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Birth Control, Sex and Marriage in Britain 1918-60 
by Kate Fisher.
Oxford, 294 pp., £24, May 2008, 978 0 19 954460 8
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For Their Own Good: The Transformation of English Working-Class Health Culture, 1880-1970 
by Lucinda McCray Beier.
Ohio State, 409 pp., £64.95, October 2008, 978 0 8142 1094 9
Show More
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John Sayles’s film Lianna broke new ground in 1982 with its portrait of a young wife and mother who comes out as a lesbian. Equally ground-breaking was a scene early in the film in which Lianna’s husband, a philandering, self-obsessed academic, suggests that she have sex with him. Lianna looks at him with a mixture of indulgence and exasperation and says: ‘I’ll go put the thing in.’

Was this the cinematic debut of the female barrier method? Did anyone other than me find it a revolutionary moment? Think about it: among the possibly thousands, certainly hundreds of pre-coital scenes any post-1960s moviegoer would have seen, how many include breathless last-minute exchanges about birth control? When Angelina and Brad lurch towards the bed, when Kate and Leo sink to the floor, they never, ever, stop to say: ‘Let me put the thing in’ – or ‘on’.

The 193 elderly, mostly working-class English women and men whose recollections form the raw material of Kate Fisher’s book would have had little trouble understanding this omission. Caps and condoms were messy, uncomfortable, expensive and required a kind of calculation that turned intimacy sour. One would get ‘nicely carried away and going up to heaven quietly’, one woman explained, ‘and the next thing is he stops, walks over to put the sheath on, well I mean that’s the most unromantic thing in the whole world.’ It was unnecessary, too, many women insisted, since the man just had to ‘be careful’. Be careful? ‘Oh, you know, take the kettle off before it boils.’

Historians of birth control in Britain begin from an obvious paradox. Fertility rates declined precipitously in the last decades of the 19th century, virtually halving between 1880 and 1910, for example, in the Lancashire towns studied by Lucinda Beier, yet not until later in the 20th century did the use of mechanical methods of birth control become commonplace. Historians who focus on the often heroic efforts of feminists and other radicals to spread sexual knowledge and to instruct women in the use of these devices – usually caps – come up against the fact that the small numbers persuaded can’t possibly account for such a steep decline. Clearly, couples not using these methods were also managing to limit their family size. How were they doing it? Mostly, Fisher tells us, through withdrawal.

The importance of withdrawal as a means of birth control was known to historians before Fisher wrote her book. Birth-control campaigners between the wars referred in some frustration to its ubiquity, and social historians like Ross McKibbin have also noted its prevalence. But the sniffy views of these campaigners have affected our understanding, with the result that withdrawal appears in the historical record as a traditional relic, a method of last resort, the recourse only of those too poor, ignorant or disorganised to master the use of caps or condoms. It would disappear, surely, as mechanical devices became readily available.

With the exception of a small, self-consciously modern and middle-class minority, the women and men interviewed for Fisher’s study told her that this was nonsense. Sometimes indirectly, and in language laden with euphemism and circumspection, they made it clear that they had relied largely on withdrawal to limit family size and had done so as a conscious choice. It is a great merit of Fisher’s book that she listened to what they told her, trying to understand not only their choices but also the sexual culture that made those decisions appropriate. She has, in consequence, written the most illuminating account we have not only of working-class birth-control practices between 1918 and 1960 but of the unwritten codes that governed marital sexuality more generally.

She began not with her informants’ statements but with their silences – silences that she insists were ‘highly revealing’. When discussing their sexual lives, she found her male informants open, voluble and straightforward; some tried hard to enlighten the seemingly clueless young woman who was asking them all these questions. (Of course, the woman couldn’t get pregnant if she didn’t climax, ‘Peter’ – a cotton mill stripper, born in 1921 – patiently explained: ‘No, no, they both ’ave to climax, you should know that.’) The women, by contrast, were ‘laconic’ and ‘hesitant’, ‘less expansive and more uncertain’. Almost uniformly, they dilated on their sexual ignorance, reported that they had found birth-control devices ‘dirty’ or embarrassing, and insisted that their husbands never talked about such ‘smutty things’. Their aversion was not usually religiously motivated: in fact most seem to have felt, as one woman put it, that the ‘flipping Jesuits’ had no business prying into their private lives. They were attached, simply, to a culture of sexual reticence – a reticence most thought should be maintained even between husband and wife. So strong were these preferences that Fisher came to realise that even more experienced women ‘practised ignorance’, as she puts it, maintaining a veneer of sexual innocence that was central to their identity as ‘decent women’. While these women did try caps or sponges, they usually found the process of fitting ‘frightfully embarrassing’, the devices ‘messy’, and the implication that they should prepare for intercourse in advance by putting in the wretched thing ‘horrible’. By contrast, abortion – or, rather, the common practice of trying to ‘bring on’ a late period with gin, potions, hot baths or jumping vigorously – did not greatly trouble them, since it was a matter of dealing with the aftermath of sexual relations, as women have always done, and did not imply they had invited them.

