PUBLIC
I
HEALTH
Women
m
in Family Planning
BARBARA R. BRADSHAW, PhD "Millions of women are asserting their right to voluntary motherhood. They are determined to decide for themselves whether they shall become mothers, under what conditions and when. This is what the fundamental revolt referred to. It is for women the key to the temple of liberty."'
At the 1971 London meeting of the Third International Congress of Psychosomatic Medicine in Gynecology and Obstetrics, Niles Anne Newton, the only woman keynote speaker, posed a question. The question was: Will an international congress on Manhood and Parenthood ever be held in which four of the five keynote speakers are women?2 One would not like to speculate about when such a woman-dominated meeting might take place, but things are changing. Margaret Sanger founded the birth control movement as an attempt to improve conditions for women. Essentially, it was a political and social movement, and Sanger, like most pioneers, had far greater hopes for her "revolution" than have yet been realized. She held the view that if women could control their own reproductive careers they would then achieve equality and control in the larger political sphere.' At the time, her ideas were considered scandalous and dangerous, as her court record attests. Jean Sharpe has analyzed the reaction of the medical profession to the early birth control movement. To physicians of the time, those advocating the use of contraceptives were perceived as "radical" or "hysterical." The potential profits and health benefits of controlled conception were largely eschewed until physicians developed their own organization (the Committee on Maternal Health) in the 1920s, which mandated contraceptive care as being exclusively a medical concern and devoted itself to getting politics out of the movement.8 This dialectic effectively killed birth control as a major women's issue. Only when federal monies became available for family planning programs in 1966-1967 did contraceptive services again arise as important governmental and political issues. During the years of male-medical domination, the birth control movement shifted from its original purpose of self-determination for women. Instead of the terms Sanger used ("voluntary birth prevention" and "voluntary motherhood"), birth control was renamed "family planning" and was viewed as part of a medical discipline involving the sexual-reproductive organs of women. As the term "family planning" implies, women using contraceptives were expected to become mothers. But which women should have children, when, and how many became major concerns of
male lawmakers and administrators as they looked on the interrelated problems of population, poverty, and pollution in terms of cost-benefit analysis. Voluntary family planning, at least on the national level, is often seen as an answer to population expansion, and population limitation is frequently a raison d'etre for family planning programs. For example, one of the four stated goals of the Planned Parenthood Federation of America is to achieve "a U.S. population of stable size in an optimum environment."4 Margaret Sanger's major concern for women's equality is no longer a stated goal of the organization she founded. With federal funding of family planning programs seriously threatened, cost-benefit analyses and population control emphases may be expected to take precedence in the political struggle for survival. A recent cost-benefit analysis, done by the staff of the now-defunct National Center for Family Planning Services, "revealed an expenditure of one dollar by Federal Government in 1972 effecting a reduction in Federal, State and local expenditures for medical care and public assistance of $2.50 to $2.90 in the first year."5 Women comprise some 7.5 per cent of all MDs in the U.S., but only 3.5 per cent of all Board-certified obstetricians and gynecologists are women.' Thus, although women are the only people defined as family planning patients, the medical specialty specifically charged with reproductive health is strongly male-dominated. However, because the federally funded expansion of family planning is a relatively new phenomenon, the question of who really administers and directs programs in the field of family planning needs to be raised. The study presented here tests two hypotheses often found in women's liberation literaturet: (1) males dominate the field of family planning; (2) physicians dominate the field of family planning. Current (1973) data on membership and leadership in major family planning organizations and programs were analyzed to ascertain numbers and percentages of woman and physician representation. The analysis included the following organizations and leaderships: the National Family Planning Forum; Planned Parenthood Federation of America; the American Association of Planned Parenthood Physicians; and project directors of all federally funded *
American
College
of Gynecology and Obstetrics. Written
communication, June, 1972. tMany examples can be found. Perhaps most publicized is Frankfort., Some interesting arguments are presented by Seaman.7 PUBLIC HEALTH BRIEFS 1239
