‘Too Many Children?’ Family Planning and Humanae Vitae in Dublin,1960

Abstract

In July 1968, the papal encyclical Humanae Vitae reaffirmed the ban on artificial contraception for Catholics. Utilising Dublin as a case study, this article explores how the Irish medical and social work community, their patients and the Catholic hierarchy responded to Humanae Vitae. Drawing on a range of medical and diocesan sources, as well as diverse material from the news media, this article illuminates the change in private behaviour that took place with regard to birth control between 1960 and 1972, and contrasts this behaviour with the public rhetoric and actions of many Catholics in positions of power. Furthermore, it highlights class inequality regarding access to and education on birth control; the health and welfare of working-class women often suffered greatly as a result of multiple births. It is demonstrated that while many exhibited a more liberal shift in their views on the issue of artificial birth control, this was not a straightforward change. A strong, patriarchal network of authority, made up of the Irish Catholic hierarchy and an obeisant section of the medical profession, sought to reaffirm control over Catholic women’s bodies in the wake of Humanae Vitae.

Keywords

contraception the pill maternity hospitals rhythm method

Introduction: Grand Multiparity

Recent historiography on the issue of birth control in Ireland has focused on related legislative and political developments in the 1970s and early 1980s.¹ Mary Daly has also shown how education even on the ‘safe period’ or rhythm method was not systematically widespread in 1960s Ireland.² Using Dublin as a case study, this article traces and contrasts public discourse and private sexual behaviour provoked by the arrival of the pill and, subsequently, the release of the papal encyclical Humanae Vitae. While the viewpoints of the Catholic hierarchy and medical profession are examined in necessary detail, attention is drawn to the opinions and experiences of the group who were in most need of effective methods of family planning during this period–working-class women with large families.

On 7 October 1960, Mrs Bridget Maguire, a street trader from Cabra, a working-class suburb of Dublin, gave birth to her twentieth child in the Rotunda maternity hospital.³ The birth of baby Thomas was reported in many newspapers not due to his myriad siblings, but because at the age of fifty-one, his mother was the oldest woman to give birth in the Rotunda since records began.⁴ The phenomenon of high parity, or frequent pregnancy, was familiar to Irish obstetricians. The problem was so common for decades in Dublin that the term ‘dangerous multipara’ was coined by Dr Bethel Solomons, Master of the Rotunda from 1926 to 1933.⁵ As the 1960s progressed, Ireland’s long-established pattern of large families and late marriage began to break down slowly. While a rise in the number of marriages and births occurred from about 1963, the average family size nonetheless began to decrease for the first time, as did the age at which couples tended to marry.⁶ Under section 17 of the Criminal Law Amendment Act, 1935, the import, sale and advertisement of artificial contraception was banned in Ireland.⁷ Additionally, the production, sale and distribution of any publication advocating contraception was outlawed under section 16 of the Censorship of Publications Act, 1929.⁸ Consequently, many Irish people were without the necessary knowledge with which to plan their families. One Irish man, born in 1926, stated when interviewed on the subject: ‘There was nothing done for “safe period” people. And every pregnancy you could say was unexpected, but that was the norm. It became kind of a mini crisis’.⁹ The contraceptive pill arrived in Ireland in 1962 and evaded a ban by means of classification and prescription as a ‘cycle regulator’; at least 15,000 Irish women were taking it by 1966.¹⁰ A survey of Irish obstetricians in the same year revealed that 75 per cent were prescribing the pill ‘for social reasons’ rather than for the purpose of regulating a woman’s cycle. 1967 was the biggest year of growth for the pill in Ireland; sales increased by about 50 per cent.¹¹ This increase led to much public discussion about the use of the pill by Catholics, which helped to facilitate a wider – albeit gradual – conversation in Irish society regarding the regulation of birth control.¹² The anomalous legal situation regarding the pill also allowed an increasing number of Irish women to choose to control their bodies and space their families during the 1960s. However, access to the pill was determined largely by social class.

In July 1968, the papal encyclical Humanae Vitae reiterated the ban on artificial contraception for Catholics. Use of the ‘safe’ or infertile period, also known as the rhythm method, was the only acceptable option for Catholics. The encyclical also stated that Catholic obstetricians should make themselves fully proficient in this method.¹³ This article explores how a portion of the Irish medical and social work community, their patients and the Catholic hierarchy responded to Humanae Vitae. It will be demonstrated that many in the medical and social work community, as well as their patients, began to exhibit a more liberal shift in views on the issue of artificial birth control. However, the Catholic hierarchy sought to reaffirm official teaching on the subject and was compelled to re-promote this teaching after the publication of Humanae Vitae. A strong, patriarchal network of authority, made up of the Irish Catholic hierarchy and an obeisant section of the medical profession, sought to reaffirm control over Catholic women’s bodies in the wake of Humanae Vitae. Two of the three largest maternity hospitals in Dublin operated with a Catholic ethos, and the Archbishop of Dublin, John Charles McQuaid, was particularly mindful of how medics operated within these hospitals with regard to birth control. Consequently, the papal encyclical created new difficulties for medical professionals working in Catholic maternity hospitals who wished to develop more sophisticated programmes of family planning therein. Even prior to the encyclical, the issue of access to artificial birth control was viewed increasingly by many medical and social care professionals – as well as many of their patients – as a private issue of health and welfare, rather than a moral problem. Moreover, this article demonstrates that family planning was a class issue. The health and welfare of working-class women – those who were least likely to access contraception – often suffered greatly as a result of multiple births.

