Family Planning Campaign - The Workplace Project

FAMILY PLANNING CAMPAIGN - THE WORKPLACE PROJECT

Family Planning Project Proposals

The FPA had long recognised that health care professionals in their contact with the public, play an important part in information, education and attitudes about birth control. Such workers can endorse the value of the information they provide and can enable their clients to discuss such information with them.

In 1983 proposals for a Workplace Project were drafted and helpful suggestions were made by Zandria Pauncefort, Toni Belfield, Helen Martins and Kay Wellings at National Office and by Sheila Bennett of Eastern Region FPA. .In March 1985 the proposals were sent to Professor Malcolm Harrington, Institute of Occupational Health, University of Birmingham and to Cynthia Atwell, Tutor in Occupational Health at the Royal College of Nursing. They were enthusiastic and offered to give help and contacts in industry. Madeleine Harrington, Professor Harrington’s wife, joined the Region as a voluntary project officer until enough funding was available to employ her.

Family Planning Aims and Objectives

The project aimed to make FPIS material available to men and women in the workplace by working in co-operation with Occupational Health (OC) staff and departments: to underline to staff the needs and problems of the workforce for information and counselling in the field of family matters – family planning, and to explore new ways of promoting the take up of FPIS materials.

It was important to evaluate the view of the OH staff on the usefulness of different categories of FPIS material and the need for new material and approaches. Staff were asked to keep records of the volume of enquiries on family planning and related topics as well as the volume of leaflets taken. It was hoped that this evaluation would enable the FPA to adopt a future strategy for Regional and National contacts in the workplace.

Family Planning Resources

The resources pack comprised a complete set of FPIS material. In addition three, ASK THE NURSE posters were designed and printed on Health, Social and Lifestyle topics; also three Information Sheets were devised and made available on topics which FPIS did not cover, these were PMT, Change of Life and Pregnancy and Work.

Supportive back up material for OH Department consisted of a Project Handbook giving information on leaflets, posters and exhibition materials including displays and book boxes. Two Regional files were provided- a comprehensive Health Directory, a shortened version of the Women’s Health Information Centre file; a Family Planning and Related Services Directory for the whole of the Midlands Region with information on family planning clinics, clinics for psycho-sexual difficulties, sexually transmitted diseases, pregnancy, counselling well woman and the menopause. Also included were several booklets;Contraceptive Handbook, Choices in Contraception, Introduction to Family Planning, and Promotion of Mental Health with a list of addresses of helpful voluntary organisations. The back of the Project Handbook included a five page evaluation form which could be filled in as an ongoing process but was needed at the end of the Project and an Enquiries Evaluation Form which had to be filled in monthly. There was also an order form for leaflets and posters.

Family Planning Funding

A year’s budget was drawn up from May 1985 to May 1986, the total came to £10,645. National Office gave £500 to get the project off the ground and a further £3,000 in 1986. 57 organisations were approached for donations. The Region received donations from five firms totalling £950. £200 worth of display stands were given by Marler Haley Ltd and £10 worth of stationery by James Harper Ltd.

Family Planning Staffing

Madeleine Harrington worked on a voluntary basis from May-September 1985, and then as a part-time worker from September to December when she resigned. Because of the shortfall in funding the Region could not appoint another part-time worker but employed Betty Hayes on an ad hoc basis.

Family Planning - Launch of the Project

Occupational Health staff from 19 workplaces attended the launch on 14th October. Professor Harrington, Cynthia Atwell, Madeleine Harrington and the Regional Administrator talked about the aims of the Project and the materials, resources, questionnaire and evaluation sheets were demonstrated. The importance of feedback to the FPA was underlined.

