Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive...
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Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive Health
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Transcript of Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive...
Effective Contraception for Teenagers
Dr Louise CookAssociate Specialist
Sexual and Reproductive Health
My talk will cover: • Effective contraception• Teenagers• Providers
I’m not sure
what to believe
!
Pill scares
• Women stopped taking the pill • Prior to 1996 abortions had been falling• By 1999, BPAS reported
– 9% rise in abortions in 1996– 11% increase for 13-15 yr olds
e.g. 1983, 1996
Contraception: the Facts
LARC methods
What is a LARC?
‘Fit and forget methods’
LongActingReversibleContraception
Implant – 3 years
Copper coil orIntrauterine Device(IUD) – up to 10 years
Hormone (Mirena™) coil or Intrauterine System (IUS) – 5 years
Injection – 12 weeks
0
5
10
15
20
Condon Pills
Injec
tion
Copper
coil
Hormon
e co
il
Impl
ant
Perfect Use
Accidental Pregnancy in 1st Year of Use
Trussell J. Contraceptive efficacy. 2007
Per
cent
age
(%)
0
5
10
15
20
Condon Pills
Injec
tion
Copper
coil
Hormon
e co
il
Impl
ant
Perfect UseEveryday use
Accidental Pregnancy in 1st Year of Use
Trussell J. Contraceptive efficacy. 2007
Per
cent
age
(%)
Accidental Pregnancy in 1st Year of Use
0
5
10
15
20
Condon Pills
Injec
tion
Copper
coil
Hormon
e co
il
Impl
ant
Perfect UseEveryday use
Trussell J. Contraceptive efficacy. 2007
LARC Methods
Per
cent
age
(%)
75% women aged 16-49yrs in UK currently use at least one method of
contraception
Pills
Condoms
LARC
Sterilisation
Other
Source: ONS 2008/09
LARC = 12%
Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
(%
)
NONE
CONDOM
PILLS
INJE
CTION
'CO
ILS'
IMPLA
NT
STERILIS
ATION
Pre TOP
Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
(%
)
NONE
CONDOM
PILLS
INJE
CTION
'CO
ILS'
IMPLA
NT
STERILIS
ATION
Pre TOP
O% LARCs
Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)
0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nta
ge
(%
)
NONE
CONDOM
PILLS
INJE
CTION
'CO
IL'
IMPLA
NT
STERILIS
ATION
Pre TOP
Post TOP
64% LARCs
NICE: LARC Guidelines 2005
• Offer information and choice of ALL methods
• LARC more cost effective at 1 year than pills
• Implant most effective LARC
• Increase LARC uptake to 20%
• Significant cost saving - pregnancies avoided
• £11,000 saving for every £1,000 spent on contraception*
*Teenage Pregnancy Independent Advisory Group
Teenagers
Teenagers: the facts
• Age at first sex• Lack skills to negotiate safe sex • Sex is often unplanned• Alcohol / drugs • 50% pregnancies end in abortion• Contraception
– Susceptible to negative comments – Chaotic lifestyles– Attitudes and beliefs - ‘It won’t happen to me?’
• Fertile
0
10
20
30
40
50
60
70
80
90
100
16-19 20-24 25-29 30-34 35-39 40-44 45-49
Age range
Pe
rce
nta
ge
(%
)
Fertility
LARC
Pill
Condom
Likelihood of fertility and contraceptive use by age
0
10
20
30
40
50
60
70
80
90
100
16-19 20-24 25-29 30-34 35-39 40-44 45-49
Age range
Pe
rce
nta
ge
(%
)
Fertility
LARC
Pill
Condom
Likelihood of fertility and contraceptive use by age
0
10
20
30
40
50
60
70
80
90
100
16-19 20-24 25-29 30-34 35-39 40-44 45-49
Age range
Pe
rce
nta
ge
(%
)
Fertility
LARC
Pill
Condom
Likelihood of fertility and contraceptive use by age
Teenagers and ‘coils’
• Offer full range of methods to all• No restriction on basis of:
– Age alone– Never been pregnancy
• Very effective contraception for 5/10yrs• Cu IUD most effective form of emergency contraception• IUS improves heavy periods• Offer local anaesthetic
But…• Involves internal examination and procedure
…migrate around the
body
…show up under strobe
lights
…always cause bleeding problems
…no way, I scared of needles
…will make me put on
weight
Implants……it really hurts when it goes in/comes out
…what’s an implant
Tackling teenage pregnancy
Implant• Most effective method• Lasts 3 years• Very low dose hormone• Usually well tolerated• Immediately reversible • Few medical reasons to avoid it • Side effects (bleeding) usually easily managed• Doesn’t involve internal examination
Access to Contraception
Women’s use of contraceptive services*
Primary Care71%
Contraception Clinics19%
Retail 25%
75% of women who use general practice
for contraceptive advice/supplies do so
exclusively*NATSAL-2: French et al 2009
Primary Care
• Wales 2009-10: contraceptive prescription items1
– 85% of items were for pills
• Gwent: pills account for– 70% of both contraceptive budget and activity
• Pregnant teenagers in UK2:– 91% had seen their GP in preceding year– 71.3% specifically for contraceptive advice
1Prescription Management Services, NHS Wales Informatics Service 2Churchill D et al BMJ 2000
Primary Care
• Positive messages re LARC • LARC - no restriction on age/nulliparity • Provide information on all methods
– typical failure rates– teen pregnancy/abortion rates
• Facilitate access to implants• Promote continuation of method• Proactive in managing side effects• Quality Outcomes Framework
Community Contraception Service Gwent Implant Activity 2001-10
0
500
1000
1500
2000
2500
3000
3500
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Nu
mb
er
of i
mp
lan
ts fi
tted
pe
r ye
ar
Total
Under 18s
Wolverhampton: Impact of LARC on Teenage Conception Rate
0
10
20
30
40
50
60
70
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
England
West Midlands
Wolverhampton MCD
Dr Louise Massey, Consultant SRH
Wales
The future…
• Normalise use of LARC– Global approach– Positive messages with realistic expectations– Dispel myths
• Primary care clinicians need to be proactive– Facilitating access to LARC– Manage side effects– Encouraging continued use
• Education and training - nurses
But……don’t forget the condoms!
Thank you for listening
