Saturday, February 19, 2005

Family Planning History - Birmingham Made A Difference

Birmingham Made A Difference Posted by Hello

If you have ever been a patient in a family planning clinic or visited your GP for the Pill then this book 'Birmingham Made a Difference', 1926-1991 written by Audrey Court and Cynthia Walton should interest you. It is a mix of history, portraits and personal impressions by people who were involved in different aspects of the family planning movement.

As a life choice, modern couples take family planning for granted, but it is thanks to the Family Planning Association (FPA) that women throughout the country have a simple and easy method of birth control. Next year in July 2005 the FPA will celebrate its 75th birthday. In 1930, the FPA's parent organisation, the National Birth Control Council, was formed with 20 clinics.

One of those clinics was in Birmingham which opened in 1927, the 7th clinic in the country. In 1926 a committee was formed to set up the Birmingham Women's Welfare Centre to offer family planning advice. Their aim was the improvement of maternal and child health, and the increase in marital happiness.

Their slogan was 'CHILDREN BY CHOICE, NOT CHANCE'. One of the moving spirits was Mr Edward Mason a local industrialist and his wife. Other prominent members included Miss Hilda Shufflebotham later to become Professor Hilda Lloyd, Professor of Obstetrics and Gynaecology at the Queen Elizabeth Hospital; Mrs Geo Cadbury; Professor Humphrey Humphreys later the Vice Chancellor of Birmingham University; and Dr Clara Macirone who was to become the first family planning doctor at the new clinic, soon to be joined by Dr Dorothy Sandilands. Sir John Sumner of Typhoo Tips Tea provided the funds for the clinic premises. The clinic doctors had to be both mentally and physically brave - as eggs and tomatoes and even bricks and stones were thrown at them!

FPA CELEBRATES 75 YEARS


Mrs Ethel Emanuel became the FPA Chairman in 1932 followed in 1951 by Mrs Lella Florence. When Mrs Audrey Court became Chairman in the 1960's, a great expansion of Birmingham FPA services took place with new clinics throughout the city. Special services were started: a clinic for Psycho-Sexual difficulties with Dr Elinor Corfan; the Domiciliary Service with Dr Helen Humphreys, to offer help to women in their own homes; a Subfertility service; one of the first trials of the intrauterine device (IUD); and the first FPA to offer cervical smears to clinic patients.

I became involved with the FPA in 1951, and worked as a researcher, clinic worker, committee member, information officer, and Regional Administrator and in the following 39 years I saw it all:

The historic meeting in Harrogate in 1967 when the FPA agreed to give advice to the unmarried.

The memorable meeting in Birmingham when Dr Pincus told a large audience about the pill. This resulted in the first clinical trials of the pill in Birmingham, run by Dr Glenys Bond and financed by Captain Bird of Bird's Custard, whose donation set up a trust for Pill Trials and Research.

The Birmingham Mail banner headline 'SEX ON THE RATES', when Birmingham became the first city to give free family planning.

The re-organisation of the FPA in 1976 when the NHS took over the majority of the clinics and provided a free service throughout the country.

After the FPA clinics went into the NHS Midlands Region FPA carried on the pioneering spirit. It ran Inner Cities Projects with ethnic workers; it set up a Menopause clinic in 1978; and in 1986 large Workplace Project was started, to take family planning information to occupational health staff for the benefit of their clients. In 1991 the Midlands Region closed.

Birmingham Made a Difference 1926-1991, 138pp available, Pub by Barn Books Copyright 2001, £2.50 inc P&P from BARN BOOKS LTD email: cynthia.walton@gmail.com

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fpa (formerly The Family Planning Association) is the only registered charity working to improve the sexual health and reproductive rights of all people throughout the UK.

Brook - Voluntary sector provider of free and confidential sexual health advice for people under 25 – outreach to 100,000 young people a year.

Wellcome Library - National Family Planning Archive - The Wellcome Library preserves the record of medicine past and present to foster understanding of medicine, its history and its impact in society.

Marie Stopes - Online sexual health information and advice on issues such as abortion, pregnancy and sexually transmitted infections - contraception, emergency contraception, female sterilisation, health screening, vasectomy.