Family Planning in Dublin Maternity Hospitals Before Humanae Vitae

Two of the three largest maternity hospitals in Dublin, the Coombe Lying-In Hospital and the National Maternity Hospital (NMH), were Catholic hospitals, and the Catholic Archbishop of Dublin, John Charles McQuaid, was chairman of their boards of governors. Earner-Byrne has outlined how the history of medicine in twentieth-century Ireland been characterised by a long alliance between medical professionals and members of the Catholic hierarchy: ‘Many in the medical profession were deeply influenced by Catholic social teaching, and used papal teaching to bolster their arguments’.¹⁴ Groups such as the Irish Guild of St. Luke, SS. Cosmas and Damien were established to preserve Catholic moral teaching in medicine, thus safeguarding a conservative ethos on birth control.¹⁵ The matter of Catholic marriage guidance clinics was discussed in committee meetings by the guild in 1962 and 1963, and it was agreed that there was ‘strong need for such’.¹⁶ However, some members of the medical and social care community – both Catholics and those of minority faiths – began to advocate publicly for the use of artificial contraception on a controlled basis from the 1960s. The ideas presented by these groups later functioned as key arguments for the legalisation of contraception throughout the 1970s, prior to (and, indeed, after) the introduction of the Health (Family Planning) Act, 1979. As the Act made contraception available via prescription only to those who sought it ‘for the purpose, bona fide, of family planning or for adequate medical reasons’, it has been assessed by Girvin as a conservative piece of legislation.¹⁷ However, overall adherence to the law by prescribing doctors and pharmacists after 1980 remains to be interrogated.

In Dublin and the rest of Ireland during the 1960s, working-class women were the group most gravely affected by the absence of ready access to artificial contraception. If a local GP would not prescribe the pill, public postnatal care at a maternity hospital was often the only other instance during which many of these women could potentially access a prescription elsewhere. Of the GPs willing to prescribe the pill, many would only do so if a patient presented with an irregular menstrual cycle. Middle-to upper-class women living in urban areas who were armed with the appropriate knowledge and income were most likely to gain a prescription. A 1966 article on the pill in the Irish Press outlined how

The medical profession in Dublin is fairly sharply divided…Women to whom the matter of preventing a pregnancy is of prime importance find out, by word of mouth – gossip if you like – the names of doctors who are known to prescribe it, and the symptoms which will prompt them to do so…The pill, then, is certainly available in Dublin to women who can afford a consultation fee and know whom to consult.¹⁸

In central Dublin and its growing working-class suburbs, an increasing number of young couples were marrying during the 1960s. Reflecting on his time as a priest in Cabra during this decade, Father Anthony Gaughan wrote that of the marriages he performed, ‘nearly all of them were marriages of teenagers and quite a few were already pregnant’. Some of these women would go on to have:

a very high number of successive pregnancies…With poor knowledge or little success with natural family planning, it was difficult for families of all classes to space births. However, couples with a higher income were more likely to have success with family limitation, which could require multiple trips to the right doctor, or the means to travel and purchase contraceptive devices abroad.¹⁹

Travel to Northern Ireland, where contraception was legal, was particularly common.²⁰ As Leanne McCormick’s research has outlined, women from the Republic frequently visited the Belfast Women’s Welfare Clinic (BWWC) for family planning services from the 1950s onwards.²¹ Additionally, the BWWC and the Northern Ireland Family Planning Association received a ‘constant stream’ of letters from the Republic requesting family planning advice; supplies were sent by the Association to the Republic ‘in plain packaging and addressed by hand to avoid customs’.²²

While a more open discussion of birth control began with the arrival of the pill in Ireland, this was further prompted in 1966 by news of the Pontifical Study Commission on Family, Population, and Birth Problems. The Commission’s majority report to the Pope was in favour of reformulating Church teaching on the legitimacy of using some birth control methods other than the ‘safe period’ or rhythm method. Thus, a climate of expectation that the Pope might sanction additional methods of birth control within marriage grew. The overall role of individual responsibility had gained increasing currency among Catholics in the 1960s, as the Second Vatican Council ‘outlined the primacy of conscience’.²³ However, the rate of change should not be overstated. While controversial issues were discussed and aired in newspapers, on the radio and television in the 1960s, ‘the voices of those opposed to change were as strong as those who argued for it, and women’s voices were seldom heard on any side of the debate’.²⁴ One newspaper article noted this silence:

The ordinary women of Ireland have been ignored. While men leisurely debate the lofty moral issues involved, the women continue to endure the monotonously repetitive pregnancies and struggle to raise unwieldy families in conditions, often, where each new pregnancy poses a serious threat to the whole family structure.²⁵

Eleanor Holmes, head medical social worker at the Rotunda throughout the 1960s, repeatedly gave samples in clinical reports of patients who were referred for family planning based on the severity of their cases after giving birth. These women spent much of their married lives in a pregnant state, and the growth of their families was a continuous source of stress. The following examples are from the 1967 report; it is notable for case 3 that there was no Deserted Wife’s Allowance until the introduction of the Social Welfare Act, 1970:²⁶

Mother, thirty-nine years, with T.B. history, gravida 21 (twenty-one pregnancies), twelve living children – all the children undernourished, five had primary T.B., one had cardiac trouble. Chronic financial stress.

