Publication
International year of the family report (phase 1): an overview of academic attempts to define the family
2. Health care professionals views of the family
Gaining an understanding of the ways in which the front-line health care professionals conceive of the family is of significant importance. It has long been recognised in the field of social policy that in order to adequately understand and evaluate policy outcomes it is necessary to give attention to the ways in which front-line staff actively interpret and opperationalise the policies handed down from the higher bureaucratic echelons (Lipsky 1980, Sabatier 1986). This theme is developed further in the final section of this report dealing with suggestions for the second stage of HEBS IYF Project.
However, having noted the importance of this section, it is necessary to report that repeated computer aided literature searches have identified very few works related to medical professionals’ views of what the family is or should be. This may in itself be a reflection of the power and prestige of the medical profession within our society. The one area where there is literature looking at doctors’ views of the family is in the expanding field concerned with assisted human reproduction.
In this area the recent work of Donavan (1993) is of particular interest. Donavan conducted in depth qualitative interviews with doctors working in fertility clinics. Her explicit aims were to gain an understanding of the ways in which the doctors made decisions concerning an applicant’s suitability for assistance with conception and more generally, made judgements about who should or should not become parents. Donavan reports that nearly all of the doctors in her study maintained that they tried to refrain from moral non-medical judgements during their practice. Her analysis reveals, however, that in reality this proved near impossible and doctors were forced to draw upon their own personal belief systems and what they perceived to be public opinion. This led to a situation whereby, in the main, the doctors aimed to reproduce the heterosexual nuclear family.
the majority of the respondents ... (sought) to reproduce the heterosexual nuclear family. A third of the respondents also preferred heterosexual couples to be married. Over half showed some allegiance to middle class norms in relation to financial, living and material resources and paid employment. The result of donor recruitment practices is that white people find it easier to attain access to parenthood through the use of DI (donor insemination). Women with disabilities and genetic conditions will also find the question of their access comes under scrutiny because of belief that genetic conditions should not be propagated (Donavan 1993 p 171) (brackets added).
Abbott and Sapsford (1990) offer insights into the role and practice of health visitors and their views of the family. This work is of particular interest because in the final section of this report it is suggested that health visitors should be included in the second stage of the HEBS IYF project. As Clarke (1982) notes, although health visitors are often charged with the care of elderly people in addition to children and mothers, in reality the majority of their time is spent working with families. For Abbott and Sapsford, although health visitors claim to engage in family health education and promotion rather than the policing of child care, and attempt to adopt a non-judgmental approach to their practice, they invariably resort to a common-sense notion of the ideal type of family in which to rear children. The authors argue that the common-sense notion of family most often used by health visitors is one that is essentially ‘patriarchal and middle class’ (Abbott & Sapsford 1990 p120). Rigler (1982) argues that the employment context of health visitors (often general practices) has important implications for their practice. Abbott and Sapsford, in searching for the reasons behind the ways that health visitors view and relate to families, look to the child development theories which are learnt during training. As they write:
We suggest that this tendency to work with an individualistic perspective is compounded by child development knowledge which health visitors learn on their specialist training courses ... and the stress that midwives and health visitors place on mother-child bonding and ‘normal’ mother-child interaction. Furthermore, psychological theories of child development tend to assume the ‘normal’ family, even if this is not made explicit (Abbott and Sapsford p 131).
Orr (1986) has provided an explicitly feminist analysis of health visitor training and practice which draws heavily upon the concept of patriarchy. Abbott and Sapsford summarise her arguments when they write:
health visitor training reinforces middle-class values, patriarchal attitudes to the family already held by trainees - that is, they are taught that the ideal-typical nuclear family is biologically given and socially necessary as the context for normal child development. She argues that rather than helping women to care for their own and their children’s health, the health visitor’s interactions are designed to reinforce/maintain/create the patriarchal nuclear family (Abbott & Sapsford 1990 p 131 referring to Orr 1986).
In relation to social work McLeod and Saraga (1988) provide evidence to suggest this professional group also commonly work with a particular model of the ideal family. The authors argue that social workers tend to focus more upon ‘unnatural’ families (single parents, step-fathers etc.), and their interventions reflect their views that the worst thing for any child is family break-up.
To summarise, academic work in relation to medical doctors, health visitors and social workers suggests that within all of these professions there is a tendency to work with a particular model of the ideal family type. Most commonly this appears to be the nuclear heterosexual family, wherein there are clear gender divisions and related responsibilities. Often, however, the professionals involved do not appear to be aware of the ways in which these common-sense notions of the family guide their practices. The following section will turn to look at the reality of the varying family types in Scotland.