
We must emphasise the fact that this operation can be carried out under local anaesthetic. There is some opposition from the medical profession, not to the operation being carried out at all but to its being carried out in local family planning clinics. It is important to look into this aspect. An anaesthetic introduces a certain amount of danger, since there is hazard in any form of anaesthesia; if the operation is safe and simple, we should not insist that it be done under general anaesthetic if that can be avoided. There should be no medical reasons for not undertaking this operation in as simple a way as possible under out-patient procedure.
It is right that the operation should be regarded as irreversible. Recent figures from Bombay, where doctors have had a great deal more experience in this field than we have had, show that one surgeon there is now achieving a 50 per cent. effective reversibility rate. We must bear this factor in mind. However, it is important to stress to the patient that at present the operation in this country is irreversible.
It must be the aim of every civilised society to see that every child is a wanted child, and that children are conceived by choice and not by chance. I think this Bill will go some way to help make certain that we minimise the problems associated with unwanted children. Therefore, I ask the House to support the Bill.
§ 11.45 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
Although this is a Private Member's Bill, I thought it might be for convenience of the House if I were to intervene to put the Government's attitude on this Bill. I shall do my best to steer clear of the dangerous shoals involving how many children one should have and what bearing this Bill would have on the future manpower of the Conservative Party.
I should first like to congratulate the hon. Member for Derby, North (Mr. Whitehead)—if for nothing else, on his success in getting his prominent place in the Ballot for Private Members Bills and also on his wide-ranging introductory speech.
It may help to set the scene for discussion of the Bill if I remind the House briefly of the present organisation and scale of family planning services so that we can consider the Bill in its proper context.
The main statutory responsibility falls upon the local health authorities, and it was in fact the Act passed in 1967, involving Edwin Brooks, as the hon Gentleman said, which this Bill would seek to amend and which conferred on them the main powers that are at their disposal. These are the powers to provide contraceptive advice and supplies, not just for those who require family planning on medical grounds, but also for those who have what might be described as a social reason for wishing to space or limit their children. There has been some criticism of the extent to which local health authorities responded to the opportunities which the 1967 Act gave them, but it has to be recognised that, valuable though family planning services may be, local authorities have many other very important responsibilities and in general one service can be expanded only at the expense of another.
§ Mrs. Renée Short
Would the Minister not agree that that is a rather shortsighted view—in other words, that family planning health guidance and advice can be given for around £10 per head per annum and that that, if carried out effectively on a reasonable scale, would save an enormous amount of money which the local authority now has to spend not only on maternity services but on the whole range of health education and housing expenditure? Does he not 843 think this would be a good bargain for local authorities and the Government?
§ Mr. Alison
Whether one looks at this matter on a national or local scale, it is again a matter of a responsible judgment of the priorities to be accorded to, alas, inevitably scarce resources.
The local authorities were faced with those difficult decisions about priorities that confront all those who are concerned with the responsible spending of the taxpayers' and the ratepayers' money. Accordingly local authorities got off to what some considered to be an unduly slow start.
This was up to the beginning of the present financial year; but I am glad to inform the House that the pace has now considerably hotted up. In fact, over this and the next financial year local authorities propose to treble their expenditure on family planning services, an intention which the Government were glad to support by making the necessary provision in the rate support grant. The result is that in 1972–73 local authorities should be spending well over £2 million on these services, a modest sum perhaps in relation to the total outgoings on the National Health Service, but nevertheless a significant improvement on what has been possible up to now.
My right hon. Friend issued a circular to local authorities last year, encouraging them to develop their family planning services and to pay particular attention to the need for domiciliary services, which have proved so useful in some areas in meeting the needs of those who cannot go to the local family planning clinic or to their general practitioner or who are unwilling to do so. He also sent a circular to hospital authorities, asking them to provide advice on family planning for those patients who wished to have it.
The initiatives taken last year did not affect the position of general practitioners in providing family planning services, but they are already the source of advice and supplies for a large number of people.
My right hon. Friend also decided that the time had come for a full and careful review of the family planning services. This is partly because the results are now starting to come through of research which my Department put in hand into 844 the functioning of the present services, and into people's attitudes to them; and also because of the need to examine how the opportunities offered by the forthcoming reorganisation of the National Health Service could best be exploited to the advantage of family planning.
As the House knows, the Government propose to bring together under one administrative structure the personal health services for which hospital authorities, local health authorities and executive councils—the tripartite system—are at present responsible. When that happens, the local authorities will lose their existing responsibilities for providing family planning and other personal health services, although their social services departments will of course need to work closely with the new authorities.
I hope that it will not be long before it is possible for my right hon. Friend to announce the conclusions which the Government reach as a result of the review, but the study has not yet been completed and I am sure that the hon. Members will understand that I am unable today to give any indication of the directions and pace of the future development of official centrally administered family planning services.
All I can say at the moment—and this brings me to the subject-matter of the Bill before the House today—is that as vasectomy is a surgical operation, we regard the hospital services as the sensible place to provide it. In fact, hospitals are already doing some of these operations where they are required for the health of the husband or his wife. The number of operations that can be performed in hospitals is of course limited by the resources available: in particular I am thinking of the demands made upon medical personnel and pathological facilities and of the constant demand for other forms of surgery, much of which must take precedence over vasectomy in the interests of life or health of the patients concerned.
§ Mr. Laurie Pavitt (Willesden, West)
Can the hon. Gentleman give the House any more information about the timetable of the reconstruction? As has been pointed out already, this will have a profound effect upon the Bill. Will there be a White Paper in this Session and 845 legislation next Session, so that the integration of the three wings may take place early in 1974?
§ Mr. Alison
The hon. Gentleman is tempting me to stray considerably wider than my brief on this Bill. We are anxious to produce a White Paper as soon as possible, and we are all anxious that the implementation of the reorganisation of the National Health Service should take place on the ground at the same time as the application of the Local Government Bill. The hon. Gentleman must work back from 1974 and make his own computation.
§ Dr. Stuttaford
Does my hon. Friend agree that vasectomies would not go on the surgical lists for major operations? There would still be an out-patient procedure, and in fact, as the Family Planing Association provides its own staff, the hospitals would be required only to provide the theatre facilities which, presumably, would be unused at that time.
§ Mr. Alison
They would have to provide the pathological facilities, and the staff might conceivably be elderly surgeons who, if they were not being used by the Family Planning Association, might be available for the hospital services, though that would not apply in every case.
§ Dr. Stuttaford
What would be the situation if the Family Planning Association provided all the staff?
§ Mr. Alison
That would be an advantage. For reasons of superannuation, all the surgeons used by the Family Planning Association could not necessarily be employed in the hospitals, so that there need not be a diversion of medical resources from the hospitals. But that would not necessarily be the case with all vasectomies.
Where vasectomy is sought for nonmedical reasons, it has at present to be performed under the normal arrangements for private treatment. Out-patient vasectomy clinics are run by private nursing homes and by voluntary organisations such as the Family Planning Association. Between them, these organisations perform several thousand operations each year. They normally charge the patients a fee, which in a typical case would be something under £20. In a small number of cases, I understand they may waive 846 the fee altogether where the patient would be unable to afford it. In the case of other forms of contraception, the organisation can accept a patient sponsored by the local authority, who would then meet the cost, but this is not at present possible where vasectomy is concerned.
§ Mr. Whitehead
Does the hon. Gentleman accept that these organisations have waiting lists of about 10,000 at the moment?
§ Mr. Alison
Certainly I accept that. I do not minimise the pressure that there is on the availability of this operation.
There is no doubt that vasectomy is an efficient form of contraception. At the same time it is not suitable for everyone because it is not a form of family planning that can be switched on and off as it were, and it is therefore something to be carried out only when a couple have completed their family and are sure they do not want more children.
It is of course for these reasons very important to ensure that people proposing to undergo the operation should fully understand its implications. The hon. Gentleman and my hon. Friend the Member for Norwich, South (Dr. Stuttaford) both touched upon these aspects.
§ Mr. Alison
I am not sure that we could ever be satisfied that adequate counselling is available for all aspects of family planning. There are cases where, for personal reasons, individuals will deliberately by-pass counselling facilities which are available, be they available statutorily or voluntarily. There can never be a completely water-tight system of adequate counselling. For a full answer to the hon. Gentleman's question about the quality or lack of it in this Bill, he must go back to its parent instrument, the 1967 Family Planning Act. It is slightly wide of the matter that we are considering at the moment. However, if the hon. Gentleman has any strong views on this point, no doubt he will have an opportunity to table Amendments if and when the Bill goes to a Committee.
847 At the present time, local authorities have no power to arrange for vasectomy. Indeed I am not aware of any overwhelming pressure on their part to have the extra power which the Bill would confer on them and to use it to any substantial extent. The hon. Gentleman has cited one or two local authorities. But I can understand that there are occasions when local authorities feel a particular need to be able to arrange the operation for families who have all the children they want, and who have difficulty in persisting with other methods of contraception.
To be frank, the Government would not have wished to introduce legislation to give local authorities a power to arrange for an operation which would more sensibly be carried out by the hospital service. Indeed we prefer to defer legislation on any aspect of family planning at the present time, since the services generally are under a very basic review, and substantial changes in the organisation of the National Health Service are in prospect. However, we appreciate that the Bill will fill a need, even if local authorities cannot be expected to make very extensive use of the new power before further legislation is placed on the Statute Book that would, amongst other things, provide for fresh administrative arrangements for organising the different parts of the family planning service.
Since there is some real need which will be met by the Bill, few people will want to stand in its way. The Government will not take any steps to oppose its enactment.
§ 12 noon.
§ Mr. Leo Abse (Pontypool)
The whole House is grateful to the sponsor for having afforded us an opportunity to consider the operation of the National Health Service (Family Planning) Act, 1967, and whether the inclusion of vasectomy within its provided facilities is a desirable way of extending its scope.
I am particularly grateful for the opportunity that this Second Reading gives to review the Act, since it was immediately following a debate which I initiated in the House that Edwin Brooks, then a new Member, who had drawn a place in the Ballot, approached 848 and offered me the opportunity, if I would assist him, of co-operating in putting through the Family Planning Bill. I regret, as I am sure many hon. Members do, that electoral hazards prevent Edwin Brooks participating in this first evaluation of the Act.
Before considering whether new responsibilities should be placed under the Act, we must inevitably ask ourselves whether it would be wise to ensure, first, that the present powers will be sufficiently used. At the time, Edwin Brooks and I were encouraged with some real assistance from Kenneth Robinson in drafting the Family Planning Bill. Edwin Brooks and I naturally considered carefully whether we dared seek to make the powers mandatory rather than permissive for local authorities. I am sure that our final decision was right. But, although 169 out of 174 authorities are apparently using some of the powers under the Act, it must remain disappointing how few are using the full range.
Although I am grateful to the Under-Secretary for the review which he has given and the encouragement which the Minister has given through circulars. I am bound to say that, on the rare occasion when I share the view of the hon. Member for Wolverhampton, North-East (Mrs. Renée Short) on these matters, the tepidity with which she spoke of the priority of family planning in the local authority sphere rather disturbed me. However, we have at least heard from the Under-Secretary, with great clarity, what steps are being taken by the Government to further encourage the integration of family planning in this country and, I hope, as a result, to further encourage local authorities to stop dragging their feet in the meantime.
The second point which I wish to make before proceeding to a view on the merits of the specific proposals before the House, is to ask whether, before proceeding to encourage more exotic and controversial techniques of birth control, we should ensure that the traditional methods are made available more inexpensively than at present. In our involvement with the present suggestion, we should not overlook the fact that in Britain 125 million condoms are used each year and that the male contraceptive remains by far the most widely used means of family planning.
849 The price that the public pays for these articles, in the light of their actual cost of manufacture, is quite absurd. On Second Reading of the Family Planning Act I said, and I repeat, that the community and the family planning services were being and are continuing to be exploited by a sinister monopoly, L.R.C. International Limited, as the former London Rubber Company now describes itself. This monopolistic company, which manufactures 95 per cent. of the rubber sheaths used in Britain, unlike some monopolies, has a long history of social irresponsibility. It has protected its inordinate profits, both in the past and, as I will show, in the present, by the most ruthless methods. In order to ensure that no competition would emerge, it has taken over or crushed almost all who have entered this sphere.
This company's utterly irresponsible behaviour was revealed, the House will recall, in consequence of an investigation in 1965 by some highly intelligent journalists of The Sunday Times. It was discovered that this company clandestinely created and endowed a unit, known as the Genetic Study Group, with the object of disseminating to medical officers of health, Women's Institutes and Members of Parliament misleading and alarming propaganda concerning contraceptive pills. With the aid at that time of some very curious public relations officers, attempts were made fraudulently to induce medical officers of health to act as patrons to this unit. The unit was created, promoted and activated by this company to mislead and alarm women to dissuade them from using contraceptive pills and to use instead its rubber products. It was a disgraceful episode which was ended by newspaper reports and Questions which I put in the House at the time.