OH Nurses and Doctors were invited to ask questions. Their main areas of concern were that they needed more information on contraception, the menopause and PMT so that they could be comfortable in counselling members of the workforce who came for help; that they feared they would be deluged with enquiries which would take up an enormous amount of their time and disrupt their normal work schedule; and that they were worried about keeping the Enquiries Sheet up to date and completing the questionnaire. In response to these concerns the FPA agreed to put on a Study Day about contraception and women’s health in the near future, and that the Project Officer would offer support about the Questionnaire and Enquiries Sheet.

Family Planning Participants

23 workplaces agreed to participate. As the OH Departments taking part were from network contacts they were not a random sample but there was a spread of different workplaces both in type of industry and size. Approximately 150,000 employees were involved. There were two firms in heavy industry, 15 centres in light industry, three in the NHS, two in local government and two in the media.

Family Planning & Occupational Health Departments and Staffing

The size of the workplace had a bearing on the size of the OH Department and the number of OH staff employed. At one end of the spectrum were large industrial factories with big well appointed OH Departments into which members of the workforce came constantly for attention of staff which included physiotherapists, audiometrists, dentists and radiographers. At the other end of the scale were departments which consisted of a small first aid room. All the workplaces employed OH Nurses in either a full or part-time capacity but only six employed full time doctors and these were concentrated in firms employing 2,000 employees or more.
Visiting the Workplaces.

All workplaces were visited by appointment between October 1985 and February 1986 to meet OH staff and to take them their boxes of material. At this visit the Project Officer explained how the Enquiries Form and Questionnaire should be completed. Together the Project Officer and OH Nurse looked at suitable areas to display leaflets and posters and arranged a date for the display WHO CARES ABOUT YOUR HEALTH to be put up in the OH Department or works canteen. Madeleine Harrington made a number of visits up to Decembers but the bulk of visits after that were made by Betty Hayes. The Study Day took place on 20th November at the Royal College of Nursing and was attended by 25 OH representatives. Topics for discussion included Pregnancy at Work, Health in Pregnancy, Family Planning, PMT and The Menopause.

Family Planning - Evaluation of the Project

Family Planning IS Materials

Although 23 workplaces took part only 21 completed the Questionnaire. Leaflet racks were displayed by all participants in the OH Departments, Nurses Room, Welfare Room and Doctors Room. In one case an OH nurse only made the material available to the female workforce. At three sites.material had to be removed owing to offence being caused to office staff although there was no objection from shop floor staff. The initial supply to each workplace consisted of 930 leaflets and 27 posters. 48% of the workplaces placed further orders and a total of 41,915 leaflets were used. Predictably there was a mixed response to the leaflets. Favourable reactions included Coventry City Council, ‘your leaflet stand encouraged more to ask for information,’ but there were unfavourable comments elsewhere, at LCP ‘Mixed sexes objected to the display of material in the canteen and the material put in the toilets had a poor response’. OH staff noted gaps in information on hysterectomy and mastectomy, and there was no material available for self-examination for males. Of all the leaflets displayed a third were taken on family planning, a third on sexually transmitted diseases and a third on women’s health.

Family Planning Exhibitions

10 workplaces took up the offer of the exhibition WHO CARES ABOUT YOUR HEALTH boards and were also lent Marler Haley display stands. The exhibitions ran for a minimum of two weeks to a maximum of six months. In some cases bookstalls were run for one day in conjunction with the exhibition.

Conclusions
69% of the OH staff were appreciative of the project although some were unable to participate fully because of pressure of work. The back up material and training support for OH staff on a Study Day were fundamental to the Project. In general FPIS materials were very well received and the leaflets were appropriate for the Project. FPIS posters were not so well received as there was difficulty making space to display them The specially designed posters ASK THE NURSE were a disaster although the new Information Sheets on PMT, The Menopause and Pregnancy at Work were extremely popular and met a need. The exhibition boards were well accepted on the general health theme. The OH Department at Birmingham City Council was particularly enthusiastic about the Project, ‘Employees from their comments found it very useful to be able to get information from the workplace instead of having to spend their own time to look for information. If this project could be spread to the outlying areas of the city I am sure the response would be tremendous’.

