766 to provide suitable care. Of the 28 had used either an oral contraceptive or intrauterine device at some time and 5 had had one or more abortions. Thus all these women must have had contact directly related to contraception with health professionals, yet they still had unwanted pregnancies. Clearly the standard ways of providing contraceptive advice are inadequate for some women. Is termination of an unwanted pregnancy an "abuse" of N.H.S. resources? The benefits of aborting unwanted pregnancies (both to the individual and to society) are well known. In addition, unlike many other surgical procedures, abortion is an effective operation-it has a definite indication, if done correctly it is safe, and the outcome is measurable. However available and acceptable contraceptive advice is, it seems probable that some abortions will always be needed. It is therefore reasonable to regard abortions, as these women did, as an adjunct to the family-planning services. Michele Beaconsfield accepts that some abortions are "necessary and advisable", although she does not give the criteria for this definition. Yet she obviously disapproves of the decision about abortion being made by anyone other than a doctor. Many women faced with an unwanted pregnancy are able to make a rational decision to request an abortion. In these circumstances there is no role for the doctor in labelling some abortions as necessary and others as unnecessary. By requesting their abortions through the N.H.S., these women are merely exercising their right to one particular type of health care.
derstood, is still unable women most
3 Horwood
Close,
Headington, Oxford
might conclude that feckless women must be taught a lesson by being forced to bear children they do not want, and who have an unfortunate tendency to grow up just as feckless as their mothers-and their fathers, by the way. Pregnancy Advisory Service, Austy Manor, British
Wootton Wawen, West Midlands B95 6DA
PREVENTION OF HANDICAP
SIR, -I read with great sympathy your editorial of Sept. 24 which asked "How much more evidence must be offered before prevention of handicap is rated as important as maternal and perinatal mortality, and maternity and neonatal services are developed to an acceptable and uniform standard ?" Perhaps the most compelling evidence in a cost-conscious world is economic. At today’s prices it will cost approxi-
(p. 244)
mately 200 000 to keep a severely handicapped spastic person in a Spastics Society centre for 50 years: that is, from the time of leaving school to, say, the age of 66. There are also the negative economic costs which are probably greater. It is by almost any standards cheaper to prevent than to provide care, humanitarian considerations apart. The Spastics Society is about to embark on a campaign to bring this and other points home to the Government and the British public. Director
STROKES: A COMPLICATION OF MITRAL-LEAFLET PROLAPSE?
SIR,-Does Michele Beaconsfield feel sick "when perfectly but careless" men have car or motorcycle accidents and then treat their hospital treatment as just another part of the N.H.S.’s job. If she does not feel this way about all patients with avoidable illness (including lung cancer in smokers) she is surely being less than honest when she writes that she has no prejudice about termination of pregnancy. British
Pregnancy Advisory Service, Austy Manor,
DIANE MUNDAY
Wawen, West Midlands B95 6DA
SIR,-In my study’ of women who had three or more abortions I did not find a single case in which abortion was deliberately chosen as a method of contraception. About half these 50 women had been trying hard to avoid pregnancy and were rather than unusually feckless. Several had asked for an intrauterine device or sterilisation but had been refused. Others had had to stop using oral contraceptives because of side-effects. Apart from 3 women who had changed their minds about an initially welcome pregnancy, the others had indeed been erratic in their contraceptive use and had taken chances, but there was a significant relationship between erratic use and previous psychiatric consultation. Women whose contraceptive habits are consistently inefficient and poorly organised also tend to be inefficient and poorly organised in other areas of life. An abortion concentrates the mind wonderfully and is generally followed by more effective contraception, but some people never learn, even when subjected to lectures from angry doctors. In any case, taking chances, as Luker has shownis by no means restricted to the manifestly feckless, and is on a level with reluctance to wear seat-belts in cars. Perhaps Michele Beaconsfield had better avoid working in family planning or gynaecology. I would hate to think that she
merely unusually unlucky
1. Brewer, C. J. biosoc. Sci. 1977, 9, 99. 2. Luker, K. Taking Chances. Berkeley, California,
JAMES LORING,
Spastics Society, London W1N 4EQ
SHEILA A. ADAM
aware
Wootton
COLIN BREWER