One hoped that after that incident the company would behave itself. Indeed, it looked as though a few years ago there was to be a genuine act of reparation by this company to set up a genuine family planning research trust of a type which certainly would have been extremely helpful to us in considering this delicate matter. To a fanfare of trumpets, and after inducing men of considerable integrity in this House and in the House of Lords and distinguished economists and sociologists—people of impec- 850 cable character who were genuinely interested—the company announced the setting up of a Sociological Research Foundation. But undoubtedly because the trustees—men of integrity—wanted to ensure that this would be a genuine research body, I now discover that L.R.C. has withdrawn from the foundation, and the public, despite the original fanfare, have been told nothing whatsoever of the reasons.
Not content with frightening into inaction smaller public companies, fearful of a takeover, which were confident that they could manufacture condoms to sell much cheaper than at present, in recent months this company has moved in to gain a stranglehold over what is rapidly becoming a most important area of retail distribution, namely, through vending machines. The independent Safeguard Company, a vending company, has been acquired, as have the sites of the Self-Serve Company. So, the London Rubber Company, not content with 95 per cent. of the manufacturing side of the industry, is now taking control of 90 per cent. of retail distribution, too.
I hope that the Under-Secretary will note my comments and discuss anew with the Department concerned, in the light of this new development, so contrary to the interests of family planning and the public, a reference of this company, whose profits last year on its rubber goods mounted by a further £1 million over 1970, to the Monopolies Commission.
The City is blamed for many things, but it is an additional and droll fact that the citizens of London can now blame Sir Edward Howard, Lord Mayor of London and chairman of this monopoly company, for the needlessly high cost of loving in Britain.
The proposals now before the House, as the sponsor has clearly indicated, do indeed move delicately into the sphere of human relations. I have heard so far from the two sponsors high confidence in the Bill, which is no doubt based upon conviction; but it is not a confidence which can be based upon the research, inadequate as it is, which is available. Whilst in the past contraceptive methods have usually been introduced into the developing countries only after prior periods of considerable experience in the 851 more developed countries, the situation here is the reverse.
This operation has been used on a large scale in Asia. Indeed, about 4 million were sterilised in India between 1967 and 1969, and nearly 1 million in Pakistan during the same period. But in the West we have to recognise that experience is limited. I am sure that even the most zealous and determined steriliser here would hesitate to suggest that the experience of lands where the cultural conditions permit men to swap their fertility for transistor sets is necessarily relevant to the familial needs of Britain. What is clear from research in the United States, and from the limited but revealing research done here, is that it would be a grave error to leave the task of sterilisation of men to technicians, and that is the real danger here. That is the real danger of the Bill in its present form.
We must begin with the insight that the rising number of men who are submitting themselves to sterilisation is not necessarily an index of a more rational approach to family planning. The community is well aware of the dangers of sadism, and there are many protestors against those who excite and pander to sadistic impulses, but the task surely of this sophisticated House must be to alert the nation just as well and as equally to the dangers of masochism. The present cult for violent films, epitomised by the "Clockwork Orange", viewed this week by a naturally concerned Home Secretary, is founded not only on those who identify with the sadistic anti-heroes of such spectacles, but also those who morbidly enjoy identifying with the victims.
The highly publicised perversions of the sad Lawrence of Arabia are not unique. The vast sale of Soho pornography shows how many unfortunates yearn for punishment. Our prisons, as anyone acquainted with a smattering of penology knows, abound with disturbed men who are self-mutilators, and the practice of circumcision throughout many peoples of the world, among African tribes, Moslems, Jews and many public school parents, reveals how great is the attraction for symbolic castration.
We must distinguish between those who seek sterilisation as part of a voluntary programme of planned parenthood and 852 those who neurotically, loaded with guilt, desire self-abasement. It is no part of the duty of the State, no part of the duty of family planning associations or the medical profession to yield to the masochism that is within the community.
Those who are sensitive to the aberrent moods of violence within our contemporary society, replete with aggression which is directed against the self as well as against others, cannot be surprised at the clinical results produced by those who researched into the psychological effects associated with contraceptive vasectomy.
All the evidence suggests that preexisting marital sexual or psychological instability must be taken as contraindications for vasectomy. Indeed, it may be that there are some contra-indications in all men. Those who have read Morris's well known book "The Naked Ape", which I have heard quoted by hon. Gentlemen opposite on at least two occasions during recent months, will recall how he builds up a persuasive theory concerning the adaption of man's behaviour patterns to serve his unique paternal role in the animal kingdom. Irrational and unconsciously motivated behaviour primarily patterned to protect the young he begets persists, he suggests, redundantly in modern man. The total and the irrecoverable removal of a man's ability to impregnate his mate to reproduce the young he still unconsciously acts to protect may affect all men at some level, no matter how deeply unconsciously.
But leaving aside such imaginative but persuasive speculations of the ethologists, let me presume to draw the attention of the House to some of the conclusions of field workers to which I have had my attention drawn since I raised, perhaps for the first time in the history of the House, the issue of vasectomy in 1966. I should like to draw a little attention, too, to the research which has come my way since some 18 months ago I was questioning the Labour Government's Departmental Minister on prevailing practices.
In 1965 a group of American field workers produced work implying that men seeking vasectomy for contraceptive purposes were more likely to be neurotically disturbed than those who did not, and that men who had undergone vasectomy as a contraceptive act were 853 more likely to show increased mental disturbance than those who had not. By the pre-operative demonstration of a personality inventory these field workers identified a sub-group of men showing a tendency to depression amongst a group of candidates for voluntary sterilisation, and this same group, when tested one or two years later, showed an increase in psychological disturbance in 43 per cent. of the cases.
Other types of study have come from psychiatrists' case histories of patients who were mentally ill who in the past had vasectomies. All these doctors condemn vasectomy as a psychological dangerous procedure. I am not necessarily adopting their view. I am putting it because it needs to be met when there is so much masochism abroad. They assert that vasectomy, though often requested as a contraceptive measure, seldom is.
In some cases they affirm that it is a means for emotionally sick women symbollically to castrate their husbands. In these seasons of women's liberation movements, when some women seem to be so permanently at odds with their own womanhood that this aggressive hostility to men takes this order in this odd form does not surprise me. Indeed, the emasculating female has, after all, been known to surface in party political conferences which hon. Members on both sides of the House have often attended.
Another distinguished American analyst, although fully understanding that vasectomy is not castration, considers, nevertheless, that the unconscious equating of vasectomy with castration is an unavoidable reality. It is no good hon. Members saying that people should learn something about physiology or anatomy, and it is surprising that people do not know about it. The fact is that I am not surprised that psychiatrists and psycho-analysts in America are insisting that, whatever may be said, unconsciously there is this equation of vasectomy with castration, and because of that, since the preservation of gender is a biological necessity, its wilful, albeit symbolic, destruction inevitably leads to a lowering of self-esteem. Is that a surprising result?
§ Dr. Stuttaford
Would the hon. Gentleman say that the same applied to the 854 female who is sterilised? Or is there one law for men and one for women?
§ Mr. Abse
I am not imposing any law. I am trying to collect the evidence that is available. The hon. Gentleman is a doctor, and he should know that a great deal of work has been done over 50 years on the effect of the castration complex upon the behaviour patterns of himself, myself, and almost all men, and in a different way upon women. If it leads, as this American psychiatrists suggests, to a lowering of self-esteem, is that so surprising a result? Do we not all speak depreciatingly of the spayed bitch, the dumb ox and compare them adversely with the spirited stallion or, judging by some of the comments of my hon. Friend, the virile man? Are not these colloquialisms themselves evidence of universal unconscious attitudes of human beings to fertility? After all, the capon or steer is only meat, but roosters and bulls are living creatures.
It is not surprising, therefore, that another group of American psychologists, using projective tests, have demonstrated that vasectomised men are seen as emasculated and that behaviour was affected, according to their studies, after vasectomy, in that activities such as child rearing and household chores assumed new dimensions in family relations.
Indeed, this group found adverse changes in marital relatitons as the operation appeared to give rise to scrutiny of the man by himself and by others for evidence of unmasculine behaviour. This finding too cannot surprise anyone even casually acquainted with the Freudian view that Oedipal anxieties lead in all of us to some fears of genital mutilation. Certainly, these American researchers' warning that failure to limit family size by the conventional methods could of itself reflect other unnoticed problems in the marriage, which then become centred on the operation, cannot be brushed aside either.
There is at least one American physician, Professor Connor, on record as claiming that making the man safe sexually has even resulted in marital infidelity and in domestic discord. I am in no position to assess his evidence, and that may be a highly emotional reaction, but what I am wholly convinced about is 855 what appeared in another report on husbands which revealed that some of them appeared to treat the vasectomy as a highly valued pawn in a sub rosa bargaining procedure, so that, post operatively, they reflected as though they had made a significant sacrifice for the marriage and no longer needed to be so considerate of their wives. If the backlash of a vasectomy is a cruel husband, some wives may think that they have had a bad bargain.
If it were not that I knew that the Birth Control Campaign, which has circulated hon. Members in support of this Bill was the discredited Abortion Law Reform Society in another guise—
§ Mr. Neil Kinnock (Bedwellty)
May I inform my hon. Friend that, far from being the discredited Abortion Law Reform Society, the Birth Control Campaign has won the highest status and esteem and took the precaution of circulating interested hon. Members with an article from the British Medical Journal of October, 1970, which drew attention to the psychological implications for postoperative vasectomy cases. So we are familiar with all the details to which he has drawn our attention. If this body were discredited, it would not have tried to put the other side of the coin.
§ Mr. Abse
If my hon. Friend is trying to persuade me on the insights of the Abortion Law Reform Society and the Birth Control Campaign, he is little acquainted, as a new Member, with the whole history behind that lobby or with the reasons why this House decided, by means of pressure placed on the Minister, that there should be a full inquiry into the working of the Abortion Act.
§ Mr. Kinnock
On a point of order. I apologise to my hon. Friend the Member for Pontypool (Mr. Abse), whom I greatly admire, for bringing this point of order to you, Sir Robert. He just referred to me as a new Member, which carried some implication about my ability to judge issues and institutions. I wanted the opportunity of pointing out that my newness does not affect my judgment.
§ Mr. Deputy Speaker (Sir Robert Grant-Ferris)
The hon. Member's newness, oldness or intermediate standing is nothing to do with the Chair.
§ Mr. John D. Grant (Islington, East)
Further to that point of order. I take some exception to the last remark, since I could also be described as a new Member. I was in no way associated—
§ Mr. Abse
I was pointing out that some of us lived through the passing of the Medical Termination of Pregnancy Act and the National Health Service (Family Planning) Act and are well acquainted with the strategems and effective lobbying of a highly articulate lobby, which is at work again.
§ Mr. Whitehead
On a point of order. Is it not due custom of the House that, 857 when a reference has been made to the proponents of a Measure in this way, and they have been described as those who have been lobbying for abortion—which I certainly never have, and I am the principal proponent of the Bill—it would be right and proper to give way when I rise to correct that interpretation?
§ Mr. Deputy Speaker
Whatever the custom of the House, the laws of the House are not necessarily the same and they say that no hon. Member can rise to speak unless the hon. Member who has the Floor gives way.
§ Mr. Abse
I will certainly give way again if my hon. Friend wants to dissociate himself from the Birth Control campaign. But it is inescapable that all of us have observed that a statement came out from that movement and appeared in The Times which showed a considerable identification of interests between that movement and the contents of my hon. Friend's Bill. I do not and would not wish to accuse him in any way of associating with the abortion law reform lobby, if that is the fact.
§ Mr. Whitehead
I should like to point out to my hon. Friend that the question of who supports or who opposes this Measure and the motives of both parties concerned do not necessarily detract from the intrinsic merits of this Measure. I should like further to inform him that my own views on abortion to some extent mirror his reservations at the time of the passing of the Act, but that he does no service at all to the reservations which he is trying to express today by attempting in this manner to smear those who have brought this measure forward.