Mother, thirty-five years, ten children…Husband self-employed tradesman, alcoholic.

Mother, thirty-nine years…ten children. Husband had left her, unsupported, on last four pregnancies and returned during postnatal periods. Known to a multiplicity of statutory and voluntary agencies. Efforts to effect a legal separation have been fruitless.²⁷

The Rotunda ran an ‘Infertility and Marriage Guidance Clinic’, primarily for couples who were struggling to conceive. The reports from this clinic allude almost as often to couples’ poor knowledge of the facts of life as they do to biological anomalies as reasons for their infertility. As an example, one couple treated in 1961, both aged twenty-six and married for five years, had their reason for infertility listed as ‘non-penetration’ in the annual clinical report. Their treatment, specified in the report as ‘marriage guidance’, resulted in a pregnancy that was ‘normally progressing’ later in the year.²⁸ In 1963, Dr Michael Solomons, a Jewish obstetrician and son of the former Master of the Rotunda, published Life Cycle: Facts for Adults. The book was, to his knowledge, the first sexual education volume by an Irish author.²⁹ Complete with diagrams and a detailed glossary of biological terms, the book was inspired by Solomons’ patients; their ‘problems, unawareness of facts and appreciation of their explanation prompted the idea in the first place’.³⁰ Life Cycle emphasised the necessity of marriage for intercourse to take place, and due to censorship regulations, did not mention contraception. Nevertheless, it proved popular. The agony aunt Angela Macnamara recommended the book in her column in the Sunday Press, and it was also reprinted in 1969.³¹

Of Dublin’s three maternity hospitals, the Rotunda was unique in that it was not a Catholic hospital, and the Catholic Archbishop of Dublin did not sit on its board. However, due to its size and location in the north city centre, the vast majority of the Rotunda’s patients were Catholics. This led Archbishop McQuaid to maintain an interest in the hospital, albeit from a distance, and without an official position of authority within its hierarchical structure. Informing McQuaid on the situation at the Rotunda in 1965, a cleric at University College Dublin flagged that there may be difficulty in ensuring the existence of ‘a medical staff which would be sufficiently competent in medico-moral problems, and who would know at least when a priest should be consulted’.³² Family planning at the Rotunda had conservative beginnings; education was given on the rhythm method only. Nonetheless, family planning developed in an increasingly flexible manner at the Rotunda as the 1960s progressed. Attention was paid to patients’ individual beliefs and conscience, as well as their physical and mental health.

In the 1961 annual report, Dr Raymond G. Cross of the Rotunda Infertility and Marriage Guidance Clinic noted that patients were increasingly seeking advice on family planning in accordance with Catholic teaching.

A recent development in this Department has occurred wherein the Almoners [social workers] refer cases who have had medical and obstetrical difficulties and who wish to evolve some method of controlling the situation consistent with Catholic moral principles…To both husband and wife separately is given a long lecture on the physiology of menstruation, ovulation, frequency and timing of intercourse. It is then explained how to create the maximum or the minimum degree of fertility.³³

The rhythm method was only provided to selected needy cases at this stage. Three years later in 1964, Dr Cross addressed the British Royal Society of Medicine on how the pill was prescribed in the Rotunda. A Catholic himself, Dr Cross was nevertheless eager to resolve problems of family limitation. He did not appear to have any major qualms with the use of the pill but prescribed it only in certain circumstances. A summary of his speech read as follows:

The practice of the infertile period required the co-operation of both husband and wife and could be reliable and efficient. There were circumstances, however, in which mutual co-operation was not available: ignorance, drunkenness, selfishness and non-cooperation unfortunately seemed to go hand in hand with ill health and grand multiparity…If a woman had heavy or irregular periods she was quite justified in taking the pill to regularise her periods or to make them normal. Under these circumstances he used the pill considerably in the Catholic Marriage Guidance Clinic at the Rotunda Hospital. Admittedly it was not the ideal solution to the problem but it was very efficient and reliable and was greatly appreciated by the poor frightened patient.³⁴

The non-co-operation of men emerges as a theme in many discussions of the rhythm method and its shortcomings during this period; there was little, if any, conceptualisation of women’s consent to sexual activity.³⁵

In 1965, Dr Mary Martin, head psychiatrist at the Rotunda, reported to the Medical Research Council of Ireland on psychiatric illness in women both during and post-pregnancy. Her observations are illuminating in terms of the difficulties faced by many of the Rotunda’s less well-off patients:

Many of our patients were found to live in tenement rooms with quite inadequate water and sanitary facilities; others, in small Corporation houses with relatives. Some families have had to split up due to gross over-crowding in these houses. Emotional strains have often been great, and many marriages have been in danger of floundering due to the unnatural family stresses.³⁶

Martin’s psychiatric department was the first of its kind in a maternity hospital in Ireland. According to Eleanor Holmes, head medical social worker at the Rotunda, Martin’s appointment ‘met a long-felt need’.³⁷ Visiting Rotunda patients in their own homes at the height of the housing crisis in 1960s Dublin, Martin was frequently struck by how severely distressed many women were as a result of gross overcrowding. In the Rotunda’s annual report, she noted these conditions as a possible precipitating factor to psychiatric illness; another factor was ‘an undesired rapid rate of successive pregnancies’.³⁸ By 1966, over 400 women per year were receiving advice at the Rotunda Family Planning clinic, which was held weekly and, notably, run by four Catholic doctors.³⁹ The pill was prescribed only in certain cases ‘where there are medical symptoms which justify corrective treatment with hormones…this might apply to 40 or 50 women’.⁴⁰

With similarly conservative beginnings, the NMH opened a family planning clinic in 1963.⁴¹ The NMH was Ireland’s largest Catholic-identified maternity hospital; Archbishop McQuaid was ex-officio chairman of the board of governors.⁴² The ‘Marriage Guidance Clinic’, as it was initially known, was overseen at the NMH by Dr Declan Meagher, consultant obstetrician at the hospital.⁴³ Meagher had consulted closely with the Catholic Marriage Advisory Council in London prior to opening his clinic. In 1965, it was stated that ‘family planning is actively propagated as an ideal and an advisory service, and is accepted as an essential feature of the hospital’.⁴⁴ Advice was based solely on the safe period. By 1966, doctors at Holles Street were voicing their frustration at the limitations presented by prescribing the use of the safe period only. Dr Meagher underlined this in stating that ‘experience shows that whilst this method meets the need of many couples, it is inadequate in serious medical and social cases’.⁴⁵ In a Teilifís Éireann documentary on the subject of birth control, entitled ‘Too Many Children?’, Meagher also stated that he had little confidence in the method.⁴⁶ By 1967, the Master of the NMH, Dr Kieran O’Driscoll, was compelled to point out that

It is now common experience for our patients to reject advice on the infertile period because they are advised the Pill elsewhere…our position in continuing to withhold this most effective and now widely accepted method, particularly in ill women, causes a serious problem of conscience for me and for other members of our medical staff. One can only hope that clear guidance will not be much longer delayed. Meanwhile we are depriving families of an important form of treatment – a policy which, in charity, is becoming increasingly difficult to defend.⁴⁷

Medics at the hospital began to prescribe the pill to a very limited number of patients – that is, those who fell into the category of ‘serious medical or social cases’, and also felt that they could use it in good conscience.⁴⁸

From 1960, the Coombe Lying-In Hospital in Dublin delivered babies in record numbers.⁴⁹ As well as the antenatal clinics held in the hospital twice weekly, the hospital operated weekly clinics in the nearby suburbs of Ballyfermot and Crumlin. The Coombe’s social work department wrote often of the difficulties experienced by many mothers with large families. In annual reports, Dr Feeney of the Coombe described the many associated difficulties. In his experience, the mothers ‘were usually poor and deprived; they were becoming old for pregnancy and childbirth. Frequently recurring pregnancies had a harmful effect on tissues, organs…and, indeed, the mind’.⁵⁰ In 1964, Dr William Gavin, Master of the Coombe, wrote to Archbishop McQuaid wishing to discuss the possibility of establishing ‘a marriage guidance clinic to help women who have large families’.⁵¹ McQuaid was also chairman of the board of the Coombe. Dr Gavin sought to provide information on the safe period only and did not mention the Pill:

For economic, social and medical reasons our mothers who have already been delivered of several babies frequently ask our doctors and nurses for information relating to the “safe period”…I am sure it will be appreciated that there is a very definite place for a clinic of this kind which will be conducted in accordance with the teaching of the Catholic Church.⁵²

The matter was referred by the Archbishop to Dr P.C. Jennings, Master-General of the Catholic guild of doctors in Ireland. Working in the North Strand area of inner-city Dublin since 1947, it is likely that Jennings was also familiar with high parity.⁵³ He responded:

I do not feel that independent clinics in the Maternity Hospitals are sufficient answers to this pressing problem but at least it is some answer. Dr Gavin’s proposed clinic would help many of the couples served by his hospital and may also provide a guide to other Catholic doctors.⁵⁴

Dr Gavin was asked to attend a meeting with McQuaid’s secretary and to submit a detailed written proposal, which revealed that the gravity of conditions experienced by many patients of the Coombe. It was;

mainly populated by people in the lower income group. Many of these patients have very large families (about 10% of our mothers have more than 7 children). Some of them have had a pregnancy every year since marriage, and because of poor housing, lack of proper nourishment and help they become anaemic, tired and generally worn out so that they have no sooner recovered from one confinement when they are pregnant again. They are therefore in a chronic state of debility. Women with heart disease, tuberculosis and other general illnesses would also benefit from some instruction in regard to family planning.⁵⁵

