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Reproductive behavior andcontraceptive practices in comparativeperspective, Switzerland (1955–1970)Caroline Rusterholza

a Department of Contemporary History, University of Fribourg,Fribourg, SwitzerlandPublished online: 01 Dec 2014.

To cite this article: Caroline Rusterholz (2015) Reproductive behavior and contraceptive practicesin comparative perspective, Switzerland (1955–1970), The History of the Family, 20:1, 41-68, DOI:10.1080/1081602X.2014.983139

To link to this article: http://dx.doi.org/10.1080/1081602X.2014.983139

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Reproductive behavior and contraceptive practices in comparativeperspective, Switzerland (1955–1970)

Caroline Rusterholz*

Department of Contemporary History, University of Fribourg, Fribourg, Switzerland

(Received 12 June 2014; accepted 29 October 2014)

This paper focuses on marital birth control practices c. 1955–1970, i.e. before the eraof widespread uniform adoption of modern contraceptives, in two nearby Swiss citiescharacterized by different religious cultures. It asks how responsibility forcontraceptive practices was shared within the marital couple, whether it was theobject of discussion between spouses, how the choice of a method of contraception wasmade and how religious culture affected these elements. This paper uses writtensources reflecting medical authorities’ views about birth control and 48 semi-structuredinterviews with elderly persons from the lower middle and working classes. The resultspoint to three key conclusions. Firstly, the findings show a joint responsibility of bothspouses for contraceptive practices. Secondly, the paper shows that religious cultureplays a key role in the access to means of birth control. Specifically, Fribourggynecologists were reluctant to prescribe modern methods. Thirdly, the resultsunderline that a combination of methods are used throughout reproductive life,depending on the spouses’ desire to have additional children and on men and women’sindividual attitudes toward birth control methods.

Keywords: birth control; gender; contraception; religion; fertility

1. Introduction

This paper studies decision-making processes regarding birth limitation in Switzerland

between 1955 and 1970, a period generally regarded as marking the transition from the

baby boom to the baby bust. In Switzerland, this period also witnessed a remarkable

homogenization of reproductive outcomes. Whereas fertility rates differed across regions

before the onset of the baby bust (1965), especially between regions characterized by

different religious cultures, they had converged markedly by 1975 (Wanner, Fei, & Cotter,

1997, p. 491). This paper posits that this ‘silent revolution’ (Oris, 2007) can be explained

by a homogenization of birth control1 practices that arose before the so-called

contraceptive revolution and proved potent enough to reduce heterogeneities attributed to

religious background.

Specifically, this paper attempts to understand how religious culture shaped birth

control opportunities during the period under study. How, among this opportunity set, did

gender bargaining result in specific contraceptive choices? Did religious culture also

influence the way husbands and wives communicated about and negotiated the issue of

birth control, reinforcing the differences between Catholic and Protestant fertility?

These research questions imply two methodological options: an individual-level

analysis of decision-making processes and a comparative approach that sheds light on the

constraints faced by individuals, which varied according to the religious culture.

q 2014 Taylor & Francis

*Email: caroline.rusterholz@unifr.ch

The History of the Family, 2015

Vol. 20, No. 1, 41–68, http://dx.doi.org/10.1080/1081602X.2014.983139

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Scholars have recognized the need to adopt a micro-level mode of analysis that

observes the decision-making process at the individual level (Garrett, Reid, Schurer, &

Szreter, 2001; Gillis, Tilly, & Levine, 1992; Greenhalgh, 1995; Kertzer, 1995; McNicoll,

1994; Praz, 2007; Szreter, 1996). Studies employing this methodology have demonstrated

that men and women have neither the same interests nor the same power in decision-

making processes related to birth control (Folbre, 1983, 1994; Janssens, 2007;

MacKinnon, 1995; Seccombe, 1990, 1992; Szreter, 1996 pp. 443–464, 481–503, 546–

578; Watkins, 1993). This paper contributes to this new line of research by studying how

gender relationships interact with religious constraints. Toward this aim, this paper uses

interviews with elderly persons from the lower-middle and working classes who entered

parenthood between 1955 and 1970. Documenting decision-making processes regarding

birth limitation among individuals from this social background is difficult because these

individuals often did not leave behind testimonies or ego documents. Thus, oral history is a

promising method to explore individual agency in birth control choices.

To identify the impact of religious culture on birth control practices, this article adopts

a comparative approach, focusing on two Swiss cities located near one another that

differed in terms of religion: Protestant Lausanne and Catholic Fribourg. Before the onset

of the baby bust, these cities were characterized by significantly heterogeneous fertility

trends. In the city of Lausanne, the total fertility rate increased from 1.36 in 1955 to 1.66 in

1965 and decreased to 1.43 in 1970 and to 0.97 in 1975. The total fertility rate in the city of

Fribourg followed the same trend as that in Lausanne, albeit at a higher level. It increased

from 1.84 in 1955 to 2.46 in 1965 and decreased to 1.92 in 1970 and to 1.44 in 1975. Thus,

in both cities, the number of children per woman decreased markedly from 1965 onward.

This decrease suggests that more couples adopted birth control measures or were

successful when employing them.

2. Study design and context

This paper examines three aspects that the literature has shown to be of particular

significance for understanding the spread of birth control practices: (i) the influence of

religion on access to information and means of contraception, (ii) the gendered bargaining

power and responsibility for contraceptive practices and (iii) the methods actually used.

In a recent historical synthesis, Derosas and Van Poppel (2006) emphasized that

research should focus on the mechanisms through which religion affects family life and

fertility. This is both the aim and the limitation of this study. The purpose of this research

is not to attempt to test specific hypotheses because there is a lack of sufficient and

representative data for these purposes. The aim of this qualitative analysis is to explore

plausible mechanisms of interaction among the three elements mentioned above: religious

culture, communication and bargaining between spouses on the issue of birth control, and

the contraceptive method(s) adopted.

This research is inspired by the abundant literature concerning the impact of religion

on reproductive behavior (Dalla-Zuanna, 2011; Gervais & Gauvreau, 2003; McNicoll,

1994; Sevegrand, 1985; McQuillan, 2004; Somers & Van Poppel, 2010). For some

Catholic regions during the first half of the twentieth century, scholars have shown a clear

intrusion of priests into the private lives of their flocks; they attempted to discourage

women from using birth control, thus increasing their moral guilt in practicing family

limitation. A contribution that considered the same Swiss cantons we study, but for the

period of 1870–1930, attests to the fact that Protestant authorities were more open to and

tolerant of birth control than Catholic authorities. The latter, influenced by the Catholic

C. Rusterholz42

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Church, implemented a policy of silence regarding birth control issues and constrained the

diffusion of contraceptive information (Praz, 2005). Furthermore, in granting numerous

exceptions to compulsory school attendance for girls, Catholic authorities reduced the

costs of education for families, thus making fertility control less imperative. In Praz’s

study, it was not individuals’ beliefs that were of particular significance to understanding

the impact of religion on birth control, although these beliefs were important, but rather the

impact of religion on institutional constraints regarding access to birth control

information. This impact was perceptible through the Church’s influence on public

policy. The authors of this public policy, who were members of the Catholic conservative

party, were instilled with this religious culture due to their educational and social

backgrounds.

The aim of this study is to interrogate the role of religion in a later period (1955–1970)

to assess whether this influence persisted. Was this religious influence still present, or was

there a perceptible weakening of the moral constraints that enhance the legitimacy of birth

control and facilitate its access? At first glance, we see that the Catholic Church

condemned all methods of birth control with the exception of the rhythm method, whereas

the Swiss Protestant churches only emphasized parental responsibility for its use.

In Fribourg, the Catholic doctrine was spread through parish journals, but condemnations

of birth control and the bishop’s discourses were also published in the main local

newspaper. However, it is much more important to determine whether the individuals in

the sample were aware of this Catholic doctrine and respected these norms. Because

individuals’ beliefs were not the only mechanisms through which religious culture

operated, this paper will also investigate other possible channels. Particular attention will

be devoted to institutional constraints, such as the health policies that differed in the two

cantons due to the federalist system, which could be shaped by the respective dominant

religious culture. This impact might have weakened during the period studied.

A comparative study conducted in 1968 on Roman Catholic fertility showed that ‘in

developed countries of Judeo-Christian tradition, Catholic fertility exceeds that of non-

Catholic in almost every country and socio-economic group’ (Jones & Nortman, 1968,

p. 3). That study also emphasized that Catholics practiced contraception, and although

they relied on the rhythm method to a greater extent than non-Catholics, the majority of

Catholics had used methods condemned by Catholic doctrine (Jones & Nortman, 1968,

p. 24). Consequently, this paper will determine whether individuals from Fribourg recalled

using methods of birth control condemned by the Catholic Church, whether Catholics and

Protestants used similar methods, and the extent to which couples had access to these

methods.

Gynecologists’ attitudes on this issue have been investigated as part of the institutional

constraints that modulated access to contraception. Some interviewees suggested this

focus and referred to the influence that religion had on gynecologists. Several studies also

recommended considering physicians as new actors in issues relating to birth control.