family planning programs.* Actual analysis of who has important input into family planning programs today yields a picture different from the one presented by the women's movement. Consider the following facts: 1. The National Family Planning Forum, organized to provide leadership in public affairs, was begun as an "invitation only" organization for the most important people in the family planning field. Analysis of the initial 1971 listing of 139 members showed that 40 (27 per cent) were women. By July, 1973, the active membership listing had grown to 265, of whom 49 per cent were women. There were also 151 associate members (people who were not invited, but who chose to join), of whom 56 per cent were women. When analysis was made of physician members of the Forum, it was found that 51 per cent of the 1971 membership were MDs. Of these MDs, 62 (44 per cent of the total) were men and nine (6.4 per cent) were women. In 1973, 56 (21 per cent of the total) were MDs. Of these, 45 (17 per cent) were men and 11 (4 per cent) were women. In 1973, there were 11 men and nine women among the officers and executive committee of the Forum. Of these, four men and one woman were physicians (25 per cent). 2. Even among physicians, women tend to exhibit a special interest in family planning. Approximately 17 per cent of the members of the Association of Planned Parenthood Physicians are women, as contrasted with the even lower female representation among MDs noted earlier. 3. The Planned Parenthood Federation of America is staffed predominantly by women: 159 (64 per cent) of 249 total employees. However, analysis of positions held reveals that men hold 14 per cent of the top positions (those titled Director, Chief, Assistant Director, or Associate Director), and that 39 per cent of the male employees hold such top positions, as opposed to only 15 per cent of the female employees. There are only four physicians on the staff and all are men (1.6 per cent of total employees). At the lower level, women predominate. Sixty women (24 per cent of the total staff) are secretaries, clerks, or typists and seven men (2.8 per cent) are clerks (Table 1). The composition of the board of directors of Planned Parenthood Federation of America is almost evenly divided between the sexes (54 men and 53 women). In top positions, 17 men (57 per cent) and 13 women (43 per cent) serve as officers or are on the executive committee. Physicians are very much in the minority. There are 11 MDs on the board (approximately 10 per cent), of which nine are men and two are women (Table 2). 4. Perhaps the most unexpected finding was who the
project directors of federally funded family planning programs are. Of the 287 persons receiving federal project funds as of July, 1973, 133 (46.3 per cent) were *The author is indebted to Russell Richardson, President, National Family Planning Forum, Jeanne Rosoff, Director, Washington Office, Planned Parenthood Federation of America (PPFA), and Lillian S. Hayden, Information Systems Manager, Washington Office, PPFA, for their invaluable assistance, which made these
data analyses possible.
1240 AJPH NOVEMBER, 1975, Vol. 65, No. 11
TABLE 1-Planned Parenthood Federation of America: Staff,* July, 1973 Women
Men No. (%)
159 (64) 34 (10) 0 60 (24)
88 (36) 38 (14) 4 (1.6) 7 (2.8)
Total staff Top level stafft Physicians Secretaries, clerks, typistst
* This total does not include consultants. t Of all men employees, 39 per cent are top level. Of all women employees, 15 per cent are top level. t Of all women employees, 37.7 per cent are secretaries, clerks, or typists. Of all men employees, 7.8 per cent are clerks (no male secretaries or typists).
TABLE 2-Planned Parenthood Federation of America: Board of Directors Women
Men
Non- MD
MD
14 (47)
3 (10)
45 (42)
9 ( 8)
MD
Total
13 (43)
0
30
51 (48)
2 (2)
107
Non- MD No. (%)
Officers and executive
committee Total board
TABLE 3-Federally Funded Family Planning Programs: Project Directors, July, 1973 Total No. (%)
Persons with federal grants Persons with multiple grants Grants all-inclusive Men receiving grants Men MDs receiving grants* Men non-MDs receiving grants Women receiving grants Women MDs receiving grantst Women non-MDs receiving grants
287 18 308 154 (53.6) 87 (30) 67 (23) 133 (46.3) 29 (10.1) 104 (36.2)
Of all men project directors 56.5 per cent are MDs. Of t all women project directors 21.8 per cent are MDs. *
woment (Table 3). Men do predominate increasingly with size of project, but women are not summarily relegated to lower budget programs. As can be seen from Table 4, women are responsible for 58.4 per cent of the funded grants under $1,000,000, 53.7 per cent of those between $100,000 and $250,000, 32 per cent of those between $250,001 and $500,000, 32 per cent of those between $500,001 and $1,000,000, and 16.6 per cent of those over $1,000,000. t Data are from a report prepared by Mary A. Harris, Office of Financial Management, National Center for Family Planning Services, July 18, 1973. To determine the federal funds for which individuals were responsible, all grant funds allocated to any one individual were combined together in the calculations of grant size. (Eight men and two women were the recipients of 18 multiple grants.)
