Effective Contraception for Teenagers Dr Louise Cook Associate 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 yr olds e.g. 1983, 1996

Contraception: the Facts

LARC methods

What is a LARC?

‘Fit and forget methods’ Long Acting Reversible Contraception

Implant – 3 years Copper coil or Intrauterine Device (IUD) – up to 10 years Hormone (Mirena™) coil or Intrauterine System (IUS) – 5 years Injection – 12 weeks

Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy Percentage (%)

Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy Percentage (%)

Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy LARC Methods Percentage (%)

75% women aged 16-49yrs in UK currently use at least one method of contraception Source: ONS 2008/09 LARC = 12%

Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)

O% LARCs

Gwent unplanned pregnancy service: 100 consecutive abortions (all ages) 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

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 Care 71% Contraception Clinics 19% 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 : contraceptive prescription items 1 –85% of items were for pills Gwent: pills account for –70% of both contraceptive budget and activity Pregnant teenagers in UK 2 : –91% had seen their GP in preceding year –71.3% specifically for contraceptive advice 1 Prescription Management Services, NHS Wales Informatics Service 2 Churchill 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

Wolverhampton: Impact of LARC on Teenage Conception Rate Under 18 conception rate per 1000 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