West Midlands Association of Family Planning Doctors.

Faculty of Family Planning & Reproductive Health Care.

For more Barn Books including 'A Grounding For Life - A History of Maltman's Green School' by Cynthia Walton & Pauline E Hodder.

Family Planning History & National Approval & Local Opposition in Birmingham

FAMILY PLANNING & NATIONAL APPROVAL - OPPOSITION LOCALLY IN BIRMINGHAM

Lambeth Conference 1930

Church and state gave qualified approval to the use of Birth Control methods in certain cases at the 1930 Lambeth Conference when the Bishops submitted a report on Marriage and Sex. ‘Sex is a God-given factor in the life of mankind and its functions are therefore essentially noble and creative. Correspondingly great is the responsibility for the right to use it…there are cases in married life which justify and even demand the limitation of the family by some means. The Church is concerned with the moral principle which must govern such limitation…it can never be right for intercourse to take place which might lead to a conception, where a birth would involve grave danger, even the life, of the mother, or would inflict upon the child a life of suffering; or where the mother would be prematurely exhausted and additional children would render her incapable of carrying out her duties to the existing family….we cannot condemn the this of scientific methods to prevent conception which are thoughtfully and conscientiously adopted’. The Bishops at the Lambeth Conference accordingly passed a resolution approving birth control by 193 votes to 67 with the proviso, ‘where there is a morally sound reason for avoiding complete abstinence.’

Ministry of Health Memorandum

Also in July 1930 the Ministry of Health issued a Memorandum permitting Local Authorities to provide birth control for women on medical grounds. In November the same year the principal women’s societies in Birmingham sent a resolution to the City Council asking for action on the memorandum. The Maternity and Child Welfare committee report published by the Medical Officer of Health in Birmingham vetoed the MOH proposal on the grounds that he considered advice with mechanical methods contrary to the interests of both parents – a view directly challenged by medical authorities. As a result a signed protest was sent to the Lord Mayor, the Chairman of the Maternity and Infant Welfare Committee and the Press!

‘WE THE UNDERSIGNED feel compelled to protest against the decision of the Birmingham \Maternity and Child Welfare Committee to take no action in response to the Memorandum 153 of the MOH, which indicates the conditions under which Local Authorities may provide birth control advice for mothers, in cases where further pregnancies would be detrimental to health. We believe the inability to obtain individual advice on this matter from qualified and disinterested medical sources is responsible for much unhappiness and ill health and is calculated to drive overburdened mothers to ignorant advisers and to agencies associated with dubious types of commerce. We therefore urge that the MOH reconsiders his action in the interest of public health and in justice to a section of the community unable to obtain suitable medical advice at its own expense’.’
Signed by: 1 Alderman, 3 Councillors, 14 Reverends, The Bishop of Birmingham, Mrs George Cadbury the ex President of the National council of Evangelical Free Churches, 5 Professors, 5 Doctors, 2 MPs, Prof. Lofthouse, Principal of Handsworth Weslyan College.

The matter was raised again at the City Council and lost by 46 votes to 25.
The Committee noted that authority had already been given to Medical Officers of Child Welfare Centres and Ante Natal Clinics to refer patients needing avoidance of pregnancy on medical grounds to private practitioners or hospital for advice – and that, in Birmingham, would include referrals to the voluntary birth control clinic in the city. In her Annual Report the Chairman of the Birmingham Women’s Welfare Clinic wrote ‘We hope that Medical Officers at Welfare Centres take full advantage of this ruling, and we shall welcome as many patients as they care to send. But if we are to assume this responsibility on behalf of the municipality, then the City of Birmingham must support generously this important piece of social work.’ However no money was forthcoming!

In 1930 there were 660 new patients and 3,718 return visits. At one session there were 43 patients, including 17 newcomers. ‘Such numbers keep our staff on the run’ and the 1 1/2hr session had to stretch until all patients had been seen. Another session was desperately needed but not possible due to lack of funds.

