Sexclamation! - Post number five
One more day to go until I get my results. I am keeping busy and trying not to keep looking at my phone. They did say within five days, so I guess they could come early. If you are all reading this, we are waiting for a certain text message! That's a lot of people waiting!
Today I thought I would write a piece about teenagers and sexual health in the UK. It is actually a tale of positive outcomes. 10 years ago we had the distinction of the having the highest teenage pregnancy rate in Europe. Completely shocking. Especially for a country where contraception has been available completely free of charge since 1977.
So why were we in such a predicament? The answer is complex.
Some people may think what's so wrong with teenage pregnancy anyway? Sadly there is data to support the fact that teenage pregnancy has a very negative outcome for young people. It is associated with an increased chance of not completing their education, lower educational attainment, reduced earning capacity, as well as an increased chance of alcohol and substance abuse. The pregnancies themselves are higher risk, with increased chances of medical complications for teenage mothers, such as premature labour. The children born to teenage mothers tend to have worse physical and emotional health than those born to older mothers.
The first contraceptive pill went to market in April 1962. It has always amazed me, that the pill and I have the same birthday! I had no idea I would grow up to be a contraceptive specialist and the pill would be my specialist subject!
Now the arrival of the pill, in 1962, had huge socio-political impact. Prior to this, all that was available was a condom, or a diaphragm. These were relatively poor choices, with low user satisfaction and consequently women often had numerous pregnancies, perhaps 10 or 12 children each! Women were always pregnant or breastfeeding. With expanding families and so many young children to care for, women could not complete their education, follow career pathways and become financially independent. So the pill gave women an opportunity to control their fertility and make choices. The Pill changed women's lives forever.
What an amazing discovery! - And over the next 50 years followed a range of new and different contraceptive choices (see Blog Post 4).
So, why, if all these methods had been freely available for more than 30 years, were young women not using them - or not using them reliably?
There are a huge number of answers to this question. To obtain contraception the young person has to get to a clinic. She may wish to do this without the knowledge of her parents, as is her right, but to do this requires a good excuse to be out of the house, and transport she can afford, plus availability of appointments that she can attend, let's say after school. She then needs appropriately qualified staff, to listen and provide safe clinical care. She needs the contraceptive of her choice to be available there and then, not a 3-6 month waiting list for an implant - by which time she will surely be pregnant. She also may need such things as a translator, help if she has special needs, and possible guidance and support as required around any safeguarding issues. She may need STI testing and treatment (see blog Post 2).
For all this to happen requires funding. Funding for a robust sexual health provision from both GP surgeries and specialist contraception & sexual health clinics. Prior to 2010, provision was insubstantial, fragmented and the quality and consistency was not great.
After the 2010 Teenage Pregnancy Strategy, there was an income boost to ensure that all these measures were in place for young people. Other resources included programs to make emergency contraception (the morning after pill) more readily available, for example enabling pharmacists and practice nurses to be able to prescribe it, without the young person having to see a doctor. More resources were put into sex education in schools. The NICE LARC guidelines (see blog Post 4) meant the government could no longer protest that LARC methods were expensive, and funding was ring fenced to get these excellent method to the young people who needed them. There was an emphasis on joined up working, to ensure young people's needs were being met, and they were being followed up appropriately.
So what was the result? Eureka! A huge concerted national effort over the past 10 years, has led to a very welcome 55% drop in <18 conceptions! We now have the lowest under 18 conception rate since records began in 1969!
Yes, it's an amazing turn of events that I am proud to have been part of. Unplanned pregnancies can cause severe emotional trauma and whatever the decision that young person makes, the experience will be with them forever. Surely, so much better to have prevented that unplanned pregnancy in the first place.
Now, we have an integrated approach to sexual healthcare in the UK, such that any patient should come to the clinic and be offered both contraceptive care and STI screening, all at the same appointment. This has increased the length of the appointments, but it has also meant the patients' sexual health needs are all met at one visit. Generally, if you ask patients to come back to have a chlamydia test next week because you are pushed for time, they won't come back, and the opportunity for screening is lost. So much better to have the time to do it all in one go.
This a story of a real campaign to change health statistics around, that has actually been very successful! What a triumph! Let's hope these improvements can be maintained.
So - it's day five tomorrow. Surely my wait - and yours - will be over! Let's see what happens tomorrow!
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