Forida Akhtar, a 35-year-old Sylheti woman, complained of pains in her back and shoulder. No diagnosis could be made from routine clinical assessment and over a matter of weeks she became more and more uncomfortable with the pain, finally volunteering that it was, in her view caused by her coil. Her husband who was sympathetic and attentive, readily concurred, and although the doctor felt that the pain could be psychosomatic, she was not confident that the IUCD was the cause of the problem. With little room to negotiate, the progestogen-only Pill was prescribed while the couple received instruction in barrier methods, their preferred choice once the coil was removed. Once released from the necessity of putting up with the coil, the couple revealed that they had never felt that the coil was allowed by their religion, and were relieved to be able to do without it. The initial choice of a coil had been made mostly on medical grounds.

As in so many aspects of their lives, newcomers to the West are in a state of flux, and fall somewhere between the traditions of their homeland and the current mores of the UK. If nurses and doctors are sensitive to the changes that are taking place, often very quickly, the patient can use them as facilitators, and thus find their own position in their particular cultural and social context. For a couple who previously believed that all children should be accepted, and that no contraception should ever be used, the experience of one years’ infertilty on the basis of postponing the next pregnancy rather than limiting the family can be profound. The essential part of the learning process is that their experience of infertility is achieved with contraception rather than by geographical separation.


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