Monica Suter (1995) study on the role of Swiss physicians in the legitimacy of birth

control practices explained that physicians became specialists in these issues to acquire a

new field of competence to develop their clientele. Cornelia Usborne, in a study on

women’s reproductive rights in Weimar Germany, emphasized that the medical profession

‘had usurped the churches’ power in issues relating to birth control to a significant extent’

(Usborne, 1992, p. 16). It would be interesting to determine whether the situation in

Switzerland was similar and whether religion influenced physicians’ attitudes.

During the period under investigation, the sale of contraceptives was allowed, but

advertising such products and the public display of objects used to prevent pregnancy were

Reproductive behavior and contraceptive practices in comparative perspective 43

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forbidden by the Swiss Penal Code of 1942 (article 211). After 1946, a federal law allowed

abortion if the health of the mother was in danger. However, two practitioners had to agree

on the necessity of this procedure. This federal law was applied differently across cantons.

Although this federal law became the object of a cantonal law in 1954 in Lausanne’s

Canton of Vaud, there was no specific law on the subject in the Canton of Fribourg. The

contraceptive pill became available with a prescription on the Swiss market in 1961. Thus,

physicians came to the forefront of issues relating to birth control and access to it. As for

the Swiss health system, health insurance was the responsibility of the central government;

hence, the same conditions prevailed in both cities. Although there was no individual

obligation to obtain health insurance, it became increasingly widespread among the Swiss

population (Wyss & Lorenz, 2000, p. 106). In 1960, there was one gynecologist for every

26 532 inhabitants in the Canton of Fribourg, whereas there was one for every 33 039

inhabitants in the Canton of Vaud. In the sample, nearly all of the respondents (46 of 48)

affirmed that the wife had visited a gynecologist for delivery and for regular examinations.

Birth control counseling was instituted at the maternity ward of the cantonal Vaud

hospital through a private initiative in 1959, and the public authorities opened a family

planning center in 1967. There were no such institutions in Fribourg during the same

period, which raises the question of whether the lack of these institutions had

consequences for the experiences of our respondents.

There is little scientific consensus on the respective roles of men and women in

controlling fertility during the two demographic transitions. Historical research has

obtained different results concerning responsibility for and communication about birth

control according to local and cultural contexts. Whereas women appeared to be the

‘driving force’ of birth control behaviors in some studies of Australia, Germany, and the

United States, (Cook, 2000; Gittins, 1982; Ittmann, 1995;MacKinnon, 2010; Schwarzkopf,

2007; Usborne, 1992), this was not the case in some communities in England (Cook, 2004;

Fisher, 2000, 2000, 2006). Hera Cook found that English women relied uponmalemethods,

whereas Australian women relied upon female methods, thereby apparently testifying to

their greater sexual and reproductive autonomy in the latter case (Cook, 2000, p. 127). The

assumption that women were primarily responsible for the demographic transition in

Britain has also been challenged by the research of Kate Fisher (2006) on birth control

practices between 1925 and 1960, which showed that gender roles were of particular

importance to understanding negotiations regarding these issues. Instead of explicitly

discussing birth control practices and family size, Fisher found that working-class couples

conducted a sort of ‘tacit negotiation’. She argued that men were deemed responsible for

birth control within the marital couple because they were typically the initiators of sexual

relations; women were expected to be ignorant as a sign of their respectability.

Communication between spouses was a central aspect advanced by both Diana Gittins

(1982) and Elizabeth Robert (1985) as a condition for successful contraception and thus

for the first demographic transition. Research on the history of sexuality and marital

intimacy has underlined the advent of the companionate marriage model that became

ideologically dominant in the mid-twentieth century (Davidoff, Doolittle, Fink, & Holden,

1990; Finch & Summerfield, 1991; Rebreyend, 2008). This type of spousal relation tended

to be more egalitarian, which seems to imply that spouses communicated regarding birth

control. This assumption has been investigated in detail for the 1940–1970 period in

Britain through oral history (Szreter & Fisher, 2010). The authors argued that working-

class couples did not discuss birth control together. In practice, this situation made men

responsible for contraceptive practices. This type of implicit arrangement was less likely

to prevail among middle-class couples. However, even these couples did not necessarily

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agree on the choice of a particular method; couples regularly reported tensions and

disagreements as well as sexual dissatisfaction (pp. 229–267). This paper seeks to

determine who was responsible for contraception and whether this responsibility differed

across cities. Did individuals communicate on the subject of birth control?

The Swiss gender context also influenced the way individuals discussed birth control

by giving more power to men or women in bargaining and by assigning responsibility for

contraception. In Switzerland, a sexual division of labor in which the man was cast as

breadwinner and the woman as housewife was widespread and supported by the welfare

system in most cantons (Christe, Natchkova, Schick, & Schoeni, 2005). Illustrative of this

conservative context is the fact that women only gained the right to vote at the federal level

in 1971, as well as in Fribourg. In comparison, in the more progressive Canton of Vaud,

women gained the right to vote at the cantonal level in 1959. Rusterholz (2014a, 2014b)

demonstrated that the articles published in the main local newspapers of both cities (La

Liberte and La Feuille d’Avis de Lausanne) attested to the preponderance of patriarchal

gender norms as well as an evolution toward more egalitarian relationships.

The methods of contraception that facilitated the fertility decline serve as the third

focus of this paper. Recent research has underlined the utilization of traditional methods of

birth control, such as withdrawal or abstinence, in addition to newer methods of

contraception during the course of the fertility decline (Fisher, 2006; Oris, 2007; Szreter,

1996; Usborne, 1992). Hera Cook emphasized that most women ‘who had large families in

the 1950s did not plan to do so and they had them because they could not control their

fertility’ (Cook, 2004, p. 265). Traditional methods of birth control were not particularly

effective but remained widespread. Were these traditional methods of birth control also in

widespread use in the two cities of our study?

There are no systematic national fertility surveys in Switzerland on the use or speed of

adoption of methods of contraception. Few studies, primarily by sociologists, have

approached this issue since 1975. A study conducted by Bassand and Kellerhals (1975) on

the contraceptive practices of 2460 married women who were pregnant in Geneva between

1966 and 1968 revealed that only 7.1% of them had used the contraceptive pill. The Swiss

women in the sample used withdrawal (23.49%), the rhythm method (33.8%) and

technical means of birth control, such as the contraceptive pill, condoms, intrauterine

devices or sterilization (24.4%). The foreign couples in the sample predominantly resorted

to traditional methods of birth control (Bassand & Kellerhals, 1975, pp. 157–158).

Swiss couples were more likely to use different methods of birth control than foreign

couples (Bassand & Kellerhals, 1975, pp. 169–170). The couples underlined the

disadvantages of mechanical means of birth control; they implied that women had to either

ingest or introduce a foreign element into their bodies, which frightened them. The

sociologist Franz Kuhne (1984) conducted a study on the contraceptive practices of 600

Swiss married couples in the 1980s. He noted that there were no accurate data on the

diffusion of the contraceptive pill since its release on the market in 1961. He estimated that

3.4% of Swiss women took the contraceptive pill in 1965 and 14% did so in 1970 (p. 5).

In the same study, Kuhne presented the methods used by married couples in 1980: 27%

used the contraceptive pill, 15% were sterilized, 10% used the IUD, 7% used condoms,

and 4.5% practiced the rhythm method or the temperature method, only 1.7% referred to

withdrawal whereas 30% did not use anything (p. 55). The advantage of the modern

methods was their efficiency. However, the disadvantages of certain methods were also

presented in this study: withdrawal was perceived as inefficient and as impairing the

quality of intercourse, whereas the rhythm method and the temperature method were

regarded as unreliable and overly complicated in practice (p. 187). Although the

Reproductive behavior and contraceptive practices in comparative perspective 45

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contraceptive pill was widely used, individuals referred to the health risks associated with

its use as its main disadvantage.

It is thus of particular interest to examine whether the individuals interviewed in this

study used different methods of birth control and why they used a particular method rather

than another method.

3. Sources and methodology

Two types of material are examined here: (1) semi-structured interviews with elderly

persons, including men and women from the middle and working classes, who became

parents between 1955 and 1970 and (2) written sources reflecting the views on birth

control held by gynecologists from the cities of Lausanne and Fribourg.

As mentioned above, oral history makes it possible to some extent to compensate for

the paucity of written sources documenting this topic among the middle- and working-

class populations and provides a valuable resource for understanding individuals’

perceptions of birth control practices, the decision-making processes regarding birth

limitation, and access to means of contraception (Fisher, 2000, 2000, 2006; Gervais &

Gauvreau, 2003; Gauvreau, Gervais, & Gossage, 2007; Szreter & Fisher, 2010).