SiR,—Dr Kostuk and his colleagues (Aug. 13, p. 313) sugthat cerebral transient ischaemic attacks (T.I.A.) may be symptoms associated with prolapsed mitral valve (P.M.v.). Since they first published this work’ I have consulted several
gested
colleagues and looked assiduously myself for evidence of P.M.v. in patients with T.I.A. and negative angiography, but without detecting a single case. I would be very interested to know the frequency of this association in the group of patients investigated. What percentage of patients with T.i.A., but negative cerebral angiography, were shown to have P.M.v. syndrome? This information would be a useful guide as to whether, for instance, echocardiography should become a more routine part of investigation ofT.I.A. Middlesbrough General Hospital, Ayresome Green Lane, Middlesbrough, Cleveland TS5 5AZ
*)
derstood, is still unable women most
3 Horwood
Close,
Headington, Oxford
might conclude that feckless women must be taught a lesson by being forced to bear children they do not want, and who have an unfortunate tendency to grow up just as feckless as their mothers-and their fathers, by the way. Pregnancy Advisory Service, Austy Manor, British
Wootton Wawen, West Midlands B95 6DA
PREVENTION OF HANDICAP
SIR, -I read with great sympathy your editorial of Sept. 24 which asked "How much more evidence must be offered before prevention of handicap is rated as important as maternal and perinatal mortality, and maternity and neonatal services are developed to an acceptable and uniform standard ?" Perhaps the most compelling evidence in a cost-conscious world is economic. At today’s prices it will cost approxi-
(p. 244)
mately 200 000 to keep a severely handicapped spastic person in a Spastics Society centre for 50 years: that is, from the time of leaving school to, say, the age of 66. There are also the negative economic costs which are probably greater. It is by almost any standards cheaper to prevent than to provide care, humanitarian considerations apart. The Spastics Society is about to embark on a campaign to bring this and other points home to the Government and the British public. Director
STROKES: A COMPLICATION OF MITRAL-LEAFLET PROLAPSE?
SIR,-Does Michele Beaconsfield feel sick "when perfectly but careless" men have car or motorcycle accidents and then treat their hospital treatment as just another part of the N.H.S.’s job. If she does not feel this way about all patients with avoidable illness (including lung cancer in smokers) she is surely being less than honest when she writes that she has no prejudice about termination of pregnancy. British
Pregnancy Advisory Service, Austy Manor,
DIANE MUNDAY
Wawen, West Midlands B95 6DA
SIR,-In my study’ of women who had three or more abortions I did not find a single case in which abortion was deliberately chosen as a method of contraception. About half these 50 women had been trying hard to avoid pregnancy and were rather than unusually feckless. Several had asked for an intrauterine device or sterilisation but had been refused. Others had had to stop using oral contraceptives because of side-effects. Apart from 3 women who had changed their minds about an initially welcome pregnancy, the others had indeed been erratic in their contraceptive use and had taken chances, but there was a significant relationship between erratic use and previous psychiatric consultation. Women whose contraceptive habits are consistently inefficient and poorly organised also tend to be inefficient and poorly organised in other areas of life. An abortion concentrates the mind wonderfully and is generally followed by more effective contraception, but some people never learn, even when subjected to lectures from angry doctors. In any case, taking chances, as Luker has shownis by no means restricted to the manifestly feckless, and is on a level with reluctance to wear seat-belts in cars. Perhaps Michele Beaconsfield had better avoid working in family planning or gynaecology. I would hate to think that she
merely unusually unlucky
1. Brewer, C. J. biosoc. Sci. 1977, 9, 99. 2. Luker, K. Taking Chances. Berkeley, California,
JAMES LORING,
Spastics Society, London W1N 4EQ
SHEILA A. ADAM
aware
Wootton
COLIN BREWER
SiR,—Dr Kostuk and his colleagues (Aug. 13, p. 313) sugthat cerebral transient ischaemic attacks (T.I.A.) may be symptoms associated with prolapsed mitral valve (P.M.v.). Since they first published this work’ I have consulted several
gested
colleagues and looked assiduously myself for evidence of P.M.v. in patients with T.I.A. and negative angiography, but without detecting a single case. I would be very interested to know the frequency of this association in the group of patients investigated. What percentage of patients with T.i.A., but negative cerebral angiography, were shown to have P.M.v. syndrome? This information would be a useful guide as to whether, for instance, echocardiography should become a more routine part of investigation ofT.I.A. Middlesbrough General Hospital, Ayresome Green Lane, Middlesbrough, Cleveland TS5 5AZ
*)
