The Health bulletin [serial] - University of North Carolina at Chapel Hill

tile couples try to limit their family
size but are unable to do so because of
the inappropriateness of the method of
contraception chosen^ Data from a
large North Carolina family planning
clinic show that low income women still
have little experience with contraception.
In 1961, 44 percent of the newly
admitted women to that clinic had
never before used any contraception;
during the first half of 1966 slightly
more than 50 percent had nof. it
would seem that public services are
clearly required.
Let us move on from family size to
family formation. Until just recently
age at first marriage had been dropping
steadily for all segments of the popula-
tion. As an example, in 1965 the babies
delivered by teenagers accounted for
25% of all births in North Carolina'.
Early age at marriage and early age of
the mother at the birth of her first
child are more frequent among low income
families". A close relationship between
early age at marriage and later
divorce has been noted and very young
couples are reported to be more unhappy
in subsequent years than those
who delay marriage". Pre-marital pregnancy
is often the precipitating event
in high school students' marriages. Fur-
ther educational opportunities are then
shut off for one or both partners. The
boy may end up unemployed or with
poor employment. For these young
people family formation quickly demands
formidable adjustments.
Illegitimacy is another serious aspect
of family formation. Looking again at
1965 data in North Carolina, we find
that 28% of teenage births were recorded
as illegitimate. There is deep
concern about out-of-wedlock births,
especially among teenagers, not only
because of the unfavorable consequen-
ces to individual mothers, their infants
and even the putative fathers, but also
December, 1967 THE HEALTH BULLETIN
for the heavy burden placed upon
community health, welfare, education-
al and economic resources. In North
Carolina, as elsewhere, the numbers of
illegitimate births have been rising.
Although numerous psychological,
social and economic explanations for
illegitimacy have been developed, and
they are useful in enhancing our under-
standing of the problem, they offer us
little opportunity for direct interven-
tion. But health workers have an opportunity,
indeed a challenge, to move
more aggressively. Family planning as
a health service can be of immediate
benefit. To be blunt, illegitimate preg-
nancy and reproduction are health
issues involving real risks to the mother
as well as the child born out-of-wedlock.
Because a fertile female is unmar-
ried should not deny her access to a
health service. We have no responsibili-
ty to judge moral status. Public health
nurses are particularly aware that many
girls and women will not change
their way of life because of fear of
another pregnancy. It is loneliness,
despondency and lack of emotional
support which drive many single girls
into relationships leading inevitably
to pregnancy. These root causes, it goes
without saying, must be attacked, but
pending their resolution, we should
not withhold help. Furthermore, pro-
tection against unwanted pregnancies
and children is an absolutely necessary
part of all attempts at social and educa-
tional rehabilitation of these girls.
From the foregoing, brief exami-
nation of population growth, family
size, and family formation, let us move
to family size and its relationship to
family health. Most of us are intuitively
convinced that family size limitation
and birth spacing favorably affect the
health of mothers and children. As
health professionals, however, we will
want to have clearly in hand the avail-