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3. Student social workers from Hatfield Polytechnic have continued to come to work with the domiciliary
service for a 3 month placement which forms part of their training. This has proved a successful and mutually
satisfying venture—the students have learnt about contraception and the vital part it can play in helping to
solve some families' problems and the domiciliary team have been able to learn more about social casework
techniques.
4. General Practitioners have been as helpful and co-operative as in the past. Only one refused to allow his
patient to be put on the pill (although there were no medical contraindications) because of personal anxieties
about the side effects of oral contraceptives.
5. Medical Problems
The domiciliary service (as mentioned in previous reports) continues to function as a pregnancy advisory
service. The comment is often made that if contraception were used more there would be less need for
abortion. This may occur eventually. However, there is a paradox that once a couple have accepted
contraception they may be more likely to seek abortion if an unplanned pregnancy occurs as a result of
method (or patient) failure and may after this accept and persevere with a more reliable method.
A new consultant was appointed to the North Middlesex in January 1973 and patients requesting abortion
have been referred to him. Several terminations have now been done in the North Middlesex.
There have been 2 suspicious cervical smears, one from a woman who had 7 children, and which when
repeated was negative; the other (a West Indian girl with one child) necessitated a biopsy that fortunately
also proved negative.
One woman developed hypertension with the pill; she is awaiting sterilisation.
There has been another vasectomy failure resulting in the wife getting pregnant for the fifth time. Two
vasectomies have had to be done under general anaesthetic because the vas deferens could not be identified
with certainty under local anaesthetic.
It is interesting to note that culture and background influence which method is chosen, for instance, more
West Indian women chose sterilisation and IUD compared to English women who opted more for the pill
(and their husbands for vasectomy) than other groups. It is important to be aware of these kinds of differences
when offering contraceptive advice.
REFLECTION ON 5 YEARS DOMICILIARY WORK
What is domiciliary family planning?
It means the free provision of contraceptive advice and supplies by a doctor or nurse in the privacy of a woman's
own home and at her request after referral by a health visitor, social workers, GP etc.
Why is it necessary?
Recently there has been a great deal of discussion on the subject of family planning and it may be thought that
this kind of work is unnecessary. There is, however, still much ignorance and embarrassment about contraception
and other sexual matters that make it difficult for some women (mainly in social classes IV and V) to seek
help. Added to this are feelings of disgust and shame that surround sex, many thinking that sex is permissible
only for procreation. Attendance at a family planning clinic in a sense implies—sex for sex alone, and this may
prove too embarrasing for some women. Although the impression is often given that sex education is widespread
in schools this is in fact not the case. Sex education at home is often of the "don't" and "be careful" variety
without any explicit instructions so that often women do not realise the connection between menstruation and
being able to have a baby. They may assume (having been forbidden to explore their own bodies) that they have
only one opening 'down below'. Many still have the feeling that birth control is 'unnatural' and that interfering
with nature will produce ill health—"babies keep you young". One West Indian woman with 8 children was very
anxious about birth control methods and was concerned that using them would make her ill and prevent her
caring for her children—she always felt marvellous during pregnancy. She was eventually fitted with an IUD
(as she did not want more children) and has happily remained well after 3 years. There is also a strong element of
fatalism among women from poor homes—they feel that the future cannot be planned. One such woman said
"I believe that if you are meant to have a certain number of children then even the pill will not stop you". Some
women feel that children are 'grown up' by the age of 5 and thus they "do not need you any more". There is
also the feeling among some families that where existing children have "failed" and have not achieved what has
been expected of them, success may be achieved with a new baby.
How does the Service function?
Firstly and more importantly it depends on the referring agent and how well the referral has been made. The
majority of health visitors are now aware of the kind of woman that needs this help: the young fertile mother
with 3 children in as many years, the unmarried mother, the mother or her husband or cohabitee who has
physical or mental ill-health, the mentally handicapped, the large family with multiple problems "well known to
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