Document 17J: Norman Himes, "Clinical Service for the Negro," Birth Control Review, 16, no. 6 (June 1932): 176-77.

[p. 176]

Clinical Service for the Negro

IN RECENT years the statement has frequently been made in birth control literature that Catholic women attend the birth control clinics in this country in a proportion comparable to their proportion in the total population of the community served by the clinic. In connection with this special number of the Review it is well to ask corresponding questions: Are Negroes being reached? In what proportion?

   It is well known that the United States now has more birth control clinics than any other country in the world. Evidence is accumulating tending to show that, while birth control may have operated somewhat dysgenically in the recent past, it is increasingly becoming eugenic, as knowledge which was formerly available almost exclusively to the upper classes percolates downward. This diffusion is caused mainly by the work of the clinics, and by the published literature.

   By no means an insignificant group to receive this newer knowledge has been the under-privileged Negro population, especially that located in some of our larger northern cities. The New York clinic, in Harlem, which has done such splendid work, serves almost exclusively the Negro population of that district. Likewise the Baltimore Bureau for Contraceptive Advice and the Cleveland Maternal Health Center are serving a goodly proportion of Negroes.

   Table I shows, according to the latest reports, the number and percentage distribution of white and Negro patients at four birth control clinics. These are the Cleveland, Baltimore, Cincinnati and Detroit centers. Out of a total of 4850 cases, 3677, or 75.8 per cent were whites, and 1164, or 24 per cent were Negroes.

   Table II compares the percentage of Negroes in the clinic populations studied with the percentage of Negroes in the total population of the cities in which the respective clinics are located. At Baltimore there is no appreciable difference; Negro women attend in about their proportion in the total population of that city. But at Cleveland, Cincinnati and Detroit the Negro rate of clinic attendance is approximately three times the rate in which Negroes exist in the respective city populations. This fact seems to me socially significant.

   The 816 Baltimore patients had an average of 5.81 pregnancies; while the average number of living children was 4.84. But since the average age was 31 years, and since these women had been married slightly over 11 years on the average,



Total Cleveland Baltimore Cincinnati Detroit
No. % No. % No. % No. % No. %
White 3677 75.8 1220 79.4 659 80.8 678 67.8 1120 74.8
Negro 1164 24.0 316 20.6 157 19.2 313 31.3 378 25.2
Unknown 9 .2 9 .9
Total 4850 100.0 1536 100.0 816 100.0 1000 100.0 1498 100.0

Source of data: Baltimore and Cleveland, latest clinical reports; Cincinnati and Detroit, correspondence. the reproductive rates are high. But it should be observed in this connection that at Baltimore, where the aim of the clinic is primarily scientific research, a rather conservative attitude toward the advising of patients prevails; ordinarily they must have serious reason for requiring contraceptive advice. This selective influence makes the average age higher. None the less, calculations by Dr. Pearl tend to show that the fertility of the


Percentage of Negroes in Clinic Populations Compared with Percentage in the Total Population

City Per Cent Negroes
in Clinic Population
Per Cent Negroes
in Total City Population
(as of 1930)
Cleveland 20.6 7.9
Baltimore 19.2 17.8
Cincinnati 31.3 10.7
Detroit 25.2 7.7
clinic women is much higher than that of the general population of Baltimore, perhaps even three times as high. This in itself, regardless of any medical or economic indications, is pretty good evidence that the Baltimore clinic is reaching those individuals who most need contraceptive advice.

   The Baltimore Bureau women who had from 0 to 9 pregnancies had an abortion or miscarriage rate of 13.2 per cent; while women who had from 10 to 22 pregnancies had a rate of 25.4 per cent.

[p. 177]

Dr. Pearl observes that, since the difference in percentages (12.2) is more than 14 times the probable error, "there are odds of many million to one that women with ten or more pregnancies have a larger percentage of abortion and/or miscarriage than women with fewer than ten pregnancies."1

   Figure 1 shows the trend of total pregnancies in children born among colored and white patients in Baltimore in recent years. We have the family income for 583 white women and 145 colored women. For white women the mean number of pregnancies

and of children born appeared to decrease as the family income decreased. For 145 colored women the mean number of pregnancies and of children born appear to increase as the family income decreased. If this trend represents a real situation, this is most significant. However, as Dr. Pearl points out, the numbers are small, and the trend may be merely accidental. Moreover, not all the marriages are as yet completed. Even if the above requirements were met, we would need to re-arrange the data in order to determine whether or not this trend is a genuine one.

Norman E. Himes


   1 Fourth Report of the Bureau for Contraceptive Advice, Baltimore, 1932, p. 8.

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