Family Planning & The Future

This Project was never published. However despite the lapse in time it should be possible to take a similar project nationwide using network contacts from those who train OH nurses. Such a project should merit support from the government or Health Authority because of the high health educational content and access to the workforce which does not normally come into contact with other health and social work professions.

NOTE: The full Workplace Report is available from Cynthia Walton 0121 471 5223

You can read more about the history of the Birmingham Pioneers in Family Planning in 'Birmingham Made A Difference' by Audrey Court and Cynthia Walton. published by BARN BOOKS and available for only £2.50 post free

Family Planning Campaign - Menopause Clinic

THE MENOPAUSE CLINIC

One of the greatest achievements of the Midlands Region was to set up a Menopause Clinic and then to devise a training scheme for doctors and nurses in Management of the Menopause. The decision to open such a clinic was made at one of the first meetings of the newly formed Regional Executive Committee and the Regional Administrator started to put out feelers for a doctor who would be interested in running such a clinic.

In 1978 The Region arranged a talk on the Menopause with Wendy Cooper, author of ‘No Change’, the medical best seller, and a medical panel chaired by Dr Glenys Bond. The meeting was held in December at the Vaughan Jeffreys Lecture Theatre at Birmingham University and some 300 women attended. The Region put up displays on women’s health and sex education and ran a bookstall with copies of ‘No Change’ and books on health topics.

In 1979 the Region opened a regular weekly Menopause Clinic session. There had been some disappointments in appointing a Medical Officer for this clinic. Professor John Newton of the Department of Obstetrics and Gynaecology suggested that one of his lecturers, Mr Tony Parsons, should run the clinic as a pilot project and plan to train further doctors to carry on the work. and he was keen to be involved. Mr Parsons and Dr Ron Fletcher arranged the protocol for the clinic and from the outset the clinic was a great success. Mr Parsons decided he would collate results as a research project and patients were given a formidable questionnaire to complete when they came for their medical consultation and examination.

The Region circularised all the family planning clinics in Birmingham and surrounding areas about the opening of the Menopause Clinic .The clinic had seven patients per session and soon built up a waiting list. The clinic session was held in the clinical suite on the first floor of the Regional Centre at No 7 York Road. This was leased to Birmingham Brook Advisory Centre for its birth control sessions and Brook agreed to let the Menopause Clinic have the use of the suite one afternoon a week. Patients used the downstairs Regional Book Centre as a waiting room and went upstairs straight into the clinical suite. This worked fairly well but was far from ideal because sometimes Brook’s lunchtime clinic ran late which meant that the Menopause Clinic was held up on several occasions. At the same time the Menopause Clinic had to finish punctually so that Brook could start its early evening clinic on time.

Brenda Taylor was the first Clinic Secretary dealing with appointments and enquiries. At the clinic the patient had her medical history taken by the nurse to find out her symptoms and why she had come to the clinic. The patient then saw the doctor who went over her medical history, gave her a routine examination and took a smear test and blood samples to assess haemoglobin and follicle stimulating hormone (FSH) These samples were sent to Professor Whitehead’s Woolfson Laboratory. The doctor also discussed treatment and asked the patient to return for a second visit to learn the results of her blood test.

Although in general medication was not prescribed until the results were obtained, there were some exceptions. Some patients were so desperate and miserable, had come some distance, and were loth to wait for their result. In these cases they might be started on medication right away. The prescribed supplies were dispensed at the clinic. All patients were told their GP would be sent a letter about their attendance at the clinic with the results of their examination, their tests and the medication prescribed.

