If Toddler and Tiddler were to acquire a little brother (I’m going to call him I’m-A-Tiddler-Too), I expect I would love him to bits. There would be big blue eyes, gummy smiles and phrases like ‘he might not have been planned, but he’s very much wanted.’ He would become a positive part of our lives, we would do our very very best for him and I hope that he would feel that his life had been worthwhile.
On the other hand, I’m-a-Tiddler-Too is not a likely occurrence. The opportunities for sex seem to diminish exponentially with each sprog but – far more importantly – this is the twenty-first century in a country where healthcare is provided by the state. Contraception is available and it has been drummed into me since the day I was diagnosed that diabetic ladies have particular reasons to make sure they use it properly.
But in both our general and diabetic populations, unplanned pregnancies are common. It is difficult to find statistics: a google search for ‘Unplanned Pregnancies’ starts giving the not-really-a-synonym ‘Teenage Pregnancies’ very quickly. However when I spent three weeks on the antenatal ward waiting for Toddler, all but two of twenty-odd pregnant women I spoke to informed me without my even asking that theirs was actually a ‘happy accident’ or a ‘mistake’.
An Evriwoman survey a decade ago put the UK figure at 40% of all births being unintended and of those 20% being regretted. I don’t know how those figures were obtained or at what stage: it would take some emotional grit to tick a box in a questionnaire saying: ‘now that I have my baby I regret it.’
Bayer estimated the figure for unplanned pregnancies in the UK in 2006 as 394,690 but I have to point out that Bayer have an interest in selling coils to the medical profession.
Still the point is that in an age when the main contraceptives are described as being more than 99% effective (this apparently means that 99% of shagging couples don’t have an unintentional birth, rather than the less impressive suggestion that one in a hundred shags results in progeny) at least some women must not be using it – or if they are, then not effectively.
Which is odd, because good contraception and advice are free and easy to get hold of…..
…..or so you would think.
Let me take you back to a conversation with a male doctor six years or so ago now. Remember that (being a vet) I can talk about stuff to do with sex and genitals very easily while remaining my normal shade of pale pink and looking my opponent directly in the eye. Yes, I said ‘opponent…’
Me: I’m here because I’m needing some contraception….
Doctor (reaching for the prescription pad and poised to write): No problems at all. I just have to check with you, have you taken the pill before-
Me: Actually, I wasn’t wanting a pill. I’m really forgetful, travel around a lot, work erratic hours, that kind of thing –
D (putting down pad and looking mildly surprised): Oh, OK. What do you want?
Me: I was wondering about a coil….?
D: It wouldn’t be an inter-uterine device I’m afraid. Those are generally only prescribed for women who have already had babies because they are incredibly painful to fit otherwise.
Pregnant pause. Pun intended.
Me: Oh right! Really? But my friend has a coil…..? I’m pretty sure she doesn’t have kids.
Me: So what else is there?
The guy reached into a drawer and pulled out a piece of card with a table of possibilities. There were two or three types of pill; condoms and caps; different kinds of coil; regular injections; implants. The doctor pointed with the end of his biro, indicating that an implant or three-monthly injections would be best. But if I wanted an implant then he couldn’t help me because no-one at that surgery could fit them.
I went home, read the NHS website, realised that he was potentially being misleading about the coils but settled for injections anyway.
Some months later I wanted to go travelling so sought out an implant. In order to get an appointment at the local walk-in, I sat in a waiting room and filled in a four-page questionnaire covering my previous sex-life, partners, conceptions, miscarriages, STIs and other medical history. Amusingly, the Priest who married my husband and myself walked in while I was doing this (presumably he was there to see the doctor not the family planning folk) so I turned the clip-board over while we had a quick chat about life. But I did manage to come out with an implant.
Anyway, it’s 2013. I’ve had Tiddler, moved to a different GP, spoken to a helpful midwife and know what I want. This time it is going to be very easy.
I stride in.
– Can I make an appointment with Dr S, please?
– Oh, she’s right popular at the minute, luv. Can you see one of the others?
– I’m actually wanting a contraceptive implant fitted so I was told it had to be with Dr S?
– (glancing at a queue that is forming behind me): Pardon luv?
– (loudly): It’s for a CONT-RA-CEP-TIVE IM-PLANT. The other doctors can’t do them.
– Oh well it won’t be while next month now luv. There’s a waiting list to see her. And I’m not sure you won’t have to see her for a chat first, make sure it’s suitable, then she’ll make you a longer appointment to get it fitted.
She makes no move what-so-ever to look at her computer screen and find an appointment.
– OK. Can you tell me where else I can go?
– There’s a walk-in clinic on so-and-so street.
– Where’s that please? Do you have their opening times? How about a phone number. Right. Please would you write that down for me: I seem to be restraining a child with each hand at the moment so am unable to write and my memory’s actually quite shocking.
Isn’t it lucky that I’m an expert at extracting blood from stones.
The point is however that most women in the UK are NOT experts at extracting blood from stones. I suspect that some women take weeks to get the confidence up to go and talk to doctors about contraception, let alone stand up to an unhelpful doctor or receptionist when they get in there. I am also educated: a lot of people would have walked out of my first appointment with a pill, unaware that there were choices available. I only hope the doctor would have managed to overcome his embarrassment quickly enough to explain that the success rate quoted does only apply if pills are taken correctly. An oft-quoted American survey suggests that unwanted pregnancies are 20 per cent more likely with a pill than with an intra-uterine device (and IUDs or ‘coils’, for the record, are even available for women who haven’t had kids). The Evriwoman survey suggested that 16% of the women experiencing unwanted pregnancies blamed a failed pill regime.
Luckily, those who bypass their GPs in favour of the Internet are more likely to succeed: the NHS website gives out the factual information and it isn’t hard to find helpful, informative walk-in clinics, which no longer seem to give out long embarrassing questionnaires and most of which don’t even have the local Priest lurking in the waiting room. Obviously getting to these isn’t always easy (I am lucky enough to live within walking distance of one) but clearly it’s worthwhile. The staff there are not only respectful but have even been trained to fit implants, an obvious improvement on the GP situation.
So it IS possible to get good contraceptive advice in this country, but it isn’t exactly handed out on a plate. I do suspect that more women (who might, for instance, be less determined, informed and pushy than myself) could be encouraged to seize control of their reproductive lives if a little more encouragement were offered.
I am painfully aware that I’m-a-Tiddler-Too might have been destined to be the next Mozart. However, this is a risk that many of us would really like to take.