TABLE 4-Federally Funded Family Planning Program: Project Directors by Sex, Status, and Size of Project,* July, 1973t Men Project Size
Under$100,000 $100,000-$250,000
$250,001-$500,000 $500,001-$1,000,000 Over$1,000,000 *
Women
Non-MD
MD
Total
Non-MD
MD
Total
Total
31 (10.8) 9 (3.1) 10 (3.4) 7 (2.4)
13(4.5) 28(9.7) 24 (8.3) 12 (4.1)
44(15.3) 37 (12.9) 34 (11.8) 19 (6.6)
4(0.8) 12 (4.1) 8 (2.7) 3 (1)
62(21.5) 43(14.9) 16 (5.5) 9 (3.1)
106(36.9) 80(27.8) 50 (17.4) 28 (9.7)
10(3.4)
10(3.4)
20(7)
No. (%) 58(20.2) 31 (10.8) 8 (2.7) 6 (2) 1 (0.3)
3(1)
4(1.3)
24(8.3)
Percentages reflect proportion of total number of project directors.
t Of all people receiving grants under $1,000,000, 58.4 per cent are women; of all those receiving grants between $100,000 and $250,000, 53.7 per cent are women; of all those receiving grants between $250,001 and $500,000, 32 per cent are women; of all those receiving grants between $500,001 and $1,000,000, 32 per cent are women. Of all people receiving grants over $1,000,000, 41.6 per cent are male MDs; 12.5 per cent are female MDs; overall, 54.1 per cent are MDs. Of all grants women are receiving, 46.6 per cent are under $100,000; 32.3 per cent are between $100,000 and $250,000; 12 per cent are between $250,001 and $500,000; 6.7 per cent are between $500,001 and $1,000,000; and 4 per cent are over $1,000,000.
The data also indicate that physicians, male and female, no longer dominate the field. Overall, 40.1 per cent of all federally funded projects are directed by MDs. However, physicians (particularly men) tend to be in charge of the larger grants. Fifty-four per cent of all grant funds over $1,000,000 are in the hands of MDs (41.6 per cent are male MDs and 12.5 per cent are female MDs). Overall, male project directors are more likely to be physicians than are female project directors. Thus, men are more likely than women to serve as project directors, particularly for large grants. Women, however, do hold many key decision-making positions and play important roles in the direction of family planning service programs. 5. One further fact should be noted before concluding. None of these analyses reflect the activities of radical women operating in free clinics or disseminating contraceptive information. From the data available it would appear that none of the radical women's liberationists participate in the National Family Planning Forum, belong to the American Association of Planned Parenthood Physicians, or receive federal monies. Yet the impact of these women is probably great. For example, over 3 million copies of Birth Control Handbook, produced by a radical health collective in Montreal, were distributed between 1969 and the time of the issuance of the new edition early in 1973. Our Bodies, Ourselves has had a similarly wide circulation.8 Radical women are involved in the free clinic movement throughout the country and are highly vocal in their criticisms of the medical and male chauvinism in family planning programs.* While it is almost certain that the actual deliverers of * During a short period given them upon demand at the 1973 Meeting of the American Association of Planned Parenthood Physicians, representatives of radical women's groups advocated that male physicians remove themselves entirely from the business of serving women.
services on the clinic level are male MDs, further investigation is needed to determine what kinds of superordinate relations nonphysician women have with male physicians who are technically their employees. Additionally, it should be noted that women's liberation critics have largely ignored the women who are decision-makers and have directed their charges against the males in the field. Given the large numbers of women in key positions, it would appear that it is now time to involve women decision-makers in any actions directed toward enhancing the quality of contraceptive service delivery. This paper has investigated the dual hypotheses of male and medical dominance in leadership positions in the field of family planning. In summary, large numbers of women in key positions are found in the family planning field. The data also indicate that physicians, male or female, no longer clearly dominate the field. It seems possible that the field of family planning might indeed provide the vehicle for women's leadership which Margaret Sanger envisioned: "She has learned that whatever the moral responsibility of the man in this direction may be, he does not discharge it. She has learned that, lovable and considerate as the individual husband may be, she has nothing to expect from men in the mass, when they make laws and decree customs. She knows that regardless of what ought to be, the brutal unavoidable fact is that she will never receive her freedom until she takes it for herself."'
