Factors influencing breast feeding

A survey is reported of infant feeding practice at the time of discharge from a single maternity ward. It is shown that a change in the attitude of nursing staff increased the number of mothers breast feeding their infants and eliminated the practice of giving the infants formula feed complements. This change in attitude, however, did nothing to prevent the rapid decline in lactation after leaving hospital, such that 50% of mothers discharged breast feeding were no longer doing so by 2 months. The early introduction of solid feeds was common practice, 50% of mothers discharged breast feeding having introduced mixed feeds within 2 months. Successful lactation was found to be commoner in those mothers who had themselves been breast fed in infancy and in mothers from socioeconomic classes I and II. Successful lactation was not related to parity. The survey also shows the influential role of the health visitor, district nurse, and midwife upon mothers' decisions about infant feeding.

An international study of health and general systems of financing health care

In a previous study the author explored the linear relationship between infant mortality and real gross domestic product per capita, the number of physicians per 10,000 persons, and the number of hospitals per 1,000 persons in 18 countries. That study is here expanded and updated to include the experience of 7 additional countries for a current total 25 countries. In addition, the present study extends the analysis to include several additional explanatory variables, and it includes data for 1965 so that the data set now covers 1955, 1960, and 1965. Following the methodology of the initial study, the relationship estimated between infant mortality and the several explanatory variables is used to calculate the level of infant mortality that one would expect to find in each country for each of the 3 years considered, given the values of the explanatory variables. The size and sign of the difference between the actual and expected levels is then used to approximate the effect of different general systems of providing and financing health care on overall health status, since infant mortality is an approximate index for the overall level of health. The results of the initial study are by and large confirmed. They show that the percentage of health services financed or directly controlled by governments, and information on the relative size of the health sector, are apparently not important determinants of levels of health. On the other hand, the proportion of health care resources devoted to the provision of nonpersonal public health care does appear to be a significant determinant and therefore the role of nonpersonal public health warrants further study.

FPA disappointed in Great Britain

The Family Planning Association of Great Britain has released a statement on the role of family planning within the reorganized system of the National Health Service (NHS). The statement is critical of the limitations placed on availability of birth control means to NHS patients. It had been hoped that contraceptives would be free to all people covered by the NHS. The government, however, made the advice on family planning free to all, but the prescriptions and supplies would be given free only in cases of social or financial need or to women within 12 months after a birth or an abortion. Thus, the effect upon the decrease of the number of abortions and unplanned pregnancies will not be as great as it was hoped it would be if contraceptive means would be supplied freely.

Free contraceptives in Great Britain

An amendment to the National Health Service (NHS) Bill has been submitted to the Parliament of Great Britain recommending free contraception within the NHS. Free contraceptive pills and devices for both men and women who would desire them, would cut down the number of unwanted pregnancies and would decrease the number of abortions presently performed under the Abortion Law of 1969. Many doctors resent the legalization of abortion since the patients seeking abortions crowd the hospitals and take away the physician's time and hospital bed availability from patients with diseases needing immediate attention. Also, a great number of young girls undergo abortions, the consequent trauma of which endangers their future emotional and physical health. Prevention rather than termination of pregnancy would be more desirable. Besides there is a need for population control. Parliament will most likely act favorably on this proposed amendment.

British consider pill safe

The British Committee on the Safety of Medicines concluded that all the research performed on more than 13,000 experimental animals indicated that prolonged administration of both estrogen and progesterone for contraceptive purposes does not create a hazard of developing cancer in women.

Animal tests suggest no cancer risk for the pill

Tests carried out over several years on rats and mice for the possible carcinogenicity of the constituents of oral contraceptives have satisfied the British Committee on Safety of Medicines that there is no carcinogenic hazard to women. The experiments are discussed in a recent publication of the Committee and were continued at varying dosages for most of the lives of the animals involved (both male and female). Progestagens and estrogens were tested both separately and together at a low dose (2-5 times the human dose), a medium dose (50-150 times the human dose), and a high dose (200-400 times the human dose). Only at the medium and high doses were any benign or malignant tumors found in any organs, and these were not always seen in both species of animal tested. While the results are complex, and it is difficult to transfer the experience gained with 1 species to another, the Committee concluded: "Although a carcinogenic effect can be produced when some of the preparations are used in high doses throughout the life-span in certain strains of rat and mouse, this evidence cannot be interpreted as constituting a carcinogenic hazard to women when these preparations are used as oral contraceptives." Long-term experiments on dogs and primates are continuing in the US, and their results will be carefully s crutinized by the Committee when they become available. On present evid ence, however, based on the results of the rat and mice experiments and the added clinical experience and physiological knowledge of the last few years, the Committee has opened the way for a number of new Pills to be licensed for the British market. 10 new preparations are expected to appear - 5 "minipills" or progestagen-only preparations, of which 3 have already been registered, 4 combined oral contraceptives, and 1 sequential preparation.

Is the pill getting safer?

The Office of Population Census and Surveys in London maintains a constant observation of possible drug-related mortality in the United Kingdom. In 1969 there were 28 deaths in England where on the certificate of registration the doctor had implicated oral contraceptives as a possible cause of death. The number of deaths in which therapeutic drugs have been implicated, in selected categories, for the years 1967, 1968, 1969, and 1970, respectively, are: contraceptives, 2, 17, 28, and l3; for analgesics, 17, 20, 19, and 24; for anticoagulants, 18, 30, 32, and 28; for antirheumatics, 21, 35, 31, and 27; for corticosteroids and similar drugs, 31, 62, 59, and 57; and psychiatric, 9, 11, 15, and 7. In 21 cases of death from oral contraceptives this was due to venous thrombosis and embolism, in 1 case to coronary thrombosis, and the remaining 6 were ascribed to other adverse effects of estrogen. In 1970 there were 13 such deaths reported: 7 cases of venous thrombosis and embolism, 2 of coronary thrombosis, and 4 resulting from other adverse effects of estrogen. Death certification is not necessarily totally accurate, and in some cases the pill may have been wrongly implicated and in other cases its possible causal relationship may not have been reported on the death certificate. However, Adelstein, reviewing these data, writes: "Although these comparisons are based on relatively few cases, they afford highly suggestive evidence that mortality related to the pill has decreased materially. Hopefully, one could speculate that any morbidity that may be related to the pill should have diminished, roughly speaking, in parallel." The number of oral contraceptive users in England has now returned to the level reported before the adverse publicity which oral contraceptives received early in 1969.