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Under no circumstances is advice and help on family planning given unless the patient actively
requests it. Those patients who want the IUD (which is not fitted at home) go by themselves to
the Prince of Wales's IUD Clinic. Those wanting sterilisation similarly attend hospital by
themselves.
General Practitioners have co-operated (closely in some cases) with the domiciliary service and
no Practitioner has withheld his consent to my visiting his patients.
2. Again (as in my report of a year ago) it will be seen that the majority of referrals concern mothers
between the ages of 20 and 34 with 3—6 children, i.e. many potential problem families.
Those patients who refuse advice often give religion as the reason. It is my impression that
some of the husbands exert considerable pressure on their wives not to accept family planning
because this would lessen their control over their wives. They may fear that their wives wilI
become promiscuous once free of the fear of pregnancy. Some wives do appear to be the victims
(sometimes willing ones) of their husbands' determination to make them pregnant every year
only in order to keep control of them. These husbands will not themselves take precautions.
3. The oral contraceptive is the most popular method of birth control because of its effectiveness
and ease of usage. There was much anxiety at the time of the Dunlop Committee Report in
December 1969, and this entailed extra work in attempting to allay fears and give reassurance.
It is interesting to note that there have been increasing requests for information about male
sterilisation, possibly related to the uncertainties surrounding the Pill. There are no requests
for diaphragms. The homes I visit often have no bathroom and there is usually very little
privacy for the mother to use this kind of method.
4. Some of these patients request sterilisation. They may have already tried various methods of
contraception unsuccessfully; they may be intolerant to the IUD because of resulting heavy
periods, or be afraid of the Pill because of the controversy surrounding it: husbands cannot
be relied on to use the sheaths all the time, and caps are not requested because of the reasons
stated above.
With their families complete, sterilisation is often seen by the patient as the only effective
answer to their problem. The request is usually made to the North Middlesex Hospital after
the last confinement as this hospital (with 3,000 deliveries per year) serves the Tottenham area
where most of the patients I see live. These requests unfortunately are sometimes refused.
In June 1969 I met the Consultant Obstetricians of the North Middlesex Hospital and asked
them about this situation. I was told that sterilisation was done only on medical grounds and
not as a method of contraception. It seems regrettable that provision for sterilisation for
contraceptive purposes cannot be made under the N.H.S. Acts. A mother with many successive
pregnancies under poor social conditions usually suffers from chronic ill-health (anaemia, various
gynaecological complaints and severe varicose veins), and often is unable (with the best will
in the world) to cope with her family. Indeed the children of such families have frequently been
in hospital for illnesses such as gastro-enteritis and bronchopneumonia, and in a few cases
meningitis.
The psychological damage to children is incalculable. 2 families have all their children in
care (10 in all): 5 other families have respectively 1, 4, 1, 2, 1 children in care. Thus the
total number of children in care is 19.
THE FIRST YEAR'S WORK OF A CLINIC FOR UNMARRIED GIRLS
December 1968 — December 1969
(Report by Dr. E. Christopher)
In December 1968, it was decided to start a fortnightly evening clinic to give contraceptive advice
and counselling (when needed) to unmarried girls in the London Borough of Haringey. Unmarried girls
seen at other F.P.A. Clinics in the Borough were to be directed to this clinic.
The clinic started with 3 lay workers, a nurse and a doctor (myself). After one month the clinic
was held every week because of increased demand. Since July 1969 it has been necessary to call
on the services of an additional doctor and nurse, usually at fortnightly intervals. It is held on
an appointment system which works reasonably well. Occasionally appointments are not kept and
the patients tend to come the following week, and of course, they must be seen. At this kind of
clinic patients must be free to come when they want to.
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