§ Mr. Abse
I would advise my hon. Friend not to provoke me into a position which I have no intention of taking up. I am not smearing his motives. What I am saying is that I feel that I have a duty to alert the House to the fact that, in their appraisal of the evidence in deciding what should or should not be in the Bill they must take into account the established fact that there is a campaign which is being conducted by the same movement which has now 858 metamophosised itself as the birth control campaign—[Interruption.] I do not understand why those who identify themselves with it seem so shamefaced about acknowledging it. It is a fact; why should they be so concerned? The reason they are concerned—
§ Mr. Whitehead
Since my hon. Friend exercises his powers of scrutiny so carefully, could he tell the House if, when the Measure which the Bill seeks to amend was given its Second Reading—he has accepted part authority for that Bill—he devoted equal time to the possible side effects of things like the inter-uterine device and other things which apply purely to women that he is now giving to the possible consequences of sterilisation for men?
§ Mr. Abse
I assure the hon. Member that when, with Edwin Brooks, I had the opportunity of dealing with the other Measure I was aware, and always have been aware of the point that the Under-Secretary has made, that there is a qualitative difference between this type of contraception and all the other types. The difference is that this is irrevocable, it is final and everyone undergoing it has to be told that it is improbable that it can ever be reversed. That is a big distinction and it is no good, in our enthusiasm for it, denying it or acknowledging that there is this distinction. I hope that I shall be allowed to continue as I am already taking more time than I am sure the sponsors would like me to take.
It would be profitable for those people to study—and I commend them particularly after the interventions—the available papers revealing the psychological motivations behind their enthusiasm. There are many papers in existence dealing with why it is that, for psychological reasons, certain people blot out the contra-indications of vasectomy. We certainly need to be on guard against those women who, masking their sadism under the guise of benevolence and concern for the future of humanity, campaign with such intemperate zeal for the present symbolic emasculation of mankind.
859 It is no part of the rôle of this House in my judgment to institutionalise and to give legislative form to the sadomasochism now surfacing in contempory Britain. We are entitled to ask those sponsoring the Bill why they have—as they have—under-estimated the hazards associated with vasectomy. I do not believe that it is a lack of candour on the part of those associated with it. I think it is naivety. They surely cannot speak quite as casually as my hon. Friend did when, fairly, he put forward one piece of evidence against it. We cannot treat as contemptuously as perhaps some of the zealots will of the findings of Dr. Helen Wolfers of the Fertility Research Unit of the London School of Hygiene and Tropical Medicine.
Even if they have been too indolent to seek out the American evidence that is available, with the benefit of aid from the Ministry of Overseas Development, utilising the survey and case study method with the co-operation of the Simon Trust, which the House will remember claimed to screen its candidates, the doctor discovered that the proportion of couples reporting psychological ill-effects after vasectomy was 13 per cent. Such findings, inconvenient as they may be, cannot be brushed aside. We have a duty before giving direct State encouragement to local authorities to embark on vasectomy to ensure that no one blindly submits to the surgeon's scalpel.
Applicants must surely be screened effectively by psychiatrists and marriage guidance counsellors. The present screening—last year I inquired into the matter in some depth—is not in my opinion always up to the standard it should be. It is varied, patchy; it is insufficiently conducted by those who are removed from committed family planning matters and who are over-confident that no harm can result. When we appreciate that 13 per cent. have been adversely affected from among those who have been screened by the Simon Trust, we are entitled to be on inquiry and to ask whether sufficient screening is going on.
The so-called safety Clause in the Bill is inadequate. What does "medical grounds" mean? I put the question, but the answer has not been given by one of the sponsors who is a doctor.
860 We have had great difficulty and much protest from the medical profession precisely because we have attempted to shift the burden in abortion on to the profession when determining what "social grounds" constitute. How can the Under-Secretary or the Department be satisfied with the safety Clause which says:…or otherwise on medical grounds".Does that include social grounds? The hon. Member for Derby, North said that it does. Has the medical profession been consulted? Is it accepting that it should determine the social grounds?
§ Dr. Stuttaford
If the social grounds will affect the mental health of the patient, then of course it includes social grounds. Is the hon. Gentleman aware that this same clause has applied to female sterilisation for 20 or 30 years and has worked extraordinarily effectively?
§ Mr. Abse
I ask the question because the British Medical Association has certainly taken a very different view of this attempt to shift on to the profession the determination of social grounds, as the Under-Secretary knows. I am not saying that there are no good social grounds for vasectomy. My hon. Friend has rightly pointed out that it was I who was stressing in 1966 that there are social grounds which justify this. What I am concerned about are the safeguards in the Clause which at the moment do not give any indication what the social grounds are or whether they will be determined by anyone other than a doctor and whether, as a consequence, we will not have the same variation in attitudes and patterns as notoriously exists among the medical profession over the abortion Act.
The other ground which is regarded as a safeguard is the fact that this cannot be done to anyone by a local authority unless that person has reached the age of 30. That is a pathetically inadequate safeguard particularly when many of us are aware that there are these difficulties and there is this need for scrutiny. Is it suggested—I gather it is not from what my hon. Friend said—that a 30-year old bachelor should be encouraged to have the operation? My hon. Friend says that he does not want that, but that 861 is not in the Bill. As it stands, a 30-year old bachelor can have a vasectomy.
I do not know whether the House considers, when it estimates what right we have to be paternalistic, whether we have the right to try to stop such people or to say that since a 30-year old bachelor can have a vasectomy privately and pay for it he should be able to have one on the Health Service. Because the rich are insane and do stupid things is no reason for us wanting to encourage the working-class man to do so.
I have warned my hon. Friend the Member for Wolverhampton, North-East on the passing of the abortion Act that she should remember that she was engaged on law reform and not waging the class struggle. We do not want to be in the position in which we are saying that bachelors can get a vasectomy through local authorities.
We have only to start looking at the drafting of this Bill to see that insufficient thought has been given to it in that respect. Should a man of 35 who has been married for only a few months he eligible? Is it intended as one of the features of the Bill that a man can have this operation irrespective of his wife's wishes? There is nothing in the Bill to indicate that. All that he has to do is to be a man of 30. Is that good enough?
I am not trying to destroy this Bill. I am showing up its weaknesses, and I warn hon. Members that the country will become aware of its weaknesses and that it is far wiser and more sensible for us to get this Bill right. We have had enough trouble from the abortion Act and we do not want a repeat performance. I am not being iconoclastic, however much it may be imagined that I am. Because I saw the enthusiasm abroad, I am merely using the opportunity to adumbrate what precautions are necessary.
Is it being suggested that the State would give this in the case of a childless couple over the age of 30? These are issues that have to be decided. As the Bill stands, there is no question about their eligibility. Is that for ever? I very much doubt whether the House would want to approve that, but certainly it has to be discussed. It cannot be ignored, and the precautions existing do not prevent that. I have had a little to do with the passing of divorce Acts. I 862 will not give last year's divorce figures because they were artificially inflated, but even in normal years there are about 60,000 divorces a year. Most of the marriages that break down are, unfortunately, among the young, not among middle-aged people. I mention that because the hon. Member pointed out that the people who sought vasectomy at the moment are middle-aged. We have to recognise that most divorces and marital breakdowns are taking place amongst younger people.
§ Mr. Pavitt
Would my hon. Friend follow that statistic with a similar discovery, namely that the reason was not bad sexual relations but cash, and that the greatest factor in the breakdown of marriage was not incompatability of sexual relations or personal matters but always cash.
§ Mr. Abse
I do not want to follow up my hon. Friend's point. My experience of divorce, as a practitioner, is that cash trouble is a symptom and not a cause of the breakdown.
However, if a younger man in his thirties, satisfied with having sired two children, then opts for sterilisation, what happens if divorce strikes at the family? Today it is a statistical fact that most divorced men re-marry and found another family. The divorced sterilised man would re-enter the marriage market unable to offer any woman the prospect of a child. Even if a woman initially romantically in love accepts him on those terms, who knows what buried resentments may eventually smoulder amidst her childlessness, particularly if the husband has the custody of the children of the former marriage? As no one knows the future and death is indiscriminate, if a sterilised young man is left a widower with a few children, a new mother for those children would be compelled to know that she is fated to be barren.
These questions have to be raised when we talk about the safeguards. I am already personally aware—I am not talking second-hand—that hasty surgery has brought tragedy into the lives of married couples with small families far too eager to end their capacity to procreate. Sickness or accident has hit the children of such families, and the death of a little one has brought irreparable grief. From 863 time immemorial a mother who has lost her child has worked through her sorrow by being blessed with the miracle of another birth. But the sterilised husband will be able to bring her no comfort. She will be denied the hope of another child to compensate her for her terrible loss.
I have had the experience of being confronted with a father who has, within months before he saw me, been sterilised —a young father; too young in my opinion—and then lost his child. Perhaps not surprisingly in all the circumstances, he was absolutely loaded with guilt and an irrational feeling that recrimination had fallen upon him. We have to be satisfied, too, that if we pass the Bill we certainly do not create the situation of encouraging the immature—who later may maturate—in new marriages to be more concerned with a new car and holidays than with the blessings of parenthood. Today the couple may be confident that a refrigerator is more important than a baby and may even jointly decide that going in for male sterilisation may be the way to afford to go in for a colour television. But as the years pass, greater maturity and wisdom may give them a different scale of value.; but since there will be no possible opportunity of going back on the decision, no opportunity for second thought, a wife wanting a child would have the choice only of infidelity or of divorce if she wishes to assuage her belated awakenings of a desire for parenthood.
I have categorised some of the misgivings which, if we bring them to the surface, can result only in our being more, not less, prepared to see how we can shape a useful Bill. If I have aroused some resentment and irritation amongst those sponsoring the Bill, they must try to contain themselves. We want a Bill which will mean that we can avoid the prolifieration of abortions. We want a Bill under which, in the particular social situation, we should be able to give people the opportunity of choice. But it has to be a choice where people have supporting aid, proper counselling and proper psychiatric guidance.
Therefore, I hope that although, I trust, a Second Reading will be given to the Bill, we shall hear from the sponsor at the end of the debate that he is sensitive to the problems, and that when 864 he says that he is ready to be open minded, he means it, and that we do not get a repetition of the Abortion Act but a new opportunity to be able to replace and, I trust, put on the Statute Book the pre-requisite that there has to be psychiatric guidance before this decision is taken. We need to give very much more thought to the Bill than I suspect has been given up to present.
§ 12.46 p.m.
§ Mr. Anthony Fell (Yarmouth)
I came to the House today not intending to make a speech, but having come into the Chamber and heard one or two of the things said, particularly the intervention of the Minister, I make one or two points.
If he will forgive me, I will not follow the extremely well thought out speech of the hon. Member for Pontypool (Mr. Abse), to whom I should have thought the House should be as grateful as it is to the sponsor of the Bill, who initiated the debate, because the hon. Member for Pontypool has obviously given as great an amount of thought to this as has the mover of the Bill. Neither will I attempt to compete with the sheer brilliance, self-confidence and experience of my hon. Friend, the Member for Norwich, South (Dr. Stuttaford) about vasectomy. I shall content myself with one or two questions.
From every conceivable point of view I am against the interference, by the State or by any busybodies, with families and with people. When we are talking about vasectomy we are not talking about thousands of men in the generality but about ordinary individuals who have somehow managed to rub along in this world for thousands of years without the advantage of being able to go to the State and get on the cheap some method of being able to enjoy their sexual pleasures without any risk to themselves or their wives. What so worries me is the mentality that we may be developing in this country on the part of those who think they know. The previous Member of Parliament for Yarmouth, who managed to throw me out in 1966, introduced a Bill on euthanasia a few years ago. If the Bill that we are now discussing had been introduced in the House 10 years ago it would have caused just as much horror then as euthanasia did two or three years ago when the then Member for Yarmouth, Dr. Gray, introduced his Bill.
865 My horror is that all this kind of interference by the State is leading up to the position when these things will be done not only with the blessing and the permission of the State but at some stage they will be taken advantage of and used by the State for compulsory birth control. Ultimately that is what will happen. What is it less than that in India, or in Asia? What is it less than compulsory birth control if what the hon. Member for Pontypool said is true?
The speech of the hon. Member for Pontypool deserves the most careful thought, for another reason. The hon. Gentleman paid great attention to the effect on the mind of such things as vasectomy and to the reasons for people wanting such an operation.
One thing that the hon. Gentleman did not bring into his evidence was the extraordinary thing that has been happening over the last few years in the film world. I do not know very much about the film world, but I have a film producer friend who produces small, unambitious films. Not long ago I saw a film called "The Music Lovers", and I have avoided films ever since. The hon. Member for Pontypool spoke about masochism. I thought that the film I saw was so horrible, so horrifying, and so dreadful, because the film was not only unadulterated horror at the beginning and at the end, where it was shown graphically how somebody was cured of a disease by being put into a boiling bath, but it also brought in aid, and in the process did its best to destroy, the music of a great composer, Tchaikovsky.
