VOL: 97, ISSUE: 05, PAGE NO: 40
Alison Kilcoin, RN, is senior sister, family planning services, South Essex Mental Health and Community Care NHS Trust
Chris Clark, BSc, RGN, is lead nurse, adolescent health;Karen Payne, BSc, RGN, RM, is clinical nurse manager, family planning services; South Essex Mental Health and Community Care NHS TrustThe Social Exclusion Unit has set itself the target of halving Britain's teenage pregnancy rate by 2010. But improving access to emergency contraception by making levonorgestrel 0.75mg (Levonelle-2) available over the counter in pharmacies is not likely to have a direct impact on this rate.
The Social Exclusion Unit has set itself the target of halving Britain's teenage pregnancy rate by 2010. But improving access to emergency contraception by making levonorgestrel 0.75mg (Levonelle-2) available over the counter in pharmacies is not likely to have a direct impact on this rate.
However, any move that highlights contraceptive issues usually attracts the attention of teenagers and could improve awareness. Over-the-counter emergency contraception is not likely to result in droves of teenagers descending on pharmacies, but publicity may encourage them to seek contraception from their GP or family planning clinic. Open discussion of such issues increases the correct use of contraception, as the Dutch experience shows (Day and Lane, 1999).
Teenagers need to be made aware of a number of issues regarding the availability of emergency contraception from pharmacies. The most relevant is cost. At £20 a treatment it may be prohibitively expensive for younger people. Emergency contraception will still be available free of charge from traditional sources, but this crucial point seems to have been omitted from much of the publicity surrounding pharmacy supply.
Then there is the lower age limit of 16. Pharmacists will have to refer younger girls in need of emergency contraception back to their GP or family planning clinic. This will inevitably lead to delays in obtaining emergency contraception, which needs to be taken as soon as possible after unprotected sex to be most effective.
Pharmacists' training and preparation should enable them to offer a private 10-minute consultation with the patient. But how many pharmacists will have the time to spare on a busy Saturday afternoon or during restricted Sunday opening hours when, with GP surgeries and family planning clinics closed, the demand for emergency contraception is likely to be highest?
How many young women will be willing to walk into the local pharmacy and ask for emergency contraception in front of a queue of people, which could include a neighbour or family friend? Many women prefer the privacy of family planning clinics.
Any sexual health consultation requires a degree of skilled counselling. Are pharmacists prepared to ask intimate details about their clients' sex lives, particularly previous incidences of unprotected sexual intercourse, or discuss the possibility of sexually transmitted infections? Will pharmacists be willing to do a pregnancy test before supplying levonorgestrel when a woman presents late in her cycle? In which case, who pays for it?
Traditionally, when emergency contraception fails the patient will return to the prescriber for a follow-up appointment. Inevitably, GPs and family planning clinics will see patients asking for pregnancy tests after taking levonorgestrel purchased from pharmacies. They may have difficulties in obtaining an accurate history of contraceptive use and women may need to be encouraged to keep a record of each event of unprotected sex and emergency contraception to aid assessment in early pregnancy.
This may seem a simple task, but anyone who has worked in the field of sexual health knows how difficult it is for many women to remember the date of their last menstrual period.
Over-the-counter emergency contraception is therefore not the only answer to unwanted teenage pregnancies and risky sexual practices. All professionals - health, education and social services - should recognise that collaborative innovative practices must be found to deal with these issues. Professionals need to be sensitive to young peoples' needs while empowering them to make informed choices about their health and lifestyle. Projects in progress around the country aim to achieve this, but reports of good practice do not make headlines in the mainstream press.
We need a more pragmatic approach to young people, ensuring that they receive quality education on sex and relationships, with an emphasis on life skills. Parents also need to be supported in informing their children about the issues involved in sex and relationships. To reduce the teenage pregnancy rate we need a cultural shift to enable open discussion of teenage sexuality.