REFERENCES 1. Sanger, M. Women and the New Race. pp. 5, 98. Truth Publishing Company, New York, 1920. 2. Newton, N. A. A Woman's Viewpoint on Women's Problems. In Third Internati6nal Congress Proceedings on Psychosomatic Medicine in Gynecology and Obstetrics, edited by Norris, N., p. 13. S. Karger, London, 1972. 3. Sharpe, J. Women and the Health System. Health PAC Bull. No. 40. pp. 1-12, 1972. PUBLIC HEALTH BRIEFS 1241
4. Planned Parenthood Federation of America. Statement of Purpose. New York, 1973. 5. Planned Parenthood Federation of America. The Amplified Five Year Plan: 1974-1978, p. 3. Aug., 1973. 6. Frankfort, E. Vaginal Politics. Quadrangle Books, New York, 1972. 7. Seaman, B. Free and Female. Fawcett Crest Press, Greenwich, CT, 1972.
8. Stempson, C. Book Review. Our Bodies, Ourselves. MS, p. 34. April, 1973.
Dr. Bradshaw is Professor, Kent School of Social Work, University of Louisville, Louisville, Kentucky 40208. This paper was presented at The American Public Health Association Annual Meeting, Family Planning Session, Maternal and Child Health Section, San Francisco, November 7, 1973.
Contamination of Soil in Two City Parks with Canine Nematode Ova Including Toxocara canis: A Preliminary Study STEPHEN DUBIN, VMD, MS STANLEY SEGALL, PhD JANE MARTINDALE, MS Introduction Visceral larva migrans (VLM) results from the partial development within the human body of the larva of Toxocara canis and Toxocara cati, a most common intestinal parasite of dogs and cats. Human infection can occur by ingestion of ova in feces, soil, or other contaminated materials. The disease affects children primarily-usually those younger than 4 years of age. Except for persistent eosinophilia, the signs are variable and often confusing diagnostically (even to the point of confusion with retinoblastoma). The true incidence of the disease is not known, but it is believed to be much greater than reported cases indicate. 1-5 In order to estimate the risk of VLM, other investigators have studied the risk of soil contamination indirectly, by examination of fecal samples found on the street or obtained from clinical pet populations. In addition to these methods, we have examined soil samples directly for the following reasons: (1) ascarid and other nematode ova remain viable in soil for long periods after visible evidence of feces is lost, (2) cats usually bury their feces, (3) many clinical cases have been associated with a history of pica, and (4) contact with contaminated soil would seem to be a particularly insidious source of infection for children. One would assume that children are warned against contact with feces directly, but "regular dirt" does not cause such alarm or prohibition.
Material and Methods Hospital Samples Records of fecal examinations were obtained from two large veterinary hospitals in Philadelphia, one (P) located in a residential neighborhood, the other (S) in an area charac1242 AJPH NOVEMBER, 1975, Vol. 65, No. 11
terized primarily by public housing and industrial plants. Fecal samples in these two hospitals are examined microscopically after flotation on saturated sucrose solution. The treatment of the clinical data was dictated, in part, by the form of the available animal hospital records. Thus results from dogs and cats are reported together and findings are reported as either positive or negative for each category by the common clinical names: ascarids (Toxocara canis, T. cati, Toxascaris leonina), hookworm (e.g., Ancylostoma caninum), whipworm (Trichuris vulpis) of the parasitic nematodes. The above classification (ascarids, whipworm, hookworm) represents groups of parasites which can be easily recognized by the microscopic appearance of their ova, and is in common clinical use by veterinarians. A total of 4686 fecal specimens are represented in the hospital data. Fecal Specimens Fecal specimens collected in the field were examined microscopically after flotation on saturated sodium nitrate solution using the Fecalizer. Soil Specimens The isolation of helminth eggs from soil is more difficult than isolation from feces. Ova are likely to be present in much lower concentration, and they may adhere to heavier soil particles thus defeating the concentration effect of simple flotation.* Dog feces which were strongly positive for ascarid ova were admixed with soil and allowed to equilibrate in the outside environment for at least 2 weeks in order to approximate the type of sample which might be encoun*
Beaver, P. C. Personal communication, 1972.