Patients were usually prescribed Prempak which was an oestrogen and progestogen preparation. The protocol for prescribing was strict; with oestrogen alone there was a danger of cancer of the uterus. After Dr Gillian Stuart took over the regular running of the clinic in 1981 later joined by other doctors, Mr Parsons acted as a consultant to the clinic. By the end of 1980 the Menopause Clinic had been running for 18 months. During 1980 there were 157 new patients and 473 patient visits. Many patients were recommended by word of mouth and for some months there was a three month waiting list. In 1983 the Region moved into its new premises at No 5 York Road with space for a clinical suite on the 1st Floor. Dr Kind and Mr Parsons advised how this should be planned for the use of doctors and nurses. There were private interview rooms for the doctors and for the nurses, and a sterilisation unit bay for gynaecological instruments. Gifts were made of curtains, two examination couches and an instrument trolley. Nurse Grenfell’s husband worked at the Selly Oak Colleges which were modernising their student accommodation and furniture. The Region gave a donation to the Colleges and acquired small desks and chairs for the consulting rooms.

In 1982 patients were coming to the clinic from West Midlands, Leicestershire, London, Wales and even Cornwall. A fortnightly session was opened on Tuesdays in addition to the two weekly sessions on Wednesday morning and Thursday afternoons. Dr Wishart joined Dr Stuart at the clinic and Dr Chandramani and Dr Plant came for occasional sessions. The Clinic nurses were Mrs Jean Lawrence, Mrs Jean Dodds, Mrs Anne Hines, Mrs Sheila Hetherington, Mrs Irene Groves and Mrs E Grenfell. Joy Bosworth became the Clinic Secretary.
Mr Parsons and Dr Stuart drew up a plan for a pilot project of Menopause Training. As well as running the Regional Menopause Clinic they had been running a clinic at the Women’s Hospital. Mr Parsons was now a Senior Lecturer at Warwick University and Consultant Gynaecologist at St. Cross Hospital, Rugby. The Menopause Training was approved by the FPA Nnational Executive Council and started in 1984. It was the first such system in the country. Each trainee had to attend nine practical sessions and seven seminars before being granted an FPA Certificate in Management of the Menopause. Dr Stuart and Dr Wishart were both involved in the training course.

After five years the clinic had two weekly sessions and a fortnightly session on Monday afternoons which alternated with the Well Woman Clinic run by Dr Chandramani. When she gave up her sessions due to other commitments Dr Plant came to run the Monday Clinics.

By 1986 six doctors had completed their Menopause Training. There were three prospective trainees for 1987/8. In 1988 a One-Day Seminar was held in association with the Post-Graduate Centre at the University of Warwick and two more seminars were proposed for other parts of the Region where no menopause clinics or training existed. Midlands Region and Yorkshire and North East Region were chosen for an in depth investigation by National Office for a Clinic Feasibility Study which reported favourably in June 1988.

By 1989 the clinic had been running for 10 years. Because of increased demand there were three sessions a week and during the summer months a further six ad hoc sessions were put on to keep pace with the demand for new patients and return visits. Because demand for the Well Woman Clinic fell the clinic as such was discontinued but some patients from the clinic came to the Menopause Clinic sessions. Joy Bosworth who had been Clinic Secretary for eight years resigned to work for the Regional Health Authority. Betty Hayes and Yvonne Cleland took on the Secretary’s duties jointly.

Two open meetings were held on ‘The Menopause, Yours Questions Answered’, one at the Region’s Annual General Meeting at Warwick University and one at Smethwick Swimming Baths.

In 1989 the Region was threatened with closure due to a cash crisis at FPA National Office. It had been hoped that the Menopause Clinic would be taken over by BPAS but this did not happen and the clinic closed at the end of 1990. Patients were advised to go to their local family planning clinics, many of which by now held Menopause Sessions or to their GP.

Family Planning Campaign - S/ex Education

S/EX EDUCATION

Parents and S/ex Education

The Region tried to offer parents help with this sensitive topic. All secondary and primary schools in Birmingham were contacted offering speakers for Parent Teacher evenings, and a few schools took this up. Jill Stein and Janet Sinclair mapped out a course, ‘What shall we tell the children’, to give parents and teachers the information needed to talk to their children about sex, emotional relationships and sexual growth and development. This was offered to various colleges which ran adult education courses; one college in Solihull agreed to put on the course but at the enrollment evening no one signed up for it.

