School of Historical and Philosophical Studies - Theses
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Item'Survival of the fittest in contraceptives': charting the British Family Planning Association's scientific and medical efforts to standardise contraception, 1920-1969( 2017)This thesis argues that the Family Planning Association (FPA), its predecessor the National Birth Control Association (NBCA), and affiliated societies and groups, developed and shared an ideology during the 1920s that supported the scientific legitimisation and standardisation of contraceptives as a result of sexological, medical and scientific advances that made the matter a viable research concern. In addition they worked toward perfecting their methodology throughout the next decade in order to pass their regulatory responsibilities to the medical profession and government as soon as was viable. To achieve this scientists in Scotland and Oxford were commissioned to develop a replicable qualitative technique to assess the efficacy and safety of available spermicidal products. Once convinced this had been achieved, the NBCA developed and published an annual approved list of contraceptives, which was touted as a definitive register of effective contraceptive devices and compounds sold in Britain. They then convinced the majority of local contraceptive manufacturers that gaining NBCA/FPA approval, through passing their standard tests and having products appointed to the list, would be fiscally practicable, as the Association increasingly dominated public support and custom through their contraceptive clinics, and eventually aimed to be considered the arbiter of contraceptive products and advice in Britain. The NBCA/FPA recruited physicians and scientists to undertake clinical and research work to implement and increasingly raise contraceptive standards. Clinical trials were initiated from the early 1930s to investigate product safety, effectiveness, quality, ease of use, and acceptability to users, and were increasingly employed to regulate products that passed approved list quality testing. Further, the Association introduced a regulated universally applicable clinical procedure, and standardised record keeping, developing and implementing patient case cards and standardised equipment and dressings in Association clinics. This ensured medical and lay machinations of Association clinics were effectively identical throughout the United Kingdom as the century progressed. The gaining and sharing of sexual and contraceptive expertise framed scientifically and medically, offered the NBCA/FPA a means to standardise another aspect of contraception. The Association’s medical and administrative staff grasped that if they could fill gaps in sexual, physiological and contraceptive knowledge, they would be able to formulate and direct lay and medical training in those areas. This was achieved through the introduction and refinement of a medical training curriculum for doctors and nurses, the setting of educational standards for contraceptive clinic medical staff, and the introduction of public lectures and marital and sexual guidance courses. The success of the medicalised regulatory aspirations of the NBCA/FPA is apparent in the British experience of oral contraceptives in their first decade. The Association was by 1960 seen as the arbiter of safety and efficiency, and in that capacity founded a specialised research body, the Council for the Investigation of Fertility Control. The Council, in collaboration with the medical profession and health authorities, developed and implemented large-scale chemical and animal trials of oral contraceptive preparations before they would consider human clinical and acceptability trials. Their scientific and medical authority allowed them to stagger the release of oral contraceptives, until means were developed for their regulation, as per the standards applied to all other contraceptives issued by FPA clinics, which dominated the contraceptive landscape of Britain at the close of the 1960s.