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A POPULATION POLICY FOR BRITAIN
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fession does not fully meet their needs. Increasingly often it is the patients who call (or seek to call) the tune-for example, in seeking contraception, abortion, cosmetic operations, or simply inoculations to protect them against disease in foreign travel. Many doctors resent such calls on their time, because they may seem to undermine clinical authority, on moral grounds, or because such work is mostly tedious and" repetitive. For these largely " non-consultative needs, people come to doctors not so much as patients seeking expert advice as clients bent on specific aid. The doctor in last week’s case put this neatly. He said: I hope this case may help young girls by persuading clinics to treat them as patients and not as clients. Patients consult: clients instruct." This remark does less than justice to the work of most clinics; but anyhow the present-day citizen, maturing earlier and more knowledgeable than his parents, knows what he wants and is intent on getting it. If, in his role as client, he receives a cold welcome from his doctor, he will turn elsewhere: and agencies, each set up to meet one particular need, will proliferate. Perhaps this is inevitable; but before the trend goes further the medical profession might squarely face two related questions: Are doctors to discourage approaches by patients for services of which the patient, and not the doctor, is the arbiter ? If so, why ? "
A POPULATION POLICY FOR BRITAIN
WHEN he announced that the Government was to make available more resources for local-authority family planning, Sir Keith Joseph was asked why he had no plans for bringing family planning under the National Health Service. He replied that he was concerned to help those people who would not of their own volition seek advice; most people, he said, were capable of seeking advice on their own initiative and of paying for it out of their own pockets. The extension of the family-planning service was not, he emphasised, intended as part of a population policy; the object was to increase family happiness. The reluctance of the British Government to introduce a population policy is causing increasing anxiety among those who are aware of the seriousness of the situation and realise that any plan must take many years to have effect. The Government has now decided that population trends should be systematically studied so that policy decisions on social and scientific questions may be based on accurate population forecasts. But still there is no suggestion that the Government will introduce any kind of planned control of population, despite the continued pressure of evidence from its advisers that such a policy is essential. Present population estimates show that the population will be at least 60 million in 1980, 65 million in 1990, and 70 million by the end of the century. Much emotion has been generated by the change in the law concerning abortion, and as a result the Government has instituted an inquiry into the working of the Abortion Act, Yet the implications of the
present trends in Britain’s population growth, which should be much more worrying in that they are on so much larger a scale, seem incapable of arousing a similar response. When pressed for an inquiry into the Abortion Act, Mr. Richard Crossman, who believed that a population policy for Britain was essential, said that his main concern was that it should not be thought that abortion was any substitute for adequate family planning, but he admitted that the familyplanning service in Britain was inadequate. According to a Labour Party report on population, to be delivered to the Labour Party women’s conference, local authorities often fail to take their full responsibility for family planning, and have to rely heavily on the good will of voluntary agencies. Neither the hospitals nor general practitioners are equipped, the report says, to deal with the potential demand for contraceptive advice; under the new family-planning arrangements, more facilities will be made available by hospitals for family planning, but there will be no change in the provision of family-planning advice and equipment by general practitioners. The report also suggests that a change of attitude is needed: women should not be pressurised into believing that they can fulfil their function in life only by raising a family. The achievement of a population policy may well depend to some extent on the expansion of educational and employment opportunities for women in order to give them a satisfactory alternative to having children.
DEVELOPMENT AND VERY LOW BIRTH-WEIGHT THE common view of the outlook for the very low
birth-weight baby is that he or she carries an increased handicap, especially mental retardation and
risk of
behavioural disorder. In this group survival is fast becoming the rule rather than the exception-one London hospital last year took in thirty-three babies of birth-weight in the range 1001-1500 g., and twentyfour (73 %) survived. More than a decade ago Drillien2 " was warning that it seemed likely that as the survival rate in this low birth-weight group improves an increasing number of damaged children will survive ". Only a year ago Holt repeated this view,concluding that : " The chance of these, the smallest babies, escaping abnormalities is small, and abnormalities are almost always severe." He calculated, from Drillien’s later data and from figures from the National Perinatal Mortality Survey, that if, in a group of thirty babies of birth-weight 1500 g. or less, survival rose from one in six to one in two, the number of surviving handicapped children would rise from four to eleven. In a review for the National Bureau for Co-operation in Child Care, Dinnage4 agrees that for most of the very smallest babies the prognosis with regard to handicap is poor, and she points to the part played by socioeconomic factors and neonatal complications. On p. 516 of this issue a paediatric team from
University College Hospital paints
a
happier picture.
1. Labour Party, Transport House, Smith Square, London S.W.1.
10p. 2. Drillien, C. M. Archs Dis. Childh. 1958, 33, 10. 3. Holt, K. S. Maternal Child Care, 1970, 6, 211. 4. The Handicapped Child: Research Review vol. I. DINNAGE, M.A. London: Longman. 1970. Pp. 414.