Talks and Education – a few thoughts by Dr Shirley Toogood

Approaching the 80’s there was an ever increasing realisation – perhaps reluctant in some quarters – that wider dissemination of methodology, and understanding of the importance and the place for family planning, was rapidly becoming essential to meet the needs of society.

To this end the FPA continued to undertake speaking and counselling in schools, colleges and the University of Birmingham. The opportunity to develop this work in schools came at a time when a vital shift in attitude towards a more structured approach to Sex Education took place. The debate as to what age school children should receive this education still continues.

In the early 70,s when my work in schools began, the 14-15 years olds were the focus group. A general view at that time was that sex and contraception were best dealt with by a relevant doctor or nurse. Teachers were often unsure of taking the lead in these issues.

Meetings with parents were necessary to broach the need for such courses and to allay the fear that this would inevitably lead to promiscuity. As the demands for help from an ever increasing number of schools grew, so it became impossible for the FPA to meet them all. Fortunately as time went on more of the teaching staff took courses either run by the FPA, Brook Advisory Centre or their local education authority. They then felt comfortable and competent to cope themselves and the pressure gradually eased. They continued to contact the FPA for leaflets and the hire of films.

My responsibilities as an Honorary Senior Clinical Lecturer in the Medical School, Birmingham University, were in two departments. In the Department of Obstetrics and Gynaecology my talks were to First Year undergraduates from all faculties on Family Planning, Abortion and Psycho sexual issues. Medical students were introduced to the importance of counselling in these matters. In the Department of Community Medicine a number of students were allocated individual projects to pursue on a yearly basis. This required, in addition to relevant reading and research, visits to a variety of services and voluntary organisations such as the FPA. Thus medical students might gain some knowledge and insight into the interdependency of medical care with professionals outside the health service and the importance of local authority and good community care.

Perhaps surprising was the somewhat sceptical attitude of some professionals to the way in which the expectations and needs of society had changed, and their reluctance to adapt.

Family Planning Campaign - S/ex Education in the 60's and 70's.

S/EX EDUCATION IN THE SIXTIES AND SEVENTIES

An interview with Dilys Went, FPA National Speaker and Honorary Life Member (this interview has been shortened, full version available in Birmingham Made a Difference 1926-1991)
In the late 60’s the national FPA drive for sex education spread out to Birmingham. At that time the FPA ran a series of courses in London bringing over a stream of sex education experts from Minnesota, USA.

At this time there was concern about the FPA’s role in S/ex Education. There was the idea that if you didn’t talk about it people would cope on their own, but talk about sexual matters would highlight them and make people more interested in sex and more likely to do it! In the early days the FPA was battling to get the whole idea of talking about s/ex and sexuality accepted, and a lot of course work we did with teachers at this time was getting them to accept sexuality as an intrinsic part of everyone’s personality and to look at the big social issues involved.

When National Office started up S/ex Education they felt there was a need for an overall policy and approach. The Education Unit consisted of Freda Parker, Vanessa Fenton, Joan Scott and Zoe Long. They were well organised, very professional and provided good motivation and interesting, dynamic, participatory courses using experts at the front of s/ex education research. Zoe Long produced many of the visual aids.

They decided to have a team of National Speakers and these were always very carefully trained. First the speakers had a one-day course explaining what characteristics a National Speaker needed and they all had to present a three minute talk for assessment. Then they were asked to go on a longer course for two or three days when a 20 minute presentation had to be prepared in advance. This consisted of ten minutes explaining the structure of the presentation and ten minutes actual presentation. Each speaker was assessed for capability for speaking to different groups, small groups of health professionals, students or whatever. When there was a nucleus of National Speakers the FPA both nationally and regionally advertised that National Speakers were available to give talks.