I
HEALTH
Women
m
in Family Planning
BARBARA R. BRADSHAW, PhD "Millions of women are asserting their right to voluntary motherhood. They are determined to decide for themselves whether they shall become mothers, under what conditions and when. This is what the fundamental revolt referred to. It is for women the key to the temple of liberty."'
At the 1971 London meeting of the Third International Congress of Psychosomatic Medicine in Gynecology and Obstetrics, Niles Anne Newton, the only woman keynote speaker, posed a question. The question was: Will an international congress on Manhood and Parenthood ever be held in which four of the five keynote speakers are women?2 One would not like to speculate about when such a woman-dominated meeting might take place, but things are changing. Margaret Sanger founded the birth control movement as an attempt to improve conditions for women. Essentially, it was a political and social movement, and Sanger, like most pioneers, had far greater hopes for her "revolution" than have yet been realized. She held the view that if women could control their own reproductive careers they would then achieve equality and control in the larger political sphere.' At the time, her ideas were considered scandalous and dangerous, as her court record attests. Jean Sharpe has analyzed the reaction of the medical profession to the early birth control movement. To physicians of the time, those advocating the use of contraceptives were perceived as "radical" or "hysterical." The potential profits and health benefits of controlled conception were largely eschewed until physicians developed their own organization (the Committee on Maternal Health) in the 1920s, which mandated contraceptive care as being exclusively a medical concern and devoted itself to getting politics out of the movement.8 This dialectic effectively killed birth control as a major women's issue. Only when federal monies became available for family planning programs in 1966-1967 did contraceptive services again arise as important governmental and political issues. During the years of male-medical domination, the birth control movement shifted from its original purpose of self-determination for women. Instead of the terms Sanger used ("voluntary birth prevention" and "voluntary motherhood"), birth control was renamed "family planning" and was viewed as part of a medical discipline involving the sexual-reproductive organs of women. As the term "family planning" implies, women using contraceptives were expected to become mothers. But which women should have children, when, and how many became major concerns of
male lawmakers and administrators as they looked on the interrelated problems of population, poverty, and pollution in terms of cost-benefit analysis. Voluntary family planning, at least on the national level, is often seen as an answer to population expansion, and population limitation is frequently a raison d'etre for family planning programs. For example, one of the four stated goals of the Planned Parenthood Federation of America is to achieve "a U.S. population of stable size in an optimum environment."4 Margaret Sanger's major concern for women's equality is no longer a stated goal of the organization she founded. With federal funding of family planning programs seriously threatened, cost-benefit analyses and population control emphases may be expected to take precedence in the political struggle for survival. A recent cost-benefit analysis, done by the staff of the now-defunct National Center for Family Planning Services, "revealed an expenditure of one dollar by Federal Government in 1972 effecting a reduction in Federal, State and local expenditures for medical care and public assistance of $2.50 to $2.90 in the first year."5 Women comprise some 7.5 per cent of all MDs in the U.S., but only 3.5 per cent of all Board-certified obstetricians and gynecologists are women.' Thus, although women are the only people defined as family planning patients, the medical specialty specifically charged with reproductive health is strongly male-dominated. However, because the federally funded expansion of family planning is a relatively new phenomenon, the question of who really administers and directs programs in the field of family planning needs to be raised. The study presented here tests two hypotheses often found in women's liberation literaturet: (1) males dominate the field of family planning; (2) physicians dominate the field of family planning. Current (1973) data on membership and leadership in major family planning organizations and programs were analyzed to ascertain numbers and percentages of woman and physician representation. The analysis included the following organizations and leaderships: the National Family Planning Forum; Planned Parenthood Federation of America; the American Association of Planned Parenthood Physicians; and project directors of all federally funded *
American
College
of Gynecology and Obstetrics. Written
communication, June, 1972. tMany examples can be found. Perhaps most publicized is Frankfort., Some interesting arguments are presented by Seaman.7 PUBLIC HEALTH BRIEFS 1239
