Contraception and Young People

Conception rate in girls aged 13-16 is about 1% and approximately half of these pregnancies are terminated. Overall over 1/3 of all teenage pregnancies are terminated.

• Teenage pregnancies in the UK are the highest in Europe: Germany has half the pregnancy rate, France one third and the Netherlands one fifth. The UK comes second only to the USA in the developed world.
• Recent studies show that 18.7% of teenage women and 27.6% of teenage men had sexual intercourse before the age of 16.
• Another study in London reported that 1 in 5 children aged 13 years stated that they had already taken part in penetrative or oral intercourse. At this age they are far less likely to use contraception.
• Successful reduction is achieved where an open, tolerant, pragmatic attitude to sexuality is adopted with effective programmes of sex education and confidential contraceptive advice.¹

• Teenage pregnancy is a serious social problem. Having children at a young age can damage young women's health and well-being and severely limit their education and career prospects.²
• Children born to teenagers are much more likely to experience a range of negative outcomes in later life. Children born to teenage parents are also much more likely to become teenage parents themselves.²
• Abortion carries its medical and emotional adverse effects whilst continuing pregnancy carries a higher risk of maternal and fetal disadvantage.
• Teenage pregnancies are more likely to suffer anaemia and pre-eclampsia. The fetus is at risk of high rates of perinatal mortality, low birth rate and higher incidence of congenital abnormalities.

• Rates of teenage pregnancy vary widely within the UK with much higher rates in underprivileged areas. Teenage girls particularly at risk are those who:
  • Have been in care
  • Who truant from school
  • Are from a large family
  • Are themselves children of teenage mothers
• Fears that sex education will make them more likely to experiment have been shown to be unlikely. One Bristol study in which schoolchildren aged 14-15 years were educated in the use of emergency contraception showed no change in their sexual activity or use of the facility.³

• A study in Devon showed that over half of female teenagers had consulted their GPs for contraceptive advice. Reasons given were convenience and the fact that they may not necessarily be there for contraceptive advice.
• Main concern of young people is that their interview is confidential and fears over lack of confidentiality are main reason for not attending GP. For this reason, provision of community family planning clinic may also be an important feature of an effective service.

• Guidance from BMA and others states that 'the duty of confidentiality owed to a person under 16 is as great as that owed to any other person'.
• However, there is complete right of confidentiality where issues such as abuse and child protection are involved.
• Guidance also states that 'any competent young person, regardless of age, can independently seek medical advice and give valid consent to treatment'.
• Following the Gillick case the Department of Health issued the following guidance on providing contraceptive advice and treatment to young people under the age of 16. A health professional needs to be satisfied that:⁴
  • The young person could understand the advice and have sufficient maturity to understand what was involved in terms of the moral, social and emotional implications.
  • They could neither persuade the young person to inform the parents, nor to allow the health professional to inform them, that contraceptive advice was being sought.
  • The young person would be very likely to begin, or to continue, having sexual intercourse with or without contraceptive treatment.
  • Without contraceptive advice or treatment, the young person's physical or mental health or both would be likely to suffer.
  • The young person's best interests required the health professional to give contraceptive advice or treatment or both without parental consent.

• If you are not the patient's usual doctor and the patient has significant medical problems, you may need to obtain permission from the patient to obtain medical and family history from her GP before treating.
• Allow adequate time for counselling with discussion about relationships, sexually transmitted infections and general health matters.
• It may help to provide information of all methods of contraception, their benefits and risks to allow informed choice. If partner is present, involve him.
• Most reversible methods may be suitable for young, fit women.

• Low dose combined oral contraceptive pill offers non-contraceptive advantages in terms of irregular menstrual cycles, premenstrual symptoms and heavy or painful periods.
• Can also run treatment courses together to avoid menstruation during examinations etc. Effectiveness depends upon taking the pill as instructed and in typical use associated with pregnancy rate of 3-20%.
• Teenagers are particularly at risk because of missed pills. Before prescribing, take the blood pressure. Cervical smears are not indicated in this age group although advice about human papilloma virus in cervical cancer is useful.
• Progestogen only pills are less suitable because of need for them to be taken regularly - although cerazette may be most appropriate of this group as the missed pill rules are as for combined oral contraceptives.

• Depot injections of progestogen may be suitable as the contraceptive effect last 8-12 weeks and they are very reliable.
• Implants may be a suitable option as they last for 3 years and are extremely reliable.
• Such preparations can be used in young people (benefits are considered to outweigh risks), but the use of depot preparations should be regularly reassessed, at least within 2 years.⁵

• The copper-based IUD and the progestogen-releasing intra-uterine system may be considered, although it may be difficult to insert a coil into a nulliparous uterus and there is no protection against sexually transmitted diseases.
• There is a small increase in risk of pelvic infection in the 20 days after IUD insertion, but there is no increased risk after the first 20 days.

• Diaphragm may be suitable for some girls in stable relationships, but storing and transporting device may be difficult if not telling parents.
• Male and female condoms are relatively unreliable if used alone.
• If combined with other methods they enhance effectiveness and protect against sexually transmitted infection.

• One study showed that a quarter of girls presented at clinic for emergency contraception and many do not return for continuing advice.
• They are high risk group for new unintended pregnancies.⁶