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Effective Contraception for Teenagers

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Effective Contraception for Teenagers

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    1. Effective Contraception for Teenagers Dr Louise Cook Associate Specialist Sexual and Reproductive Health

    4. Pill scares Women stopped taking the pill Prior to 1996 abortions had been falling By 1999, BPAS reported 9% rise in abortions in 1996 11% increase for 13-15 yr olds

    5. Contraception: the Facts

    8. What is a LARC?

    9. ‘Fit and forget methods’

    12. Accidental Pregnancy in 1st Year of Use

    13. Accidental Pregnancy in 1st Year of Use

    14. Accidental Pregnancy in 1st Year of Use

    15. 75% women aged 16-49yrs in UK currently use at least one method of contraception

    16. Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)

    17. Gwent unplanned pregnancy service: 100 consecutive abortions (all ages)

    18. Gwent unplanned pregnancy service: 100 consecutive abortions (all ages) 6/12 x80 TOPs in under 18s, 80% left with LARC6/12 x80 TOPs in under 18s, 80% left with LARC

    19. NICE: LARC Guidelines 2005 Offer information and choice of ALL methods LARC more cost effective at 1 year than pills Implant most effective LARC Increase LARC uptake to 20% Significant cost saving - pregnancies avoided Ł11,000 saving for every Ł1,000 spent on contraception* What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods...................What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods...................

    20. Teenagers

    21. Teenagers: the facts Age at first sex Lack skills to negotiate safe sex Sex is often unplanned Alcohol / drugs 50% pregnancies end in abortion Contraception Susceptible to negative comments Chaotic lifestyles Attitudes and beliefs - ‘It won’t happen to me?’ Fertile By 15yrs age, 41% girls and 30% boys are sexually activeš (HBSC 2006) Approx 50% didn’t use contraception 1st time they had sex Teenage conception rate 2008 (per 1000 females aged 15-17) 44.3 Ceredigion (27.2), Merthyr Tydfil (73.3) Conceptions end in abortion 50% of under 18 62% of under 16s Twice as likely to become pregnant while using pills than are women aged 30yrsBy 15yrs age, 41% girls and 30% boys are sexually activeš (HBSC 2006) Approx 50% didn’t use contraception 1st time they had sex Teenage conception rate 2008 (per 1000 females aged 15-17) 44.3 Ceredigion (27.2), Merthyr Tydfil (73.3) Conceptions end in abortion 50% of under 18 62% of under 16s Twice as likely to become pregnant while using pills than are women aged 30yrs

    22. Likelihood of fertility and contraceptive use by age

    23. Likelihood of fertility and contraceptive use by age

    24. Likelihood of fertility and contraceptive use by age

    25. Teenagers and ‘coils’ Offer full range of methods to all No restriction on basis of: Age alone Never been pregnancy Very effective contraception for 5/10yrs Cu IUD most effective form of emergency contraception IUS improves heavy periods Offer local anaesthetic But… Involves internal examination and procedure

    26. What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods................... What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods...................

    27. Tackling teenage pregnancy Implant Most effective method Lasts 3 years Very low dose hormone Usually well tolerated Immediately reversible Few medical reasons to avoid it Side effects (bleeding) usually easily managed Doesn’t involve internal examination

    28. Access to Contraception

    29. Women’s use of contraceptive services* In Wales 8% of female population aged between 13 and 44 attend CCC with 16% of 16-19 yr olds and 4% of women 35-44yrs of age.In Wales 8% of female population aged between 13 and 44 attend CCC with 16% of 16-19 yr olds and 4% of women 35-44yrs of age.

    30. Primary Care Wales 2009-10: contraceptive prescription items1 85% of items were for pills Gwent: pills account for 70% of both contraceptive budget and activity Pregnant teenagers in UK2: 91% had seen their GP in preceding year 71.3% specifically for contraceptive advice

    31. Primary Care Positive messages re LARC LARC - no restriction on age/nulliparity Provide information on all methods typical failure rates teen pregnancy/abortion rates Facilitate access to implants Promote continuation of method Proactive in managing side effects Quality Outcomes Framework

    32. Community Contraception Service Gwent Implant Activity 2001-10

    33. Wolverhampton: Impact of LARC on Teenage Conception Rate What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods................... What I didn't say was that there is an enhanced cost effectiveness of LARCs for young people - the low hanging fruit if you like - that if you can encourage a 16 year old who is currently having unprotected sex to use an implant from the word go it is 'cheaper'. I mean this as opposed to encouraging current "good" pill takers to switch from pill to LARC where the number of pregnancies averted will be quite small. I did a cost effectiveness analysis to support the Ł60,000 that i spent on my social marketing intervention. We worked out that we would only need to get 45 current "non contraceptors" to use an implant to save the cost of the campaign compared with getting 290 current pill users to switch methods...................

    34. The future… Normalise use of LARC Global approach Positive messages with realistic expectations Dispel myths Primary care clinicians need to be proactive Facilitating access to LARC Manage side effects Encouraging continued use Education and training - nurses

    35. But… …don’t forget the condoms!

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