That is relevant in the context of what the hon. Member for Pontypool said, in that I am told by the film companies that, so far from their wrecking the film business by producing horror films and the terrible films that are being produced, they are forced to produce them, because the box office sellers are those that are the most horrifying amongst all the films.
My hon. Friend the Under-Secretary of State seemed to give qualified blessing to the Bill. What worries me about this arises from what the hon. Member for Pontypool said, namely, that there is not sufficient knowledge. Despite what my hon. Friend the Under-Secretary may say, about the state of medical knowledge on the vasectomy operation, it is clear to me that there is not sufficient knowledge.
866 What is more, Parliament must start being a little careful to ensure that it does not run so far ahead—or behind—the people that it gets so out of step that in the end the British people will take no notice of Parliament.
§ Mr. Fell
No, I would not at the moment. With slight respect to my hon. Friend, he was not, perhaps, as friendly towards a fellow Member from his area as he might have been. I do not intend to pay him out in kind, because I shall certainly give way—but not for a few moments.
On the question of the House being in tune with the people, it is true that it is Parliament's job to lead. It is also true that over the last few years the House of Commons has got wildly out of step with the British people on a number of issues. I believe it to be true that on the question of Rhodesia and Rhodesian sanctions the British people are not at all in step with Government policy, whether it was the Labour Government's policy or whether it is the Conservative Government's policy. The British people are certainly not in concert with any Government that destroyed free local radio, even though everybody can see the reasons and how difficult it was. The people demanded that a Conservative Government should bring in commercial radio as quickly as possible. We have not been able to do it. We are out of step.
Again, it has been obvious that the British people are utterly out of step with Parliament on the question of the Common Market. I do not know whether that will continue to be the case, but it is so at the moment. As a final example, it is obvious and well known to everybody that the British people are not in tune with the leaders of thought in the country, and have not been for many years, on the question of crime and punishment.
In view of this, I appeal to the Government to be a little careful about bestowing their blessings on doubtful—at any rate highly controversial—Bills of this nature. Can we at least be sure that the Government will inquire deeply into the effects of vasectomy on those who 867 subject themselves to this form of mutilation before the Government play any part in helping to sponsor such operations?
Further, I ask the Government to inquire deeply, to the best of their ability, into what is the feeling of ordinary men and women about vasectomy, about—one can hardly call it its twin, though my hon. Friend the Member for Norwich, South, to whom I will give way in half a second, might well do so, namely, abortion or contraception. Can we be sure, before the Government do anything to support any such move, that we know what the British people think about this interference with the freedom of the lives of the British people, for that is what we are talking about?
§ Dr. Stuttaford
I wonder if my hon. Friend will answer one or two questions for me on the points that he has raised. Does he agree that there is no compulsion, even in India, to have vasectomy and that people come forward to have the operation because they want it? It is the Government who are responding to a need, not the other way round, and there is now a waiting list in Britain of people who want the operation to be performed upon them, and the facilities are not there for them to have it.
I apologise to my hon. Friend if I was rude to him. I did not mean to be. I had even intended to be polite about his grandfather, who was well known and well respected in our mutual district.
§ Mr. Fell
My hon. Friend—as he well knows—is of so polite a character that it would not be possible, even if his words sounded rude, for him to have meant them.
Surely the answer to my hon. Friend's question about the situation in India and those parts which have been subjected to this new operation is that males in those areas have been very strongly advised to have the operation. I am not an expert on India. I wish that perhaps for a moment there could be a reincarnation of the man who represented Yarmouth before me who is an expert on India and who no doubt has helped and is now helping to encourage the carrying out of vasectomy among poor people.
868 It is true that nobody is made to lose his virility. I must not be rude to my hon. Friend the Member for Norwich, South, who said that this operation leads to an increase in virility in some circumstances. Only a man of my hon. Friend's brilliance and experience would be able to deduce from looking at a person before and after he had had a vasectomy, and perhaps after bringing in a psychiatrist, "This man has a more virile appearance than he had before the operation".
§ Mr. Whitehead
There is a simple explanation for the reason why some people, having undergone a vasectomy, report an increase of libido and that is that sexual relations may have been inhibited between the marriage partners because of the fear of pregnancy before the operation. It is therefore conceivable that an increase of libido would be recorded.
§ Mr. Fell
I am not, and I do not pretend to be, an expert on the question of libido and sexual relations. I am a rather ordinary man who looks at these matters—and may I say without being pompous that I hope that I look at these matters—from a reasonably common sense point of view. If we want to replace personal responsibility by inviting the State to take over the responsibility of a human being on every occasion that he is worried about his future, the argument must be right.
§ Mr. Whitehead
The hon. Gentleman's concern that the ordinary man should be considered and represented. However, the overwhelming majority of people who voluntarily request this operation to be carried out have heard about it by word of mouth. There is no question of Government brainwashing, much less Government compulsion.
§ Mr. Fell
So what? If a couple go to a marriage guidance counsellor and this Bill is on the Statute Book so that the operation can be done free under the National Health Service, the hon. Gentleman is surely not telling me that the counsellor will not try to persuade the man to have the operation. The hon.
869 Gentleman cannot, for example, assure me about the question of how strong the personality of the marriage guidance counsellor may be when contrasted with that of the person he is counselling.
The hon. Member for Pontypool referred to a very sad case in which a man who had had this operation divorced his wife, remarried and then wanted children. Surely the hon. Member for Derby, North (Mr. Whitehead) does not say that in no case will a marriage guidance counsellor counsel a husband to have this operation. Suppose that the man is then persuaded that out of kindness to his wife he should have the operation, has it and then his wife is killed in a motor car accident, he remarries and wants children. Should the State set up such organisations which will be responsible for the future ethical lives of the people? I will have no part of it. [Laughter.] My hon. Friend laughs, but I warn him and the supporters of the Bill that there will be a revolt among the people against this sort of sloppy thinking and against the ways which are being engineered to enable people to avoid personal responsibility.
§ 1.5 p.m.
§ Dr. Shirley Summerskill (Halifax)
I wish to intervene shortly in a dual capacity.
As the Opposition Front Bench spokesman, I should like to say that the Opposition's official attitude to the Bill is distinctly neutral. We believe that, on a Private Members' Bill of this nature which many people feel involves moral, ethical and high personal issues, the matter should be left to the decision of individual Members.
However, in my other capacity, I wish to speak briefly as an individual Member and a doctor. I welcome the remarks of the Under-Secretary of State. The Bill has implications which both Parliament and the public should appreciate. It is an important Bill, although it is limited in that it is an amending Bill to the original National Health Service (Family Planning) Bill. It seeks to extend to the local authority field an operation which is already being carried out legally under the National Health Service.
I do not under-estimate some of the fears of my hon. Friend the Member 870 for Pontypool (Mr. Abse). In any operation, the doctor and patient are aware of the difficulties, the side effects the fears and the possible psychological results. That would apply to any operation which any surgeon carried out. In this case, there are as many similar fears and results as there are in the sterilisation of women. However, some of the fears and results are different, but obviously they are all taken into consideration by those performing the operation and they are, and should be, conveyed to the patient having the operation. However, this is the only method of birth control which is totally irreversible and therefore it is a singular and special method which should be given careful consideration.
Approximately 2,000 vasectomy operations are carried out each year in hospitals all over the country. The number is increasing. There are lists of people waiting for the operation to be carried out by reputable surgeons on the advice of equally reputable general practitioners.
§ Dr. Summerskill
I should say from my knowledge that all of them are carried out for mental or physical health reasons, because the 2,000 operations represent only a small number of the cases referred to hospital. As I have said, there are waiting lists for the operation. Many people have been referred but cannot have the operation; it may not be available in the area in which they live. The two criteria of mental and physical health apply either to the man or woman.
As we have heard, the Bill extends the opportunity for this operation and this particular method of contraception which, I think, is a method which any couple would, obviously, consider as the very last resort. They would not resort to this unless they sincerely and positively had made every effort to succeed in other ways, or if the health, mental or physical, of the wife—usually the wife —or husband were at risk.
§ Dr. Summerskill
Well, I dispute that it would be advice readily given. Nobody is going to advise this operation till all the other methods of birth control have been tried. I say again that there are many mental and physical indications. Very often the health of the mother is the common cause for this method, but it is the very last resort.
Obviously, in a Bill like this, which is based to some extent on knowledge of anatomy, physiology, psychology, psychiatry and surgery, it is difficult for hon. Members and the public to appreciate the results of the operation or the method of the operation, but, as I say, it is being carried out daily in National Health Service hospitals and it looks to me as though it will be carried out more in the future.
We come, then, to the question of the voluntary aspect. This is stressed in the Bill in two ways. First of all, the Bill stresses that it is voluntary for the individual concerned. It has not been mentioned in the debate, I think, that the Family Planning Association does require that the wife signs the consent form as well as the husband, and that there is always an interim period advised so that both husband and wife should be absolutely certain in their own minds that they want to go forward with the operation and that they fully understand the implications of it. I fully agree with my hon. Friend the Member for Pontypool that if this provision is to be extended by the Bill it is essential that there should be proper counselling and psychiatric and psychological guidance and aid. These are fundamental. I believe that the Family Planning Association appreciates this and that this is a vital part preceding and succeeding the operation.
The second way in which the voluntary aspect is stressed is that the Bill does not make it obligatory upon the local authorities to provide voluntary vasectomy services but simply makes it possible for them to do so. As the hon. Member for Barkston Ash (Mr. Alison) has pointed out, it is difficult to assess 872 exactly what the need for these services is, but I do not consider that that is a strong argument for not making it possible for local authoriites to introduce them if they consider there is a need.
The World Health Organisation has described health as a state of complete physical and mental and social well-being and not merely the absence of disease and infirmity. I think that most hon. Members would accept that the basic human right of a married couple to decide the size of their family is one that should be preserved, because this can affect the health and the happiness not only of individual families but of the nation as a whole. This Bill, by extending the availability of one recognised and established method of contraception—although, I repeat, a very different method from the others—can play a small part and meet a small need in preserving this basic human right.
§ 1.15 p.m.
§ Dr. Gerard Vaughan (Reading)
I also had not intended to intervene in this debate today and I am going to do so only briefly because of the remarks of the hon. Member for Pontypool (Mr. Abse). I wish to come in because I would like from my more clinical experience to offset some of the things he said. I felt that he was speaking rather luridly and rather alarmingly of the psychological side. I do not feel that life is like that. It may be like that in books, it may he like that in films, I am possibly as well read as he is in that kind of book!
The problems which bring a person to ask for sterilisation or termination, all these matters we are discussing, can be very complex. But the main issue which brings them to seek this is in itself very simple. It is usually grounds of very severe mental distress, mental illness, or quite clear medical conditions. It is not as complicated as the hon. Member suggests. I agree that there are individual cases, particularly in middle age, in which people who are depressed and worried about their sexual potency seek operations which will finalise it one way or another. Frequently women seek hysterectomy and become distressed and disturbed afterwards. Many of us are worried about the motives which bring them for this operation. Also if this Bill goes through there may be a few people 873 who will seek these things on perverted or eccentric grounds, as the hon. Member says.
That I accept entirely, but one knows from ordinary clinical experience that there are a small, but a very important, number of people who are in great family and personal distress of one kind and another and they ask, "What sort of thing can be done to help?" For various reasons the woman may not be suitable for sterilisation, which can be very complicated and carry a risk. Therefore a couple will say, "What is the alternative?" and all we are discussing today is a Bill which will give us an opportunity to look at this matter and to consider what the alternatives are. One of the alternatives is vasectomy, and I would say on the psychological side that if there are proper grounds—and there must be, not found on just one short interview but on perhaps two or three interviews by a doctor who really cares, and understands what he is trying to sort out for the patient—the risks of widespread psychological damage are very small indeed.
If this Bill goes through, it will be for older people, not young people, who will, perhaps, change their views radically within a few years. It is a final thing, but this merely increases the need for proper advice before recommending it.
I was very glad that my hon. Friend the Under-Secretary of State thought that, although the Government would not support this Bill, they would certainly not oppose it. I take his point that in the long run it would be much better as a developement of the hospital services. The hon. Member for Derby, North (Mr. Whitehead) said that this was a modest Bill, and I agree with him. There are many things which we shall want to look into in Committee, but on the general principle I certainly support it.
§ 1.20 p.m.
§ Mr. Neil Kinnock (Bedwellty)
I support the Bill which was so ably introduced by my hon. Friend the Member for Derby, North (Mr. Whitehead). My hon. Friend the Member for Pontypool (Mr. Abse) voiced many able reservations but, if I might speak of him in his absence, I think he made a slight mistake in presuming that the people who sponsor the Bill or are known supporters of the 874 principle of freely available vasectomy are acting on impulse or are unaware of the severe difficulties that may precede the decision to undergo a vasectomy or of the even more severe difficulties that might arise from this novel method of contraception, unique in that it is the only permanent form of contraception.
