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Methods of Contraception chosen (by the 145 visited)
Methods are discussed fully with the patient by the Doctor, and provided there are no medical
contraindications to the method decided upon the decision of what to use is left to the patient
and her husband.
1. Oral contraceptive 41 (2 patients transferred to Clinic, pay for themselves)
(2 patients transferred to Clinic, Local Authority pay)
2. I.U.C.D. 32 (8 transferred to IUD Clinic at Prince of Wales's.
No pregnancies so far with coil.
2 coils spent, expelled.
1 coil removed because of menorrhagia).
3. Sheaths and pessaries 19 (3 supply own sheaths, off list)
4. Sterilisation Female 21 (5 terminated and sterilised) 4 male
Waiting sterilisation 5
Of the 21 sterilised: 13 West Indian
5 English
2 Irish
1 Greek Cypriot
3 patients left the area.
8 patients refused advice (despite the assurance by the referring agent that this had been requested
by the patient):-
(a) Mother of 1 patient (unmarried mother) is prostitute, refused to let daughter be seen.
(b) 2 patients objected on religious grounds - 1 R.C., 1 Jehovah's Witness.
(c) 2 unmarried mothers were immature West Indian girls with poor motivation.
(d) 1 patient wanted 10 children (she had 9) despite being advised by Royal Free Hospital not to,
as she is Rhesus negative and has antibodies.
(e) 2 patients not allowed to accept advice by husband.
1 subnormal girl came to Clinic for discussion - she had no children.
Of the remaining 8 patients:- 4 pregnant — 1 sheath failure
- 1 forgetting Pill
— 2 pregnant before visited
2 have just had badies and are still to be visited
2 unmarried girls, pregnancy terminated (for both it was 3rd illegitimate
pregnancy)

Discussion and comment
1. The number of referrals has continued to increase, many coming from Health Visitors. Referrals
can, of course, originate from many different sources, in fact from anyone in close contact with
the patient (some patients try to refer their friends!).
The Children's Department, with their detailed knowledge of the family, can be especially
important. It may be mentioned here that the role of the Domiciliary Doctor is not primarily
concerned with the social problems of a family (though it is inevitable that they do affect the
doctor/patient relationship to a certain extent). A special point is made to keep the Social
Worker or other referring person informed of what is happening with regard to family planning.
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