Most recent international health newscast in addition to examination from our health explore band.

The health visitor will have seen how she is coping with the baby, and will probably have had a chance to observe her relationship with her partner and with other members of the family. She may well have some insight into the future family intentions of the woman and her partner. Either sheaths or the contraceptive pill (the progestogen-only pill if she is breast feeding) will probably be the most medically appropriate methods at this stage, but as always, a balance must be sought between what is medically advisable and the woman’s preferred method, or indeed whether she wishes to use contraception at all. To help her with this decision, the family planning training of health visitors and midwives is very important.

The early postnatal weeks are a time of great potential for helping the woman with a chaotic lifestyle. If it is possible for the woman to use some form of contraception and thus provide a breathing space before the next pregnancy, it can be the first stage in helping her to take some control over her own life. However, the subject has to be raised with great tact as the woman may feel that she is being coerced by heavy-handed people in authority. The idea of birth spacing is usually more acceptable than contraception. It is also important to explore and value any fears and mythical beliefs about the methods that she may have.

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Comments (0) Apr 07 2009

Why do men consult doctors so little about contraception? One may assume that they do not have strong feelings on the subject, or what feelings they have are aired and dealt with outside a doctor’s surgery. A less satisfactory but more likely explanation is that men are conditioned by their upbringing to believe that they should have adequate internal resources to deal with any conflicts that arise. Is this the case? Few contraceptive textbooks deal with men’s feelings, and they offer little more than chapters on the mechanics of condom use and vasectomy. Where attitudes are mentioned, they tend to come over as generalizations or personal assumptions of the writer. This chapter has been written after listening to the views of many actual men.

To find a current cross-section of men’s ideas about contraception, this author interviewed about 20 men in some depth over three months, giving them opportunities to air their feelings. Often their initial responses to probings were in the form of neat, acceptable replies, but as they relaxed their attitude changed to become more questioning, and at times there was considerable distress. Men were seen at home, alone, and in comfortable surroundings. This author has known them all for some time in the capacity of either their GP or their family’s GP. Men were selected who differed widely, ranging from one who was proud of his tide as ‘the virgin cracker’, through to married and ummarried couples, the sample including two men of over 50 years.

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Comments (0) Apr 07 2009

Relationships rarely end neatly and couples may break up and get back together several times in an attempt to confirm their feelings for each other. The woman may give up the Pill in the belief that the relationship is over or perhaps out of anger and pain associated with her sexual life. Lack of sexual pleasure may make a woman less well motivated to cope with the perceived risks and side-effects associated with contraception. Sometimes the pregnancy may be used to test out her relationship, as in the case of Miss B. (p. 51, above). If a woman finds herself pregnant once the relationship has ended, she may decide on abortion not just because of the practical difficulties of single parenthood, but out of a desire to rid herself of everything to do with her former partner.

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Comments (0) Apr 07 2009

The vast majority of patients come on their own into the actual consulting room, though they may have come to the clinic with a girlfriend. Occasionally, the patient will ask if the friend can come in with them. The sensitive doctor will make the distinction between those who are nervous (true fear of the unknown) and those in whom the need for support may shed light on their emotional maturity. The boyfriend is also sometimes in the waiting room and may ask to come in with his partner, or she may ask him to do so. Here again, from the verbal and nonverbal communication of the two, the doctor will gain some insight into what the boyfriend’s presence might signify. Is he genuinely offering support in a loving way? Is he concerned about the perceived risk factors, or has he come for further information about the methods?

The number of boys asking for help for themselves is very small, in line with the general under-use of contraceptive services by men. In a given year, the ratio of women to men seeking contraception (all age groups) in a city is 25:1 (Brook Advisory Centre, 1990). Efforts are now being made to provide services that are more attractive to men, such as men-only clinics. It is hoped that such clinics might be able to tackle the problems of contraception and human immunodeficiency virus (HIV) infection together.

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Comments (0) Apr 07 2009

Some women are faced with choices that they find very hard to make consciously, and they may then begin to use their contraceptives erratically as though they hope that fate may somehow make decisions for them.

Miss F. was a 19-year-old who had a steady partner. The relationship had lasted several years and she had taken the Pill regularly with no problems. She felt the relationship was important to her, but she had now gained a university place which would mean moving away from home and from her partner. She felt torn in two, pleased to have a university place but fearful that going away would end the relationship. She began forgetting to take her contraceptive pills and the inevitable happened and she became pregnant. Paradoxically perhaps, this enabled her to make her choice. She now realized that she did not want a baby and realized how resentful she would feel if she did not go to university. She had an abortion and went to university.

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Comments (0) Apr 07 2009