Move to Masshouse Lane

In 1931 the clinic moved to larger premises at 22 Masshouse Lane again through the help of Sir John Sumner who arranged the lease and bore the expense of ‘transforming an extremely dirty old house into a thing of beauty in its modest way’. There they had the protection of steel mesh on the windows. The Committee was chaired by Mrs Smith-Ryland, who shortly after moved from Birmingham into the country and was succeeded by Mrs Ethel Emanuel, with 20 committee members who now included Rev. A. Cohen, Councillor Mrs Huggins JP, Canon Guy Rogers and Mrs Julia Rogers as well as the three doctors and one nurse. The committee felt that many women did not come to the clinic because they were not aware of its existence. In the hope of publicising the service Councillor Alderson presented a petition to the City Council from over 3000 working mothers, collected by the Women’s Labour Party and Women’s Co-operative Guilds asking that information on birth control should be made available, but the MOH refused to sanction the giving out of birth control information at Municipal Welfare Centres.

The Centre’s Annual Report for 1931 showed that expenditure had exceeded income by £40, about 1/10 of the income and expenditure account! The Treasurer Mr Mason called for donations to support the Centre.

In 1932 the Departmental Committee on Maternal Mortality and Morbidity published a Final Report showing there were 3805 deaths of women in childbirth, of which at least half could have been prevented; and 514 deaths were due to women giving birth when suffering from organic disease. ‘Where it appears that further childbirth will endanger life, medical advice should be given as to prevention of pregnancy’.

A further breakthrough came in 1932 in Plymouth where the MOH agreed to lend the premises of a Maternity and Child Welfare Centre to the local birth control committee to run a family planning clinic. This set the pattern all over the country but it was only in the 1960s that Birmingham FPA was invited to expand its work all over the city by the public health department.

Public Health Committee Refuses Grant

The Birmingham Women’s Welfare Clinic offered its service to the City of Birmingham in an official capacity and asked for a grant towards the cost of the work it was doing for the City from the General Purposes Committee. The Town Clerk replied that he was not in the position to bring this request to the General Purposes Committee because the Medical Officer of Health informed him that the Chairman would resent very much any reference being made to this Committee. So a letter was sent to the Public Health Committee and the response was '‘making of any grant would be subversive to the wishes of the council. I am therefore to state that the Committee are unable to see their way to accede to the application'’ Mrs E. W. Barnes, the wife of the Bishop of Birmingham, expressed indignation at the unimaginative attitude of local authorities who refused to support family planning.

The Birmingham Federation of Medical Women held a meeting at the Centre and Dr Sandilands explained the work of the clinic and the methods of contraception. An after care service was started: reminder forms were sent to patients who failed to return to the clinic for their second visit or at the end of six months from their initial registration. Mrs Ethel Emanuel continued as Chairman during the 30’s. Her Hon. Secrataries were Mrs M. Wharton, 1931-33; Mrs G. P. Mills 1934-7; and Mrs Jessamine Weeks 1937-38, who then went to London during the war years.

By the mid thirties three strands in support of birth control had emerged in Birmingham. The first was to prevent ill health of a serious nature to the mother caused by repeated childbirth; the second was eugenics, ‘birth control is a direct means of race improvement’; and the third was economic – the problem caused by high employment in a big city. Case histories from the Annual Report highlighted these strands – Mrs D was sent by her doctor with a history of eclampsia, having had 30 fits during one confinement; Mrs E had eight children of whom four were mentally defective and she herself suffered from a prolapse; and Mrs B had 14 pregnancies including four miscarriages in 10 years – her husband was an unemployed labourer.

In 1934 Worcester County Council asked permission to send patients from their welfare centres and gave an annual grant of £5. By 1935 an additional weekly session was held at the clinic and, with the exception of Liverpool, it was the only clinic holding three sessions weekly. There were 700 new patients in the year and 2967 patient visits. This year there was a very successful clinic AGM with Prof. Philip Sargent Florence in the Chair and Miss Vera Brittain and Prof. H. F. Humphreys as speakers.

Birmingham municipal birth control clinics started at Dudley Road and Selly Oak Hospitals for those patients with gynaecological conditions or forms of sickness which would make another pregnancy detrimental to health.