The recourse to oral history raises a number of concerns. One concern is that the

respondents reconstruct past events in light of their present feelings, opinions and

knowledge (Peschanski, 1992; Ritchie & Spencer, 1995; Silverman, 2006; Thompson,

1972). However, one must not regard this as an insurmountable problem but rather as an

inevitability that demands analysis (Summerfield, 2004, p. 67). Indeed, the historian must

engage as critically with oral history as with written sources, paying attention to silence

and the words employed by individuals to narrate their life stories and the meanings

individuals invest in their narratives. A possible bias induced by the time between the topic

of the interview, which was family life in the 1960s, and the time of the interview (2011) is

that sexuality has become a widespread topic in recent decades, which may have altered

the respondents’ answers and perceptions in favor of greater openness on these issues. This

openness was useful for the researcher, as individuals were willing to discuss what is

usually described as a sensitive topic. However, it is relevant that the majority of the

respondents clearly distinguished between their current and past judgments, emphasizing

the difference between the researcher’s generation, which was described as too open with

regard to sexuality, and their own generation, for whom sexuality was not a public topic.

One might further argue that the recollections of the elderly should not be trusted

(Bertaux & Thompson, 1993; Jeffrey & Edwall, 1994). However, psychological studies on

this matter have demonstrated that the memories of elderly persons, especially if they are

in good health, seem to be as reliable as those of younger individuals (Schuman & Scott,

1989). Memory losses associated with aging primarily concern recent memory. Memories

of youth and the early years of marriage, which are the subject of this study, seem to be

spared by aging (Schuman & Scott, 1989). The crucial information for this research was

the attitudes of the interviewees regarding family formation and birth control and the

strategies they followed rather than the accuracy of their testimony.

To facilitate recollection, scholars have recommended using interviewguides that follow

a chronological order based on biographical events that formed the pattern of the

respondent’s life to provide respondents with diachronic points of reference (Bertaux, 1997).

Our interview guide followed this advice. The guide addressed numerous issues related to

family formation in chronological order, such as employment, marriage, household budget,

children, and birth control. Issues related to birth control were raised in the middle of the

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interview, after trust between the interviewer and interviewee was well established. Nearly

all of the questions were open, and a semi-structured interview guide was followed that

allowed the respondents to have sufficient liberty to present their memories at length while

enabling the researcher to draw meaningful comparisons between the interviews.

A further concern raised in the literature relates to the dynamic between the respondent

and the interviewer. The interview represented a moment in which two individuals worked

through a process of constructing a sense of self. The interviewer played an active role, and

this relationship between the interviewer and the interviewee could, to a certain extent,

bias the recollection of information (Bornat, Perks, Thompson, & Walmsley, 2000;

Summerfield, 2004). It is possible that the age, gender and social class of the individuals

interacting during an interview could affect its course. However, as suggested by Fisher

(2006) and as confirmed in this study, young interviewers can exploit their apparent

inexperience to obtain further information. Indeed, being a young female researcher was

useful because the respondents had to clarify the euphemisms they used when speaking

about birth control. The interview with Leonie, born in 1926 in Fribourg, married to a

railway worker and mother of three children, illustrates this strategy:

– We had to be careful.– Well, I heard a lot the expression ‘being careful’, but what do you really mean by that? Idon’t understand . . .– It means the husband had to withdraw or sometimes women avoided sexual relations.2

Between March 2011 and March 2012, 48 (anonymised) interviews (28 with women,

13 with men and seven with couples) were conducted.

As shown in Table 1, 24 interviews were conducted with respondents who lived in

Lausanne during the period under investigation together with 24 interviews with

respondents who lived in Fribourg. Individuals born between 1921 and 1946 and who

became parents during the period under scrutiny were recruited for this study through

associations and institutions for the elderly. This sample was constructed according to the

demographic characteristics of the two cities. The intention was to ensure that the

demographic characteristics of the sample reflected those of the population of the canton.

As shown in Table 2, between 1950 and 1970, the mean age of Swiss individuals at

marriage was 24.5 years for women and 26.4 years for men. Total fertility rates are higher

in our sample than in the cantonal averages. The total fertility rates in 1960 were 1.97 in

Fribourg and 1.49 in Lausanne. Childless couples, who are not represented in the sample,

could partially account for these differences, as could the use of the average number of

children, which obscures the chronological evolution of these indicators.

All interviewees came from the working or lower-middle classes. This study

conjectures that couples from the upper class had already reduced their family size

(Wanner & Fei, 2004, pp. 23–27; Oris & Duvoisin, 2013, p. 10). In the sample, nearly all

respondents from Fribourg were Catholic. There were more Catholics in Lausanne

because there was substantial immigration from the Catholic cantons to the Protestant

ones. These figures were in line with the religious compositions of the two cities. Between

1950 and 1970, 90% of the Fribourg population was Catholic. In Lausanne, 71% of the

population was Protestant in 1950, whereas 25.5%was Catholic. In 1970, the proportion of

Protestant inhabitants fell to 54.6%, whereas the proportion of Catholics increased to 40%.

The high number of migrants from Catholic countries and cantons who came to live in

Lausanne between 1950 and 1970 explains this increase (see Table 2). A study of

Switzerland conducted in 1964 (Boltanski, 1966) revealed that church attendance was

higher among Catholics than among Protestants.

Reproductive behavior and contraceptive practices in comparative perspective 47

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Table 1. ID of individuals from Fribourg and Lausanne.

ID Name ofindividualsfrom Fribourg

Dateof birth Place of birth

Dateof marriage

Date of birthof children

Husband’ssocio

professionalcategories

A, B C, D* . . .

1F Chantal 1936 Fribourg 1959 1960,1961,1967 B2F Sylvie 1933 Fribourg 1958 1961,1963 E3F Denise 1937 Fribourg 1964 1965,1968 D4F Jacques/Annie 1921/

1923Rechthalten/Fribourg

1960 1961,1962,1963,1966,1971

E

5F Carlo 1935 Italy 1960 1962,1965,1970 B6F Sophie 1924 Wallenried 1948 1949,1953,1961 D7F Claudio 1943 Italy 1969 1969,1971,1973 C8F Marie 1927 Fribourg 1958 1958 A9F Josette 1937 Fribourg 1954 1955,1959, 1963 A10F Stephanie 1924 Enney 1944 1945,1950, 1956 E11F Hans/Bernadette 1934/

1936Laupen/ Vaud 1962 1970,1972 C

12F Leonie 1926 Fribourg 1951 1953, 1957, 1959 D13F Marie-Jeanne 1944 Estavayez-

Le-Lac1964 1964,1966 E

14 F Francesca/ Silvio 1940/1938

Italy 1961 1962, 1967 E

15 F Georgette 1933 Etoy (VD) 1955 1955,1959,1961,1962

D

16 F Rene 1943 Lugano 1964 1965, 1967,1969, 1977

D

17 F Yvonne 1944 Marly 1966 1971 C18 F Davide/Carla 1936/

1943Italy 1969 1971 twins E

19 F Andrea 1927 Grison 1950 1952,1953,1959 A20 F Adelaıde 1928 Fribourg 1953 1953, 1954,

1957, 1965D

21 F Anne-Sophie 1929 France 1955 1956, 1957,1962, 1966

A

22 F Giorgio 1940 Italy 1968 1970, 1972 E23 F Filipe 1936 Italy 1966 1968,1972 E24 F Pascal 1942 Fribourg 1967 1968,1972 E

ID Name ofindividualsfrom Lausanne

Dateof birth

Placeof birth

Dateof marriage

Date ofbirth ofchildren

Husband’ssocioprofessionalcategoriesA, B C, D

25L Franc�ois 1935 Tramelan 1959 1965,1968 D26L Donatella 1942 Italy 1961 1962,1965 D27L Lotti 1944 Buch 1965 1968,1971 C28L Annette 1942 Bruxelles 1965 1967,1969 B29L Marlyse 1932 Renens 1954 1956,1961,1965 B30L Helene 1947 Lausanne 1964 1964,1968, 1974 E31L Christiane/Paul 1938,

1937Swiss-German/Lausanne

1958 1959,1961,1962,1964

D

32L Monique 1939 Lausanne 1963 1965,1968 D

(continued)

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The second type of material used in this study is written sources reflecting the views on

birth control of the medical communities of the two cantons under study. As mentioned

above, institutional constraints were a determinant of access to birth control. For the period

studied, scholars have suggested that physicians replaced priests as important actors in

issues relating to birth control (Usborne, 1992). This is why it is important to document

Table 1 – continued

ID Name ofindividualsfrom Fribourg

Dateof birth Place of birth

Dateof marriage

Date of birthof children

Husband’ssocio

professionalcategories

A, B C, D* . . .

