NICE publishes public health guidance to reduce unwanted pregnancies among young people through improved contraceptive services.

Although under-18 conception rates have fallen, England still has one of the highest teen pregnancy rates in Europe. Improving contraceptive services will help ensure young people get the support they need and reduce unwanted pregnancies.

The National Institute for Health and Care Excellence (NICE) advises commissioners of services in England to give all young people access to contraception and advice at convenient locations so no-one is denied services because of where they live.

Professor Mike Kelly, Director of the Centre for Public Health at NICE said: “It is really important that sexual health services offering information and advice can be found in places where young people have access to them. Evidence clearly shows that the availability of contraception reduces the rate of unwanted pregnancies. Local planners and providers of services must make sure that what they offer is right for their area.”

Professor Kelly added: “Young people often find contraceptive services and advice difficult to locate. This can be for a number of reasons. They may not know where services are, who provides them or when they are open. They can also be wrongly worried that information they give may not be treated confidentially. For that reason, this guidance focuses on ensuring they receive culturally sensitive, confidential, non-judgemental and empathic advice and support tailored to their individual needs.

“Many of the recommendations made in the new guidance from NICE will cost nothing to implement. They look at existing services to ensure everything is being done to give all young people the support and advice they need.”

The new guidance focuses on helping those up to the age of 25. It is aimed at those who have responsibility for contraceptive services. This includesthe NHS, local authorities and those working in education, and the wider public, private, voluntary and community sectors.

Since 1 April 2013, local authorities have had the mandatory responsibility for commissioning and delivering all community and pharmacy contraceptive services, except for services provided by general practitioners. To support local authorities, NICE has also produced a specially tailored Local Government Briefing on contraceptive services. Based on the guidance recommendations, the briefing will help councillors and local authority staff decide which health actions and services are most effective in improving the health of people in their area, while also providing the best value for money.

Recommendations include:

• Providing contraceptive services for young people: Doctors, nurses and pharmacists should provide information about the full range of contraceptives available, including emergency contraception (both oral and intrauterine) and long-acting reversible contraception, and the benefits and side effects.
• Providing contraceptive services after a pregnancy: Midwives should discuss with pregnant women what type of contraception they intend to use after their pregnancy. They should provide information on the full range of options and should advise them (and their partners, if appropriate) on an effective method that best meets their needs. They should also provide information on how and where to obtain it.
• Providing contraceptive services after an abortion: Before - and as soon as possible after - an abortion, discuss contraception and explain the full range of contraceptive methods available. GPs and those working in contraceptive or abortion services should help young women and their partners identify and obtain the most effective method that best meets their needs. They should dispel the myth that there is no need for contraception after an abortion and explain that women are fertile immediately following an abortion.
• Providing school and education-based contraceptive services: Governors, teachers and youth workers in schools, as well as nurses, doctors and counsellors working in contraceptive services should ensure accurate and up-to-date contraceptive advice, information and support is readily available to all young women and men. Information on the location and hours of local services should be available.
• Providing emergency contraception: Suitably qualified nurses and pharmacists should be given the ability, through patient group directions (PGDs)[1] to dispense free oral emergency contraception to young women. Ensure young women (and young men) know where to obtain free emergency contraception.

Young women should be informed that an intrauterine device is a more effective form of emergency contraception than the oral method and can also be used on an ongoing basis. Young women should have timely access to emergency contraception using an intrauterine device.

• Providing condoms in addition to other methods of contraception: Those working in contraceptive services, social care professionals and public health specialists should advise all young people to use condoms consistently and correctly, with a water-based lubricant, as well as other contraception. Condoms should always be provided along with other contraception because they help prevent the transmission of STIs.

Anne Weyman, OBE, Chair of the independent committee that developed the guidance and former Chief Executive of the FPA, said: “Most sexually active young women use at least one method of contraception. The good news is that the number of under-18s becoming pregnant is falling. But we really need to build on this recent progress because England still has one of the highest teen pregnancy rates in Europe.