I support in principle, as I suppose most people do, the idea of planned birth control. That is why I support the Bill and why, if I had been here at the time, I would have supported the legislation which has given to the British people an extensive right—probably more extensive than in most countries—to have the resources of the State at their command when they wish to undertake contraception. This is because not only do I not want to see unwanted children and believe that married partners have a right to limit the size of their family on social, economic, health or other grounds, but also because I am aware of the prospect of a world that is becoming increasingly overcrowded, the population of which will increase as much in the next 50 years as it has increased since before recorded history.
This subject was mentioned by the hon. Member for Yarmouth (Mr. Fell) in a different way when he spoke of moral values and the State imposition of a restrictiton of population. If he were here I would say to him that in 1972 we may take a democratic decision to put at the disposal of our citizens a voluntary means of State-financed contraception. If we do not do that, or if we are not successful in controlling our population, then our sons and daughters, grandsons and granddaughters, will curse us for being feckless moral cowards and for not facing the monumental disaster of the overpopulation of the world and of this country in the next 50 years.
As a general reason for supporting all forms of birth control, which must surely include vasectomy, I would say that it is not just a fortunate accident in our generation that science has taught us this form of contraception. It is our duty to see, where science has put at our disposal a means of contraception which is sure and safe, that our citizens are at least aware of it, and to leave it to them as democrats to choose whether they want to use it. It is erroneous to suppose that the State, or my hon. Friend 875 the Member for Derby, North, is instigating any imposition on our society. If we do not take this step we shall be casting the curse of over-population, over-crowding, starvation, strife, squalor, poverty and all the things which we think we have overcome on the generations of 50 and more years hence. As a man with a young family I am peculiarly conscious of this and I do not want to see these conditions return or to be experienced for the first time. On those broad grounds I support the Bill.
§ 1.25 p.m.
§ Mr. Geoffrey Finsberg (Hampstead)
This has been an interesting debate, and we are all grateful to the hon. Member for Derby, North (Mr. Whitehead) who, having been lucky enough in the Ballot to come first, has introduced such an interesting Measure. I have some claim to intervene in the debate since my local council, the London Borough of Camden, has always been extremely farsighted and progressive in these matters.
Only this week in the House, in answer to a Question, figures were given showing the amount of money spent by local authorities throughout Great Britain upon family planning from which it appeared that the London Borough of Camden in the three years from 1968–69 to 1970–71, spent more money than any other local authority in Great Britain. The credit for this largely goes to a most dynamic medical officer of health, Dr. Wilfred Harding, who is well known in this field. Credit goes equally to the hon. Member for St. Pancras, North (Mr. Stallard) who outside this Chamber is a friend but inside this Chamber is not referred to by me as such. I can also claim a certain amount of credit for this, having been leader of that council for two years, when we substantially increased the amount of money expended on family planning.
This is a small but valuable Measure. The Member of Parliament for Hampstead, having a somewhat literate constituency, gets many letters, and I receive between 30 and 40 letters a day. On this subject I have had a substantial number of letters, but unlike almost every other issue upon which people write to me, on this issue I have not had a single letter of objection. The letters of sup- 876 port have also been different from those I normally get. One is used to getting a printed postcard, topped and tailed, which asks that the Member shall vote in favour of or against a particular measure. One is used to getting duplicated letters or cut-outs from newspapers. But all the letters which I have received asking me to come here and support the Bill today have been individually written, and this shows the great depth of feeling that there is on this subject, certainly in my constituency.
The Measure should commend itself to us basically on the grounds of common sense and of sheer economics. I will deal first with common sense. Why, if Parliament has conceded the right to local authorities to pay for contraceptive supplies and for family planning, should they be barred from this particular method? It seems utterly illogical.
It is perhaps important in this context to show what a local authority is at present able to do. I have more accurate figures for the London Borough of Camden than elsewhere so, without being parochial, I am able to tell the House that Camden holds 21 sessions weekly on family planning, in addition to sessions which are organised and run by the Family Planning Association.
We already reimbuse organisations like the Family Planning Association, the Margaret Pyke Centre, the Marie Stopes Memorial Foundation and the Brooke Advisory Centre for those residents of Camden who consult those associations and organisations. The cost of vasectomy at the Marie Stopes Memorial Foundation is £15.50p. This foundation has been running on a trial basis a scheme that offers the operation as one of the options in a domiciliary family planning service. Patients referred are not charged a fee and the Foundation bears the cost. This private scheme is expected to end in a few months time when the Foundation hopes that those local authorities who have referred patients under the scheme will have had sufficient experience to evaluate it and will come to some financial arrangement with the Foundation for future referals for vasectomy. So far under the domiciliary scheme some 20 Camden residents have had vasectomies at a cost to the Foundation of some £300. A further 63 have had the operation under 877 what is called the normal scheme, most of them paying the full cost of £15 themselves, though in some cases the Foundation reduces or waives the charge.
I believe it is more practical and sensible and less expensive to permit local authorities to pay directly for vasectomy as this measure proposes than to continue the present method of reimbursement in certain cases to various local bodies. That is the common sense point of view. It also shows that the cost of a vasectomy operation—which is, as I have said, some £15—is in the end much cheaper for the nation as a whole than is the making available of a continuing supply of other birth control requisites.
I wish to make one thing clear—and the hon. Member for Derby, North made this point in his sincere, capable and moving speech, but it is necessary to repeat it—that I would not give any support to this measure if it in any way involved a degree of compulsion. It does not do so, and nobody has tried to suggest it ever would.
I tried to follow the flights of fancy of the hon. Member for Pontypool (Mr. Abse) but could not relate much of what he said to practical reality. He referred to new Members and I can only say that I, as a new Member, have read some of his previous speeches and his speech today seemed no different from some of those.
We hear a great deal today about ecology, the environment and over-population. If we are not prepared to do anything about it then we shall, as the hon. Member for Bedwellty (Mr. Kinnock) said, be cursed by the generations who follow us. There is no doubt that the world is becoming overcrowded and that world food supplies are becoming less and less; and there is no doubt that some of the ideas for increasing such supplies, such as hydroponics, do not seem to be working out.
I regard vasectomy as a simple method of birth control which, as I have said, has not been objected to by any of my correspondents. I should like to know whether other hon. Members in their mailbags have received any opposition on this subject, because it does not appear to amount to anything at all. I feel that this system is a wholly acceptable way 878 of moving one pace forward, and no more than one pace. It is a holding operation which seeks to plug a slight gap until such time as the inquiries and further proposals mentioned by the Under-Secretary of State as being in train have results. This is a way of stemming over-population on a voluntary basis.
If we do not give this Bill a Second Reading today, we shall be making a mockery of all that is said on the problems of over-population and of all we are trying to do to improve the environment, and we shall deserve to be called hypocrites.
§ 1.35 p.m.
§ Mr. John D. Grant (Islington, East)
I cannot hope to match the expertise of some hon. Members who have already spoken, and I would not seek to make a speech of great virility such as we heard from the hon. Member for Yarmouth (Mr. Fell), or to indulge in the fertility of the imagination as reflected in the speech of my hon. Friend the Member for Pontypool (Mr. Abse)—at least as regards part of his speech, although in some respects he made some very valid points.
I wish to take up one or two points made by the hon. Member for Hampstead (Mr. Finsberg) since I wish to say something about the activities of my local authority in Islington. We have recently been told by a number of eminent scientists about the growing need for a population policy—a view which I share. My local authority in Islington is making its contribution by taking the view that it should respond in a positive fashion to the growing pressure for an entirely free family planning service, which I see as an essential part of any population policy. It believes that a free service removes any financial deterrent to the public, and that the costs would be offset by savings, particularly those arising from the prevention of the birth of unwanted children and the frequent additional costs to the social services which this subsequently entails. I understand that the average cost of keeping a child in care can be as much as £1,200 a year or £350 a year in a day nursery. What is more important, is that much human tragedy can arise from an unwanted birth and this is immeasurable in cash terms.
879 We all know that local health authorities have statutory powers to provide a free service. The Islington Borough Council has agreed that family planning advice and supplies to borough residents attending council, Family Planning Association or Brooke Advisory centres and clinics will be free from 1st April this year. Therefore, my council is well to the fore in this respect. One illogicality in the scheme is that such clinics will not be able to deal with vasectomy. The Family Planning Association runs a weekly vasectomy session at a clinic in Islington. The Association charges a £15.50 fee to the patient, which includes £3 consultation fee which is returnable if the patient decides not to go ahead with the operation.
My hon. Friend the Member for Pontypool talked about the great need for counselling and preliminary care. I am told that the F.P.A. operating in the borough administers the service with very great care and that the F.P.A. doctor interviews the couple to establish that they understand all the implications of the operation. I take it that this would include all the difficulties and reservations spelt out by my hon. Friend the Member for Pontypool. The doctor then obtains the written consent of both partners, and subsequently the written consent of their general practitioner, before arranging an appointment for the husband approximately a month later.
Not long ago a patient was operated on as a result of going to the clinic, and the association wrote asking the Islington Borough Council to meet the cost since it felt that the patient could not afford it. In turn, the council asked the Department of Health and Social Security, which told it that local authorities have no powers to make payments to voluntary organisations for providing this service. Not surprisingly, the council decided to take up the matter with the Association of Municipal Corporations and to seek support there. A week ago, Islington Borough Council's Health Committee formally registered its support for a free vasectomy service on the same basis as it provided contraceptive advice. I take it that that means that the borough council gives full support to the Bill.
It is a Bill which will enable other local authorities to do what Islington Borough 880 Council want to do, which is to eliminate this anomaly in the family planning services. I believe that this is an all-party Measure which deserves our support.
§ 1.40 p.m.
§ Sir George Sinclair (Dorking)
As one of its sponsors, I am glad to be able to speak in support of this small but important Bill. Like my hon. Friend the Member for Hampstead (Mr. Geoffrey Finsberg), I have had many letters from my constituents asking me to speak in support of the Bill. No one has asked me to speak against it.
There are only three points that I shall seek to make, since the case has been made with great thoroughness and sensitivity by the hon. Member for Derby, North (Mr. Whitehead).
My first point is that there is in the country a growing demand for increased Government assistance for family planning advice and help to be available on the National Health Service. I hope that the Government will, in the end, decide to give this Measure active support since it is an important addition to the methods of family planning. I hope, too, that they will make the operation available on the National Health Service for social as well as for medical reasons. Many people will not be able to afford the cost privately.
My second point is that a decision to undertake the operation is to be based on the wish of both partners to a marriage. It makes it possible for the man to shoulder personal responsibility for taking out of his relationship with his wife any anxiety about unwanted pregnancies. In the past, when married couples sought as a last resort a complete removal of uncertainty and anxiety over unwanted pregnancies, it was usually the wife who took the initiative by undergoing an operation for sterilisation. I welcome a Measure which will allow the husband and wife together to decide who shall take the initiative if they want this final relief from anxiety.
My third point is brief. I hope that this Measure will soon form a small but important part of a more vigorous programme of Government help for family planning.
§ 1.45 p.m.
§ Mrs. Renée Short (Wolverhampton, North-East)
I want first to congratulate 881 my hon. Friend the Member for Derby, North (Mr. Whitehead) for bringing in this Bill. I am especially glad that, on the whole, we have had a debate which has indicated the considerable support for the Bill which exists on both sides of the House.
Let me assure my hon. Friend the Member for Pontypool (Mr. Abse) that, in supporting the Bill, I have no masochistic designs on any of my men friends—
§ Mrs. Short
Or sadistic. I support the Bill because, as the House knows, I have campaigned ever since I first came to this House for family planning to be freely available on the National Health Service. This Measure is a move in that direction.
I hope that the Under-Secretary will tell his right hon. Friend that the House today has expressed the view from both sides that there should be very much more generous help from his Department in terms of the provision of family planning to both men and women, and that, in addition, there should be a great deal more propaganda for family planning directed to both men and women.
The other reason why I welcome the Bill is that it is aimed at men. There are but two methods of contraception used by men. The first is the condom, which is the most popular, though it is not particularly sure. The other method used by men is the deplorable practice of withdrawal, which is psychologically and physically frightful. All the other methods are used by women and, in many respects, a number of them are undesirable. The pill, for example, has undersirable side effects for some women, and the use of the I.U.D. can be very objectionable to many. I am glad that the Bill imposes a measure of responsibility upon men.
