Although figures have decreased since the late 1990s, Britain still has the highest teenage pregnancy rate in Europe. Levels of sexually transmitted infections (STIs) amongst the teenage population are also high. Access to good quality sexual and reproductive healthcare services are needed to counter the high teenage pregnancy and STI rates.
Doctors need to ensure they provide tailored contraception services and advice to teenagers whether via the NHS or through private not-for-profit organisations, as these early experiences with clinics shape the teenagers' future attitudes toward contraception.
Many of these first consultations occur in GP surgeries or family planning clinics but the challenge often lies with getting teenagers to actively seek information and advice about contraception care from the right sources, where clear and accurate information is provided. Many young people rely on friends or the internet for information and are often shy about speaking about their sexual activity with clinicians, making it difficult for doctors to offer appropriate advice.
The author suggests that doctors raise awareness about the risks of unprotected sex and take opportunities during routine or gynaecological consultation to educate their young patients about lifestyle choices. The assurance of confidentiality between the health professional with young people is of utmost importance and doctors seeing women under-16 without parental consent must adhere to the Fraser guidelines, which assess the young woman's maturity and her ability to understand the advice provided, alongside the possible effects of the use of contraceptives on her wellbeing.
Other areas for doctors to consider include ascertaining the nature of sexual activity and whether it is consensual. Clinicians must be sensitive to any abusive or coercive sexual activity. An inter-agency approach is required with child protection and social services so that young vulnerable women are protected.
Contraceptive methods
The contraceptive pill is the most common method both known to and used by young women but long acting reversible methods of contraception (LARCs) are also suitable and effective for those under-16s who have never given birth.
The main issue for women using LARCs is reliability but many young women have preconceived and mistaken ideas of their side-effects such as weight gain, irregular bleeding and pain associated with these methods: this, in turn impacts on the uptake of these methods. Young women choose LARCs because they remove the daily routine of taking the Pill. Doctors have to be mindful of communicating the risks and benefits of the use of LARCs, including the potential side effects. The recommended LARCs are the contraceptive patch, subdermal contraceptive implants and contraception injections.
The use of intrauterine devices (IUDs) and intrauterine systems (IUSs) in adolescents is a further option although some have concerns over the use of this invasive method in young women.
The condom is the most commonly-used barrier method in young people and has the added advantage of protecting users from STIs. The author recommends the use of ‘double Dutch', a combination of a contraceptive method with a barrier method in young people to prevent unplanned pregnancies and STIs.
Gillian Vanhegan, author of the paper and a Medical Director at sexual health charity Brook said, “Young people, under the age of sixteen, consulting a doctor for contraceptive advice raise two main issues for doctors. Firstly, in the consultation, the doctor must assess the maturity of the patient, her Fraser competence and ability to consent to treatment.
“Secondly, it is often not recognised that there is an extensive range of contraceptive options available to this age group. Long acting reversible methods (LARC), such as injectables, implants and intrauterine devices (IUD) or systems (IUS), are often more suitable than contraceptive pills or patches, which rely heavily on the user for their efficacy. The use of a barrier method, such as a condom is important in addition to contraception to reduce the incidence of Sexually Transmitted Infections (STIs) in this age group.”
Professor Neil McClure, editor-in-chief of TOG, said “Offering advice to young women can sometimes be difficult if they are self-conscious or embarrassed when talking about their sexually activity. It can be particularly difficult to have an honest and open conversation if these girls are accompanied by a parent who insists on being present throughout the consultation.
“We as a profession have an obligation not only to treat teenagers but also to correct their misconceptions and to enable them to make correctly informed decisions. For the doctor or nurse to provide good contraceptive advice that is suitable to each woman, we must ensure that the young women are comfortable with us and the advice that we offer is presented in a non-judgemental and open, accessible manner.”
ENDS
Notes
The Obstetrician & Gynaecologist ( TOG ) is published quarterly and is the Royal College of Obstetricans and Gynaecologists' (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Reference
Vanhegan G. Contraception in the under-16s: issues of confidentiality and choice of methods. The Obstetrician & Gynaecologist 2008;10:22 – 26.
To speak to Gillian Vanhegan please call 07977106248 or email Gillian.vanhegan@virgin.net . To speak to Professor Neil McClure please email n.mcclure@qub.ac.uk or call 028 90632506.
