Periabortal contraceptive practices among teenagers

Periabortal contraceptive practices among teenagers

A.O. Bale

The Royal Oldham Hospital, Obstetrics/Gynaecology, Oldham, North West,


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.


  1. To determine the prevalence of contraceptive

    usage among teenagers before pregnancy.

  2. 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


Scroll to Top