family planning programs.* Actual analysis of who has important input into family planning programs today yields a picture different from the one presented by the women's movement. Consider the following facts: 1. The National Family Planning Forum, organized to provide leadership in public affairs, was begun as an "invitation only" organization for the most important people in the family planning field. Analysis of the initial 1971 listing of 139 members showed that 40 (27 per cent) were women. By July, 1973, the active membership listing had grown to 265, of whom 49 per cent were women. There were also 151 associate members (people who were not invited, but who chose to join), of whom 56 per cent were women. When analysis was made of physician members of the Forum, it was found that 51 per cent of the 1971 membership were MDs. Of these MDs, 62 (44 per cent of the total) were men and nine (6.4 per cent) were women. In 1973, 56 (21 per cent of the total) were MDs. Of these, 45 (17 per cent) were men and 11 (4 per cent) were women. In 1973, there were 11 men and nine women among the officers and executive committee of the Forum. Of these, four men and one woman were physicians (25 per cent). 2. Even among physicians, women tend to exhibit a special interest in family planning. Approximately 17 per cent of the members of the Association of Planned Parenthood Physicians are women, as contrasted with the even lower female representation among MDs noted earlier. 3. The Planned Parenthood Federation of America is staffed predominantly by women: 159 (64 per cent) of 249 total employees. However, analysis of positions held reveals that men hold 14 per cent of the top positions (those titled Director, Chief, Assistant Director, or Associate Director), and that 39 per cent of the male employees hold such top positions, as opposed to only 15 per cent of the female employees. There are only four physicians on the staff and all are men (1.6 per cent of total employees). At the lower level, women predominate. Sixty women (24 per cent of the total staff) are secretaries, clerks, or typists and seven men (2.8 per cent) are clerks (Table 1). The composition of the board of directors of Planned Parenthood Federation of America is almost evenly divided between the sexes (54 men and 53 women). In top positions, 17 men (57 per cent) and 13 women (43 per cent) serve as officers or are on the executive committee. Physicians are very much in the minority. There are 11 MDs on the board (approximately 10 per cent), of which nine are men and two are women (Table 2). 4. Perhaps the most unexpected finding was who the
project directors of federally funded family planning programs are. Of the 287 persons receiving federal project funds as of July, 1973, 133 (46.3 per cent) were *The author is indebted to Russell Richardson, President, National Family Planning Forum, Jeanne Rosoff, Director, Washington Office, Planned Parenthood Federation of America (PPFA), and Lillian S. Hayden, Information Systems Manager, Washington Office, PPFA, for their invaluable assistance, which made these
data analyses possible.
1240 AJPH NOVEMBER, 1975, Vol. 65, No. 11
TABLE 1-Planned Parenthood Federation of America: Staff,* July, 1973 Women
Men No. (%)
159 (64) 34 (10) 0 60 (24)
88 (36) 38 (14) 4 (1.6) 7 (2.8)
Total staff Top level stafft Physicians Secretaries, clerks, typistst
* This total does not include consultants. t Of all men employees, 39 per cent are top level. Of all women employees, 15 per cent are top level. t Of all women employees, 37.7 per cent are secretaries, clerks, or typists. Of all men employees, 7.8 per cent are clerks (no male secretaries or typists).
TABLE 2-Planned Parenthood Federation of America: Board of Directors Women
Men
Non- MD
MD
14 (47)
3 (10)
45 (42)
9 ( 8)
MD
Total
13 (43)
0
30
51 (48)
2 (2)
107
Non- MD No. (%)
Officers and executive
committee Total board
TABLE 3-Federally Funded Family Planning Programs: Project Directors, July, 1973 Total No. (%)
Persons with federal grants Persons with multiple grants Grants all-inclusive Men receiving grants Men MDs receiving grants* Men non-MDs receiving grants Women receiving grants Women MDs receiving grantst Women non-MDs receiving grants
287 18 308 154 (53.6) 87 (30) 67 (23) 133 (46.3) 29 (10.1) 104 (36.2)
Of all men project directors 56.5 per cent are MDs. Of t all women project directors 21.8 per cent are MDs. *
woment (Table 3). Men do predominate increasingly with size of project, but women are not summarily relegated to lower budget programs. As can be seen from Table 4, women are responsible for 58.4 per cent of the funded grants under $1,000,000, 53.7 per cent of those between $100,000 and $250,000, 32 per cent of those between $250,001 and $500,000, 32 per cent of those between $500,001 and $1,000,000, and 16.6 per cent of those over $1,000,000. t Data are from a report prepared by Mary A. Harris, Office of Financial Management, National Center for Family Planning Services, July 18, 1973. To determine the federal funds for which individuals were responsible, all grant funds allocated to any one individual were combined together in the calculations of grant size. (Eight men and two women were the recipients of 18 multiple grants.)