33L Ricardo/Valerie 1944,1946

Italy, Lausanne 1969 1969 D

34L Martine 1930 Paris 1955 1960,1963 B35L Sandrine 1935 Roveray 1959 1962,1965,1967 C36L Nathalie 1930 Lausanne 1955 1957,1961,1964 E37L Ines 1939 Lausanne 1956 1960,1964,1966 B38L Laurence 1937 Lausanne 1960 1956 E39L Dominique 1932 England 1955 1956,1958,

1959,1967A

40LVeronique 1940 Lausanne 1964 1966,1969 A41L Jose Maria 1936,

1936Spain 1960 1964,1968 E

42L Serge 1946 Moudon 1968 1970 E43L Suzanne 1930 Jongny

sur Vevey1951 1952,1955,1959 D

44L Ruedi 1930 Hoftringen 1955 1955,1958 E45L Benjamin 1925 Tessin 1952 1955,1958 A46L Jean 1933 Lausanne 1958 1959,1962 E47L Bernard 1945 Ennens 1966 1966,1969 D48L Antonio 1937 Italy 1966 1967 E

*Category A: Tradesperson, shop or business ownerCategory B: Manager, accredited professionalCategory C: Intermediate occupationsCategory D: Administrative, sales or service occupations, employeesCategory E: Manual labourer

Table 2. Description of the sample.

Fribourg Lausanne

Mean age of individuals at marriage 23 25.1Average number of children 2.70 2.25Mean age of individuals at marriage for those married before 1961 24.9 23.15Mean age of individuals at marriage for those married after 1961 25.36 22.63Average number of children for those married before 1961 3.15 2.62Average number of children for those married after 1961 2.18 1.81Number of wives working (full or part time) during the marriage 16 15Number of Protestants 2 14Number of Catholics 22 6Number of individuals not religious 0 2Number of individual with other religion 0 2Number of intra-national migrants 7 8Number of inter-national migrants 7 6

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physicians’ attitudes toward birth control in each Canton because medical practices and

professional culture may have varied across cantons. This variation may have been the

result of different religious cultures.

To evaluate and document the hypothesis that religious norms had an influence on

gynecologists, their publications were analyzed. All gynecologists practicing in the two

cities were identified, and articles they wrote concerning birth control issues that were

published in the medical journals of the French part of Switzerland between 1955 and

1970 were collected.

4. The religious impact on access to birth control

Historical demographers have characterized the impact of religion on reproductive

behavior as twofold (McNicoll, 1994; McQuillan, 2004; Praz, 2005). First, religion

strongly conditions personal beliefs, as illustrated in particular by the adherence of the

interviewees to the Church’s doctrine and the norms governing sexuality and birth control.

Second, the impact depends on ‘the significance of social institutions for translating

religious values into an active force in the lives of the faithful’ (McQuillan, 2004, p. 32).

Against this background, this paper first assesses the interviewees’ adherence to Church

doctrine and, second, examines the way that social institutions (gynecologists, in the present

case) constrained individuals to the use of methods authorized by the Catholic Church.

This section asks whether individuals were aware of the position of the Church. Did

they follow religious rules or norms concerning birth control? Did priests attempt to force

individuals to confess their birth control practices? Finally, did religion increase the moral

costs of contraception? To assess the interviewee’s adherence to religious norms, this

paper examines the way individuals defined themselves with regard to religion and

religious precepts. Among Protestants, only half of the respondents reported that they were

practicing believers. Among Catholics, 75% of respondents defined themselves as

practicing believers and reported attending church on a weekly or monthly basis. The other

25% affirmed having distanced themselves from the Church. Among the latter, three

women did so because of a disagreement with its teachings.

However, the fact that individuals defined themselves as practicing believers does not

necessarily mean that they were aware of and adhered to religious precepts related to

sexuality. Protestant respondents were aware of the Church’s position on issues related to

birth control. They stated that the Protestant Church was open to birth control and left

believers free to decide whether they wished to limit the size of their families and which

methods to employ. The following account illustrates this awareness. Monique was born in

1938 in Lausanne. In 1963, she married a post office employee. They had two children in

1965 and 1968. Monique defined herself as a Protestant but explained that she was linked

to the Church by tradition rather than by a personal attachment:

– I was wondering if there were any religious rules about birth control from the ProtestantChurch?Monique: No, there weren’t any, not from the Protestant Church.3

Strengthening these assertions, Protestant respondents emphasized that the Catholic

doctrine was more restrictive than the Protestant doctrine. One example is the testimony of

Jean, born in 1933 in Lausanne. Jean was trained as a skilled worker and married a Swiss

German woman in 1958. They had two children in 1959 and 1962. Jean used withdrawal

during his entire matrimonial life because he was confident in this method. He defined

himself as a practicing Protestant:

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– Did the Protestant Church have a specific position on birth control?Jean: No, it did not. The Protestant Church thought that it was a matter about which only thecouple should decide. The Protestant Church even recommended not having big families.I mean, that was exactly the opposite of the Catholic Church.4

Catholic believers, by contrast, were occasionally unaware of the Church’s position on

birth control. Despite wide diffusion of the doctrine of the Church (especially in Fribourg,

where the majority (22) of the respondents were Catholic), some respondents tended to

ignore the strong condemnation of birth control (four of 22). They explained that priests

did not address this subject during Mass.

However, for those who were aware of the Catholic Church’s condemnation of birth

control, their adherence to this doctrine was not strong enough to prevent them from using

birth control. Although 75% of the interviewees affirmed that they were practicing

Catholics, most of them used methods of birth control condemned by the Church. This

detachment from the teaching of the Church was apparent through three main indicators.

First, we identify an explicit refusal to follow the rules of the Church on issues relating

to birth control. The majority of respondents (18 of 28) did not feel a moral obligation to

abide by these rules. They knew that Church doctrine condemned all methods of birth

control with the exceptions of the rhythm method and abstinence, but they asserted that

they did not take this condemnation into account when deciding to use birth control, as

illustrated in the following account. Bernard was born in 1945 in the Fribourg countryside.

He studied at a Catholic school and then completed an apprenticeship as a postman in

Geneva. His girlfriend became pregnant, and they decided to marry in 1966 and moved to

Lausanne. They had two children. His wife took the birth control pill, and when they

decided that they did not want another child, Bernard underwent a vasectomy:

– Did the Church have a specific position on birth control at that time?Bernard: Yes, we were taught that the Church didn’t allow it. In fact, regarding the issue ofbirth control, we didn’t take it into account. I mean, even in a Catholic canton, we didn’t listento the priests.5

Second, some respondents resorted to personal justifications to legitimize their refusal to

follow the doctrine of the Church. Being able to raise children adequately and financial

capacities were presented as justifications for the use of contraceptive methods.

The testimony of Stephanie is illustrative of this justification. Stephanie, born in 1924 in

the Fribourg countryside, was raised by her grandparents, who encountered financial

difficulties. She married an unskilled worker in 1944. They had three children, although

the last one was an ‘accident’. Stephanie combined the rhythm method with withdrawal.

She emphasized that she was aware of the condemnation of the Church, but she

consciously transgressed it because of her financial situation:

When we married, the priest asked us to confess. We had to go to see him. I directly told him,‘I would like to have children, I want to, but according to the money I have’, I said, ‘I don’twant to give birth to children if they have to deprive themselves’. He looked at me: ‘Do younonetheless want children?’ I said, ‘Yes, but we need to consider our salary, to see if we areable to provide for them, to give them an education if they want to’. I will always rememberbecause he winced!6

Finally, this detachment is also evident in a few believers’ assertions that birth control

belonged to individuals’ private domain. Consequently, the Church did not have the

authority to debate or interfere with it. One such example was provided by Jose and Maria,

a Spanish couple born in 1936 in Spain in the same village. They married in 1960, moved

to Switzerland and worked as an unqualified worker and a taxi driver. They had two

children and used condoms their entire matrimonial life:

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– Didn’t it bother you that the Church condemned all methods of birth control apart from therhythm method?Maria: Not at all.Jose: As I told you, I had my points of view, and I didn’t like the fact that the Church meddledin those private things. The Church had enough to do with other things . . . 7

This excerpt refers to privacy, a topic that has already been underlined in the study of

Szreter and Fisher (2010, pp. 348–363). Historical studies have examined the practice of

confession and the refusal to grant absolution as a way to increase the moral cost of

contraception (Gervais & Gauvreau, 2003). Among the Catholic interviewees, the

majority (75%) did not confess, and those who did declined to address this specific subject

and affirmed that the priest did not ask questions on this topic. This silence is consistent

with the findings of Somers and Van Poppel, who reported the testimony of a priest active

in the Netherlands between 1935 and 1970: ‘You didn’t want to scare people away from

the Church. It was one thing to tell them off for what they were doing wrong, but you

didn’t want people to keep away from the Church’ (Somers & Van Poppel, 2010, p. 78).

Only four respondents confessed their birth control practices. Two women asserted

that they sought absolution for their sins because they felt guilty regarding the use of birth

control. For instance, Sophie, born in 1924 in the Fribourg countryside, regularly attended

church. She married a railworker in 1948 and had three children. She confessed to

resorting to withdrawal:

It was always incomplete, he withdrew. And we had to confess it. I mean, because we werepracticing believers, we confessed before the main ceremonies. When we were kids we wentmore often, but . . . as adults we confessed according to our will. I mean, that was inside us, butmaybe I was also a bit stupid to tell them about that.– What was the reaction of the priest?Once a priest from another parish said something different. He said that was not really a sin,that was not serious at all, as long as there was love. I thought that he must be very smart.I thought he found me a bit too scared . . . 8

The reaction of the priest demonstrates that the clergy did not always act in accordance

with official church doctrine. This priest seemed to recognize the necessity of expressing

mutual love between a husband and wife.