Archbishop McQuaid agreed to the establishment of a clinic where ‘birth mothers may receive correct instruction on the so-called safe period, on the strict condition that only Catholic medical practitioners operate the clinic for Catholic women’.⁵⁶

Dr Ristéard Mulcahy, consultant cardiologist at the Coombe during this period, reflected in his memoirs on the conservatism of his colleagues working in obstetrics. Dr Mulcahy held a weekly heart clinic at the hospital; pregnancy was dangerous for many of his patients. Dr Mulcahy did not take a conservative stance on artificial birth control:

I had no compunctions about prescribing the pill and one of my functions was prescribing it for patients who came to me specifically for this purpose. I cannot recall that my intervention in this matter caused any concern to my obstetrical colleagues. They never spoke to me about the matter, nor did the Master ever intervene despite his and his colleagues’ reluctance to prescribe the pill.⁵⁷

A mother of nine from Ballyfermot, a working-class suburb of Dublin, who was interviewed for BBC’s Panorama programme on the subject of Humanae Vitae, stated that she was given a prescription for the Pill while in the Coombe in 1966. After a couple of difficult births – she had been given the last rites twice – it was dangerous for her to have any more children. The hospital had told her to consult her priest on the matter, but she never went.⁵⁸ This is in keeping with Betty Hilliard’s sociological study of female sexuality and Catholic teaching, which found that some women accommodated the situation by adopting a strategy of deliberate distancing, choosing not to comply with the requirement to confess and, instead, to follow their own conscience.⁵⁹

The Response to Humanae Vitae in Dublin

Upon its publication on 25th July 1968, Humanae Vitae reiterated the ban on artificial contraception for Catholics:

Excluded is every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible.⁶⁰

In the wake of the papal encyclical, and at the suggestion of Archbishop McQuaid in private correspondence, Dr Kieran O’Driscoll of the NMH released a statement which was printed in the Irish Times, stating:

I feel it my duty…to dispel any misunderstanding that may arise at this time by stating that the recent Papal Encyclical is accepted by the staff in this hospital as a clear directive against the use of the Pill to prevent conception, in any circumstances.⁶¹

Dr O’Driscoll’s statement of compliance contrasted sharply with what he had previously written elsewhere prior to the encyclical, for example, in the annual reports of the NMH. From 1968, all mention of family planning was dropped from the NMH’s reports; the hospital was no longer prescribing the pill in even the most difficult of cases.⁶² It is not possible to ascertain in detail how doctors operated on an individual basis at the hospital or what advice they might have given in private consultation.⁶³ It is known that some had a far more conservative outlook than others. Both Dr Arthur Barry and Dr Éamon de Valera (consultant obstetricians at the hospital) walked out of the original proposal meeting for a family planning clinic in 1963, and a number of the older nurses also resisted involvement.⁶⁴ Speaking to the Irish Press after the publication of Humanae Vitae, Dr de Valera made his loyalty to the Pope clear: ‘We will obey him. This ruling comes as no surprise. It endorses the traditional teaching of the Church on the issue. We accept this without question’.⁶⁵ It is notable that Dr de Valera (son of the politician) was taught by McQuaid at Blackrock College.⁶⁶

In May 1968, Dr Michael Solomons wrote to the secretary of the International Planned Parenthood Foundation:

Recently the large majority of the patients attending the family planning clinic at the Coombe Hospital refused to hear any more about rhythm methods and insisted on the pill or nothing. The clinic had to be closed.⁶⁷

The closure of this clinic did not fully shut down the question of family planning at the Coombe Hospital. In 1969, a member of staff, Sister Hannon, attended a course on ‘Responsible Parenthood’ in Cambridge, and the issue was discussed at several board meetings. It was reported that these discussions on ‘the anxiety to achieve responsible parenthood’ were prompted by ‘the complications of high parity and by the death of a woman in her nineteenth pregnancy. There were, of course, several difficulties to be overcome including religious views on contraception’.⁶⁸ Ostensibly as a compromise, patients were given leaflets on the rhythm method.

