1. Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive Health

2. My talk will cover: Effective contraception Teenagers Providers I’m not sure what to believe!

4. 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

5. Contraception: the Facts

7. LARC methods

8. What is a LARC?

9. ‘Fit and forget methods’ Long Acting Reversible Contraception

10. 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

12. Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy. 2007 Percentage (%)

13. Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy. 2007 Percentage (%)

14. Accidental Pregnancy in 1 st Year of Use Trussell J. Contraceptive efficacy. 2007 LARC Methods Percentage (%)

15. 75% women aged 16-49yrs in UK currently use at least one method of contraception Source: ONS 2008/09 LARC = 12%

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

17. O% LARCs

18. Gwent unplanned pregnancy service: 100 consecutive abortions (all ages) 64% LARCs

19. 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

20. Teenagers

21. 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

22. Likelihood of fertility and contraceptive use by age

25. 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

26. …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

27. 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

28. Access to Contraception

29. 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

30. Primary Care Wales 2009-10: 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

31. 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

32. Community Contraception Service Gwent Implant Activity 2001-10

33. Wolverhampton: Impact of LARC on Teenage Conception Rate 0 10 20 30 40 50 60 70 19971998199920002001200220032004200520062007200820092010 Under 18 conception rate per 1000 Year England West Midlands Wolverhampton MCD Dr Louise Massey, Consultant SRH Wales

34. 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

35. But… …don’t forget the condoms!

36. Thank you for listening