Twenty-One Years' Experience with a Public Health Contraceptive Service

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Abstract
A contraceptive service was introduced into the Public Health program in North Carolina in March 1937. The program was re-evaluated after 21 years'' experience. The initial indications for the program were high maternal, perinatal and infant mortality particularly among some economic groups. Initially, the contraceptive program was isolated from the maternity program then in existence. However, over a period of years there was a natural tendency for the program to become consolidated into the overall maternity program. A review of the status of Public Health maternity programs in the state in 1954 revealed that 74 of the 100 counties in the state provided some obstetric care for the indigent and medically indigent in the area. In spite of the fact that the Public Health Clinics provided the only pre-and postnatal care for approximately 12 to 14% of the total obstetric population of the state the care was found to be inadequate in many aspects. In view of the fact that only 20% of the patients returned for postpartum visits, it is difficult to conceive of an effective contraceptive program. The logical starting point, therefore, appeared to be with the improvement of pre- and postnatal care, both in regard to quality and quantity. Attempts have been made to centralize the clinics in the Public Health centers, usually located in the county seat, and to improve the quality of the programs. More stringent midwife care, public health education, and coordination with the private physicians have all been involved in the overall program. It is impossible to assess the value of the contraceptive program in the reduction of maternal, perinatal and infant mortality rates, although it is certainly the feeling of those involved in the program that the introduction of the contraceptive program into the state and its coordination with the maternity service has been of some value in reducing these rates. It is to be hoped that there will be continued progress along these lines.

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