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.