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(c) Vaginal infection with trichomonas is almost endemic among the women seen probably giving rise to one
of the myths held about the IUD that "it gives you V.D.".
(d) There have been a total of 37 method failures resulting in unplanned pregnancies:—
Sheath 13
Oral contraceptive (patient failure) 11
IUD 1
IUD being expelled and patient being unaware that it has happened 4
Pessaries 2
There has been one vasectomy failure. A man who had vasectomy operation did not take his semen for
analysis and his wife got pregnant for the seventh time. 8 men developed severe haematomas after vasectomy
requiring a week off work. One man required 6/52 off work.
(e) One woman who requested termination and was refused later obtained a back street abortion and died as
a result in a South London Hospital.
6. Characteristics of Women referred to the domiciliary service
The book "Family Intentions" by Myra Woolf published by Her Majesty's Stationery Office 1971 showed that
most couples want only 2-3 children. The women seen by the domiciliary team had an average of 3.8 children.
The majority of couples referred to the service have attempted some sort of family planning usually withdrawal
and/or Rendells pessaries or Gynomin or Sheaths. Where couples are happy with these methods and have made
them work for them (possibly because the couples are not so fertile) then no attempt is made by the
domiciliary doctor or nurse to persuade them to use more reliable methods. Thus there were 26 couples who
after learning about the other methods decided to go on with their own method used prior to the domiciliary
visit, and did not have further visits. It is when these methods have failed resulting in a fourth or fifth child that
the couple want to use a more reliable method but may fail to go to a clinic. The reasons for this may be
multiple and complex. As mentioned in previous reports ignorance and embarrassment may prevent women
going to clinics; the clinics may be held at awkward times and there are anxieties about the methods themselves
especially the pill. There are now as many old wives tales about the methods as there are about pregnancy and
labour. Then there are the attitudes to sex and the roles of men and women. Women are often angry when their
husbands fail or refuse to use birth control, they feel it is "up to the man", he may not be "man enough" in
other ways e.g. not earning an adequate wage, not giving her enough money for housekeeping so that the
sexual relationship and the question of who uses contraception may become a focus for discontent with the
relationship itself. The women may resent taking the pill with its risks when it is the man "who gets all the
pleasure". The couples requesting vasectomy usually have used predominantly male methods of contraception.
The couples requesting female sterilisation usually have used pessaries or no method at all. This is especially
true of West Indian women requesting sterilisation.
When men are unemployed or have low status at work they often need to demonstrate their virility by keeping
their wives pregnant. They may resent the freedom contraception gives to women or be critical of side effects.
One man whose wife is taking the pill has chronic osteomyelitis that has caused facial disfigurement — he is
also unemployed. He became very annoyed when his wife got breakthrough bleeding with the pill and
complained that it was "interfering with our sex life" and said she should get sterilised. This may also account
for some of the complaints by husbands against the IUD which often results in 7 - 8 day periods.
The unmarried mothers, who are not cohabiting and do not have a regular relationship find it difficult to
persevere with contraception. They feel that without a regular partner it is not worth bothering about
contraception. They form a vulnerable group because as a result of their loneliness they may enter into a
brief liaison and find themselves pregnant again.
The majority of women referred to the service do accept and persevere with contraception and many will
attend clinics on their own after the initial home visit. This is especially true of these going to the IUD clinic
at the Prince of Wales's but it is still difficult to get women who are using oral contraceptives to go to clinics,
perhaps because of the anxieties still surrounding the pill they need the reassurance of frequent home visits.
A minority of women who may have multiple problems find it difficult to persevere with contraception. It is
just these women who may be receiving help from the social services and it is unfortunate that because of the
recent upheavals of reorganisation within the social services departments this aspect of preventive work
appearsto have suffered. Health Visitors, with their essentially practical approach, have seen family planning as
another aspect of preventive medicine which when it is successful can contribute to the increased well being of
the whole family. The Social Worker with his different training that places less emphasis on "direction" of his
clients may be so involved with all the varied and multiple problems of families he sees that "preventive"
work such as discussion about contraception may tend to get neglected. Family planning is not and cannot be
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