In July 1968, the Catholic guild of doctors released a statement emphasising their acceptance of Humanae Vitae. ⁶⁹ After this, however, the new Master-General of the guild, Dr Raymond Magill, wrote a private letter to members, clarifying what he viewed as their collective responsibility. For Dr Magill, research and education on the safe period was now paramount:

Once the Pope had issued his Encyclical, our views on the subject were of no importance…Our views on the efficacy of the safe period are of little moment; we know that our people require some form of birth control, and the only form left to them is the safe period; therefore, our job is to make the safe period effective.⁷⁰

Dr Magill’s letter also demonstrated the intransigence of the Catholic guild of doctors in Ireland in comparison with their Italian counterparts. Professor Guido Caprio, secretary of the Italian Roman Catholic Doctors’ Association, called on doctors to oppose the encyclical, telling reporters that it contained ‘incomprehensible and insoluble contradiction’ from a medical perspective.⁷¹ For Caprio, to advise patients only on the rhythm method, which had proven unreliable, was to act against his ‘professional conscience’.⁷² Commenting on Caprio’s statement, Magill said: ‘one cannot use an Official Position to express views contrary to the Official Policy [sic]…I do feel that his action was very irresponsible’.⁷³ By 1968, membership of the Catholic guild of doctors was very low. Even in 1965, Magill had acknowledged what he called ‘the Guild’s comparative ineffectiveness’ to members, as less than 5 per cent of Irish doctors had contact with it.⁷⁴ Elsewhere in the medical community, other doctors were making their own minds up about the encyclical. An opinion poll taken by the Irish Medical Times in 1968 suggested that 65 per cent of doctors disagreed with Humanae Vitae.⁷⁵

In September 1968, Archbishop McQuaid received a report from Rev M. J. Browne, Post-Marriage Counselling Director of Harold’s Cross Parish. The information he gave was based on conversations with priests working in parishes and on his own conversations with lay people. His summary of events was that while ‘many’ Catholic women had discontinued the pill, many were also silent and some were waiting for further clarification.⁷⁶ This report points to a certain level of confusion regarding the encyclical and the extent to which it could be interpreted as an absolute ruling. Despite hearty endorsement by the Irish hierarchy, it appears that parishioners did not react to Humanae Vitae in a uniform manner, with many resorting to their own consciences. In the aforementioned BBC ‘Panorama’ programme, which aired in August 1968, the presenter David Dimbleby described Catholics in Ballyfermot as ‘puzzled, unclear, uncertain’ on the subject. Although there was a diverse range of opinions, the majority of women stated that they were in favour of the pill – Humanae Vitae had not changed their thoughts on the matter. Mrs Esther Clooney, a mother of nine, whose health was at risk should she give birth again, said: ‘It keeps me alive…I said I’d commit sin if I didn’t get it’. Many had attempted natural methods of family planning or coital interruption before using the pill. One woman said: ‘We had tried, as we say, taking the kettle off before it burns’. One man said he agreed with the Pope and expressed his concern that ‘it will be abused among young people and become part and parcel of the contents of their handbag’. Mrs Mary Caulfield, a mother of eight, felt no guilt about taking the pill, considering the size of her family: ‘we’ve done our duty, definitely, I don’t think God could punish us…I mean, we’ve overdone it, for that matter’. When the presenter raised the possibility of abstaining from sex, the consensus was that this was not an option for the majority of married women – mostly due to the insistence of their husbands. Many of the women appeared to consider intercourse, consensual or not, as an inevitable marital duty. The women put forward the argument that large families were not financially viable and that other social problems also had a negative effect on domestic harmony, as well as the efficacy of the rhythm method: ‘you can get nowhere with a big family…the pill is necessary if there’s a lot of trouble through drink’. Emphasising the quiet power of the laity, Dimbleby concluded that

in the end, the arguments put forward by the Pope, or the hierarchy of the Church, or the liberal doctors, are nothing to the view of the ordinary practicing Catholic. It’s what they do that’ll determine whether the Irish Church retains its influence – whether what the priest says, goes.⁷⁷

While the behaviour of Catholics was increasingly related to personal conscience, rather than Catholic dogma, the influence of this teaching at Catholic maternity hospitals was, however, a hindrance to those who sought access to the pill. The encyclical had also caused many Catholics to second-guess their decision regarding the pill. At the Rotunda, Eleanor Holmes’ commentary in the annual report for 1968 referred to the extreme difficulty that Humanae Vitae had caused for many patients. Holmes, a Protestant, was evidently in favour of the use of the pill;

The inadequate and problem family has always been with us, but the problems engendered by our present day society have caused yet more stressful situations…In July, the Humanae Vitae Encyclical led to widespread debate and much upset for the many Roman Catholics who had made responsible decisions on planned parenthood via the ‘Pill’.⁷⁸

The Legacy of Humanae Vitae and the Continued Development of Family Planning in Dublin

From 1968, a study group began to meet to examine the issue of family planning in Ireland. They were united in their belief that the prohibition of artificial contraception was wrong and that the rhythm method was insufficient and unreliable. The group of eight came mostly from a medical background, including Dr Michael Solomons, but also included a social worker and a moral theologian from a Jesuit college.⁷⁹ Two members of the study group had witnessed first-hand the failure of the rhythm method. Dr Dermot Hourihane had done voluntary work instructing on the method for the Catholic Marriage Advisory Service in London but became disillusioned with the method when women became pregnant too often.⁸⁰ Máire Mullarney, a Catholic nurse and mother of eleven for whom natural methods had failed, had learned more about the subject and became ‘converted’ to artificial methods after visiting a family planning clinic in Portugal.⁸¹ Another founding member, Dr James Loughran, was part of a public campaign against corporal punishment in schools. In this context, he had seen some of the difficulties experienced by large families. In general practice, he noticed children who began bed-wetting when they started school: ‘they were afraid…they were in huge classes in school and often came from families so large that the mother was anxious to get them to school out of the way’.⁸²