Yet these couples did want to have smaller families, to have, say, between two and four children, not the six or ten their mothers or grandmothers had borne. Remarkably, they accomplished this. It is often assumed that, at least before the pill, successful family limitation required discussion of the matter by a couple and the use of female birth-control methods, but Fisher’s findings drive a stake through those assumptions. Family limitation emerges here primarily as a male achievement, one brought about by women quite deliberately leaving the whole problem to men. While some couples confirmed that they practised abstinence, especially if pregnancy had to be avoided at all costs, and a majority of respondents reported using condoms at some point in their marriage (although many did so only briefly or sporadically), most relied on withdrawal. Fully three-quarters of Fisher’s Oxford, Blackburn and South Wales respondents, and almost half of the rural Hertfordshire sample, used it to limit or space births.

Their wives thought this was just fine. Birth control really ought to be men’s responsibility anyway: ‘Well he were enjoying hisself weren’t he? . . . They should see to it.’ They were relieved to be spared the burden and mess, and appear to have felt able to trust their husbands. Withdrawal was ‘natural’ and private, and – if referred to at all – could be described through euphemisms or homely metaphors (‘getting off at Mill Hill’; ‘taking the kettle off’) far removed from the medicalised or sexualised language of the birth-control clinic or the rubber shop. Even its unreliability was almost a virtue, for these couples were not usually trying to avoid having any children but rather to limit their number. It ‘didn’t do’ to plan babies, they told Fisher, and they certainly hadn’t done so – and yet, through men’s sometimes intermittent use of withdrawal or condoms, they had more or less the children they wanted, each a ‘nice surprise’, not a calculated creation.

For men, too, withdrawal had its advantages, especially in comparison to condoms, which were costly, ‘a struggle to put on’, uncomfortable (‘like washing your feet with socks on’) and embarrassing to ask for at a chemist’s shop. Since they were associated with prostitution and anti-VD campaigns, some men also thought condoms degrading to respectable women, and those who used them had to cope with their wives’ revulsion, indifference or even ridicule. ‘Doreen’ (a builder’s wife, born in 1922) recalled that they had a nasty habit of coming off, and disliked having ‘to fish, diving inside myself to find where it had gone’; she was much relieved when her husband said ‘bugger that’ and went back to withdrawal. Nor did men share Marie Stopes’s conviction that withdrawal was sexually enervating or harmful, but instead saw their ability to control their response as a mark of sexual prowess. Withdrawal, then, suited not only women’s strong attachment to a pose of sexual passivity but also a masculine culture in which male authority was assumed but male brutality condemned.

Accepting male responsibility for birth control had its costs. Men’s preferences about family size overrode women’s, and there wasn’t much women could do if their husbands ignored their views. The norm of female passivity also meant that respectable women never solicited sex, with some resisting any suggestion that sex might be pleasurable for them too. (‘I’m not going to behave like a loose woman,’ one woman told her disappointed husband.) Yet most of Fisher’s informants appeared to feel that this sexual culture had served them rather well, especially when compared with today’s ‘indecent’ sexual emancipation and display. Men’s responsibility for contraception made them ‘more considerate’, one woman said; they had to think about more than their own pleasure. And men, to a remarkable degree, seem to have internalised those norms, playing at a ‘dominant’ role that forced them to do pretty much what their wives wanted.

Fisher’s account is, in a sense, an ethnography: it decodes a culture’s meaning at a particular moment. What it can’t do is explain how and why that culture came to be. Lucinda Beier’s study of working-class health in three Lancashire towns, a baggier and more digressive book, provides some context. Fisher’s informants were mostly born between 1900 and 1930 and had their children between 1920 and 1950; the birth dates for Beier’s sample (which includes oral histories gathered in the 1970s by Elizabeth Roberts, one of the method’s great pioneers, for whom Beier worked), by contrast, range from 1872 to 1958. Beier, in other words, is examining the practices not only of Fisher’s informants’ generation, but also those of their parents and their children. As a result, she tells a story of change not continuity, of a ‘traditional working-class health culture’ reshaped by modernisation, medical advance and public policy.

