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.