We see from the Report of the Simon Trust, published in 1969, that just over half of the men who had the operation gave as their reason the failure of contraception. It follows that they were men who had children and obviously had more than they wanted. Unplanned and unwanted pregnancies had occurred, and the men had decided, after medical advice and counselling, to have vasectomy 882 operations. In the sample about which the Simon Trust reported, a small number of women have had six, seven or more pregnancies. I am not surprised that those women were anxious for their husbands to have vasectomies so that they could be given some kind of relief from further unwanted pregnancies.
It is interesting to see that the Simon Trust divided its patients into age groups, social groups and, of course, religious groups. It was shown clearly that the middle income groups are those which are most likely to follow family planning procedures at all and who are the most likely to be motivated to seek vasectomies. This fact also indicates to the Under-Secretary where his Department needs to direct more propaganda about family planning in general.
Five per cent. of the patients included in the sample of 1,000 patients were Roman Catholics who, on average, had three and a half children per family. This is higher than most of us now accept as the reasonable size of family if we are not to add to the problem of overpopulation. The smallest number of children, apparently, were born to Jewish families who, on average, had only two children per family.
It is also interesting to find out from this survey how people discovered that there was a vasectomy procedure. I think that for this we have to thank the Press, because 71 per cent. of the patients said that they had learned about vasectomy through either newspapers or magazines; not, significantly, through the Department's propaganda or doctors. One might have expected doctors to have played a more lively part in informing their patients about the possibility of a vasectomy operation, but they came well down the list. In fact, only 7 per cent. of patients said that they had heard about the operation from their general practitioners. This underlines the need to include the whole of the contraceptive procedures for both men and women in medical training so that medical students become capable of giving this kind of advice to their patients.
After the doctors with 7 per cent., radio and television came next with 5.6 per cent. That is rather surprising, because there have been a large number of discussion programmes on both radio 883 and television about the whole question of over-population; but apparently these have not made as much impact as newspaper and magazine articles. So there are lessons to be learned here. I hope that the Minister will take this very much to heart.
The disturbing thing about family planning is how many people take no precautions at all; they just take the risk and think, "It cannot happen to me." It is difficult to explain to some of our male colleagues in the House, who opposed the Abortion Act, for example, the problem facing a woman of becoming pregnant when she does not wish to have a baby. In my view, it is a major tragedy for the woman concerned and often for the family. Therefore, we need to urge doctors to be more lively in propaganda about family planning, and vasectomy in particular, we need to urge the clinics where the work is being done to do more to spread the word, and we need to encourage men who have had the operation successfully performed to pass on the information.
It is interesting that 76 per cent. of patients who had the operation did so because they wished to spare their wives the more serious operation of sterilisation, which is a major abdominal procedure requiring at least two weeks in hospital and a considerable period of recuperation afterwards. This relieves the Health Service, the hospital service and doctors of a good deal of the burden of carrying out sterilisation procedures on women.
I will not repeat what my hon. Friend said about the speed of the vasectomy operation and the fact that it can be done under local anaesthetic as an outpatient procedure. This is now well known. The general fact of the lack of disagreeable after effects in the large majority of cases indicates that it is a very successful procedure.
I welcome the procedure because it is a safe means of contraception and it removes from women the fear of unwanted pregnancy which can have such a disastrous effect on a marriage relationship and can compel some women to contract out of the sexual rôle altogether with bad effects on the unfortunate husband and children and the general atmosphere in 884 the home. Anything which can be done to remove this burden is a great advantage not only to families and individuals, but to society as a whole.
Another problem came to my mind when my hon. Friend the Member for Pontypool was making a somewhat intemperate attack on those hon. Members on both sides who support the Bill, who are supporters of the birth control campaign and who also supported the introduction of the Abortion Act. I am proud to have played a part in the proceedings on those Bills, which became Acts of Parliament, and the contribution which they are now making to a better and more balanced relationship between men and women in this country.
My hon. Friend mentioned that doctors were objecting to having a kind of social referee rôle put upon them. Many doctors do not accept this stricture. They do not accept that it is not part of their rôle. In fact, they accept that, with the development of modern medicine, more attention is being given to the social reasons for certain conditions occurring.
One point which causes me concern in the operation of the Abortion Act may operate in a similar way on this Bill if it becomes an Act. I refer to the attitude of those members of the medical profession who are not in favour of carrying out vasectomy procedures for many different reasons. They may have religious or professional objections, but the end result to the patient is the same because they may well refuse to operate. This is a dominant feature in the major objections which have been made to the Abortion Act, and many representations have gone to the Lane Committee in this regard.
We know that this accounts for some of the discrepancies between hospital regions concerning the number of operations carried out. I wonder whether we ought in some way to amend the Bill so that the patient shall be able to seek other advice if his own doctor is unwilling either to carry out the operation himself or to refer him to another doctor who would take a more liberal view. I do not want that major shortcoming in the operation of the Abortion Act to be perpetuated when it comes to the operation of this Amendment to the National Health Service (Family Planning) Act. I hope, therefore, that when the Bill goes 885 into Committee it will be possible to give consideration to this matter.
Another point about which I am rather concerned is that, from what the Minister said, it appears that in the long run he is not in favour of either family planning clinics or, presumably, general practitioners carrying out vasectomy operations on their own premises even though they may be equipped to do it, as many general practitioners do now. The Under-Secretary said that he thought that all these operations should ultimately be carried out in hospital. I wonder whether that is necessary. The hospital service is very much overburdened. I do not particularly want to encourage private operations to be carried out in hospitals by consultants. I think that the family planning clinics have made such a marvellous pioneering beginning in carrying out these operations in many parts of the country. In the West Midlands there are now three or four operating sessions a week at the F.P.A. headquarters. It started with one session. To this extent it is relieving hospital facilities and staff of a good deal of work. I wonder whether the Minister might not alter his view that all this work should be done in hospitals.
This is a good Bill. I hope that it will be carried with a good majority this afternoon, and that in due course it will become an Act.
§ 2.0 p.m.
§ Mr. John Cordle (Bournemouth, East and Christchurch)
When I came into the House today I did not think that I should take part in the debate. I came to consider the matter and to learn a little more about the subject, which seems to be so widely unknown. and which, as the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) said, should be more publicised.
When I was in India in 1967 a great deal was being done to cut down the population and to promote family planning. It was largely because those concerned could not get it across to the nation that this method of contraception would be beneficial that there was such a long delay before any family planning took place, but we heard today during the debate, which has been particularly interesting that about four or five million people in India have undergone this important and serious operation.
886 My hon. Friend the Member for Hampstead (Mr. Geoffrey Finsburg) said that he had received a number of letters on this subject, and the same comment was made by my hon. Friend the Member for Dorking (Sir G. Sinclair). I, too, have received a number of letters from my constituents complaining about the further erosion of a family life and asking whether we are opting out of the responsibility of parenthood and providing a further opportunity for more sexual permissiveness.
There are, of course, objections to abortion based on religious grounds. Indeed, the objections cut right across the denominations in our religious life. I came into the Chamber completely undecided on how to advise those who had written to me. I have listened to the debate, and I have heard the specialists speaking. We have had the privilege of listening to those who know something about the subject, and now I am certain that it would be right and proper to support the Bill. I congratulate the hon. Member for Derby, North (Mr. Whitehead) on introducing the Bill so well and so fully, as well as on getting advice from his Front Bench on which there is an expert in these affairs. It is through lack of information, counsel, guidance and consultation that we fall down on the valuable medical advice that we should be giving our young and older people.
The hon. Member for Pontypool (Mr. Abse) raised the question of causing further distress and hardship in family life. I suggest that this operation could bring relief and could become a blessing and not a curse to the nation.
In view of the seriousness of the letters that I have been receiving and the objections made to the whole case for this type of contraception, I got in touch with a well-known local surgeon and asked for his views. He gave them to me, and I pass them on to the House. He said that responsible doctors and clergy supported this small operation, and he went on to say that it was not the end of the road when the operation took place because, in one case in ten, the reconnection operation was a success. Serious research in the medical world is going on into this question, and it could be that there will be about 50 per 887 cent. successes in reconnection if it is desired.
Vasectomy is a small operation. It takes about two hours to perform, and then it is back to work for the patient. This surgeon told me that he was doing about 10 operations a month, and he was good enough to let me know the sort of figures which he was charging. We have heard today of people being charged £15, 25 guineas, and £70. It seems that the average is about 30 guineas, and that includes not only the anaesthetic—local or general—but the after-tests and the visits that must take place for at least six weeks following the operation. This surgeon went on to say that there was virtually no complication rate, and very little danger in the operation itself.
It is clear that responsible doctors and clergy believe that this service should be available to those who choose freely to avail themselves of it, and I sincerely hope that the Bill will receive the blessing of the House.
§ 2.7 p.m.
§ Mr. Frank Tomney (Hammersmith, North)
Like the hon. Member for Bornemouth, East and Christchurch (Mr. Cordle), I did not intend to take part in the debate, but I expected to find more Members present to debate what is an important matter concerning the Health Service, and even more important in so far as it concerns the world's most grievous problem.
The trouble with democracy is that when confronted with issues of a startling nature it always adopts the procedure of staggering to a conclusion. This is no longer going to be possible. It has in the past staggered to conclusions, resulting in famine and war. We have it in our power in this small Bill to give a lead to the world by enshrining this principle in legislation. This House of Commons is a forum acknowledged throughout the world as one of legislative expertise.
We come here to debate, we indulge in propaganda, and we pass laws which affect our population, but it is sometimes necessary for Parliament and the legislature to take its population gently by the hand and to show it the way it should go, and that, in essence, is the basic 888 purpose of a Bill of this character. We have to go along this road of limiting population—whether we like it or not—not only in this country, but worldwide.
I do not make many speeches in this House, perhaps not as many as I should, but about two years ago I spoke on economics and said that by the end of this century this country would be overpopulated to the extent of 20 million unless we did something drastic about family planning, social planning and economics. I do not for one moment depart from that view. In fact, events every day prove that I was more than right in my judgment.
For the first time in a modern economic society, a producer and consumer society, we have the ability to live at a high consumer rate, to invest, to make profits, and yet to maintain one million unemployed. This is not a nice situation, but it is applying throughout the rest of the civilised industrial world. If one stands on Manhattan or Tokyo underground stations, or at San Francisco, Natal, Durban or Paris stations in the early morning and looks at the countless population on the move, the services they are using and consuming, and if one considers the tremendous population of the West, one cannot help thinking, in a kindly way, how much better it would be if we organised things better. We should start to organise it by means of prime factors such as population control and industrial and economic expertise.
Unless we do this, the whole world is heading for a situation which it cannot control. One of the benefits of being a Member of Parliament is that it allows one's mind to expand and travel and allows one to see on the spot some of the human tragedies of over-population in South America and India and to look at the customs, the sects and tribes. All this has not altered in hundreds of years, and unless our civilisations give them a positive lead, it will not alter. That is why this little Bill is so necessary not only for us but to guide these people on the way that they should want to go. They urgently need it.
The Bill enshrines the liberty—as all Measures of this kind do—of individual choice, and in this case joint decision of husband and wife. The man has to decide what size family he can afford and 889 the Government must decide what resources they can afford.
So let us pass this Bill and hope that this process will carry on from this prime legislature to other legislatures in Berlin, Paris or Tokyo. This is urgently necessary if people are to live fuller and happier lives. The Bill has my blessing and I hope that it succeeds.
§ 2.12 p.m.
§ Mr. Richard Luce (Arundel and Shoreham)
I support the Bill, not as a medical expert but as a layman, for the same reason as the hon. Member for Hammersmith, North (Mr. Tomney). That is that, in the United Kingdom as much as anywhere else, we have a population problem and need a population policy. I am critical of many of those who indulge in scaremongering about the population explosion, but we must recognise that it is a growing problem.
This is shown by the fact that it took from the beginning of the world to 1830 for the population to reach 1,000 million. It took the next 100 years to double to 2,000 million. It took only the next 30 years, to 1960, for the population to increase to 3,000 million, and it is estimated that, by the end of the century, it will be 7,000 million.
If the United Kingdom's present growth continues, our population will double over 130 years and by the end of the century, it might be about 70 million. The United Kingdom is the seventh most densely populated country, and England alone is third. There is also a considerable surplus of births over deaths in this country—300,000. We are entitled to ask what our optimum population should be. No Government can take a clear judgment on this. It is a value judgment, but my estimate is that, when the size of the population begins to restrain the freedom of those who live in the country, it is too large.
There are already signs this is beginning in this country—the strains on housing, transport, water and food supplies and materials generally. There is the effect of pollution and the question of amenities and other human values. Crowded conditions bring neuroses and increases in crowds. This problem is becoming more and more serious, and it is largely due to the density of our population.