Many of the sexual norms Fisher documented come out even more starkly in Beier’s interviews. She, too, notes her subjects’ puritanism, their equation of all sexual discussion with ‘badmindedness’ and all birth-control devices with ‘dirtiness’, their preference for ‘being careful’ and their relative tolerance of early abortion. Yet because she examines the more rigid late Victorian and Edwardian years and pays particular attention to childhood memories, a rather less rosy picture emerges. The strict insistence on female ‘innocence’ left girls dismayed and astonished by menstruation, drove parents to threaten their daughters with whipping if they so much as touched a boy, and surrounded pregnancy with shame: so much so, indeed, that one woman confessed that she ‘never went out when I were pregnant . . . because I knew they would think what I’d been doing and I used to think it was terrible.’ The premium placed on chastity meant that the victims of sexual violations were ostracised: one girl recalled that when her best friend was molested, her mother forbade her from speaking to the friend ever again.

Beier stresses the coercive character of this valorisation of sexual ignorance, but she also makes clear its limits and its logic. If female chastity was prized, female helplessness was not, since a poor family’s health and well-being depended almost entirely on the mother’s knowledge and skill. ‘M’mother was the doctor,’ informants reported, and when it came to caring for their children’s health, the masquerade of innocence vanished. Mothers were trying to keep their children alive in the face of a host of deadly threats – diphtheria, measles, polio, scarlet fever – eager to claim them, and they threw every ounce of their energy and accumulated wisdom into the battle. Their children, in their own old age, vividly recalled the weapons of that fight: the onion poultices and goose grease rubs, the cod liver oil and opiate-laden cough syrup (‘it were gorgeous’), the scratchy woollen underwear and the constant struggle with damp.

They also reported that their mothers did not fight this battle alone. For those who upheld community norms (and this was why sexual behaviour mattered so much), neighbourly help during sickness was always forthcoming. Neighbours did the washing, brought soup and took in children: ‘It didn’t need your own relations to rally round to help in those days, you’d neighbours in your houses helping.’ Furthermore, ‘every street had its lady,’ an experienced older married woman or widow who was routinely called on in times of illness or need. These ‘neighbourhood health authorities’, as Beier calls them, would do anything from delivering babies to laying out the dead, and were the mainstays of working-class health culture before the First World War. Of the same social class as the families they served, they were trusted by mothers and tolerated by local doctors, who knew that they could be relied on to remain in a house, doing jobs no one else would do, until the crisis was over. Indeed, doctors were merely one of the triumvirate to whom mothers turned (the third being the dispensing chemist), and were remembered less for their superior skills than their higher cost.

By the interwar period – the years when Fisher’s informants were marrying – that health culture, ‘home-based and controlled by laywomen’, was already under attack. Parliament regulated unlicensed midwives and opiate use; school medical inspection and health visitors became commonplace; maternal and infant welfare clinics sprang up. Reforms like these – together with the continued use of isolation hospitals in cases of contagion – forced down childhood death rates, but they also eroded mothers’ power and destroyed that of unlicensed female practitioners. By 1950, health culture was no longer class-specific, with working-class people fully incorporated into a professionalised system controlled by doctors.

Beier clearly views this development with some distaste. The professionalisation of working-class healthcare meant, she writes, not only ‘large amounts of prescribed medication, routine attendance at healthcare facilities, and hospital admission for an ever expanding range of ills and therapies’ but also, for working-class women, ‘relinquishing personal knowledge of, discretion regarding, or participation in the medical care of self or loved ones’. In language reminiscent of the social history of the 1970s, she describes that transformation as a ‘hegemonic process’, one not only promoted by medical officers of health eager to expand their authority but also inculcated by the popular media, as ‘the familiar stereotype of the brilliant, self-sacrificing doctor’ became a mainstay of magazine stories, radio dramas and film. Yet she is forced to acknowledge that working-class women fully embraced their supposed disempowerment. The National Health Service was hugely popular from the outset, and working-class women were among its most enthusiastic patrons.

Why was this? Surely not just because they were seduced by the fantasies disseminated by the media’s ‘dream machine’. The genuine hardships and limitations of the ‘traditional health culture’ that Beier describes played a part. Mothers’ power and authority, after all, was a function partly of medicine’s impotence: as the doctors among Beier’s informants readily acknowledged, before the advent of sulpha drugs in the 1930s and penicillin during the war there was often very little they could do. Parents did call in doctors as a last resort (and spent years paying off the bills), they did run down to the chemist’s for syrups and strengtheners, but with most illnesses, attentive nursing (the province of mothers) was the only option. It wasn’t always enough, however, and Beier’s informants recalled not only their mothers’ heroic efforts but their terrible grief or guilt over the children who died despite them. Small wonder they welcomed with open arms the medical advances that helped save their children’s lives.