Having sought legal advice, and funding from the International Planned Parenthood foundation, the group formed themselves into a company, known as the Fertility Guidance Company Limited, to prevent any possible prosecution of individual members.⁸³ Their first premise in Dublin was opened on Merrion Square in February 1969. As well as prescribing the pill, the clinic offered patients access to other artificial contraceptives such as condoms, spermicides and diaphragms, which were imported illegally by friends and relations of the clinic staff. To circumnavigate the legal ban on the sale of contraceptives, they were offered free of charge, with patients making donations to the clinic.⁸⁴ After press coverage, public interest in the clinic grew; by March 1970, it was reported that new patients had to wait about a month to get an appointment.⁸⁵ Nominal ‘donations’ to the clinic varied ‘from 5s to £3 according to one’s ability to pay’.⁸⁶ The majority of patients were in the ‘middle income group’; those most in need of assistance, the lower income group, represented about 8 per cent of patients.⁸⁷ The vast majority of patients were aged between twenty and thirty-five. Demand continued to increase in 1971, as indicated by the opening of the Fertility Guidance Company’s second clinic in the city on Mountjoy Square.⁸⁸

At the end of 1971, Eleanor Holmes reported from the Rotunda that there had been an increasing demand for family planning advice. Many younger mothers were

beginning to take a more responsible attitude to spacing their children. Older mothers, weary with frequent and numerous pregnancies, particularly, patients with medical and social problems, have wished no further pregnancies.⁸⁹

In 1972, at sessions held twice a week at the Rotunda Family Planning Clinic, a total of 780 patients were prescribed the pill, given advice on the rhythm method or, quite remarkably, referred to the Fertility Guidance Company if they expressed interest in a diaphragm or intrauterine device (IUD).⁹⁰ It was radical for the hospital to present a route to patients that involved subverting the Criminal Law (Amendment) Act, 1935. The law provided that it was illegal to ‘sell, or expose, offer, advertise, or keep for sale or to import or attempt to import’ contraceptives.⁹¹ Patients attending the Fertility Guidance Company in pursuit of an IUD were referred to a clinic in Northern Ireland until September 1971. From that month, patients were fitted with IUDs at the Mountjoy Square clinic – almost 200 by the end of 1971.⁹²

Birth control remained a topic of discussion and debate in public discourse for many years after Humanae Vitae. In 1970, John Horgan wrote a scathing snapshot of the situation regarding contraception and Humanae Vitae in the Republic of Ireland for Fortnight, a Belfast magazine. The article was accompanied by a cartoon with a caption on the folly of the rhythm method, stating: ‘I’ve got rhythm, I’ve got twelve kids, who could ask for anything more…’ The illustration depicted a pregnant, exhausted housewife with eleven children. Horgan wrote that Archbishop McQuaid had been ‘perhaps unduly optimistic when, on the day that the encyclical was published, he unhesitatingly pledged the loyalty of his entire flock to the Papal teaching. That disaffection and disagreement exist is undeniable’. Horgan also shed light on the blatant class divide that existed in terms of access to contraception in Ireland;

What is worse, the fact that the pill is much more freely available to the fee-paying middle class patients of doctors in private practice than to the working-class mothers who have no option but to attend Church-controlled maternity hospitals, introduces an ugly element of class distinction into a situation already reeking of contradiction and hypocrisy.⁹³

In the same year, the occasion arose for Archbishop McQuaid to reinforce the message of Humanae Vitae. In response to the growth of a campaign to legalise contraception in Ireland, the Archbishop wrote the first in a series of three pastoral letters on the subject, in which he repeated the message that ‘contraception is evil; there cannot be, on the part of any person, a right to what is evil’.⁹⁴ After one of these pastorals in March 1971, about thirty members of the Irish Women’s Liberation Movement protested by forming a forty-foot chain across the entrance to the Archbishop’s house in Drumcondra, Dublin.⁹⁵ At Dublin’s Pro-Cathedral, eight women and one man left Mass as the third pastoral was read aloud.⁹⁶ The pastorals caused grave difficulty for many Catholics in Dublin, although some showed their support. One married man, whose wife was expecting their sixth child, rang the Archbishop’s office to comment that ‘if contraceptives are freely available we will have the permissive society in no time’.⁹⁷ Another woman rang to express her agreement with the pastorals due to ‘experience of the permissive society in England’ and informed the Archbishop of her intention to speak with a friend in a local ladies’ club to organise support.⁹⁸

Letters of praise, congratulations, desperation and condemnation sent in response to the pastorals all survive in the Dublin diocesan archive. However, confessional messages written to the Archbishop from desperate married Catholic women are especially striking and reveal a growing divergence between the hierarchy and ordinary Catholics. One letter to McQuaid read as follows:

The rhythm method does not work for me and speaking as a trained nurse I assure you we made no mistakes. We tried abstinence but my husband does not agree with this and says this is not marriage!…I had a major operation and was warned by Doctors [sic] not to have any more children…Have you any idea of the mental and spiritual anguish of a Catholic mother placed in this predicament?⁹⁹

Letters to the Archbishop from social workers in reaction to his pastoral letters also shed further light on the plight of underprivileged mothers; it was emphasised that ‘women are the only ones to suffer either physically or mentally by having too many children’.¹⁰⁰ In these situations, women with large families were often without agency. As one social worker wrote, ‘women who are affected by this repressive law have not got the time and are not articulate enough to write to the papers’.¹⁰¹ She continued:

It is illegal to advertise bingo yet it is advertised from the pulpits of Ireland every Sunday…The clergy and laymen who do not want the law changed should spend a month in one of our city slums where many women have to bring up six children in one room, or visit our maternity hospitals to see the large number of women who must have major operations because of too much childbearing.¹⁰²

The increasing conflict between the public statements of the hierarchy and the medical profession was also emphasised by this social worker. The treatment of women by the Catholic hierarchy was, in her view, cruel and misogynistic:

The medical profession say women’s lives are endangered because of the unavailability of contraceptives. If it was the lives of men that were in danger there would be a public outcry against this law but a belt of Humanae Vitae across the teeth is good enough for women. It appears that the clergy and some laymen know more about this subject than the medical profession.¹⁰³

Another social worker explained the insufficient nature of the rhythm method for women who were not in a consensual sexual relationship; a phenomenon which, as this article has already mentioned, was overwhelmingly common. In her experience, there was simply

no point in helping a woman find out her safe period when her husband will demand his conjugal rights on any day of the month…this is what I and my fellow social workers find in 98% of the people we come in contact with.¹⁰⁴

Conclusion: Public and Private Morality

While options for family planning at the Rotunda had progressed by the beginning of the 1970s in cooperation with the Fertility Guidance Clinic, the Coombe and the NMH remained conservative under Catholic guidance. A 1970 survey by the Irish Times indicated that maternity hospitals outside of the capital were similarly conservative, advising only on the rhythm method.¹⁰⁵ Therefore, the Rotunda was ahead of the curve. Independent family planning clinics set up by groups similar to the Fertility Guidance Company did not appear in Cork until 1975 and Galway until 1977, but postal order services for contraceptive devices were in operation from 1972.¹⁰⁶ With the opening of these clinics, birth control was becoming increasingly available to those who were not in a position to travel, though reports showed that the middle class remained best equipped and most likely to avail of it. From the increasing demand seen all clinics, it appears that some Catholics increasingly chose to quietly ignore Humanae Vitae and use artificial means of birth control. Despite ongoing conservatism at Catholic hospitals, medical professionals became engaged in public debate on the subject, with many pointing out the severe need for effective birth control methods in specific social or medical circumstances.

During the 1970s, activists frequently highlighted the lack of women’s voices in public debates regarding contraception. When legislation was drafted at the end of the decade, the contraceptive question remained, for politicians, ‘a moral and a legal question rather than a health matter’.¹⁰⁷ However, as this article has demonstrated, many women had already voted with their feet via a measured change in private behaviour. While many paid public lip service to Humanae Vitae, the use of birth control was on the increase quite a few years before it was legalised in Ireland. It was suggested by contemporaries that the rise in births after Humanae Vitae was in reaction to the encyclical, but this was more likely a result of the rising marriage rate rather than a decline in the use of birth control.¹⁰⁸ The metric of family size rather than the overall birth rate is useful when considering the legacy of the encyclical. While the encyclical resulted in some difficulty in public access to birth control, it did not prevent its private use. At the end of 1970, it was reported that 25,000 women in Ireland were on the pill.¹⁰⁹ The figure reported in the Seanad and in newspapers rose to 38,000 by 1974,¹¹⁰ representing 25 per cent of married women aged twenty to thirty-four as per the 1971 census.¹¹¹ In 1967, 23 per cent of mothers in Holles Street were giving birth to their fifth or subsequent child; this fell to 10 per cent by 1976.¹¹² Similarly, at the Coombe, the incidence of high parity fell. From the mid-1960s to the mid-1970s, the percentage of mothers giving birth to their eighth or subsequent baby fell from 10 per cent to less than 2 per cent.¹¹³ Humanae Vitae created a temporary obstacle for many Irish Catholics, particularly the less well-off, in accessing artificial methods of contraception (primarily the pill) in Ireland. Birth control came to be viewed increasingly as a critical problem of patients’ health and welfare issue, rather than an issue that could be addressed solely on the basis of Catholic dogma. At a time when family planning had just begun to develop at maternity hospitals, the encyclical complicated the situation for Catholic patients and doctors alike. The tendency demonstrated in this article, where patients and doctors increasingly emphasised their right to make private decisions based on personal conscience, would prove crucial throughout the 1970s as Ireland drew closer to the partial legalisation of contraception.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research for this work was partially supported by Dublin City University’s Humanities Research Publication Scheme, 2018.

‘Too Many Children?’ Family Planning and Humanae Vitae in Dublin,1960–72