Periabortal contraceptive practices among teenagers
A.O. Bale
The Royal Oldham Hospital, Obstetrics/Gynaecology, Oldham, North West, UK
Introduction Despite gradual improvement, the United Kingdom teenage pregnancy rate continues to be the highest in Western Europe. The conception rate in the under 18-age group in England and Wales in 2003 was 42.3%, although when compared to the 1998 figures, there was a 10.3% reduction in rate. The Social Exclusion Unit report on Teenage Pregnancy (June 1999) set a target of halving the rate of conception amongst under 18 year olds in England by 2010. The under-18 rate is the most important one for the Teenage Pregnancy Strategy, which has targets to reduce this rate from its 1998 levels by 15% in 2004 and by 50% in 2010. It also has a target of achieving a well-established downward trend in the under-16 rate by 2010. One of the means of achieving these goals is by improving contraceptive uptake among teenagers. The periabortal period provides the opportunity to counsel these youths on contraception and to offer them an effective method.
Objectives
To determine the prevalence of contraceptive usage among teenagers before pregnancy.
To show an increase in contraceptive uptake following periabortal contraceptive counselling.
Method A retrospective analysis of teenage patients (under 20 year olds) attending a Fertility Awareness Clinic for TOP from November 2000 to November 2004. Data was extracted from a Microsoft Access TOP database and analysis was done using the Microsoft Excel spreadsheet programme.
Results A total of 433 teenage patients attended the clinic, during the study period, requesting TOP. Only 375 (86.6%) of these eventually had TOP. The mean age at presentation was 17.3 ±1.2 years (Range 13-19 years). The majority of patients were Caucasians (84.5%), single (98.4%) and nulliparous (90.8%). About 9.0 % had undergone a previous TOP. The mean gestational age at presentation was 7 ± 1.7 weeks (Range 4-22 weeks). Forty-eight women (11.1%) presented with gestations greater than 9 weeks. The major indications for terminaton request were: unplanned pregnancy, inability to cope, poor finances and relationship breakdown in 62.4%, 17.3%, 6.9% and 5.6% respectively. Only 51.7% of the women used some form of contraception before getting pregnant. Majority were on short term user-dependent methods of contraception such as the male condom (63.8%) and COC (31.3%). Majority of the patients (84.0%) had a surgical induced abortion while a medical method was used in 16.0%. Following counselling 96.5% of the women accepted post-abortal contraception. The most common methods were Implanon, COC, DMPA, and the IUCD in 60.0%, 17.0%, 11.6%, and 11.4% of cases respectively. Only 150 (40.0%) patients attended the TOP clinic for follow up and 1.3% of these were managed for post-abortal sepsis.
Conclusion Periabortal contraceptive counselling has been shown to increase contraceptive uptake among teenagers. This 'opportunistic' strategy is particularly important in teenagers, as they are: less likely to seek contraception on their own because they often feel apprehensive and stigmatised, lack knowledge about the proper usage and availability of contraceptives, and, when pregnant, are prone to present at advanced gestation for TOP. Longer-term reversible methods of contraception are particularly suitable for this vulnerable age group. An example of such a method is Implanon and this had a high uptake post-abortion in this study. This strategy may help in meeting the 2010 target of the Social Exclusion Unit for Teenage Pregnancy in England.