This thesis is an historical account of the development and dissemination of birth control knowledge in Scotland in the twentieth century up to 1975. The question posed is, given that Scotland in the twenty-first century has a higher rate of teenage pregnancies than most of Western Europe despite there being no restriction on the ability to access contraceptive advice, was advice always so readily available and if so from whom ? Post 1870 there was a pan European fertility decline which was mirrored in Scotland some forty years later. The debate amongst demographers and social historians is thus as to the causes of this fertility decline. Religion being cast as the impediment to the early development of the fertility decline ensured that an examination of the Roman Catholic versus Scottish Protestant views on birth control be explored. Historical accounts have considered that the desire for contraceptive advice was a phenomenon of the early years of the twentieth century and that letters to Marie Stopes were the first interactions between the general public and those competent to offer advice. However, the historical record shows that from the early years of the nineteenth century members of the public sought information on methods of birth control by writing to journals, a pattern that continued throughout the period covered by this thesis. Scotland remains distinctive from other parts of the UK by virtue of its separate legal system, both civil and criminal, its separate Church history with the parish church and state having been virtually one and the same and the rural parish church being a precursor of the local authorities. The employees of the local government authorities, the Medical Officers of Health were responsible, in agreement with their political masters of whatever hue, for the policies in relation to health and welfare adopted in a particular locality; in this case birth control advice. The administrative devolution of central government has meant that successive Scottish Secretaries of State have been able to obfuscate and hinder developments in Scotland which would have facilitated widespread dissemination of birth control advice and of course the fact that the NHS Acts in Scotland and England and Wales are distinct has ensured that legislative change has been delayed. The thesis draws upon medical and scientific journals and contemporary literature to set the scene by explicating the developments in the understanding of sexuality and reproductive physiology, a necessary precursor to the developments later in the twentieth century of the oral contraceptive pill and the impact that this preparation had on society, removing the procreative function of sexual intercourse from the hedonic. Thus freeing women from ‘the burden of pregnancy’ should they wish it, should it be available, from whom and at what cost. The politicians having debated from the 1930s to the 1970s the subject of contraceptive advice being available only to married women and initially, only available to those for whom a further pregnancy would be hazardous. Oral history testimony has been taken, and used to inform the discussion, from retired health care professionals, family planning nurses, GPs, family planning doctors, pharmacists and obstetricians as well as patients and retired clergymen who were involved in prescribing, dispensing, researching methods of contraception or in the case of the patients at the receiving end of the wisdom or ignorance of the professionals and of course in the case of the clergy advising on the moral questions in relation to the practice of birth control. In Glasgow, poor housing and social conditions, grassroots’ feminism and working class women were instrumental in establishing the first birth control clinics whereas in Edinburgh the Cooperative Women’s Guild organised public meetings to raise the issue and call on government to allow maternity centres to provide guidance and instruction in birth control to married women. In Aberdeen it was wealthy philanthropic women who promoted birth control ideals and facilitated the first birth control clinic in the north of Scotland. The issue however was politically sensitive, especially in the west of Scotland, as the Labour Party needed to secure the votes of the Roman Catholic Population. The medical profession were not at the forefront of providing this advice in part due to ignorance but also lack of interest and also not wishing to be seen as promoting immorality and offending the Church, a powerful body in Scotland. The Protestant and Catholic Churches in Scotland had an alliance condemning all acts of birth control until the 1930s when the clamour from the public forced politicians, heretofore virtually absent from the debate, to confirm what was and was not available at government expense. That guidance, similar to that offered in England, was not available to the public in Scotland as evidenced by contemporary accounts in the National Records of Scotland, merely highlights the differing attitudes of politicians in Scotland who at a local and national level were ever mindful not to risk offending the Roman Catholic Church’s teachings or risk suffering at the ballot box. Teaching of birth control techniques was absent from most medical schools in Scotland although Edinburgh University appointed a lecturer in family planning in 1946. Thus most young practitioners from Scottish medical schools remained ignorant and unable to help their patients even if willing to do so. Despite the Royal Commission on Population of 1949 recommending that advice on contraception to married persons be available, as part of the National Health Service, it was to take nearly another thirty years before contraceptive advice to all who wished it were freely available. In the intervening years the medical profession, although reluctant to become involved, had accepted initially that they could charge a fee for this private service and later that item of service payments for providing contraceptive advice was acceptable, although interviewees conceded that in many cases general practitioners were untrained to provide this service. This account of the history of the dissemination of birth control advice shows how the medical profession, initially uninterested in this subject, became, as reproductive physiology was better understood and with developments of hormonal manipulation of the menstrual cycle, to embrace contraception as a legitimate topic on which to provide advice to patients. The notion, of course, of general medical practitioners having responsibility for a group of patients unless as private practitioners was only apparent after the inception of the NHS.