890 If we could contain the problem of the surplus of births over deaths and could get the rate of growth down, we should be making a contribution to solving this difficulty. The key to this is conditions in which we can reduce the number of unplanned pregnancies. There are about 70,000 illegitimate births a year and in 1970 there were 84,000 abortions. The evidence is there to show that there is a large number of unplanned pregnancies.
There is a whole range of policies which could create the incentives to reduce this—more intensive education, tax and cash incentives, for instance—but the main measure is an extension of the 1967 National Health Service (Family Planning) Act, which would create conditions and incentives for people who do not want a larger family to take advantage of the available contraceptive facilities.
If there were any compulsion in this, I would thoroughly sympathise with the views of my hon. Friend the Member for Yarmouth (Mr. Fell), but it is entirely voluntary. While I share some of the worries of the hon. Member for Pontypool (Mr. Abse) about the safeguards available, the evidence of the Simon Trust report showed not only that it is a simple operation but that it has a healthy rather than a detrimental effect on people's marriages. This is very important. Also, the Family Planning Association has a waiting list of 10,000 for this operation.
The Bill is a small contribution only to a very large and serious population problem. It can certainly do no harm, but it has the potential to contribute to the containment of the rate of growth in our population.
§ 2.18 p.m.
§ Mr. John Hannam (Exeter)
I should first like to pay tribute to the hon. Member for Derby, North (Mr. Whitehead) for bringing in this important Bill. He presented his case with convincing clarity and logic and has been ably supported.
I support the Bill because it represents a vital step forward not only in family planning and population control but also in the promotion of marital harmony. I have received a great number of letters in recent weeks supporting the Bill from doctors and experts living and working 891 in my constituency. Their unanimity of approach to the needs of our evolving society has deeply impressed me.
I am personally concerned for the future of our human society if we continue to ignore the dangers of overpopulation and of the continuing weakening of the family social unit. The two are closely related. Unhappiness in the home is often reflected in the discussions which I and I am sure many other hon. Members hold in our constituency surgeries and interviews. The breakdowns in homes are often the result of the worries and strains caused by fear of pregnancy or over-large families.
The Select Committee on Science and Technology in its first report on the population of the United Kingdom underlined the dangers of ignoring the continuing growth in size and structure of our domestice population. Every step should be taken to limit the size of the United Kingdom population to its existing numbers. Many steps are being taken. Family Planning clinics and advice centres are coming into existence everywhere, and there is also the excellent work of the Family Planning Association, the Health Service, the Simon Trust and the medical profession generally.
All of these have contributed to a welcome increase in knowledge and awareness of the immense problems facing us in Britain and throughout the world, where other poorer and heavily populated countries are looking to us for a lead in developing population control techniques which they will wish to use at some future stage. We have then this important dual rôle which we must perform, birth control and family planning. There is also the family harmony aspect which is so important in these days of stress and strain upon the fabric of society, the family unit.
This tiny operation, vasectomy, performed in 10 minutes or so, is already well-established in this country as a method of birth control. It has always been available on the National Health Service on medical grounds, but only comparatively few operations have been carried out in National Health Service hospitals. Many more have been carried out by the Family Planning Association clinics and I gather that there is a waiting list of about 10,000 or more. Local authorities are fast setting 892 up family planning clinics in hospital premises but the Act does not empower them to provide a vasectomy service in such premises. Nor are the local authorities empowered to support such services as they can other methods of birth control. The fullest methods of consultatiton with the couple planning this operatiton are used and I am satisfied that no rash sterilisations are carried out.
During the debate we have heard of problems encountered by couples wishing to be voluntarily sterilised. Shortage of finance has been a major obstacle, and I should like to quote from one letter I have received from a constituent which sums up the kind of difficulty being experienced. This letter came from a doctor in Exeter, one of many who have written to me expressing the strongest support for the Bill. He says:In one case a patient of mine underwent the operation for a fee of £25 which together with the theatre charge and the cost of a private room for a day cost him nearly £50. Unfortunately the operation was not quite successful and a second operation was offered by the surgeon. My patient unfortunately was unwilling to face another fee of this nature so nothing further could be done.This is typical of the kind of financial difficulties which often crop up in such cases. Apart from being expensive, abortions are by no means an ideal solution to the population or family planning problem and the pill is not without its dangers too. Those who in a stable married partnership can contemplate taking such a step as vasectomy find that this is a simple, safe, effective and not very costly operation. There are no side effects, after a day or two of minor discomfort and all the evidence points to happiness and more attentive relationships between married couples. I have the greatest pleasure in supporting the Bill and I sincerely hope that the House will give it a Second Reading.
§ 2.24 p.m.
§ Mr. Marcus Lipton (Brixton)
My reason for taking part in the debate is that I have in my constituency King's College Hospital, which is running an out-patient vasectomy clinic under the auspices of the Family Planning Association and the International Planned Parenthood Federation. In the last 18 months the clinic has carried out 1,000 vasectomies. Because this is a pioneer scheme the hospital is forced to charge 893 patients for what it regards as a socially necessary operation. The eminent doctors in the Department of Obstetrics and Gynaecology who operate the outpatients' clinic are firmly of the opinion that there should be provision for local authority financing of this operation.
In the majority of cases it is clear that there is a justifiable social need for sterilisation. The cost of the operation in this clinic is about £16, which is not at all excessive when we equate it with the price of long-term contraception which often has to go on for, say, 15 years and the possibility of the National Health Service having to finance the termination of an unwanted pregnancy.
King's College Hospital is situated within the boundaries of the London Borough of Lambeth and the Lambeth Council is strongly in favour of this Bill. It has asked me to make that clear. The trouble is that there is no legal machinery to enable my local council to help in the valuable work being done at the clinic. The council agrees that it should be able to provide the money and I hope that the Government will find it possible to assist this very deserving Bill on its way to the Statute Book.
§ 2.26 p.m.
§ Mr. Wilfred Proudfoot (Brighouse and Spenborough)
If it were possible to choose when one could catch your eye, Mr. Deputy Speaker, I would have chosen to be called after the hon. Member for Pontypool (Mr. Abse) because he took us into a sombre world of dark psychedelic colours which I do not believe exists. I have a healthy opinion that most people are absolutely normal and I think that he was scare-mongering. Nor do I want to join my virile hon. Friend the Member for Yarmouth (Mr. Fell) in the over-masculine approach. I think he has virilty mixed up with potency and I can see him singing Rugby songs and quaffing ale to prove virility.
I am neither an enthusiastic supporter of the Bill nor am I against it. Nor am I a person who has read deeply about it. I have paid passing interest. I went with a Parliamentary delegation to India 15 months ago and when I arrived there it was the first time I had been there for 22 years, when I was in the 894 Forces. The delegation asked me, "What is the difference between 22 years ago and now?" The simple answer was that there were more motor scooters and there were family planning advertisements on just about every available space.
I started to think about this because I remembered one of the first coolies I saw in India. They were called coolies during the war, and we had them with us mending the aeroplanes. I talked to them and I asked, to the best of my ability, "How many in your family?". He said, "Ten children, four dead, six alive, sahib." Incredibly enough, when I returned to Seamer Village in England immediately after the war I asked a man the same question: "How many children have you got?" He said, "Five children, one dead, four alive." New attitudes are evolving now. Parents took out emotional insurance against the loss of children by disease. In India they are still doing that, but it is passing.
As the father of three children I have an irrational fear that one of my children, God forbid, will meet with a terrible accident, and traffic on the roads always enters into it. When we look at this problem of population we have to accept that people do not approach it clinically but emotionally. In my lifetime I have seen the ethic and the fashion for families change. In the slump in the 1930s the thing was to have no children. It was smart and—although this expression was not used then—"with it". People felt that the world was not a right place into which to bring kids, because of the economic difficulties of the time.
Just before the war, the French evolved a family allowance system in effect to subsidise the procreation of children and to build up the French population. When we introduced family allowances there was an element of that in Britain. In this Parliament we have introduced family income supplement, and some may surely argue, looking at it objectively, that here we were encouraging larger families. I am not numbered among the pessimists who believe that the world will be over-populated. What is happening shows that we shall have a growth in agriculture, a green revolution in India and the white revolution which will come from protein, milk and so on. I am not abjectly despondent about it.
895 I apologise if I missed hearing it mentioned whilst I was at lunch, but the one matter not brought out in the debate is the business of repairing any man who has had a vasectomy. There is an alternative system which is quite simple and easy. I am delighted to tell the House that private enterprise fills the gap in this case. In America there are now sperm banks. They are run by private enterprise. I can recommend this to my hon. Friend the Member for Norwich, South (Dr. Stuttaford) as a field into which he might suitably move as an entrepreneur. All the fears of not being able to be repaired—which are absolutely natural and understandable in a man who may lose his wife or children or may get divorced—can be guaranteed or insured against by sperm banks.
In the last month in New York 1,000 people have deposited sperm in this bank. It is held at a temperature of minus 321 degrees Fahrenheit. The initial deposit costs 80 dollars. The bank keeps it as long as the depositor continues to pay 18 dollars a year. Being private enterprise, if one stops paying, the service is no longer provided. In other words, they thaw the deposit. It is incredible, but a new word has evolved in the English language. The bank has what is called an ejaculatorium.
The 1,000 customers over the last month are interesting. Amongst them are those men who fear being made involuntarily sterile, such as those working in atomic energy or where there is radiation hazard. Also, there are anonymous donors for artificial insemination. Then there are men who are not sufficiently fertile, and apparently the sperm banks now build up semen until there is sufficient sperm for a couple to conceive. One customer is simply an eccentric, a grandfather from the Middle West, who is afraid that his son might be infertile and he wants to ensure the continuation of the line of his family. These banks should be regarded by the hon. Gentleman who introduced the Bill as a safeguard which will one day be established.
But looking ahead—which the House should on this type of occasion, as these things come within the bounds of possibility in our society—I am sure that before the end of the century private Members and even Governments will 896 suggest in the House that we ought to pay bounties to people who accept voluntary sterilisation. I am sure that one day before the end of the century Members and possibly even Governments will again suggest even involuntary sterilisation. We shall get into a situation such as George Orwell talked about, where it may be regarded that something should be done about people who are imperfect physically and mentally. I certainly would not propose that, but I think that this will happen in the future.
Hon. Members have mentioned, although not in this context, that low-income families with health problems may possibly have to become non-voluntary subjects. While accetping that the Bill is sensible today, the House should look at what it portends for the future and realise that private and public ethics are concerned about the future progess in this field.
§ 2.35 p.m.
§ Dr. David Owen (Plymouth, Sutton)
I apologise for being absent for most of the debate. As a sponsor of the Bill I warmly welcome it and say how pleased I am that there seems to have been such a great measure of support for it from all sides of the House.
Most people recognise that this is only a limited Measure but, taken with what the Under-Secretary was able to say about the provision of family planning advice within the National Health Service following its reorganisation in 1974, we can say that today has been a very significant day, for the pressure has been building up now over many years for far greater provision for family planning advice and methods. Most of us have felt for many years that it has been a serious omission that this has not been available within the National Health Service.
No one in the House is unaware of the ethical problems that population control can have, especially in unscrupulous hands, for future generations. But it is a great pity that when this subject is discussed, so often people who are the critics of family planning advice and methods wish to exaggerate what many have been trying to do. It is so very easy to draw horrific spectres of enforcement and control, and to draw a picture of what no one in the House or outside it wishes to do. I notice this in 897 some of the writings of journalists about the very mildly phrased letter of a large number of distinguished physicians, and a few of us less distinguished physicians who also happen to be politicians, which appeared in the British Medical Journal and the Lancet recently.
On the subject of population explosion there is a great danger that there are too many prophets of doom. There is no doubt that we live in evolutionary times. Our history is an evolutionary one. In the years to come, the evolutionary situation itself will bring control. But equally it would be wholly foolhardy for man, given intellect and intelligence, not to look at the future and take prudent measures to anticipate future trends.
One does not have to be a doomsday man. a person who wishes to think only of unlimited projections, to say that it is prudent for civilisation and Governments, wherever they are in the world, to look at the potential of the population explosion and to adopt what sensible, rational methods they can within the bounds of preserving individuals' freedom and choice, and that not to do so would be to negate the influence of intelligence. We are not asking people to accept enforcement but that people who wish to undertake certain measures, or those who are ignorant of the availability of certain measures, should have far greater freedom and far greater access to them.
I feel strongly that we as legislators must be in advance in discussing the potential of the population explosion. But we also have a serious responsibility not to exaggerate it and not to forget the evolutionary forces that will of themselves tend to produce controls. One does not know how that will occur but one can foresee a decrease in the ability to procreate. There is the whole question of whether radiation will build up. These and other factors have to be borne in mind by those who just look at the statistics and make what I think will be shown by history to be incorrect projections.
