Sex changes

SEX and our attitudes to it have undergone a seismic shift since the early Sixties. Back then, abortion was illegal and women had to be married to use the family planning service. Today, they can buy the 'morning-after' emergency contraception pill from their local pharmacy and condoms are issued as much to prevent sexually-transmitted disease as to stop an unwanted pregnancy.

Few people in York are better placed to plot these changes than Dr Pat Saxty, the just-retired head of family planning services in York.

Abortion was still illegal when she was a medical student in London.

"During my gynae training, I was involved with the admission of a young mother of four children who died because she had had an illegal abortion. It was a very traumatic experience for me as a young student," recalls Dr Saxty.

She also recounts the story of a colleague who carried out an illegal abortion on his girlfriend - which led to an infection and made her infertile.

How times have changed.

Advice on all aspects of contraception and sexual health is something women today take for granted. GPs, practice nurses and family planning centres all offer free, non-judgemental advice to women.

But turn the clock back 40 years to the start of Dr Saxty's career and things couldn't have been more different.

In the early Sixties, access to contraception was extremely difficult for unmarried women. The Family Planning Association ran clinics across the country - including one in York dating from 1953 - but the service was only available to married women, and they had to pay for it.

Occasionally, the rules were relaxed.

"There was a family planning clinic in London where women were allowed to go three months before their wedding," says Dr Saxty.

"They were called by their married name-to-be and shown how to use the cap but were put on their honour not to use it until their wedding night."

When the first family planning clinic opened in York, such was the stigma attached to it that many staff were snubbed by friends and families.

By the late Sixties, progress was being made, asserts Dr Saxty. Abortion was legalised in 1967 and the Family Planning Act extended the service to all women, regardless of marital status.

The arrival of the pill and IUD required skilled medical intervention and family planning became firmly harnessed to the NHS, with most GPs offering it as a free service.

Dr Saxty, 61, who has three grown up children and five grandchildren, has been working in York for 30 years and has headed the family planning service since 1985.

Over those years, she has seen other changes.

Today, the main concerns are about the numbers of under-16s having sex and rising cases of sexually transmitted disease, particularly chlamydia.

"We are quite worried about the findings of a study we carried out which found that 11 per cent of women under 25 had chlamydia.

"It's a big issue as it has serious consequences. It can cause infertility, pelvic infection and ectopic pregnancy. It's a worry because it doesn't cause any symptoms."

Dr Saxty has welcomed the creation of an integrated sexual health service at the Monkgate Health Centre, where the main family planning unit is based.

Next door is the clinic for Genito-Urinary Medicine (GUM), where sexually-transmitted diseases are treated.

It's an acknowledgement of how times have changed and that diseases such as chlamydia - which has had rates increase by 75 per cent in the past five years - are as much a concern as unwanted pregnancy.

"You can't think about contraception in isolation now," says Dr Saxty. "Things are different now. Women often do change partners and have got to think of the risk of sexually-transmitted infections."

Another big worry is the pressure on young girls to have sex at ever earlier ages.

Dr Saxty estimates the service sees about 400 girls under 16 a year.

The family planning unit at Monkgate runs specific drop-in clinics for young people aged under 25 from 4pm-6.30pm during the week and from 12.30-3pm on a Saturday.

A youth worker also attends the centre to support girls under 16.

The law allows girls under 16 to make their own decisions about contraception and abortion if they are thought to be capable of understanding the issues, explains Dr Saxty. But that doesn't mean professionals don't worry about young girls having sex.

"It takes a lot of courage for them to come into the clinic," says Dr Saxty. "We like them to come in but the last thing we want to do is encourage them to have sex at that young age.

"Besides the risk of infection, there is the difficulty of dealing with contraception properly. They are a real worry to us."

But she believes it takes more than sex education to reverse the trend for girls to have sex at an earlier age.

"They need to be taught comprehensively about sex, not just contraception.

"They need to know about dealing with relationships, and being assertive.

"It also reflects social issues. Girls who have ambition and see a future for themselves are the least likely to become teenage mothers.

"If you can't see anything exciting on the horizons then becoming a teenage mum is not such a bad option.

"What is really crucial is that we help girls build self esteem and make them feel they can do something with their lives.

"It's a very complex issue and there is no easy answer."

Dr Saxty is looking forward to her retirement, particularly to spending time with her ever-expanding family.

"A new grandson and granddaughter have just arrived," she says with a smile.

"I guess you could call that good family planning."