Background: Evidence from population-level studies demonstrates that adolescent sexual health outcomes are associated with social exclusion, and that certain groups, including young people looked after by local authorities often experience poorer sexual health outcomes. The poorer sexual health outcomes observed for looked after young people has led to the Scottish Government recommending that looked after young people be prioritised for the delivery of sexual health and relationships education, and that residential carers, foster carers and social workers should play a key role in the delivery of sexual health and relationships information to looked after young people. This recommendation builds on existing policy initiatives that have emphasised that parents should be routinely talking to their children about sexual health and relationships. Despite a growing research interest in the health of looked after young people, there is currently little known about how sexual health and relationships discussions are undertaken within the care setting. This is because much of the research that has been published to date has focussed upon identifying barriers to communication rather than establishing how communications are shaped by the characteristics of carers, looked after children and the wider context of the care system. In this thesis I hope to address this research gap by exploring what factors shape communications about sexual health and relationships within the care setting, and examining the extent to which connectedness, monitoring and supervision — parenting factors identified as promoting positive sexual health outcomes for adolescents within the wider literature — mediate these discussions. Methods: 54 in-depth qualitative interviews were conducted with looked after young people (aged 14-18), care leavers (aged 16-23), residential workers, foster carers and social workers in one local authority in Scotland between August and December 2011. Data were analysed thematically, with data collected from corporate parents and looked after young people used to compare and contrast experiences of talking about sexual health within the care setting. Findings: The results presented in this study demonstrate that there has been a perceived shift in attitudes towards talking to looked after young people about their sexual health, and that residential carers, foster carers and social workers believe that talking to young people about sexual health and relationships should be a core responsibility of the corporate parent. Despite this, the results of this study demonstrate that talking to young people about sexual health and relationship is a subject that is fraught with tensions, with many of the corporate parents interviewed expressing difficulties reconciling their own views about the appropriateness of talking to young people about sexual behaviours with their professional responsibility to inform and protect looked after young people from risk. Looking specifically at how communications about sexual health and relationships were undertaken within the care setting, the results of this study show that talking to young people in care about sexual health and relationships is mediated by the impact or pre-care and care histories, in particular maltreatment and poor attachment security, upon young people’s understandings of relationships and their ability to trust other people and seek out help and support. Whilst corporate parents emphasised the need for training to help them identify strategies for talking to young people about sexual health and relationships, the results of this study show that corporate parents are already undertaking sexual health and relationships work that is tailored to the age and stage of the child, and is balanced by the provision of monitoring and supervision to minimise risk. Conclusions: The results of this thesis show that discussions about sexual health and relationships need to be underpinned by a trusting relationship between corporate parents and looked after children. As such, an emphasis needs to be placed upon improving young people’s ability to trust other people. Improving permanency for young people in the care system, in conjunction with the development of attachment based sexual health practices, may result in the promotion of positive outcomes for looked after young people. Future policies and training relating to the provision of sexual health and relationships education within the care system should reflect this fact.

Background: The human secondary sex ratio has been the subject of long-standing medical, environmental and social scientific curiosity and research. A decline in male birth proportion in some industrialised countries is linked to endocrine disruption and is validated by some empirical studies. Increasing parental age and population stress and associated decreases in sex ratio have also been demonstrated. A thorough literature review of 123 relevant and diverse studies provides context for these assessments. Methods: A spatial-temporal investigation of birth sex ratio in Scotland and potential determinants of endocrine disruptor pollution, socio-economic factors including neighbourhood stress, deprivation, smoking, and maternal age, was conducted. This involved review of national and regional sex ratio time trends, and stratified/spatial analysis of such factors, including the use of GIS tools. Secondary data were sourced from Scottish Government web portals including Scottish Neighbourhood Statistics and the Scottish Environmental Protection Agency. Results: Regional differences in sex ratio between 1973 and 2010 are observed which likely lever the national male birth proportion downwards, with the region of poorest air quality from industrial emissions, the Forth Valley, displaying the greatest sex ratio reduction. Further analysis shows significant upwards skewing in sex ratio for the population cohort experiencing the least and 2nd most deprivation. Localised reductions in sex ratio for areas of high modelled endocrine disruptor pollution within the Central Region in Scotland are also displayed. Discussion: Limitations of the analyses include the danger of ecological fallacy in interpreting from area-based measurement and the simplified pollution modelling adopted. Despite this, and given elevated incidence of testicular cancer in Scottish regions mirrors the study’s results, tentative confirmation of the endocrine disruptor hypothesis can be substantiated. Further, elucidation on advanced parental age as a contributory factor to secondary sex ratio change is also given. Recommendations are made with respect to environmental monitoring and health protection, and preventative health strategies in Scotland.