A new venture by the Women’s Welfare Centre in 1938 was the Mail Order Service for birth control supplies, for washable sheaths, prescribed caps and spermicidal cream. The Mail Order Service grew into a very large concern, and at the end of the war a part time worker, Mrs Ivy Barlow, was engaged by Mrs Emanuel and Mrs Mollie MacMillan, first for this and then additional duties. She was the first paid worker of a very loyal band of administrative and clerical workers who formed the budding secretariat which grew rapidly.

In 1939 the affiliated birth control clinics throughout the country changed their name to the Family Planning Association. However Birmingham kept its old name and continued to run its own service in its own way. It did not change its name until 1950 when it became the Birmingham Family Planning Association.

Lella Florence must have continued to find life frustrating on the Birmingham Committee which seemed very reluctant to enlarge its services as she would have liked, and was content to run a smaller service. Not only did a growing number of women demand contraception but middle class women were using contraception themselves perhaps for the first time. Women who married in the 30’s and did not like a clinic often went privately to Dr Helena Wright in London or Dr Mary Winfield in Birmingham. But they never discussed contraception among themselves. Their parents had used coitus interruptus and many middle-class women started to use the cap because they began to make their own way in life unot just as wives and mothers, and needed to space their children.

Family Planning History - The Birmingham Project

THE BIRMINGHAM PROJECT

In 1987 the FPA Region decided to look into the possibilities of applying to the City of Birmingham Development Unit for grants for Employment Training (ET) of a multi ethnic team. As a result the FPA was given six Manpower Services Workers (MSC) which included four outreach Workers, an Information Worker and an Administrative Worker who mainly dealt with the accounts of the Project. Ernie Pearce from the Development Unit visited the RA on a number of occasions to offer encouragement in the work and iron out any administrative difficulties with the funding from the City.

Detailed training plans were worked out for the team and Health Education Officers, family planning doctors and nurses and National Office training stall all took part, the training costs being born by the ET project. On the job training too place with the RA and ad hoc Information Officer going out with bookstalls and displays all over the Regional area in health clinics, libraries, community centres, shopping and leisure centres, courses and conferences. The team consisted of Lyn Eshelby, Mrs D Bennett, Jenny Grimes, Ada Leslie, Gillian Zarb and Elisabeth Wilson. Ada was the administrative worker and also had training on a PC computer. Ada was on a college course part time.

During the summer months the FPA took part in the Birmingham Women’s Festival and the FPA was put on the map all over the city with 22 displays and ten bookstalls in two weeks. Every week sessions were held with the RA for feedback from the various activities the workers had been engaged in, and they were encouraged to write short reports about the success or failure of their work which could be discussed in the group.

At the suggestion of Ernie Pearce proposals were sent to the City for an expanded team of 10 workers in 1988, the Project was approved for three months and then extended for a year from 1989. The Rationale for the employment and employment training by the FPA was shown to be u9nique in that the work itself had a benefit to the individuals concerned and a positive community benefit; it offered job and training opportunities to workers from different ethnic background who found it more dificult to secure permanent jobs and it took health resources to ethnic communities and others in the |Inner Cities areas.

60% of the women were of Asian and Afro-Caribbean background. There were now two administrative/clerical workers who dealt with time sheet, employment records, appointments and typing of reports and memos. They were also trained to use the word processor. Two women were information/resource workers and continued to build up the comprehensive files for the Women’s Health Information Centre using the word processor.

They also updated the Region’s specific book lists, made up book boxes for bookstalls and exhibitions; ran a press cuttings service on health issues for the Region’s topics files; looked up new publications for inclusion in the |Book Centre and prepared materials for the Outreach Workers to take with them for visits. The trainees helped to devise and make up displays. Lyn Eshelby made up one of the Region’s most successful displays, ‘Information is only a phone call away.’ In 1988, 80 displays were held.

The six outreach workers went into the community to statutory and voluntary agencies with FPA resources. They set up displays and Health Days and bookstalls; organised and took part in exhibitions and conferences; arranged informal group meetings with professionals to demonstrate what the FPA could offer; networked between agencies; liaised with local Health Education Officers and made up exhibition materials. In addition the ET scheme provided a Supervisor, who, with the RA ensured the work was carried out, co-ordinated the programmes and updated and supported the workers. Lyn Eshelby who was one of the original six ET workers became the supervisor during 1988.