I cannot stress sufficiently that the Bill is broadly welcomed by the medical profession. There are those who are anxious about certain aspects of it. In this debate, comments have been made about the type of person wishing to have a vasectomy operation and, indeed, about 898 the type of person who is prepared to do that operation. I feel that these anxieties are seriously exaggerated.
I do not believe that this will always be the most popular form of family planning or birth control, but we may well see a major change. Many of those who are strong advocates of the pill for women, as I am, know that there are problems associated with it. There are problems, for instance, associated with long use. An alternative method which does not involve any hormonal interference with the natural balance of the body may well, over the years, become much more attractive. Such a change will develop of itself as people themselves choose. What is proposed here is that we give them an option, and it is clear that the demand to choose that option is already not being fully met.
I welcome the Bill, therefore, and I congratulate my hon. Friend the Member for Derby, North (Mr. Whitehead) on it. It is a sign of the maturity of the House, if I may say so, that the Bill has been received on both sides in an atmosphere free from hysteria and in the knowledge that we are discussing what will increasingly be seen to be a major issue for all Governments and all nations.
§ 2.41 p.m.
§ Mr. Laurie Pavitt (Willesden, West)
The Bill, like the surgical operation which we are discussing, is brief and to the point. We have had a full and interesting debate, the quality of which should in no sense be judged by the number of hon. Members who have been able, on a Friday, to attend it. The contributions which have been made, not least those by the four medically qualified hon. Members who have spoken, have added considerably to our knowledge and understanding of the subject. What is more, we have conducted our discussion with considerable moderation. It is often thought that someone who has the prefix "doctor" before his name is a doctor and nothing more. In fact, the four doctors who have spoken have given us the benefit of their considerable knowledge of medical practice in a variety of different specialties and spheres, and they have, in my view, done the House a great service.
I join in the congratulations accorded to my hon. Friend the Member for Derby, North (Mr. Whitehead) on his opening 899 speech. It was a model of its kind. There was no sensationalising of a subject which can be made sensational. There was no suggestion of panic measures. He outlined the pros and cons of the Bill, and he issued certain warnings. His speech set the pattern, which has been followed in most of the rest of the debate.
Hon. Members have drawn on their knowledge of countries overseas, and this is both natural and right, for we see the Bill not only as instituting an important reform in the life of this country but as part of a global pattern, just as we ourselves are part of a global pattern. In talking of population problems, therefore, several hon. Members have drawn on their overseas experience, for example, the hon. Member for Brighouse and Spenborough (Mr. Proudfoot), who recalled his time in Bombay. The hon. Member for Norwich, South (Dr. Stuttaford) spoke of his experience overseas. In taking up one of the themes running through the debate—children by choice, not by chance—he echoed the great publicity campaign which has gone on throughout India in an effort to do something about its great problems in this respect.
I very much welcome the Minister's green light. We are grateful to him for speaking at an early stage, for had he not intervened then many of the subsequent speeches would have been directed to a probing of the Government's attitude. Although several hon. Members both on this side and on his own side have been inclined to ask, "A little more please", I think that most of us understand the position of the Government on an issue as controversial as this. If we can have from them a categorical statement such as we had from the Under-Secretary of State, that there will be no obstruction and that the House will not be prevented from having its will in the matter, I am glad to welcome it. If only all of us who have Private Members' Bills or Ten Minute Rule Bills which we wish to put before the House could have the same sort of satisfaction, we should be delighted.
I come to the contribution by my hon. Friend the Member for Pontypool (Mr. Abse), the longest speech of the debate so far. My hon. Friend's eloquence is matched only by his sartorial elegance. No hon. Member who has spoken has 900 done more homework on this problem than has my hon. Friend the Member for Pontypool. At times during his speech, I was not sure whether he would, in the last analysis, be with us or against us, and I am glad and grateful to him that, in the end, he is, apparently, on the side of the angels—if we may so describe ourselves.
The only stricture which I put to my hon. Friend, as another old Member, is that we old Members have to be careful in this place that we do not fight again battles which we fought in previous years. I have seen this tendency in those of our colleagues who have gone to the other place. There is a temptation, sometimes, to go back over our old battles, and I felt, with respect to my hon. Friend, that he was at times rehearsing again some of the arguments we had over the previous Act. I say that, although I fully recognise that some of those arguments are relevant also to this Bill, and we are wise to take into consideration the experience derived from it; but I had the feeling that we had, so to speak, been here before.
§ Mr. Pavitt
I readily accept that, and I fully acknowledge that my hon. Friend was entirely right in drawing attention to some of the problems which have arisen from the legislation which Mr. Edwin Brooks was able to have brought before the House with the aid of my hon. Friend. They have a relevance here, too.
On another aspect of the matter, I felt that my hon. Friend the Member for Pontypool took us too deeply into the realms of psychology. The hon. Member for Brighouse and Spenborough commented on this, too. I was not sure whether it was the realm of Freud, Adler or Jung, but my hon. Friend took us a little too far beyond the fringes of the problems of psychological maladjustment, directing attention to the state of mind of people who have psychological problems and instability in their married life and emphasising the dangers in that 901 sphere. He was right to sound a note of warning, but my hon. Friend the Member for Derby, North, in opening the debate, did the same, and I feel that the House would be wrong to get that aspect out of proportion in relation to the large number of people who are likely to present themselves for this operation as a solution to their own personal problems, quite apart from its value as a means of solving the population problem in general.
As my hon. Friend the Member for Derby, North said, the House must always remember that a Measure of this kind, important though it is, will not solve all the problems to which it is directed. My hon. Friend does not claim that it would. But what he did claim—and what I claim—is that it will make an extremely valuable contribution, and that the nation will be so much the worse off if we fail in our duty today to move forward along these lines.
As one of the sponsors of the Bill, I give my hon. Friend the Member for Pontypool the assurance for which, I gather, he asked in his closing remarks. No Bill is ever perfect. My hon. Friend brings to the House a good deal of expertise in the law. Indeed, I recall a previous Chief Whip of this party telling me that my hon. Friend was the finest lawyer in the country. I do not know whether other hon. Members who are also learned Members will be able to endorse that.
I assure my hon. Friend that, when we come to the Committee stage, any effort made to improve the Bill or to incorporate some of the safeguards which he called for—so long as there is no vasectomy of the Bill itself, so to speak, preventing it from being fruitful—will, I am certain, be accepted by the sponsors with every readiness.
The only voice of real opposition came from the hon. Member for Yarmouth (Mr. Fell), who spoke with much sincerity and passion, according to his beliefs. Many of us have a soft spot for the hon. Gentleman. We like mavericks, and the hon. Member for Yarmouth is a maverick. We recall the occasion when we on this side were anxious that the Conservative Prime Minister at the time should resign, and he was the only Conservative Member to stand up publicly and say the same. I rather regretted that the hon. Gentleman 902 was unable to match the sincerity and passion of his argument with a clearly thought out case, because there are cases to be argued against the Bill.
The main burden of the hon. Gentleman's argument was that the Bill would lead to a tremendous change in the social pattern, to greater State intervention, and to tremendous pressure coming from a number of sources. I do not think that the hon. Gentleman established that case, nor did he establish that the Bill does not now contain, or will not in Committee be amended so as to contain, adequate safeguards.
A number of other problems were mentioned. I think that there was a consensus. One of the major premises upon which the Bill stands is that on medical, social and humanitarian grounds no unwanted child should come into the world. We understand the rights of the family and the rights of life. Either medically, or through their jobs here or in other spheres of public life, hon. Members can testify to the problems which arise because a child comes into the world unwanted and unloved. Hon. Members can testify to the social problems that arise, to the cost of those problems, to the misery in the community that arises from that single fact. That was the justification for the original Bill which this Bill amends. This Bill can be justified on that ground alone.
Although the effect on the local community and the national effect is only a small part of the major problem, it can be formidable. Many hon. Members have called attention to the question which arises increasingly when we are considering environmental pollution and the population explosion. One of the few ways in which one can escape from the pressure of this place is to delve into romance and science fiction, where one can travel, so to speak, in the realms of outer space. Some of the themes of the old stories—for example, the story of Noah's Ark and how it was necessary for species to take refuge, if only temporarily, from this world—get reflected in science fiction. There has been an element of this in the debate which has proceeded over the last 30 years on the question of the population explosion. My hon. Friend the Member for Plymouth, Sutton (Dr. David Owen) made a useful contribution on this question. We are aware 903 that the flood is not one of water but may well be one of people. Various examples have been given of the extent of this and of its importance for future life on our planet.
One of the best analogies with which to demonstrate the importance of this is to say that, if one were to take a line from the Bar of the House to Mr. Speaker's Chair, and if that were to represent the 2,000 years since the birth of Christ, in terms of graph for population growth, by the time it reached Mr. Speaker's Chair it would have risen by 2½ inches, but in the last 70 years the line would have turned round horizontally and would now reach the top of the clock at the end of the Chamber. This indicates the strength of the sudden spurt that has happened. My hon. Friend the Member for Plymouth, Sutton was right to say that, although one does not want to rush to panic stations, it would be a very foolish world that did not try to use its intelligence in an effort to meet the consequences.
I am rather proud of my own borough of Brent—one of the five London Boroughs which are operating a complete family planning service. Like my hon. Friends the Members for Islington, East (Mr. John D. Grant) and for Brixton (Mr. Lipton), I know that my borough council will welcome the Bill if it is enacted. We have, however, to face the usual rather cheap jibe about free love on the rates and that promiscuity would abound once something was done to solve the problem created by unwanted children being born into the world.
In terms of both local and national economics, I am confident that the extension of family planning in this direction can lead only to the saving of money rather than to additional expenditure and that in the long run it can save millions of pounds. I look at the problem as only part of a wider problem of health and, in particular, of the greater question of the National Health Service.
The highest growth rate in the Health Service we have is that of mental illness. At present, 45 per cent. of all patients in National Health Service hospitals are mentally disordered. That is equivalent to about 180,000 beds, and to those beds are attached all the services—doctors, nurses, and so on, all costing an enormous sum.
904 In terms of pressures on modern life, perhaps one of the greatest pressures still appears within family life. If that pressure can be relieved, and if we can start to get a more balanced family life within the community, apart from the question of the need for the medical termination of pregnancy and the immediate health responsibilities that arise in this narrow field, there is no doubt that in the wider field, especially in mental health, there would be a considerable saving.
By the year 2,000, a mere six years will add an increment equal to the entire expansion in the world's population from the formation of the Roman Empire to the middle of the 19th century. It is estimated by the Family Planning Association that in Britain there are between 200,000 and 300,000 unwanted pregnancies every year and that the expenditure of £40 million a year on effective birth control could save between £200 million and £400 million of public spending on maternity and child care and other services each year. At present, total expenditure on family planning services by the Family Planning Association and local authorities amounts to between £3 million and £4 million.
I draw the attention of the House to what might be a very important consequence of the Bill. There is at present intense pressure on the gynæcological and obstetric departments of hospitals, for two reasons. One is the growth of population, meaning that there are many people coming up through that age range. Further, the large number of immigrants that we have been able to absorb so successfully does not diminish the call upon the hospital obstetric service. There are also the problems arising from the fact that there are insufficient senior consultant posts. There are more doctors in training in gynæcology and obstetrics than there are consultant posts for them If anything could be done to reduce the pressure on the use of the gynæcological and obstetric services in the National Health Service, this would be extremely valuable.
One matter that the Minister talked about was the consequences of the integration of the three wings of the Health Service. I hope that in the reorganisation of the Health Service he will also look at the way in which over the whole 905 maternity field, if there is to be an integrated service, there should also be some reorganisation in that field, because that would be of considerable value. It would be of great benefit if he could split the two specialties—obstetrics and gynaecology—because they make very different calls on hospital services, and there is also need for an extension of domiciliary care in both specialties which could be extended with the integration which he foretold.
When we talk about the operation of the Abortion Act, we must remember that when figures for abortion are given in the report of the chief medical officer they include—and this is a medical phrase—"all miscarriages". The layman like myself tends to think that there has been a medical termination of pregnancy for a specific reason under the Act, whereas any miscarriage comes within that category.
In my view, the debate has shown responsibility and an understanding of the seriousness of the decision—for the man who has to take it, together with his wife, and the joint discussion between husband and wife in coming to the decision, for the family, for the nation and indeed for the world. The House has to take this decision and, in the same serious and profound way in which the speeches have been made today from both sides of the House, let the House make that decision by giving wholehearted and unanimous support to the Second Reading of the Bill.
§ Question put and agreed to.
§ Bill accordingly read a Second tune.
§ Bill committed to a Standing Committee pursuant to Standing Order No. 40 (Committal of Bills).