Research is needed before GPs can engage in “positive” family planning

To the Editor: I was very concerned to read the letter from Mazza et al1 regarding “positive” family planning and feel I must make a comment. The authors are well known for their work in the area of women’s sexual and reproductive health, but I would like to challenge some of the points they have made.

The first point: whether intervention by general practitioners would be appreciated by younger women not yet interested in motherhood. I believe it is part of the role of doctors to inform, even when a person may not be ready for the information. Telling 20-a-day smokers that they are not doing their body any favours doesn’t go down well with some people, but even this brief intervention can change behaviour and save lives.

The second point: whether GPs can respect patients’ autonomy. Every day I speak to women who have been offended and upset by doctors who have said something awkwardly, or imposed their own values, or been downright offensive. That won’t change, and recommending that well informed and tactful doctors wait before imparting vital information until the rest of the world lifts its game means we will all be waiting a long time.

Part of the art of medicine is judging the audience and knowing the perfect point in a consultation to speak, and how to say it. What can be more appropriate, when seeing a woman in her late 20s who has requested a repeat prescription for the contraceptive pill, than to ask casually (as one is unrolling the sphygmomanometer cloth), “So, do you think there might be any children in your future?” The usual response, as detailed in Cannold’s book,2 is an emphatic “yes”. The next question, “Have you got a time scale when you would be looking at that?”, may give the opportunity to mention such things as rubella vaccination, smoking and folate supplements. And if the woman indicates that pregnancy would be on her to-do list at age 38, then a reasonable and non-harassing response could be, “Could we talk about fertility rates at that age?”

The third point: doctors reinforcing the dominant paradigm (of years ago) of the woman as childbearing machine, by asking about a woman’s intentions. This seems to me as misguided as not asking about suicidal ideation in case we make it happen.

By all means do research, but don’t ask doctors to be silent about this important issue until the sociologists have spent another 10 years on it. By that time, it will be too late for a lot more women.