“Most of the young women who become pregnant while still a teenager do not plan to do so. Nearly half of all pregnancies among 15 - 18 year olds end with an abortion. The new guidance aims to reduce unwanted pregnancies by ensuring that young people have access to a full range of contraceptive methods, not just pills and condoms, but the longer acting methods, such as contraceptive injections and implants. We also need to make sure that young people get good contraceptive advice so that they can choose and use the right method for them.

“As well as the unnecessary heartache for these young women, unwanted pregnancies also have a financial cost, with abortions for young women under 25 costing the NHS approximately £53 million each year. Investing in contraceptive services is a good use of money. Not only could modest investment have health benefits for young people, it could also potentially result in reduced financial cost in the longer term.”

Penny Barber, guidance developer and Area Director Midlands, Brook said: “Young men and women find it very distressing to face the possibility of an unplanned pregnancy and want to make sure they use the best contraception.

“Local planners and providers of services must make sure that the contraceptive services they offer are appropriate for their area. It is really important that services that offer information and advice can be found in the most convenient places for young people; this may be at college, through drop in clinics or their GP.

“This new guidance aims to ensure that young men and women have easy access to a real choice of the full range of contraceptive methods and support in using them.”

Dr Pauline McGough, guidance developer and Consultant in Sexual and Reproductive Health at Sandyford, NHS Greater Glasgow & Clyde said: “This guidance aims to make sure that young people get good contraceptive advice so that they can choose and use the right method for them. Emergency contraception is only one method in a range of effective contraception methods. It is more effective the sooner you use it after sex, so it is crucial young women are able to get hold of it in case they need it. When a young person asks for emergency contraception, we also have an opportunity to talk to them about broader sexual health issues. We should also discuss the methods they are using and if a different approach may work better for them.”

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

About the new guidance

1. The new guidance, ‘Contraceptive services with a focus on young people up to the age of 25' will be available on the NICE website from http://guidance.nice.org.uk/PH51. Embargoed copies of the guidance are available from the NICE press office on request.

2. The Local Government Public Health Briefing, ‘Contraceptive Services', is available at:http://www.nice.org.uk/localgovernment.

3. The guidance was due to be published in November 2010. However it was put on hold pending a Government review of NICE's public health work and while the Department of Health finalised its sexual health framework.

The recommendations have not changed, only factual amendments have been made, for example, where names of organisations have been changed.

4. Contraceptive services refer to the whole range of contraceptive, sexual and reproductive health services. This includes services: in primary care; offered by community and pharmacy outlets (commissioned by local authorities from the NHS, the private or voluntary sectors); commissioned by clinical commissioning groups (for example, termination of pregnancy [abortion] services); commissioned by the NHS Commissioning Board (for example, contraceptive services provided within other specialist services, such as maternity services).

5. Although the under 18 conception rate for 2012 is the lowest since 1969, there were still 27,834 conceptions to women aged under 18. Nearly half (49%) of all conceptions to women aged under 18 in 2012 led to an abortion (ONS, 2014).

Younger age groups continue to account for a very small proportion of teenage conceptions. The number of conceptions to girls aged under 16 decreased by 9.3% from 5,991 in 2011 to 5,432 in 2012. (ONS, 2014 -http://www.ons.gov.uk/ons/rel/vsob1/conception-statistics--england-and-wales/2012/2012-conceptions-statistical-bulletin.html?format=print).

6. Under-18 conceptions are now at the lowest level since records began in 1969. The rate of 27.7/1000 15-17 year olds has dropped from 46.6 in 1998 - a reduction of 40.6% since 1998.

7. There is a six-fold difference in teenage conception and birth rates between the poorest areas in England and the most affluent.

8. From 1 April 2013, local authorities have a mandatory responsibility for commissioning and delivering all community and pharmacy contraceptive services (apart from services provided by general practitioners). Clinical Commissioning Groups are responsible for commissioning termination of pregnancy services (abortions) and a fully integrated range of contraception, STI testing and treatment services. They are also responsible for commissioning vasectomy and female sterilisation services.

About NICE

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