The women who confessed themselves received absolution. None of the interviewees

reported that priests refused to grant absolution to coerce believers into avoiding using

birth control. The moral cost of using birth control for these women seemed to be high

enough to lead them to confess but not high enough to eventually lead them to comply with

the doctrine of the Church.

This study reveals a gap between the teachings of the Catholic Church and the

behavior of believers, whether they were Swiss or migrants, who used methods of birth

control condemned by the Catholic Church. Other scholars have found evidence of such a

discrepancy during the same period (Dalla-Zuanna, 2011; Gervais & Gauvreau, 2003;

Sevegrand, 1985).

Although Catholic teachings were unable to strongly influence the interviewees’

behavior, the same teachings were much more effective in dissuading Catholic

gynecologists in Fribourg from providing information on modern methods of birth control.

In contrast, the gynecologists in Lausanne were willing to provide information on birth

control. This situation partially explains why the contraceptive pill was used less

frequently in Fribourg.

In Lausanne, many gynecologists published articles in medical journals or gave public

talks in favor of providing better information on birth control. They considered birth

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control information a means of avoiding unwanted pregnancies and abortion. For instance,

the gynecologist Dubuis wrote, ‘Physicians have to spread the doctrine of birth control as

often as possible in private and in public spheres and have to explain how to apply it’

(Dubuis, 1957, p. 354). In line with this claim, Professor Merz, director of the maternity

ward in the cantonal hospital of Lausanne, called for the widespread dissemination of

information on birth control methods to combat criminal abortions. He wrote, ‘It is not

enough to recommend that patients avoid pregnancy, physicians must tell them how to

avoid becoming pregnant again’ (Merz, 1957, p. 77). Physicians from Lausanne conducted

several studies on the subject of abortion in which they identified public ignorance of birth

control methods as the main cause of the increase in the number of abortions (Desmeules,

1954; Getaz, 1962; Rochat, 1957).

The local context, specifically the fact that Protestant authorities in Lausanne were in

favor of birth control, may account for this openness on the part of Lausanne

gynecologists. Among the interviewees, 11 women of the 17 living in Lausanne reported

having obtained information from their gynecologist. For instance, Lotti born in 1944 in

the German-speaking part of Switzerland, married to an educator in 1965, explained: ‘My

husband and I were informed about everything we could do if we did not want children

right away, and I was able to discuss this with my gynecologist’.9

Whereas gynecologists in Lausanne were convinced of the necessity of birth control

education (Lausanne women were given any information they requested), Fribourg

gynecologists only provided information on the rhythm method, the only method

authorized by the Catholic Church. The adherence of Fribourg gynecologists to the

teachings of the Church was perceptible through two elements. First, all Fribourg

gynecologists were members of the Medical Society of the Canton of Fribourg, which

maintained close relationships with the Church. A letter from the president of this society

to the secretary of the bishopric of Fribourg testifies that the president shared the Church’s

position on birth control practices; he asserted that doctors had to remind their patients of

the Catholic Church’s prohibition of birth control methods10. Second, Fribourg

gynecologists maintained close relationships with religious authorities at an individual

level. For instance, in 1955, Doctor de Buman was invited by the pastoral theology

department of Fribourg University to give a speech on the subject of health within

households. Another gynecologist, Marius Nordmann, wrote numerous articles in parish

journals between 1962 and 1963 promoting the temperature method and condemning

mechanical and chemical methods of birth control (Nordmann, 1962a, 1962b, 1963).

He also gave talks organized by the Catholic authorities of Fribourg a few times a year

during the regular marriage preparation days.

The adherence of Fribourg gynecologists to the teachings of the Church is

corroborated by our interviews. Five women of 18 in Fribourg claimed they were not given

any information on methods of contraception because ‘the gynecologist thought it was

good when a family had many children’11. Some gynecologists refused to prescribe the

contraceptive pill to their patients even though these women wanted no more children.

Josette is one such example. Born in 1937 in Fribourg, she married a mechanic in 1954.

They had had three children, although Josette would have preferred only two:

After my third child was born, I told the doctor, ‘Listen, Doctor de Buman (who was reallyconservative), I’ve had three children and I’m not in good health.– Yes, he said, you have to avoid getting pregnant again.– How am I going to do that? I know that there is the contraceptive pill!– But your legs are not in a good state. I cannot prescribe the contraceptive pill to you.– That bothers me, I said.

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– Well, it is what it is! Either you take responsibility or you restrain your pleasure!Those were the words of the doctor. My husband was not so happy because he needed towithdraw!12

The gynecologist de Buman justified his refusal to prescribe the contraceptive pill on

medical grounds. He suggested that Josette use a natural method of birth control. This

extract shows that Josette and her husband discussed the advice given by the physician.

She was eventually prescribed the contraceptive pill, but by her rheumatologist rather than

her gynecologist. Another woman emphasized the difficulty in obtaining the contraceptive

pill at that time. She explained that before 1970, the contraceptive pill ‘was difficult to

obtain’13, but after 1970, she gained access to it. The Fribourg respondents obtained the

contraceptive pill after 1966, whereas Protestant respondents had been given the pill since

its distribution began in 1962.

Adelaıde was born in 1928 in Fribourg and married a salesman in 1953. They had four

children, although she wanted only one child. She attributed her gynecologist’s refusal to

prescribe the contraceptive pill to his adherence to Catholic doctrine:

I didn’t have the contraceptive pill! I had nothing! That’s true. Doctors did not help us! Theydid not explain a thing!– Did you know that the contraceptive pill existed?Of course! But they wouldn’t give it to us.– Why?Because of the Church. They were Catholics.14

As a result, Adelaıde stopped attending church. However, she did not give up, and she

asked her gynecologist for the contraceptive pill several times and was eventually

prescribed it: ‘I asked several times, and after the birth of my fourth child, my gynecologist

eventually agreed to prescribe the contraceptive pill to me! Eventually!’

The previous example is indicative of Fribourg gynecologists’ reluctance to provide

information on modern methods of birth control. This example also demonstrates

women’s agency in issues related to birth control and relationships with the medical

profession when they actively sought the contraceptive pill.

5. Responsibility for birth control

The responsibility for birth control can be identified in two areas: access to birth control

information and means, and an individual’s influence in decision-making regarding birth

control. Regarding the former, this paper distinguishes between information gained prior

to marriage and information gained during the course of marriage. The latter can be

inferred by assessing (i) whether birth control was a topic of discussion between spouses,

(ii) which spouse was deemed responsible for birth control, and (iii) which spouse was the

initiator of birth control.

In our sample, 45 respondents out of 48 explained that sexuality and contraception were

taboo topicswithin their family of origin. They did not approach this subjectwith their parents

and claimed to be ignorant of these issues during their childhood and adolescence. As a

consequence of this taboo, several female respondents mentioned distress when they began

menstruating. Sylvie’s testimony provides an illustrative example. She was born in 1933 in a

working class family in Fribourg. After training in sales, she married her husband, a truck

driver, in 1958. They had two children. Sylvie recalled the first time she discovered she was

bleeding and reported that her mother did not give her any explanation of this situation:

The first time I had my period I went back home from school, crying. I did not know whathappened to me. My mother had never told me about menstruation. Then I told her, and she

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just replied that I would have that every month. But she did not explain a thing to me! It wasawful!15

Consequently, the respondents had to find other ways to gain information on sexuality.

Before marriage, most men acquired information on birth control ‘by experience’ or through

discussions with friends, whereas more than half of the female respondents (20/35) had no

information at all. Of the interviewees, 15 women actively sought information on birth

control before marriage by turning mainly to books (seven) they purchased (six) or received

(one), to friends (five) or to physicians (three). Two women gave the specific titles of these

books, whereas the other five affirmed that they were written by physicians but could not

remember the exact titles. Swiss and German physicians wrote the two books cited in the

interviews during the interwar period. The fact that the authors were Swiss and German

physicians gave these books scientific legitimacy. They were originally written in German

and translated into French. These books seem to have had a large circulation: 12 editionswere

found for Le chemin sur la hauteur16, authored by Hans Hoppeler, a Protestant physician

from Zurich, and 15 were found for Notre vie sexuelle, ses problemes, ses solutions, manuel

pratique pour tout le monde17, authored byFritzKahn, aGerman gynecologist. The first book

was explicitly addressed to women who wished to become good wives, whereas the second

targeted couples. These books covered issues related to birth control and described the

available methods of contraception in detail. Although these advicemanuals were opposed to

the use of withdrawal, they nonetheless described this method. According to our

interviewees, these books were available in bookshops. The women (nine) who confessed to

having had sexual relations before marriage found themselves pregnant and had to marry to

either repair or conceal the fault. Thus, no women mentioned premarital sexual experiences

as a means of gaining information on birth control.

