This is the discussion after a presentation by E. BAULIEU on combined oral contraceptives (ibid; 4(4)1972); it emphasized tumors, blood lipids, and management of typical problems with the pill. It was agreed that the pill does not cause breast cancer, despite the nodules reported in Beagles, but the discussants came to no concensus on the possibility of ovarian cysts and pituitary adenoma. DE GENNES described his 33 cases of vascular accidents in pill users of whom 24 had hyperlipidemia, usually (80%) of the "mixed" type 3 (i.e. high cholesterol and triglycerides). About 2% of women have abnormal plasma lipids, defined as total lipids over 9 g/1, triglycerides over 1.35 g/1, cholesterol over 2.7 g/1. Among the 33 cases, pure hypercholesteremia was underrepresented; premonitory signs (usually migraine) were only present in some cases of cerebrovascular accident, not in cardiac infarction or pulmonary embolism; the parous women had had no trouble in pregnancy. Other topics discussed included diabetes, glucose tolerance tests, hypertension, amenorrhea, menopause, and whether and when to interrupt oral contraception. The conference was concluded with a summary of the status of French legislation on contraception. The French Assembly had not authorized funds for family planning centers, nor for a national office of information, because they considered France too underdeveloped for such an antinatalist policy.
This is the question and answer session after a presentation by A.-M. DOURLEN-ROLLIER (ibid 4(4): 185-187. 1972). The panel includes L. NEUWIRTH, sponsor of legislation to liberalize anticontraception law in France. The status of legislation on the following topics was mentioned in questions: prescription of contraception to minors, government records of prescription forms, a national office of information on family education, abortion (in general, for minors and procured abroad), the Carpenter conviction, the bearing of 1973 election outcome on passing this legislation and the the legality of contraception being forbidden in France but strongly encouraged in her overseas territories. Answers tended to be complex.
This review examines 3 topics from the authors' experience in Switzerland: the psychology of a woman requesting legal abortion, handling the conflicts involved, and short and long term sequelae of legal abortion. Abortion always seems to present a conflict or a transitory psychic imbalance, even in well-balanced women. The conflict may not appear before the pregnancy is visible and subject to social consequences. Women requesting abortion do not differ from the overall population, but repeaters may be unstable, unrealistic with risks, masochistic, or acting aggressively toward the fetus. The authors believe that a physician should mediate between the roles of technician and of psycho-socio-medico-legal expert. Practically, 2 appointments with a few days between for the woman to contemplate her decision are helpful. Immediate psychologic consequences of legal abortion are usually nonexistent, except for relief or euphoria. 3-6 months later some women experience depression: studies report from 1% in Sweden to 50% in German-speaking Swiss. Many reports mention moderate regret or remorse, but very few mention serious psychiatric reactions. The regret sometimes seen 20-30 years later may be related to how the culture and the physician viewed the original abortion request.
The various physical methods of contraception are discussed with special attention to standards of manufacture and the physician's role (where such exists). The physician should counsel that good brand-name condoms be used, not reused, without regard for cycle date; a spermicide should also be recommended. For diaphragms and caps, the physician should prescribe the correct size and instruct the patient on proper placement, maximum time between placement and intercourse, and minimum time between intercourse and removal. There should be regular check-ups to verify correct size, especially in care of weight change. Spermicides should not be advised alone, but in conjunction with condoms, diaphragms, and caps. The efficacy of the C-film is still in question. Physical means of contraception should retain an important place among contraceptive methods, even if only as transition methods.
Since the Neuwirth law of 1967 legalizing contraception in France, the apparent fear of the legislature that the birth rate will fall further or the population will become promiscuous has prompted many restrictions. The law has not affected the birth rate, which has stabilized after a falling trend since 1920. The young people are sexually active at increasingly earlier ages, despite restrictions on contraception for minors. The 1967 law permits sale of contraceptives exclusively in pharmacies; not even family planning clinics may dispsense them. Prescriptions must be accompanied by a form "carnet a souche" putting the name and age of the user on file in the health department. Prescriptions may be renewed only for 1 year. Minors under 18 must have written parental consent, as must women 18-21 who want oral contraceptives. These restrictions do not apply to the territories of Martinique, Guadeloupe and Reunion. Restrictions on IUDs cover type of establishment, facilities, physicians' licenses, forms filed with the health department. Information on contraception is spread primarily by private nonprofit associations such as the French Movement for Family Planning, but with small financial resources and no government assistance. In 1972, 2 types of family planning counseling centers were established by the National Assembly: centers for information, consultation or family counseling, and centers of planning or family education. The required staff (gynecologist, psychiatrist, midwife, social worker and family counselor) and facilities of these centers have been set by law.
