Contraception and Birth Control

Contraception and Birth Control in Poor Things develop from Bella Baxter’s intention to teach women effective methods of preventing pregnancy into a wider argument about who controls reproductive knowledge and whose health medical institutions serve. The novel places that intention alongside women’s restricted access to medical training, unequal sexual-health practices, poverty, childbirth, and the hostile reception of Victoria McCandless’s writing. Birth control is presented not simply as a private choice, but as a question of education, clinical authority, material circumstances, and women’s ability to make decisions about their own bodies.

Training and the right to teach

When Godwin Baxter discusses Bella’s future, he describes a Britain in which there are only four women doctors, all holding degrees from foreign universities. The Enabling Bill of 1876 and Sophia Jex-Blake’s work have opened a path toward women’s medical education, but Baxter still imagines Bella first entering nursing and learning through work in charity wards. He argues that practical, manual training should underlie the professions, rather than leaving students to acquire knowledge only through lectures or memory exercises.

Bella identifies the people she wants to serve as little girls, mothers, and prostitutes. She also says she intends to teach the women who come to her the most modern and effective contraceptive methods. Baxter and Archibald McCandless advise her to keep that intention private until she can practise, reasoning that she can offer advice in the consulting room without provoking a public scandal. They suggest that she wait at least five years after qualifying before publicly campaigning for birth control. Bella agrees only after they acknowledge that the length of any waiting period must be her decision, not theirs. The exchange makes the tension plain: caution may help her gain access to practice, but it cannot legitimately become another authority deciding when she may speak.

Baxter’s support for women’s medical work is grounded in his criticism of their exclusion from skilled care. After returning from abroad, he establishes a small veterinary clinic where sick animals are treated free, and Bella works as receptionist and assistant. He teaches her to stitch wounds; she proves capable both in meeting strangers and in treating animals. For Baxter, her aptitude exposes the waste involved in barring women from intricate medical work. That experience anticipates his plan for her human patients: reproductive instruction is to be delivered by a woman trained to practise medicine, rather than left solely to male doctors or to informal, inaccessible sources of knowledge.

Sexual health and unequal inspection

The novel also places birth-control advocacy in the context of sexual-health rules that burden women. In Paris, Bella tells Millie Cronquebil that she can no longer work at the establishment because she is engaged to marry and regards its medical inspection system as unfair and inefficient. The women are healthy when they begin work, she argues, while their clients are not routinely examined. Millie replies that clients would refuse examination and that France has too few doctors. Bella proposes that the women themselves be trained to examine each client before the sexual encounter begins, making the check part of its prescribed procedure.

This dispute is not a description of contraception itself, but it sharpens the surrounding question of who must bear the work and risk of sexual health. The existing arrangement subjects women workers to inspection while leaving their clients comparatively unexamined; Bella’s alternative would give the women practical knowledge and a role in protecting themselves. Her proposal connects instruction to the conditions in which sexual activity takes place, rather than treating women’s health as a matter of policing women alone.

Pregnancy, care, and the limits of medical authority

The novel’s account of Baxter’s decision not to revive the drowned woman whose body becomes the basis of Bella’s life gives reproductive choice a harsher setting. He finds that she had been pregnant and that her engagement rings had been removed. He clears water from her lungs and removes the fetus, but chooses not to restore her to conscious life. His stated fear is that a woman who had chosen death would be forced into institutions that treated suicide as lunacy or crime. He also describes young women driven to drown themselves by poverty and social prejudice, and the suffering of infants born with conditions they cannot survive without artificial help. These episodes do not present a contraceptive method or a simple policy argument; they show the extreme circumstances in which pregnancy, poverty, medical intervention, and a woman’s will become entangled.

Questions of bodily autonomy recur when Dr. Prickett recounts that Lady Blessington had supposedly begged for a clitoridectomy to end her distress. Bella cannot remember the woman Prickett describes, and Baxter rejects the assumption that the drowned woman and Lady Blessington are the same person. The episode is not about birth control, but it places reproductive and sexual decisions within a medical culture in which male practitioners claim authority to interpret women’s desires and prescribe irreversible treatment. Against that authority, Bella’s planned practice would make women’s access to information and consultation central, while the novel’s conflicting accounts warn that medical claims made in women’s names may themselves need scrutiny.

Victoria McCandless’s clinic and public-health work

Bella later lives under the name Victoria McCandless, studies at the Sophia Jex-Blake School of Medicine for Women, and receives a medical degree from Glasgow University in 1890. In that same year she opens the Godwin Baxter Natal Clinic in Dobbie’s Loan near the Cowcaddens. The clinic is a charitable foundation supported with Baxter’s money, and Victoria runs it with a small staff of local women whom she trains. She deliberately sends trained employees on to other work once they have learned what she can teach them; several enter hospital nursing, although a ward sister complains that they ask too many questions. Her practice thus makes education part of care and challenges a professional culture that can treat questioning as a fault.

Victoria continues to work through pregnancy, stopping only in the final days and returning soon afterward. She explains this in relation to the poor women she treats, who cannot afford to stop working or remain at rest. Her circumstances are more secure than theirs, but they do not erase the economic pressure that shapes their experience of pregnancy. She also argues that basic nursing should be taught in primary schools and basic medical knowledge in secondary schools. Such instruction, in her view, would help people care for one another, understand when a doctor could help, and recognize the effects of unhealthy housing and working conditions. Birth control belongs to this broader public-health project: people need usable knowledge, but their choices are also constrained by the conditions in which they live and work.

A Loving Economy and the backlash

Victoria’s pamphlet A Loving Economy brings her sexual and reproductive arguments into public controversy. Clergymen from Christian churches condemn its birth-control proposals, while some birth-control advocates object to its claim that commercial contraceptives are unhealthy. Victoria argues that commercial products can focus users’ attention too narrowly on genital sex and make sexual intimacy seem separate from everyday affection. Her account treats intimacy and sexual life as continuous rather than dividing one into ordinary comfort and the other into a scarce commodity. The disagreement therefore concerns not only whether pregnancy can be prevented, but also what kinds of intimacy a birth-control message should encourage and how commercially sold methods shape that message.

The pamphlet receives only two favourable notices despite Victoria’s advertisements in major British newspapers. The Daily Express campaigns against her clinic, amplifying attacks that help deprive her of it. At her trial, a Scottish jury returns a verdict of not proven: she is neither struck off the medical register nor declared guiltless. By 1920, the clinic’s managing committee has yielded to hostile publicity, dismissed her, and transferred the institution to Oakbank Hospital as an out-patients department. Victoria, having spent her savings printing and distributing A Loving Economy, retreats to the basement of 18 Park Circus and continues the clinic on a much smaller scale. The arc from Bella’s private plan to Victoria’s public practice and its forced contraction shows how reproductive instruction can be affirmed as medical care in principle yet punished when it challenges accepted authority, commercial interests, and public morality.