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39
Family Planning
The City Council has fully implemented the National Health Service (Family Planning) Act, 1967.
Free advice is provided for all residents of the City, either directly in its own clinics or through a
voluntary agency such as the Family Planning Association or the Catholic Marriage Advisory
Service. Where family planning is needed on medical grounds, supplies of appliances or drugs are
provided free of charge.
A new service has been set up at one of the Council's welfare centres in collaboration with the
Board of Governors of St. Mary's Hospital and the Eugenics Society. All patients in the maternity
unit are visited by a health visitor trained in family planning methods. She invites those mothers who
are interested to attend the special session at which the postnatal examination is combined with
family planning advice. After this visit most patients are referred to their family doctor or to a clinic
in their own area. This arrangement has proved very successful; over 70 per cent, of the mothers kept
their appointments.
Young people, especially the unmarried, frequently require counselling and support as well as
advice on family planning. To meet their needs two Youth Advisory Clinics are held each week. A
doctor and a social worker, both experienced in the needs and problems of the young, attend. More
detailed reference to this service is made later in this report (see page 50).
Child Health
The initial examination of the neonate is undertaken by the midwife, who notifies obvious congenital
malformations and screens the baby for congenital dislocation of the hips and for phenylketonuria.
Arrangements have been introduced for performing the Guthrie test on all babies on their
sixth day. Babies discharged early from hospital and those requiring further examinations are tested
by the domiciliary midwives. All neonates in hospital are examined by a doctor before discharge,
and the paediatrician is called in for advice when necessary. Premature babies and others needing
specialised nursing and paediatric care are nursed in special care units of the hospital and are usually
followed up by the paediatrician in his outpatient clinic. Reports on all these babies are sent to the
Medical Officer of Health so that after-care arrangements can be co-ordinated.
From the fourteenth day onwards, the health visitor has a key role to play in the care of the infant
and young child. Reference is made later to the work of the health visitor but the supervision of all
babies and children in her area remains one of her main responsibilities. On her first visit to a new
baby, she will assess the mother's needs and, where necessary, give continued advice and support.
She will impress upon the mother the need for regular medical examinations and for immunisation.
She will later have opportunities for observing the child in his home and for assessing his progress.
She is often the first person to suspect that a child is not developing normally and she is of inestimable
value in identifying abnormalities.
INFANT DEATHS
As already indicated, the services available in Westminster for the care of mothers and young
children are excellent. It is therefore disappointing to find that in 1969 the number of deaths of
infants under the age of one year has risen to 65, and that the infant mortality rate is 22.42 compared
with 18 for the rest of England and Wales. More dramatic, perhaps, is the illegitimate infant mortality
rate of 39.14. Although the numbers are small and not of much statistical significance, it is necessary
to examine them in detail to try to find out how many were avoidable and what steps might be
taken in future to prevent this wastage.
Forty-eight of the deaths occurred during the first week of life; 28 were due to prematurity and
allied causes, and a further 12 were due to severe congenital abnormalities. Five deaths were
attributable to birth injuries, two to inhalation pneumonia and one to asphyxia. All but one of these
babies were born in hospital and received expert paediatric care. Among the 48 were 15 illegitimate
infants; of these, 2 of the mothers received no antenatal care.
Seventeen infants died between the ages of one week and one year; six from congenital malformations,
three from gastro-enteritis, two from broncho-pneumonia, and two as a result of inhalation
pneumonia. These two latter cases were unexpected "cot deaths" and in both there was
inhalation of vomit. Other causes of death in this age group were asphyxia (1), intestinal obstruction
(1), meningitis (1) and peritonitis (1).
In all these cases there had been good care in the home, and appropriate medical care had been
provided. In none of them was there an apparent avoidable factor.