Although the results suggest that men were better informed at the beginning of the

marriage, this situation seems to have reversed during marriage. Of the respondents, 19

reported that their wives obtained information through books they bought (two), through

friends (three) and through medical channels (14) during marriage.

Most respondents emphasized the importance of communication between spouses

regarding issues related to birth control. A total of 36 respondents asserted having

discussed with their spouse the need to limit the size of their family, whereas 12 reported

never having done so. Among the latter, four never used any method of birth control, and

two faced problems with sterility. One of these couples had five children, and the other had

several miscarriages.

The lack of communication on birth control occasionally induced frustrations and

tensions within the married couple, as illustrated by the example of Adelaıde quoted

above. She expressed her anger toward her husband, with whom she could not discuss this

subject and who was not careful enough to avoid additional pregnancies. Adelaıde

struggled with financial problems throughout her matrimonial life. Her husband did not

earn enough to meet the basic needs of the household. As a result, Adelaıde had to work

and encountered difficulties finding a place where her children could be looked after

during the day. Due to her lack of financial resources, she needed to limit the size of her

family. She had four children, although she did not want more than one:

– Could you speak with him about birth control?No I could not speak with him about that! He didn’t care! I told him to be careful, but he didn’tput it into practice. I would not like to go back to this period of my life. I was not happy!18

The fact that the majority of the couples claimed to have discussed the necessity of

limiting the size of their family with one another suggests that although birth control was a

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taboo topic before marriage, as we have shown, it acquired legitimacy within the marital

couple. Suzanne provides one such example. Born in 1930 in the Lausanne countryside,

Suzanne married her husband, a railway worker, in 1951. They had three children.

Suzanne underlined the taboo that birth control and sexuality represented in her family of

origin but stressed having had free discussions with her husband:

My parents had never told me anything. It was a taboo topic. But with my husband, I alwaysspoke openly. I mean, I had an open personality. We always spoke FREELY about love andreproduction. We were very open with each other.– Did you choose together which method you would use?Yes, we did. Of course we chose together. Yes, together, yes.19

The emphasis on communication by the respondents from both cities suggests that

religious difference does not emerge as a crucial factor in this respect. However, this result

concerning communication differs from Kate Fisher’s findings on Britain earlier in the

century (1918–1960). Without providing exact numbers, Fisher affirmed that ‘many

respondents stressed the limited nature of explicit discussion of family planning aims and

contraception’ (Fisher, 2000, p. 306). This finding is in line with those reported by Robert

(1985) and Gittins (1982) and supports the hypothesis that the cultural or regional context

shaped different gender cultures, which led to diverse forms of birth control decisions or

communication.

The fact that spouses discussed birth control does not necessarily mean that they jointly

assumed responsibility for it. Birth control was either a shared spousal responsibility (20 of

48) or a female responsibility (19 of 48); it was rarely solely a male responsibility (3 of 48).

Among the 36 respondents who claimed to have discussed with their spouse the need

to limit family size, 20 respondents affirmed that birth control was a shared spousal

responsibility. They referred to discussions and decisions regarding birth control methods

in a favorable light and asserted that they reached agreement with their spouse on the need

to limit family size and the choice of method. Some interviewees reported having jointly

decided which method they would use with their spouse after having read newspaper

articles and books on the various contraceptive methods. Based on information garnered

from these articles, they tested different methods of birth control.

A total of 19 interviewees, 16 women and three men, asserted that women were in

charge of birth control. The excerpt from Monique’s interview illustrates this female

responsibility. Monique was born in 1939 in Lausanne. She studied at a business school

and worked as an accountant until she married a post office employee in 1963 at the age of

24. She stopped working to care for the children, and while they were growing up, she

worked one day per week as a music teacher from home. Monique reported she did not use

any method of birth control before the birth of her first child in 1965 because she had

experienced difficulties becoming pregnant. Then, to space her births, she asked her

gynecologist for advice. He prescribed the contraceptive pill to her. She used this method

as a way to control and eventually stop her fertility because she did not want more than two

children. This situation demonstrates that she was responsible for birth control:

I asked my gynecologist for birth control.– Ok. Did you discuss it with your husband?Oh, you know, my man was not interested in this topic. If I decided something he wouldfollow. It was not like today. At that time, it was a female responsibility to deal with fertility.Men did not know what to do about that . . . 20

Of these women, four decided to use modern methods on their own without informing

their husbands, and four women decided which method they would use before informing

their husbands. Of these eight women, two had information prior to marriage, and the other

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six gained information on birth control during their marriages from their gynecologists

(three) or through discussions with friends (three).

Only in three cases did the husband take responsibility for birth control. In these cases,

the wives pretended to be completely ignorant on the subject, and the husbands had

obtained knowledge prior to marriage and decided which method to use.

Finally, the initiator of birth control practices within the marital couples gives us

insight into the responsibility for contraception. Although withdrawal was a male

responsibility, the wife could initiate it.

Of the interviewees, five women affirmed having taught their husbands how to use

withdrawal because they had knowledge of the subject through books (four) and

discussions with friends and family (one) before marriage. For instance, Sophie, who was

born in a peasant family in 1924 in the Fribourg countryside and married a stationmaster in

1948, bought a book on birth control before her marriage and explained to her husband

how to avoid pregnancy by withdrawal because she did not want a ‘house full of

children’21. Ultimately, they had three children. Another example is Suzanne quoted

previously22. Suzanne bought a medical book on birth control when she was a teenager and

explained to her husband how to practice withdrawal. They had three children, although

they would have preferred only two.

Of these women, three also used partial abstinence. They calculated fertile days and

avoided having sexual intercourse during that time. These women reported that their

husbands ‘became angry’ when they refused sexual intercourse, suggesting that

negotiations regarding sex did not always end in agreement. A way to avoid these tensions,

as explained by the same women, was to go to bed late in the evening when the husband

was already asleep. This form of abstinence was presented as something imposed by the

wife. The example of Sophie shows that wives motivated the impulse toward the use of

abstinence. Sophie explained that she imposed abstinence on her husband: ‘I had to

prevent intercourse; otherwise I would get pregnant all the time’23.

Szreter and Fisher identified different forms of abstinence and found that couples used

abstinence in exactly one-half of cases (Fisher & Szreter, 2003, p. 235). In half of these

cases, wives imposed abstinence on their husbands. In line with this result, Hera Cook

(2004, p. 156) demonstrated that abstinence was particularly widespread during the

interwar period because no effective contraception was available. In addition, working-

class individuals associated large families with sexual indulgence; thus, abstinence was

the only effective means of limiting family size. However, the results of this paper differ

from those cited above because only six interviewees (all from Fribourg) explicitly

reported using partial abstinence as a way to avoid pregnancy.

Either spouse could initiate the use of birth control during the marriage in an effort to

share responsibility for birth control. Some individuals asserted having tested different

methods with their spouse according to the knowledge and experience they had. For

instance, one couple used a contraceptive powder recommended by the husband before the

wife began taking the contraceptive pill (prescribed by her gynecologist). Due to the side

effects of the contraceptive pill, they ultimately decided that the husband should undergo a

vasectomy.

Due to increasing ease of access to information regarding birth control during

marriage – especially through ever-expanding recourse to medical advice – women were

better informed and either gradually assumed the responsibility for birth control within the

marital couple or were active in the decision-making process. The testimony of Felipe

attests to his wife’s progressive participation in decision making regarding methods of

contraception as she obtained better information. Felipe was born in Italy in 1936.

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He emigrated from Italy in 1960 and worked as an unqualified worker in Fribourg.

He married a fellow immigrant in 1966, and they had two children in 1968 and 1972:

–Did your wife calculate the fertile days?Yes, she did as soon as she gained information thanks to her gynecologist. She was givenbrochures by him explaining diverse methods, things like that. It is clear that these brochureshelped us. Before that she was ignorant24.

Gynecologists facilitated the acquisition of information on birth control. They became

crucial actors in the distribution of information. Contrary to British evidence, which

suggests that men actively sought medical advice during the interwar period (Davey,

1988), the Swiss men in our sample did not ask their doctors for contraceptive information.

This could be because there was no gender culture in place that gave men the

responsibility for birth control in Switzerland. In addition, it was only from 1955 onward

that gynecologists addressed the issue of birth control and primarily targeted female

patients. Only three men approached their practitioners when they wished to be sterilized

as a way to prevent childbirth.