One of the key people in the training courses was Professor Ned Wagner, a psychologist from the University of Washington, Seattle, USA.. He came to Birmingham with Freda Parker and Vanessa Fenton and ran a course over several days. The students were all FPA speakers in Birmingham and surrounding FPA Branches and included doctors, nurses and layworkers. Only those who reached the required standard were allowed to work in the FPA as S/ex Educators: it was important to set and keep to a standard.

I was in a fortunate position because I was lecturing in teacher training and had access to helpful resources Because I was working as a layworker for the FPA in the clinics I realised there was a lack of information for women, and that many didn’t understand their anatomy at all, so there was a need to begin to talk to teacher training students.

In the 60’s I was asked to talk to many students about ‘the pill’, as school children were asking students on teaching practice, ‘What is this pill?’ I was encouraged to give talks to 250 students, all learning for the first time about oral contraception and discussing the social consequences. In the Warwickshire area I spoke to a lot of groups – Young Conservatives, Young Farmers, rugger groups, parents and foster parents so there was really a wide range of interest.

The Government set up a Committee which included an HMI to assess what material should go into schools. The FPA nationally took notice because they were using similar criteria for their own materials. Looking at adolescent development and pubertal changes I was surprised to find how many schools were teaching something about contraception in the 70’s, although there wasn’t a lot of material available and they had to make their own.

I once gave a talk on resource materials available to Birmingham FPA speakers which included using felt cutouts of the reproductive system which could be put onto a felt screen. I realised we needed some was of explaining the women’s internal part because they are not visible.

When overhead projectors came in they were very useful for both presenters and audience, the overheads could be prepared in advance, they were flexible and could be updated easily. However in the 1970’s there were many power cuts so it was very useful to have a flip chart or felt chart which could be illuminated with a torch – as I did on several occasions in various church halls when giving FPA talks.

The pharmaceutical companies produced some useful materials : Ortho produced a flip char and a book with excellent reproductive drawings. It showed fallopian tubes in section and hence how it would be quite easy for them to get blocked by an infection. I believe in teaching anatomy structure and function correctly. Showing the consequences for example of an infection and how it affects fertility would be enormously helpful and a way forward for young people.

In the 60’s the FPA and Health Education Council produced ‘Loving and Caring’ a series of 5 x 5 minute trigger films which were excellent because they led to discussion. The first film, ‘Girls Talking’ showed a girl Sandra, being pressured into s/ex and she was saying ‘no’, demonstrating that people have the right to say ‘no’ to s/ex. Then there was ‘Boys Talking’, with the bravado of a boy boasting about having a girl on top of a bus.

Next the girls group discussed morals and the rights and wrongs of a sexual relationship and the last two films of the series showed Sandra talking to her mother in the kitchen and later meeting the boyfriend’s parents. His father was very sexist – this gave teachers the opportunity to talk about attitudes and ‘macho’ men, so was very useful. There was another set of trigger films on VD, boys talking about their ideas of what went on in a VD clinic, but it was fairly horrendous.

Teachers had to do a lot of work to reassure boys afterwards but it enabled the whole issue to be brought up and teachers needed the material. For both sets of films there were explanatory teachers’ notes. For any materials the correct use for and by teachers is absolutely critical. Teachers need to be taken through the materials and must be given time out of school hours to view, discuss and see them. That’s the way forward to increasing their confidence and professionalism.

FPA developed criteria for assessing materials for use in schools which led to the ‘FPA Approved’ mark. The standards were very high and professional and became something people could trust as a standard.

Both boys and girls need to know about pubertal changes but the maturity of the children is enormously mixed in primary and early secondary classes as well, as many girls mature so much earlier than many boys. To try and teach such a ‘mixed ability’ group is difficult and takes the skill and training with which the FPA helped so many children.

I feel the FPA both at National Office and in the Birmingham Branch were brave in the 60’s and 70’s going ‘where angels fear to tread’. By making sure their approach was sound and well thought out, they laid a firm foundation for future work.