<h2>Summary</h2> <ul><li>1.Our search discovers no investigation of "birth control" made in a scientific and ethical spirit and approaching the subject without bias. Review of the literature discloses a library of argument that condenses to a pamphlet of case histories.</li><li>2.Wide divergence of opinion exists largely owing to the meagerness of clinical evidence and to prepossession on the part of observers. For example, opinions gathered by questionnaire from 64 gynecologists vary greatly from the experiences published by the three birth control clinics of London and New York.</li><li>3.The committee's investigation carried on in Holland demonstrates that this much quoted paradise of birth control is without clinics or clinical reports or consensus of opinion. Our English interviews show divided counsels, with no checking up of the returns from the two clinics. German authorities urge us to conduct a thorough-going inquiry. Russia is reported as starting some investigation.</li><li>4.The medical profession is not yet cognizant of any guaranteed contraceptive. In the very large number of cases where contraception works securely, as well as harmlessly and happily, we shall expect to find a choice rightly adapted to the particular couple, often with two measures combined or in sequence, and above all with attention to detail. It is our business to discover and define such conditions.</li><li>5.Sterilization by removal of the uterus prevents future pregnancies. Removal of the ovaries produces a surgical change of life. Both entail definite hazard, particularly to those most needing protection, such as patients with active tuberculosis or rheumatic hearts. Operations on the tubes are under question since the new insufflation tests snow reopenings. This test is now essential after all such operations. The simple, "non-operative" cantery sealing of the tubes is on trial.</li><li>6.Irradiation of the ovary calls for further experiment on dosage, on possible damage to future progeny, and risks of abortion.</li><li>7.Among ordinary contraceptive devices, some that are found reasonably efficacious among the intelligent are said to fail in half the clinic patients. Yet it is among these that the need is greatest In one outstanding report from 1000 educated American women, 730 believed in the rightness of regulating pregnancy and practiced it without unduly lessening the number of progeny; in a dispensary series 41 per cent of the women had some knowledge of preventive methods, the restriction (above 4.7 children) being in proportion to their knowledge.</li><li>8.The one contraception experiment supposed to be carried out on a national scale (the French peasant's withdrawal) has not yet been subject to medical case study regarding its elect on health and reciprocity. The forty year community experiment with coitus reservatus at Oneida was medically studied and the method apparently exonerated.</li><li>9.Dependence on the plain douche and any douche alone is largely discredited.</li><li>10.Doctors and educated couples in America rely largely on the sheath. One large group shows failure in 12 per cent, whereas among else poor two clinics report 50 per cent failure in extensive series.</li><li>11.The use of the sheath calls for testing, lubrication, and ready access to a medicated douche in case of accident.</li><li>12.Among chemicals, suppositories make a lesser showing of protection than jellies and pastes and effervescing tablets with chinosol and acids, for which only 3 per cent failulre is claimed, covering 837 cases in one clinic report.</li><li>13.Infection from stems within the cavity of the uterus is not infrequent.</li><li>14.The chief measure which puts the woman's care into her own hands, and is the main recommendation of students of birth control abroad and in this country is that form of soft rubber cervix cup distending the upper vagina which was originally devised by Mensinga, but is not sold here. This device, fitted by a doctor, used for the occasion, and in proper cases, (best combined with a medicated jelly) claims minimal failures and offers case histories. It should receive careful clinic tests—with patients who fall within the law—that is, where contraception is required temporarily or continuously "to prevent or cure disease."</li><li>15.In all methods details of technic are found to be of great importance.</li><li>16.Where permanent prevention of pregnancy is required, trial should be made of the relatively simple method of sealing the tubes by the stricture that results from cautery burns of the minute intrauterine openings of the tubes.</li><li>17.The data should be collected under competent supervision, the physical questions by properly qualified members of the medical profession. The doctor is the person to select and instruct, because the need must be proved and the recommendations fit individual requirements and particular physical findings.</li><li>18.The Committee on Maternal Health, as part of a study of fertility and sterility, has carried on several steps of the investigation of contraception and has under way clinical, chemical and laboratory studies. These, in due time, with proper supervision and adequate professional collaboration and sufficient funds, should secure the facts.</li><li>19.The subject is susceptible of handling as clean science, with dignity, decency and directness.</li></ul>