The importance of contraception across the lifecourse

Alison Hadley, Director, Teenage Pregnancy Knowledge Exchange, University of Bedfordshire

Back to basics!

The importance of contraception

Improving knowledge of contraception – a pre-requisite of choice and effective use

What’s more important to women’s health?

Having a baby is least frequent motivator to have sex!

On average, a heterosexual woman in the UK will spend 30 years needing to prevent an unplanned pregnancy

Increasing evidence that unplanned pregnancies have poorer pregnancy outcomes. NATSAL estimates 1:5 pregnancies are unplanned – with prevalence highest for nullips and women with 2+ children

Contraception – and safe abortion – a key public health contribution to women’s health and wellbeing

Women voted the pill (and the washing machine) the most important inventions for women in the 20c

The impact of contraception

Maternal mortality – would be almost halved in developing countries if women’s contraceptive needs were met

John Santelli review (2007) 86% of decline in US teenage pregnancy rate attributed to improved use of contraception

St. Louis study (2007): Provision of free contraception to 9000 women aged 14-45 resulted in over 60% fall in abortion rates and a significantly lower teenage pregnancy rate

Women’s knowledge: an essential pre-requisite to choice

Sexual Health Improvement Framework ambition:

Increase knowledge and awareness of all methods of contraception among all groups in the local population…but

No data to show current knowledge of women across the fertile lifecourse, or of parents, or of professionals

No systematic way of providing information about contraception to young people and adult women: patchy SRE, no universal provision to adult women – or men

Results in patchy and often inaccurate information, disseminated through word of mouth and personal experience

Professionals’ knowledge:expanding or limiting choice?

Sexual health professionals

Definition of LARC?

Emergency IUDs?

Condoms – included in choice of methods?

The importance of incorporating the prevention role of the wider health and non-health workforce into commissioning (Sexual Health Framework)

A range of professionals in touch with women need to be well informed about contraception and local services – otherwise misinformation will limit women’s choice

Making every contact count is critical in system of reduced capacity

Knowledge makes a difference

Pharmacy intervention: intensive education of pharmacists on emergency contraception options + rapid access referral pathway tripled emergency IUD fittings (2/3 to nullips) with no pregnancies reported in the treatment group

Sex. Worth Talking About - Contraception. Worth Talking About – Chlamydia. Worth Talking About

- developed and laid the foundations of building knowledge, conversation and access to contraceptive choice among teenagers, young adults, parents and professionals – promoting open and honest discussions… but

- only ran for three months…

Impact from the campaign? Some indication from service data

Contraception

- Percentage of women using Long Acting Reversible Contraception increased from 24% in 2008-9 to 26% in 2009-10 and 28% in 2010-11*

- 2010 Under 18 conception rate showed largest single year decline: 7.8% (2009-2010) v 6.5% (2008-09)

*Community Contraceptive Clinic data

The challenge

Reassert the critical importance of contraception

Maximise the potential of free access to highly effective methods

Develop a national communications plan to improve knowledge, identify the assets in the new landscape and the current information sources of contraception and systematise the provision of information for all women – and their partners

For more information:

Teenage Pregnancy Knowledge Exchange

www.beds.ac.uk/knowledgeexchange

alison.hadley@beds.ac.uk