Illegitimacy and ignorance

Surgery

In 1964, according to the "Official Year Book of the Commonwealth of Austral la", 6.51% of all births were exnuptial, and this figure has increased each year, to reach 7.73% in 1967, despite increasing use of
the contraceptive pill. Of total nuptial first births during the same period, in from 25% to 27% the duration of marriage at the time of the birth was less than eight months; something like a fifth of brides were pregnant in their wedding gowns.

To get the. total number of extramarital conceptions it would be necessary to add to these already quite extraordinary figures the number of babies incorrectly attributed to their nominal father, and the, large number of pregnancies terminated,whether illegally, legally or by purportedly natural miscarriage. In discussing the birth rate in terms of the wishes of the general community, two further figures which are to some extent self cancelling should be included; these are the number of babies adopted or wanted by infertile couples, and the rather larger number of unplanned or deliberately planned-against pregnancies.

In an age of concern about cities creaking and suffocating in their own excreta, and concern about delinquency and social breakdown attributed to parenthood which Is unexpected, unwanted and incompetent, these figures must give rise to concern. This they have. They must. give rise to public discussion. This they have. They must give rise, to action which is widely acceptable, readily implemented and likely to have a significant effect. This they have not.

In this question, linked to fundamental urges, religious convictions, law and crime, personal trial and family upheaval, logic has a weak grip compared to that of emotion. Ultimate or absolute truth is impossible to establish ill the eyes of all or even most people. Choices made by teenagers on "morals" will often seem to be wrong. Choices made by teenagers on the information available to them will often obviously be wrong. This is the starting point for possible agreement and for some sort of effective action - information.

Most teenagers, and children, know where babies come from, and some have an over all idea of other matters related to sex such as venereal disease, abortion and the birth process. Few are aware of the mature fulfilments of sex as part of a greater personal relationship, or of the various personal and social implications of sexual drive. Teenagers will make up their own minds on whether or not they will be "chaste" or "careful" or "uninhibited". The most and the best that one could want is that these choices were made in knowledge and not in ignorance.

The sort of situation that a family doctor would like teenagers in his area to be aware of clearly rather than by chance association is as follows. A young couple who are "going steady" may have sexual relations. If they do, a pregnancy may follow. When this occurs, they may debate the alternatives of the pregnancy continuing or abortion, with a major strain on their young lives.

If the father-to be runs away from the situation, the unmarried mother has a well established but unwelcome pattern of choices. If a marriage follows, it may be a, happy one. However, it is likely to be a miserable marriage, with a. young father, aged 19 or 2.0, having a second child by the time he is a couple of years older. Before his mid twenties, his young wife is bound to the house cares of two toddlers, money is in short supply for. their wants, family tensions are high, and he is seeking solace and tranquillity each night at the pub, or outside marriage.

This is one of the many possible implications of the powerful sex urge of teenagers. It is largely a result of ignorance and unawareness, augmented by the prevailing climate of Sunday "news", fashions, entertainment and the gap to the parental generation, dumbfounded in this situation by their own rearing in a completely different world.

Can one individual doctor do anything about this? The experience of some doctors suggests that he often can if he wishes. If his personal contacts with the local headmaster will allow it, he call offer to spend a few hours, during the year, conducting tutorials on sex as it is relevant to teenagers. Possibly to his surprise, he will find this offer quickly accepted. With his frequent daily experience, of delicate personal interviews, he is in a much more comfortable position than schoolteachers to discuss sex with a dozen teenagers seated around a table.

The format of this little experiment in education is important. Experience indicates that it should be preceded a week or two by a note to parents from the headmaster, stating that a local doctor is to give some sex instruction in an after school hours class in a manner appropriate to present day sixteen year olds. If they agree to their child attending, they are asked to express their permission. The doctor will of course be wise to ensure that the arrangements are in accord with normal ethical practice.

A couple, of days before the "teach in", students are invited to prepare written questions on any particular matter they would like discussed or explained. These are placed on the table round which the group are to be gathered. One of the younger teachers is asked to act as a chaperone for the group and to lend support by being present.

The one hour session is structured in several parts. An introduction explains the reasons for the occasion: sex is in important and inevitable part of human make up, and the sexual drive can contribute to the finest and the vilest of human actions sublime love or bestial rape; beautiful songs or lavatory wall graffiti; delicate humour or coarse cruelty. Because there are large gaps in the sexual knowledge of many teenagers, they find themselves in turmoil and in troubles beyond the inevitable passions of maturing adolescence.

This introduction is followed by a brief account of human sexual structure and function, with the aid of a couple of large diagrams. For reasons of time this section is brief, but it serves to prompt later questions and discussion.

Next the speaker turns to social questions. Does anyone know the, "prematurity" rate for first born babies in Australia? Please raise your hand. What would you think it was? Does the answer surprise you? Do you think it is a state of affairs that should be altered? What would you like to see done? What can happen once a teenager girl finds herself pregnant? How should this affect her later life? How does this affect the country as a whole?

The next part of the talk can be based on one of several subjects, according to questions and comments made. Likely topics are abortion, venereal disease, contraception, the. emotional impact of the sexual drive at different ages and In different people. Other topics are homosexuality, continence, sex in newspapers and in entertainment, selfishness and generosity in sex, the sexual passions of classic figures in literature. Many of these topics have tawdry aspects, and it is important to remind the group from time to time during the discussion that a sexual relationship between mature. people is an integral part of a deeper bond, important, enriching and sublime.

After about 40 minutes one is due for a short pause and some fresh air. During this time further written questions may be placed for the speaker. A further 15 or 20 minutes of talk or discussion complete. the session.

This proposition is not to belittle the value of many excellent books and pamphlets dealing with sexual questions for teenagers and other age groups. Organizations such as the Marriage, Guidance Councils, the. Family Life Movement of Australia (formerly the Father and Son Movement) and church bodies are all concerned with such matters. There must also be a small proportion of parents both competent and willing to undertake the sexual Instruction of their children in a manner appropriate to 1970.

However good their intentions, the results of these efforts are not adequate to cope with the present needs of our society. A series of teach ins to small groups of older schoolchildren has important implications beyond imparting technical information about sex at the time. It will show those with uncertainties and questions that they can turn to others for help. For those who attend It may help set a different and better standard of honesty in their personal relationships based on knowledge displacing ignorance. Many doctors would not like to enter this field, despite its immediate practical usefulness for a small Investment of time and of effort. For those who do, there should be a rich reward in satisfaction.

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March 14, 1970 The Medical Journal of Australia p.516 Comments

Illegitimacy and Ignorance

Working or just living in a small country town it was hard not to hear of most cases when a girl became pregnant, unlike the anonymity of a city.

As a family doctor it was hard not to be aware of the frequent natural progression from unprotected sex to an unwanted young marriage and its failure and consequences.

The other feature of small town living was one's ability to intervene using the prestige of doctorhood, which counted for much more than in city medical life.

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