By ROSEMARY £2.75.
fession does not fully meet their needs. Increasingly often it is the patients who call (or seek to call) the tune-for example, in seeking contraception, abortion, cosmetic operations, or simply inoculations to protect them against disease in foreign travel. Many doctors resent such calls on their time, because they may seem to undermine clinical authority, on moral grounds, or because such work is mostly tedious and" repetitive. For these largely " non-consultative needs, people come to doctors not so much as patients seeking expert advice as clients bent on specific aid. The doctor in last week’s case put this neatly. He said: I hope this case may help young girls by persuading clinics to treat them as patients and not as clients. Patients consult: clients instruct." This remark does less than justice to the work of most clinics; but anyhow the present-day citizen, maturing earlier and more knowledgeable than his parents, knows what he wants and is intent on getting it. If, in his role as client, he receives a cold welcome from his doctor, he will turn elsewhere: and agencies, each set up to meet one particular need, will proliferate. Perhaps this is inevitable; but before the trend goes further the medical profession might squarely face two related questions: Are doctors to discourage approaches by patients for services of which the patient, and not the doctor, is the arbiter ? If so, why ? "
A POPULATION POLICY FOR BRITAIN
WHEN he announced that the Government was to make available more resources for local-authority family planning, Sir Keith Joseph was asked why he had no plans for bringing family planning under the National Health Service. He replied that he was concerned to help those people who would not of their own volition seek advice; most people, he said, were capable of seeking advice on their own initiative and of paying for it out of their own pockets. The extension of the family-planning service was not, he emphasised, intended as part of a population policy; the object was to increase family happiness. The reluctance of the British Government to introduce a population policy is causing increasing anxiety among those who are aware of the seriousness of the situation and realise that any plan must take many years to have effect. The Government has now decided that population trends should be systematically studied so that policy decisions on social and scientific questions may be based on accurate population forecasts. But still there is no suggestion that the Government will introduce any kind of planned control of population, despite the continued pressure of evidence from its advisers that such a policy is essential. Present population estimates show that the population will be at least 60 million in 1980, 65 million in 1990, and 70 million by the end of the century. Much emotion has been generated by the change in the law concerning abortion, and as a result the Government has instituted an inquiry into the working of the Abortion Act, Yet the implications of the
present trends in Britain’s population growth, which should be much more worrying in that they are on so much larger a scale, seem incapable of arousing a similar response. When pressed for an inquiry into the Abortion Act, Mr. Richard Crossman, who believed that a population policy for Britain was essential, said that his main concern was that it should not be thought that abortion was any substitute for adequate family planning, but he admitted that the familyplanning service in Britain was inadequate. According to a Labour Party report on population, to be delivered to the Labour Party women’s conference, local authorities often fail to take their full responsibility for family planning, and have to rely heavily on the good will of voluntary agencies. Neither the hospitals nor general practitioners are equipped, the report says, to deal with the potential demand for contraceptive advice; under the new family-planning arrangements, more facilities will be made available by hospitals for family planning, but there will be no change in the provision of family-planning advice and equipment by general practitioners. The report also suggests that a change of attitude is needed: women should not be pressurised into believing that they can fulfil their function in life only by raising a family. The achievement of a population policy may well depend to some extent on the expansion of educational and employment opportunities for women in order to give them a satisfactory alternative to having children.
DEVELOPMENT AND VERY LOW BIRTH-WEIGHT THE common view of the outlook for the very low
birth-weight baby is that he or she carries an increased handicap, especially mental retardation and
risk of
behavioural disorder. In this group survival is fast becoming the rule rather than the exception-one London hospital last year took in thirty-three babies of birth-weight in the range 1001-1500 g., and twentyfour (73 %) survived. More than a decade ago Drillien2 " was warning that it seemed likely that as the survival rate in this low birth-weight group improves an increasing number of damaged children will survive ". Only a year ago Holt repeated this view,concluding that : " The chance of these, the smallest babies, escaping abnormalities is small, and abnormalities are almost always severe." He calculated, from Drillien’s later data and from figures from the National Perinatal Mortality Survey, that if, in a group of thirty babies of birth-weight 1500 g. or less, survival rose from one in six to one in two, the number of surviving handicapped children would rise from four to eleven. In a review for the National Bureau for Co-operation in Child Care, Dinnage4 agrees that for most of the very smallest babies the prognosis with regard to handicap is poor, and she points to the part played by socioeconomic factors and neonatal complications. On p. 516 of this issue a paediatric team from
University College Hospital paints
a
happier picture.
1. Labour Party, Transport House, Smith Square, London S.W.1.
10p. 2. Drillien, C. M. Archs Dis. Childh. 1958, 33, 10. 3. Holt, K. S. Maternal Child Care, 1970, 6, 211. 4. The Handicapped Child: Research Review vol. I. DINNAGE, M.A. London: Longman. 1970. Pp. 414.
By ROSEMARY £2.75.