TABLE 4-Federally Funded Family Planning Program: Project Directors by Sex, Status, and Size of Project,* July, 1973t Men Project Size
Under$100,000 $100,000-$250,000
$250,001-$500,000 $500,001-$1,000,000 Over$1,000,000 *
Women
Non-MD
MD
Total
Non-MD
MD
Total
Total
31 (10.8) 9 (3.1) 10 (3.4) 7 (2.4)
13(4.5) 28(9.7) 24 (8.3) 12 (4.1)
44(15.3) 37 (12.9) 34 (11.8) 19 (6.6)
4(0.8) 12 (4.1) 8 (2.7) 3 (1)
62(21.5) 43(14.9) 16 (5.5) 9 (3.1)
106(36.9) 80(27.8) 50 (17.4) 28 (9.7)
10(3.4)
10(3.4)
20(7)
No. (%) 58(20.2) 31 (10.8) 8 (2.7) 6 (2) 1 (0.3)
3(1)
4(1.3)
24(8.3)
Percentages reflect proportion of total number of project directors.
t Of all people receiving grants under $1,000,000, 58.4 per cent are women; of all those receiving grants between $100,000 and $250,000, 53.7 per cent are women; of all those receiving grants between $250,001 and $500,000, 32 per cent are women; of all those receiving grants between $500,001 and $1,000,000, 32 per cent are women. Of all people receiving grants over $1,000,000, 41.6 per cent are male MDs; 12.5 per cent are female MDs; overall, 54.1 per cent are MDs. Of all grants women are receiving, 46.6 per cent are under $100,000; 32.3 per cent are between $100,000 and $250,000; 12 per cent are between $250,001 and $500,000; 6.7 per cent are between $500,001 and $1,000,000; and 4 per cent are over $1,000,000.
The data also indicate that physicians, male and female, no longer dominate the field. Overall, 40.1 per cent of all federally funded projects are directed by MDs. However, physicians (particularly men) tend to be in charge of the larger grants. Fifty-four per cent of all grant funds over $1,000,000 are in the hands of MDs (41.6 per cent are male MDs and 12.5 per cent are female MDs). Overall, male project directors are more likely to be physicians than are female project directors. Thus, men are more likely than women to serve as project directors, particularly for large grants. Women, however, do hold many key decision-making positions and play important roles in the direction of family planning service programs. 5. One further fact should be noted before concluding. None of these analyses reflect the activities of radical women operating in free clinics or disseminating contraceptive information. From the data available it would appear that none of the radical women's liberationists participate in the National Family Planning Forum, belong to the American Association of Planned Parenthood Physicians, or receive federal monies. Yet the impact of these women is probably great. For example, over 3 million copies of Birth Control Handbook, produced by a radical health collective in Montreal, were distributed between 1969 and the time of the issuance of the new edition early in 1973. Our Bodies, Ourselves has had a similarly wide circulation.8 Radical women are involved in the free clinic movement throughout the country and are highly vocal in their criticisms of the medical and male chauvinism in family planning programs.* While it is almost certain that the actual deliverers of * During a short period given them upon demand at the 1973 Meeting of the American Association of Planned Parenthood Physicians, representatives of radical women's groups advocated that male physicians remove themselves entirely from the business of serving women.
services on the clinic level are male MDs, further investigation is needed to determine what kinds of superordinate relations nonphysician women have with male physicians who are technically their employees. Additionally, it should be noted that women's liberation critics have largely ignored the women who are decision-makers and have directed their charges against the males in the field. Given the large numbers of women in key positions, it would appear that it is now time to involve women decision-makers in any actions directed toward enhancing the quality of contraceptive service delivery. This paper has investigated the dual hypotheses of male and medical dominance in leadership positions in the field of family planning. In summary, large numbers of women in key positions are found in the family planning field. The data also indicate that physicians, male or female, no longer clearly dominate the field. It seems possible that the field of family planning might indeed provide the vehicle for women's leadership which Margaret Sanger envisioned: "She has learned that whatever the moral responsibility of the man in this direction may be, he does not discharge it. She has learned that, lovable and considerate as the individual husband may be, she has nothing to expect from men in the mass, when they make laws and decree customs. She knows that regardless of what ought to be, the brutal unavoidable fact is that she will never receive her freedom until she takes it for herself."'
