There are several means of preventing conception which are both certain and harmless. What those means are the state laws forbid me to say. If I should defy the state laws and name those contraceptives, the federal laws would forbid this book's going through the mails. Nor can I, without coming into conflict with the laws, tell why these means are reliable. It is difficult to discuss the subject without using franker language than the statutes permit, and I do not wish to violate the law in this particular book.

"Can I rely upon this? Is it certain? Will it prevent absolutely?" Such questions, always asked by women who seek advice concerning contraceptives, testify both to their fear of involuntary motherhood and their doubt as to any and all means offered for their deliverance.

Doubt as to the certainty of contraceptives arises from two sources. One is the uninformed element in the medical profession. A physician who belongs to this element may object to birth control upon general grounds, or he may repeat old-fashioned objections to cover his ignorance of contraceptives. For, strange as it may seem, there is an amazing ignorance among physicians of this supremely important subject. The uninformed objector often assumes to speak with the voice of authority, asserting that there are no thoroughly dependable contraceptives that are not injurious to the user.

The other source of distrust is the experience of the woman herself. Having no place to go for scientific advice, she gathers her information from neighbors and friends. One offers this suggestion, another offers that, each urging the means that she has found successful and condemning others. All this is very confusing and extremely disturbing to the woman who, for one reason or another, is living in constant fear of pregnancy.

It is not at all surprising that such a state of affairs exists. There has been so much secrecy about the whole subject and so much dependence upon amateurish and nonprofessional advice that it is almost impossible for anyone to procure reliable information or to recognize it when given. This is especially true in the United States where there are both federal and state laws to punish those who disseminate knowledge of birth-control methods.

Even under present conditions, however, there is a certain amount of reliable information concerning methods of birth control. We know that there are several methods of prevention which are not only dependable, but which can be used without injury either to the man or the woman. Knowledge of what these methods are and how to apply them should be available to every married man and woman. It is safe to predict that in a very few years they will be available.

Some methods are more dependable than others, just as there are some more simple of adjustment than others. Some are cheap and less durable; others are expensive and last for years. There are some which for a quarter of a century have stood the test of certainty in Holland, France, England and the United States among the wealthier classes, as the falling birth rate among these classes indicates. And just as the reliable, primitive wheelbarrow is antiquated beside the latest airplane, so, as scientific investigators turn their attention more and more to this field, will the awkward, troublesome methods of the past give way to the simpler, more convenient methods of the morrow.

Although the law forbids information concerning reliable means of contraception, it is hardly likely that it can be invoked to prevent warnings against widely practiced methods which are NOT reliable. The employment of such methods leads not only to disappointment but often to ill health.

One of the most common practices of this kind is that of nursing one baby too long in the hope of preventing the birth of the next. The "poor whites" of the South and many of the foreign-born women of the United States pin their hopes to this method. Often they persist in nursing a child until it is eighteen months old—almost always until they become pregnant again.

Prolonged nursing hurts both child and mother, it is said. In the child it causes a tendency to brain disease, probably through disordered digestion and nutrition. In the mother it causes a strong tendency to deafness and blindness. If a child is nursed after it is twelve months old, it is generally pale, flabby and unhealthy, often rickety, one authority points out, while the mother is usually nervous, emaciated and hysterical. If pregnancy occurs under these conditions, the mother not only injures her own health but that of the next child, often developing in it a weakness of constitution which it never overcomes.

Moreover, prolonged nursing has been found to be unreliable as a contraceptive. We know this upon good authority. It should not be depended upon at all.

In the same class is the so-called "safe period" referred to in another chapter. For many women there is never any "safe period." Others have "safe periods" for a number of years, only to find themselves pregnant because these periods have ceased without warning.

One of the most frequent of all the mistakes made in recommending contraceptives is the advice to use an antiseptic or cold-water douche. This error seems to be surprisingly persistent. I am particularly surprised to hear from women that such douches have been prescribed by physicians. Any physician who knows the first rudiments of physiology and anatomy must also know that necessary and important as an antiseptic douche is as a cleanser and hygienic measure, it is assuredly not to be advised as a means of preventing conception.

A woman may, and often does, become pregnant before she can make use of a douche. This is particularly likely to happen if her uterus is low. And the woman who does much walking, who stands for long hours or who uses the sewing machine a great deal is likely to have a low uterus. It is then much easier for the spermatazoa to enter almost directly into the womb than it would otherwise be, and the douche, no matter how soon it is used, is likely to be ineffective. The tendency of the uterus to drop under strain goes far to explain why some women who have depended upon the douche for years suddenly find themselves pregnant. Do not depend upon the douche. As a cleansing agent, it is a necessary part of every woman's toilet, but it is not a preventive.

Even if the douche were dependable, the absence of sanitary convenience from households in remote districts and the difficulty of using a douche in crowded tenements would prevent many women from making use of it.

Despite the unreliability of some methods and the harmfulness of some others, there are methods which are both harmless and certain. This much the woman who is seeking means of limiting her family may be told here. In using any method, whatsoever, all depends upon the care taken to use it properly. No surgeon, no matter how perfect his instruments, would expect perfect results from the simplest operation did he not exercise the greatest possible care. Common sense, good judgment and taking pains are necessary in the use of all contraceptives.

More and more perfect means of preventing conception will be developed as women insist upon them. Every woman should make it plain to her physician that she expects him to be informed upon this subject. She should refuse to accept evasive answers. An increasing demand upon physicians will inevitably result in laboratory researches and experimentation. Such investigation is indeed already beginning and we may expect great progress in contraceptive methods in the near future. We may also expect more authoritative opinions upon preventive methods and devices. When women confidently and insistently demand them, they will have access to contraceptives which are both certain and harmless.