6. Choices of methods of contraception

The period under investigation witnessed changes in birth control options after the

contraceptive pill became available in 1961. This section documents the way couples

chose birth control methods by analyzing the arguments advanced by interviewees to

justify their choices. The aim of this paper is not to conduct a statistical analysis on the use

of birth control but rather to identify, by recourse to interviews, the discussions,

arguments, negotiations and strategies that led individuals to choose specific method(s) of

birth control or to switch from one method to another. In selecting birth control method(s),

individuals weighed what they considered the ‘quality’ of their sexual lives or good

sexuality and the efficiency of the methods. These elements were identified through three

main arguments that the interviewees presented as justifications for their choice of specific

methods of birth control: the emphasis placed on the valorization of natural methods of

birth control, the level of motivation to prevent fertility and social taboos. Only four

respondents, two from Fribourg and two from Lausanne, claimed to have not used any

method of birth control, modern or traditional.

6.1. Natural methods of birth control

The emphasis on the valorization of natural methods of birth control and their widespread

use among interviewees (more than half of the interviewees) was particularly striking.

This element contributed to the quality of the sexual lives of the interviewees. However, it

was difficult to determine what individuals meant by natural methods of birth control (one

woman cited sterilization as a natural method). In this example, natural was not linked to

nature.

Natural methods of birth control meant that they were ‘natural’ as opposed to modern

methods of birth control that modified the natural processes of the body, such as the pill or

the IUD. This interference in the natural processes of the female body was perceived as

frightening for numerous individuals. Women were reluctant to use the contraceptive pill

because it was deemed unnatural. They were afraid of its influence on their bodies and,

more specifically, of the side effects, such as cancer, disabled children or weight gain. For

instance, Felipe, born in 1936 and married in 1966, mentioned periodic abstinence as his

only method of contraception during his matrimonial life because his wife did not want to

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take the contraceptive pill: ‘She wanted natural methods of birth control. She was afraid of

using the contraceptive pill and the fact that it could result in having disabled children’25.

Another example is that of Yvonne, born in 1944 and married in 1966 to a hairdresser who

would become a socio-educator during the course of their matrimonial life. Yvonne

presented the ‘naturalness’ of the rhythm method, which they combined with withdrawal,

as the main advantage of these methods: ‘I used natural methods of birth control because I

did not want to introduce a foreign element in my body such as an IUD’26. She explained

her fears concerning the contraceptive pill: ‘I did not want to take the contraceptive pill, to

ingest a medicine. I had the feeling that it would hurt my body. That was not natural’. She

had only one child. At 40 years old, she believed that she was pregnant, but she was not.

As a result, she decided to be sterilized to be certain of not becoming pregnant again. Thus,

Yvonne did not perceive sterilization as an unnatural method of birth control, in contrast to

the pill. Another example is that of Franc�ois. Born in 1935 in the Bern countryside, he was

trained as a carpenter. He moved to Lausanne, where he married an unqualified worker in

1959. Because they wanted to postpone the birth of their first child to be able to settle

properly, they used condoms because of their efficacy. After the birth of their first child,

the wife’s gynecologist prescribed the contraceptive pill. Although this method was less

restrictive for Franc�ois, his wife experienced headaches and nausea. Thus, they decided to

return to condoms: ‘The pill, I mean it was easier, my wife took it in the morning and that

was it! But it was chemical and had side effects. Thus, we decided to use condoms

again’27. For Franc�ois, condoms appeared to be a ‘natural method’ because they had no

side effects.

This discourse on the side effects and health risks of the contraceptive pill reflects the

public discourse on the subject that prevailed at that time. In addition, these excerpts seem

to corroborate the observation that the early contraceptive pills were high-dose pills with

numerous side effects (Marks, 2001). The cohort effect was of particular significance in

the use of the contraceptive pill. As depicted in Figure 1 below, women born between 1936

and 1950 (specifically, all of the women from Lausanne born in the period of 1941–1950)

were more likely to use the contraceptive pill than women from previous cohorts, who

regarded the contraceptive pill with suspicion. Among the respondents from the youngest

cohort, which used the contraceptive pill in greater numbers, the notion that the

contraceptive pill was unnatural was not mentioned in the interviews. Thus, the cohort

effect was particularly meaningful because these women came from a younger generation

for whommedical practices and the intrusion of science into the body may have been more

accepted and tolerated than in previous generations.

As noted by several respondents, natural methods of birth control also meant methods

that did not interfere with sexual intercourse. Interviewees perceived these as spontaneous

methods that guaranteed the quality of intercourse. For instance, Marie-Jeanne, born in

1944 in the Fribourg countryside, used withdrawal before her marriage but became

pregnant in 1964 and was forced to marry. Although this method failed, she continued

using withdrawal because she appreciated the fact that this method did not require any

particular preparation: ‘All these arrangements [regarding the condom] destroyed the

spontaneity! No, I rather liked withdrawal’28. It is notable that Marie-Jeanne did not

perceive withdrawal as a method that destroyed spontaneity. Another example is that of

Sophie, born in 1924 in the Fribourg countryside, who married a railway worker in 1948.

She explained that she used periodic abstinence and withdrawal because these methods

were easy to use and spontaneous, as opposed to modern methods such as condoms.

Sophie’s husband once attempted to use a condom ‘but didn’t know how to wear the

condom correctly. That was too complicated!’29.

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As illustrated in Figure 2, which displays the types of methods used across cities,

traditional methods were more widespread in Fribourg than in Lausanne.

Fribourg respondents underlined the ‘naturalness’ of these methods as their main

advantage without referring to religious arguments (with the exception of Anne-Sophie,

who was a practicing Protestant in the Evangelical Church and referred to children as a

blessing). The Fribourg Catholic environment, in which natural methods of birth control

were valued and knowledge of the rhythm and temperature methods was primarily

transmitted by gynecologists, may explain why the Fribourg interviewees were more likely

to use these methods. Thus, religion may have impacted individuals’ representations of

their methods of birth control through an environment that valued natural methods of birth

control, although the individuals were not aware of this element and did not refer to it.

6.2. Motivation to limit family size

The different levels of motivation to limit family size or to attempt to space births were the

second line of argument that encouraged individuals to change methods of birth control.

Individuals who did not express a particular motivation to stop their fertility but

desired to postpone or space out births were likely to use traditional methods of birth

012345678 1921-1925

1926-19301931-19351936-19401941-19451946-1950

012345678

1921-1925

1926-1930

1931-1935

1936-1940

1941-1945

1946-1950

Figure 1. (a) Methods used according to the cohorts in Fribourg; (b) Methods used according to thecohorts in Lausanne.

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control because of the uncertainty of those methods. Lotti, who was born in 1944 in the

German-speaking part of Switzerland, married an educator in 1965, and they moved to

Lausanne. Lotti began using the temperature method: ‘It was when we knew that we would

like another child. We said, “No problem if it fails”’30. This wish to postpone birth without

a strong motivation to stop fertility explained why several couples persisted in using

unreliable methods of birth control; the birth of another child was not a disaster but rather

something they were attempting to avoid. For instance, the respondents (three from

Fribourg and one from Lausanne) who only used a combination of withdrawal and

periodic abstinence came from the oldest generation (born between 1924 and 1930) in the

sample. These four individuals perceived traditional methods as reliable. Although three

of them conceived additional children while using these methods, they did not change their

methods of birth control in favor of more efficient ones because an additional child was not

perceived to be a disaster. These ‘accidents’ were not dramatic or perceived as ‘failures’ of

the method; instead, individuals placed the blame on the fact that the wife had been ill at

the time, which could have disturbed her menstrual cycle.

When the motivation to stop fertility was very strong, individuals turned to efficient

methods of birth control, such as the contraceptive pill or sterilization, and exhibited

stopping behavior. An interesting result of this study is the prevalence of sterilization,

especially male sterilization. As its main advantages, sterilization guarantees efficacy and

the quality of sexual intercourse. Of the respondents, 21 elected or were forced to undergo

sterilization. As shown in Figures 1 and 2, male (11) and female (10) sterilization was

strikingly widespread in the sample. Only three women asserted that their husbands refused

to be sterilized because they were afraid that they would lose part of their masculinity.

In Lausanne, male sterilization (seven) was more widespread, testifying to the openness of

Lausanne gynecologists on this issue. It appears that male sterilization resulted from a joint

decision between spouses (five) or was initially suggested by gynecologists (five) or, in a

single case, by the wife. Nevertheless, male sterilization required communication and

debate within the couple and testifies to a strong motivation to stop fertility.

An example of a strongmotivation to stop having children that justifiedmale sterilization

is that of Chantal31. Born in 1936 in Fribourg, she completed an apprenticeship as a clerk,

married an engineer in 1959 and then stopped working to raise their children. Her husband

regularly changed jobs, placing the family in a precariousfinancial situation.Chantal believed

that the rhythm method prescribed by her gynecologist was unreliable because she had three

02468

1012141618

FribourgLausanne

Figure 2. Birth control methods usage (number of couples).

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children, one immediately after the other, although she would have preferred to space out the

births due to the family’s financial situation.After the birth of their third child, they decided to

stop having children. Her husbandwas sterilized because they believed it would be easier and

quicker for him to undergo the operation, especially because they had three small children

who directly depended on Chantal.