REFERENCES 1. Sanger, M. Women and the New Race. pp. 5, 98. Truth Publishing Company, New York, 1920. 2. Newton, N. A. A Woman's Viewpoint on Women's Problems. In Third Internati6nal Congress Proceedings on Psychosomatic Medicine in Gynecology and Obstetrics, edited by Norris, N., p. 13. S. Karger, London, 1972. 3. Sharpe, J. Women and the Health System. Health PAC Bull. No. 40. pp. 1-12, 1972. PUBLIC HEALTH BRIEFS 1241
4. Planned Parenthood Federation of America. Statement of Purpose. New York, 1973. 5. Planned Parenthood Federation of America. The Amplified Five Year Plan: 1974-1978, p. 3. Aug., 1973. 6. Frankfort, E. Vaginal Politics. Quadrangle Books, New York, 1972. 7. Seaman, B. Free and Female. Fawcett Crest Press, Greenwich, CT, 1972.
8. Stempson, C. Book Review. Our Bodies, Ourselves. MS, p. 34. April, 1973.
Dr. Bradshaw is Professor, Kent School of Social Work, University of Louisville, Louisville, Kentucky 40208. This paper was presented at The American Public Health Association Annual Meeting, Family Planning Session, Maternal and Child Health Section, San Francisco, November 7, 1973.
Contamination of Soil in Two City Parks with Canine Nematode Ova Including Toxocara canis: A Preliminary Study STEPHEN DUBIN, VMD, MS STANLEY SEGALL, PhD JANE MARTINDALE, MS Introduction Visceral larva migrans (VLM) results from the partial development within the human body of the larva of Toxocara canis and Toxocara cati, a most common intestinal parasite of dogs and cats. Human infection can occur by ingestion of ova in feces, soil, or other contaminated materials. The disease affects children primarily-usually those younger than 4 years of age. Except for persistent eosinophilia, the signs are variable and often confusing diagnostically (even to the point of confusion with retinoblastoma). The true incidence of the disease is not known, but it is believed to be much greater than reported cases indicate. 1-5 In order to estimate the risk of VLM, other investigators have studied the risk of soil contamination indirectly, by examination of fecal samples found on the street or obtained from clinical pet populations. In addition to these methods, we have examined soil samples directly for the following reasons: (1) ascarid and other nematode ova remain viable in soil for long periods after visible evidence of feces is lost, (2) cats usually bury their feces, (3) many clinical cases have been associated with a history of pica, and (4) contact with contaminated soil would seem to be a particularly insidious source of infection for children. One would assume that children are warned against contact with feces directly, but "regular dirt" does not cause such alarm or prohibition.
Material and Methods Hospital Samples Records of fecal examinations were obtained from two large veterinary hospitals in Philadelphia, one (P) located in a residential neighborhood, the other (S) in an area charac1242 AJPH NOVEMBER, 1975, Vol. 65, No. 11
terized primarily by public housing and industrial plants. Fecal samples in these two hospitals are examined microscopically after flotation on saturated sucrose solution. The treatment of the clinical data was dictated, in part, by the form of the available animal hospital records. Thus results from dogs and cats are reported together and findings are reported as either positive or negative for each category by the common clinical names: ascarids (Toxocara canis, T. cati, Toxascaris leonina), hookworm (e.g., Ancylostoma caninum), whipworm (Trichuris vulpis) of the parasitic nematodes. The above classification (ascarids, whipworm, hookworm) represents groups of parasites which can be easily recognized by the microscopic appearance of their ova, and is in common clinical use by veterinarians. A total of 4686 fecal specimens are represented in the hospital data. Fecal Specimens Fecal specimens collected in the field were examined microscopically after flotation on saturated sodium nitrate solution using the Fecalizer. Soil Specimens The isolation of helminth eggs from soil is more difficult than isolation from feces. Ova are likely to be present in much lower concentration, and they may adhere to heavier soil particles thus defeating the concentration effect of simple flotation.* Dog feces which were strongly positive for ascarid ova were admixed with soil and allowed to equilibrate in the outside environment for at least 2 weeks in order to approximate the type of sample which might be encoun*
Beaver, P. C. Personal communication, 1972.
