How good is the provision of sexual health services for young people across England?

R. French (1), J.M. Stephenson (1), R. Kane (2), P. Kingori (1), A. Hadley (3), C. Dennison (4), K. Wellings (2)

Centre for Sexual Health & HIV Research, Department of Primary Care & Population Sciences, Royal Free & University College London Medical School, UK (1); The Public & Environmental Health Research Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK (2); Teenage Pregnancy Unit, Department for Education and Skills (3); Sexual Health and Substance Misuse, Department of Health (4)

Background: One of the aims of the national Teenage Pregnancy Strategy in England is to halve under –18 conception rates by 2010. Improving provision of contraceptive services for young people is a major component of the strategy.

Objective: to present a national picture of contraceptive services for young people in England and to assess the quality of provision against Best Practice Guidance from the Teenage Pregnancy Unit.

Design and Methods: Two national surveys, distributed via local Teenage Pregnancy Co-ordinators, were conducted of contraceptive services and general practice in 2002.

Results: Data were returned by 1295 contraceptive services (64% of all services in Sexwise database). Nearly a quarter of services had been developed since the start of the Teenage Pregnancy Strategy in 1999. 49% were mainstream services e.g. family planning or GU clinics, 39% were designated young people’s services and 12% were mainstream services with specific sessions for young people. The proportion of services meeting at least 5 of the Best Practice criteria was 14%, 27% and 39% respectively. About half of the young people’s services provided a wide range of contraceptive methods and screening for STI. Data were returned from 4020 /8910 (45%) general practices. 13% ran sexual health sessions for young people. Over 90% provided oral contraceptives and emergency contraception and only 50% provided condoms. 91% offered referral for NHS abortion, but 27% had at least one GP with conscientious objections to abortion. Notices explaining under 16s rights to confidentiality were displayed in 19% of practices, and in 14% of practices, at least one GP would not see under 16 year olds without a parent present. Contraceptive methods that are less reliant on the user e.g. injectables were less likely to be offered to those aged under 16.

Conclusions: Mainstream contraceptive services do relatively well in terms of range of services offered and Best Practice criteria met. If designated young people’s services are to provide a level one standard of care, as outlined by the National Strategy for Sexual Health and HIV, further support will be needed, including effective referral pathways. In general practice, concerns remain about confidentiality and provision of services, particularly for under 16 year olds. These findings have stimulated further opportunities for training and interaction between the Teenage Pregnancy Unit, Royal College of General Practitioners, local commissioners and services providers in primary care.