Male sterilization should also be understood in light of the fear of the side effects of the

contraceptive pill. Indeed, several interviewees referred to male sterilization as the

solution to stop having children when the wife had experienced or was afraid of the side

effects of the contraceptive pill. For instance, after the birth of their second child and

because they wished to postpone the next birth, Lotti32 (quoted above) took the

contraceptive pill for a while. After learning of the possible negative health consequences

of the contraceptive pill and deciding with her husband that two children were enough,

they agreed that her husband should be sterilized.

Female sterilization was performed on medical grounds in six cases and as a means of

birth control in four cases. In two cases, the wife asked her gynecologist to perform the

procedure.

Apart from sterilization, the contraceptive pill was another efficient way to stop

fertility. More than half of the individuals interviewed (27) resorted to the contraceptive

pill at some point in their reproductive lives. Half of the wives from Fribourg (12) took the

contraceptive pill, compared to more than half in Lausanne (15). This particular method

was used to stop fertility because of its efficacy. Although two of the 12 women from

Fribourg explained that they regarded this method as dangerous to their health, they

‘preferred the fear of this danger rather than that of becoming pregnant’33. These women

weighed the risks and benefits of using the contraceptive pill, but their motivation to limit

the size of their families was strong enough to lead them to choose efficacy in the presence

of concerns about health risks.

A difference in the aim of using the contraceptive pill was evident between Lausanne

and Fribourg. The contraceptive pill was used almost exclusively in Fribourg as a stopping

method, whereas it was also used to postpone and space out births in Lausanne because its

access costs were very low in Lausanne compared to Fribourg. Among Fribourg users,

eight took the pill to stop births, and four took it merely to delay conception. Three of the

women who took the contraceptive pill to delay conception did so due to easy access to it

because they had given birth to children after 1968. Half of the women from Lausanne

took the pill to stop their fertility, and half took it to postpone and space out births. The fact

that women in Lausanne took the contraceptive pill to space out births supports other

findings presented in this study that it was easier to access there than in Fribourg. Indeed,

Lausanne gynecologists prescribed the contraceptive pill as a way to space out births,

whereas in Fribourg, it was used as a stopping method. Gynecologists who followed the

Catholic doctrine only prescribed the pill once a woman had reached a certain number of

children and fulfilled ‘her reproductive duty’, as in the case of Adelaide34, who had four

children. In addition, the increasing use of the contraceptive pill during the 1960s may

have facilitated access to it for the youngest cohorts. According to Franz Kuhne,

approximately 14% of Swiss women took the contraceptive pill in 1970. We can

hypothesize that this figure would have been higher in urban areas than in rural areas.

6.3. Social taboos

Finally, several interviewees discussed social taboos as a reason not to use condoms.

Among all respondents who used a range of birth control methods, ten used condoms (six

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from Fribourg and four from Lausanne). This small number of condom users could be due

to the social taboos surrounding sex, which remained sufficiently strong to persuade many

interviewees not to purchase condoms in public. The interviewees had to purchase

condoms in a pharmacy and had to request them from the pharmacist. The respondents

regarded the cost of breaking this taboo as too high as illustrated by Chantal’s excerpt,

quoted above: ‘There were condoms but I mean, we had to ask the pharmacist for them . . .

we couldn’t find them at the delivery machine like today. Yes, it was not so funny, we were

ashamed . . . ’35

This situation indicates how conservative this period was in terms of public space

relative to the following period, when nearly all of these taboos would be broken.

Overall, we can observe that depending on their attitudes toward birth control methods

and their motivation to limit the size of their families, the majority of the respondents (35)

used a range of methods throughout their reproductive lives.

7. Conclusion

This paper demonstrates that the majority of our respondents discussed birth control with

their spouse and recognized the need to limit family size. Religious affiliation did not

affect these elements. This result differs from the study of Szreter and Fisher (Szreter &

Fisher, 2010) on a slightly older British cohort who found that working-class couples did

not discuss issues related to birth control and that middle-class couples faced tensions and

disagreements when doing so. Contraception was rarely presented as a male responsibility,

which differs from Fisher (2006) findings for the British working-class but is closer to

British middle-class couples according to Szreter and Fisher (2010).

The influence of religion was clearly not a direct one. Among the Catholic

interviewees, the majority did not confess on the subject of birth control and those who did

received absolution. Thus, rather than exerting a strong influence on individuals’

behaviors by increasing the moral cost of birth control, as suggested in other studies

(Gervais & Gauvreau, 2003; McNicoll, 1994; MacQuillan, 2004), the impact of religion

was perceptible through institutional channels that reduced access to contraceptives.

In this regard, Catholic gynecologists played a crucial role. They only provided advice on

methods authorized by the Catholic Church. This paper thus reveals an interesting irony:

‘scientific’ medical professionals, wary of their social respectability in Catholic Fribourg,

were in fact more deferential to ‘traditional’ religious teaching than ‘ordinary’, less

educated Catholics. In Protestant Lausanne religious and medical authorities were all in

favor of birth control to avoid unwanted pregnancies and abortion; thus Protestant

gynecologists informed their patients of all available methods.

Couples combined various methods of birth control throughout their reproductive

lives. They weighed two elements: the efficacy of the method and what they regarded as

the quality of their sexual lives, namely, the spontaneity of sexual intercourse and the use

of natural methods of birth control. However, when their motivation to stop fertility or

space births was high, couples turned to more efficient methods of birth control. The

prevalence of sterilization, especially male sterilization, is particularly striking. The latter

should be understood in line with concerns of the side effects of the contraceptive pill for

the woman’s health. It is worth noticing that male sterilization required communication

and debate within the couple. As for the contraceptive pill, women from Fribourg used it

almost exclusively as a stopping method, whereas women from Lausanne ingested it as a

way to space out and stop births since its access costs were very low in Lausanne as

compared to Fribourg.

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This qualitative analysis allowed the researcher to test certain hypotheses regarding the

influence of religion and to shed light on strategies and arguments that led individuals to

limit the size of their families. Thanks to oral history, direct sources for the mechanisms

underlying the decision-making process can be probed. These sources provide first-hand

accounts of how individuals thought and behaved as well as how they decided to limit the

size of their families; this information would have been impossible to obtain through

quantitative analysis. Although this information must be considered with caution, it

provides complementary evidence with which to evaluate previous theoretical and data-

driven studies. This article has also provided additional hypotheses regarding mechanisms

underlying birth control that may be pursued through further quantitative analysis.

Acknowledgements

I am really grateful to Yuliya Hilevych, Trent MacNamara, Anne-Franc�oise Praz, as well as the twoanonymous reviewers for their encouraging and worthwhile comments on the last version of thispaper. I would also like to thank Simon Szreter and Sian Pooley and the participants at the SocialScience History Conference in 2013, all of whom offered feedback on earlier versions of the paper.

Disclosure statement

No potential conflict of interest was reported by the author.

Funding

This work was supported by the Swiss National Science Foundation [grant number FN-8005].

Notes

1. In this paper birth control means all methods to limit family size. This definition encompassestraditional methods (withdrawal, abstinence) and modern methods (chemical and mechanicalmethods and sterilization) of birth control. We use contraception and contraceptive methods assynonyms for birth control.

2. See ID 12F in the Table 1.3. See ID 32L.4. See ID 46L.5. See ID 47L.6. See ID 10F.7. See ID 41L.8. See ID 6F.9. See ID 27L.10. Archives of the Bishopric of Fribourg, carton IX 14/ ‘Correspondance au sujet de l’enquete de

la SSUP 1956’, Letter from Daguet to Kumin.11. See ID 11F, 15F.12. See ID 9F.13. See ID 14F.14. See ID 20F15. See ID 2F.16. This book was first published in German in 1939 by Hans Hoppeler. Born in 1879 in Zurich,

Hoppeler was trained as a physician. He was an assistant doctor in Berlin and in New York.He worked in Zurich since 1904. He was also deputy at the Zurich parliament. He was theeditor of the journal Evangelische Volkszeitung. He published several books dedicated tomothers and fathers on the issue of child education and birth control. A first French translationof the book quoted in the paper was published in 1942. There were 12 German editions. Thelast one was published in 1955. The book was translated by Marianne Gagnebin.

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17. This book was first published in German and French in 1935. The author was Fritz Kahn, aGerman Jewish physician, born in 1888, who studied medicine at the University of Berlin.In 1922, Kahn opened a private practice as a gynecologist in Berlin. In 1933, due to the anti-Semitic propaganda, he had to close his practice. In 1938, his books were placed on the list ofundesirable writings. In addition, the book quoted in the paper was banned by the police and allavailable copies were destroyed.

18. See ID 20F.19. See ID 43L.20. See ID 32L.21. See ID 6F.22. See ID 43L.23. See ID 6F.24. See ID 23F.25. See ID 23F.26. See ID 17F.27. See ID 25L.28. See ID 13F.29. See ID 6F.30. See ID 27L.31. See ID 1F.32. See ID 27L.33. See ID 14F.34. See ID 20F.35. See ID 1F.

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