But there is another reason, scarcely noticed by Beier, for their enthusiasm: the NHS brought decent medical care, for the first time, to working-class women themselves. It’s hard to exaggerate how overdue this was. The health insurance system of the interwar years was employment-based, and so mostly covered working men; their wives (unless formally employed, and the vast majority were not) were covered only for maternity. Such a system effectively declared working-class women’s health to be unimportant – and mothers, locked in the struggle to keep their children alive, had trouble thinking it mattered much either. (By focusing so intently on those women’s role as healthcare providers rather than consumers, Beier does little to combat this view.) When social investigators or health visitors bothered to ask, however, they found that most women were struggling with anything from anaemia and poor eyesight to varicose veins and heart disease, often for years on end. The advent of the NHS shone a bright light on that ‘vast reservoir’ of ill-health; in a nutshell, it told women that they didn’t have to live in pain any longer. In this sense, the introduction of the NHS ranks alongside the Representation of the People Act of 1918 and the Equal Franchise Act of 1928 as a milestone in women’s emancipation.

Both of these books describe a culture that is well and truly dead. However one might describe British culture today, ‘sexually reticent’ probably aren’t the words that spring to mind. Yet these books are not merely works of recovery (although they are surely that); they are also tributes to the power of oral history. Both books are exemplars of this genre, not only because of their large sample (193 for Fisher and 239 for Beier, compared to the 20 to 40 used in most earlier studies) and their vivid and extensive quotation from interview transcripts, but also because their authors have been extremely meticulous. Both took the time and trouble to do the job properly, conducting long, often multiple interviews over endless cups of tea, coding and transcribing responses, and paying attention to the balance of ages and genders, locations and occupations. Both address frankly the problem of the distortions of memory; both came to understand how their own characteristics – their age, gender, marital status, nationality – affected their subjects and shaped their responses. Indeed, Fisher’s awareness that she was to a degree exploiting her youth and unmarried status to ask naive questions and elicit richer answers may have made her particularly sensitive to the way her woman informants had used ‘ignorance’ to their own advantage. If Beier, in the end, tells us a familiar story – mothers had power, and they lost it – Fisher gives us something more complex and interesting, a chance to listen in while ‘Cecil’ explains that he would never have allowed a period of abstinence because, back then, ‘the man was always the governor,’ while his wife agrees and then interjects, seemingly out of nowhere: ‘Pardon me, but piffle.’

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Vol. 31 No. 11 · 11 June 2009

Susan Pedersen, examining working-class attitudes to birth-control techniques in the early and mid part of the 20th century, makes a delightful, if potentially disastrous howler (LRB, 28 May). The euphemism for coitus interruptus isn’t ‘getting off at Mill Hill’, as she supposes, Mill Hill being the terminus of one branch of the Northern Line. The correct expression, Liverpudlian in origin, is ‘getting off at Edge Hill’, Edge Hill being the penultimate station on the Manchester to Liverpool line before the terminus at Lime Street.

Bob Hall
Old Windsor, Berkshire

Vol. 31 No. 12 · 25 June 2009

I can understand Bob Hall’s glee at having (as he thought) found me out, but I’m afraid the Blackburn residents Kate Fisher interviewed for her study of birth control did use ‘getting off at Mill Hill’ as a metaphor for withdrawal, for the simple reason that their ‘Mill Hill’ was a suburban train station on the way into Blackburn (Letters, 11 June). Had they been Londoners it would obviously have made no sense, but they weren’t and adopted their own local bus and train stations to get across what they meant. One of the Lancashire residents Lucinda Beier interviewed for her study of public health advised that one should ‘get off the bus at South Shore, don’t go all the way to Blackpool.’ It’s hard to imagine an activity (or a phrase) less conducive to linguistic standardisation.

Susan Pedersen
Columbia University, New York

As any sailor could have told Susan Pedersen, the safe procedure is to ‘get out at Fratton’, the last station before Portsmouth.

Bill Peppe
Carbost, Isle of Skye

My version of the ‘getting off’ expression for coitus interruptus is ‘getting off at Paisley’, the station before the terminus at Glasgow. I am also reminded of a Glasgow colleague’s expression, ‘getting off at Govan’. Tom Leonard has a poem ‘A Priest Came On at Merkland Street’, and Merkland Street was the old Partick Station underground stop, the one before Govan, itself the stop for Ibrox, the Rangers football ground. Can anyone decode this?

Dorothy McMillan

It would seem that it is in the history of each major English city to have an alighting point. Perhaps its proximity to the final destination is a reflection of the inhabitants’ approach to risk.

John Cashmore
London W9

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