Daisy Lisk Carew was also part of the original team. The rest of the team consisted of Barinder Bahia, Ms Chochan, Marion Hackett, Ms Hamilton, Christine Hunt, Nancy Maddox, Anne Roe and Pauline Wright. The large size of the team entitled the FPA to a grant to buy and run a small secondhand hatchback. Lyn and Daisy were both given grants to take driving lessons.

New Co-ordinator

When Lyn left the Project to have a baby in 1988, Daisy Lisk-Carew took over as co-ordinator. Her experience as an outreach worker over the previous year meant that she understood the problems of the team, and showed good skills as an administrator as well as supervising and allotting work. She took on the big job of co-ordinating the venues where the FPA was displaying its resources at the Birmingham Women’s Festival. No small feat as that involved the team travelling all over Birmingham and dovetailing the displays with each other. In her outreach work Daisy had concentrated on making contact with Neighbourhood Offices which the Birmingham City Council had set up all over the city to give advice and information. Daisy went to every office taking with her FPIS material and posts and worked with the staff in small groups to increase their understanding and comfort with the material.

In Small Heath and Saltley she arranged for an Asian interpreter and brought Asian leaflets with her. Daisy carried out a short research project for Selly Oak Colleges, where she was studying for a Foundation Management Course, to see how far her intervention had increased the knowledge of family planning, sexuality and women’s health. She also assessed how many members of the public enquired about the various topics in the posters and leaflets on display. She felt that in this project she had ‘bridged a gap’, and she was delighted that with such a sensitive subject she had never encountered any hostility but on the contrary was always received most warmly.

Training

Once again a training programme was devised, and started quickly, so that the outreach workers could be sent into the field knowledgeable about FPA policies and services. None of the workers had had any contact with the FPA before they came to the Region, but they were soon filled with enthusiasm and quickly became committed. There was constant evaluation by the trainees of the courses which they attended, and when they were working in the field they were given structured evaluation forms to complete relating to their contacts in the community.
The training courses and seminars were intensive and all the ET workers participated in the course. The trainees had a 3-day course on ‘Sexuality and Relationships’ and a 3 module 3-day Group and Interpersonal Skills Course (GRIPS) which was put on by the FPA Education Unit and financed by a donation from the Charities Aid Foundation. There were also a series of half day seminars on family planning, AIDS, well woman screening, the Health Education Service, Community Health Councils, Report Writing and Information Retrieval. The Training Agency at the City arranged for the workers to attend relevant course at college for 40% of the time.

Based on experience it was shown that training young people from the age of 19 upwards as family planning workers had a very important part to play in communication about family planning in the community. Even workers who only stayed a few months found the benefits were considerable One of the team found a job with the Department of Health after she had been at the FPA for six months. She wrote to the Centre to say,’The work with the public and their problems is very stressful and demanding, especially with young single parents and no fixed address cases, but I feel the work and experience I gained from being at the FPOA has helped me tremendously. I have recommended cases to the AIDS officer and to various other clinics and centres. I still have a good supply of leaflets to hand out as well.

The acquisition of the hatchback revolutionised visiting by outreach workers and the setting up and provision of displays all over the Regional area. 400 visits were made to different organisations that included day nurseries, ethnic associations, community associations, a Job Preparation Unit, Winson Green Prison Visitor’s Centre, Saltley Leisure Centre and All Saint’s Addiction Unit to name but a few. Eighty displays were held in the year which included again the Birmingham Women’s Festival with 15 venues, and 12 venues for West Birmingham Health Authority’s Family Planning Campaign.

Apart from the benefit to the community, the lively mix of women on the Projects, the two Inner Cities workers, the FPA volunteers and the small nucleus of permanent paid staff made for a constantly challenging and changing regional environment, with benefits for everyone working there. During 1989 four further applications were made to Inner Cities for ethnic workers in Dudley, Coventry, Walsall and Sandwell all of which were granted.