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Widen teenage access to the pill urges NICE guidance

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Teenage girls should be given greater access to the morning-after pill in schools and GP surgeries alongside free condoms, according to new guidance.

The National Institute for Health and Care Excellence (NICE) said under-25s −including those under the age of consent − should be able to access emergency contraception more readily, including pills and the IUD (intrauterine device, or coil).

Free condoms, including female condoms, should also be “readily accessible” for young men and women at places such as “schools, colleges and youth clubs”.

The new guidance is aimed at cutting the high numbers of unwanted teenage pregnancies across England.

Under the plans, NICE said suitably qualified nurses (including school nurses) and pharmacists should be given the ability to dispense free emergency contraceptive pills in accordance with patient group directions (PGDs).

Wider teenage access to pill urged

PGDs allow health workers to supply a medicine directly to a patient without the need for a prescription.

There are two types of emergency contraceptive pill. Levonelle has to be taken within 72 hours (three days) of sex, and ellaOne has to be taken within 120 hours (five days) of sex.

Meanwhile, an IUD can be inserted up to five days after unprotected sex.

NICE also renewed its 2010 call for young people to be given emergency contraception to keep at home in case they need it. And it said young women must be told of places they can obtain free, confidential pregnancy tests with same-day results.

Young women should also be “encouraged to consider and choose a suitable form of contraception for their future needs”, the guidance said.

Regarding under-16s, NICE said health professionals providing emergency contraception must be aware that they can give it to under-16s “without parental knowledge or consent, in accordance with best practice guidance”.

It added: “Health professionals, including pharmacists, who are unwilling (or unable) to provide emergency contraception should give young women details of other local services where they can be seen urgently.”

NICE said young people should be given access to contraception and advice at convenient locations so nobody is denied services because of where they live.

“Evidence clearly shows that the availability of contraception reduces the rate of unwanted pregnancies”

Mike Kelly

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.”

He 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-judgmental and empathic advice and support tailored to their individual needs.”

The guidance also said condoms should always be provided in addition to other forms of contraception to cut the rate of sexually transmitted infections.

“Most of the young women who become pregnant while still a teenager do not plan to do so”

Anne Weyman

Anne Weyman, chair of the independent committee that developed the guidance and former chief executive of the Family Planning Association, 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 to 18-year-olds end with an abortion,” Ms Weyman said.

She added: “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 £53m each year,” she said. “Investing in contraceptive services is a good use of money.”

Office for National Statistics figures released in February showed that the UK under-18 conception rate remains the lowest since 1969 at 27.9 per 1,000 women aged 15 to 17.

The number of pregnancies in those under 18 fell to 27,834 in 2012 compared with 31,051 in 2011 - a 10% drop.

Some 5,432 under-16s fell pregnant in 2012, compared with 5,991 in 2011 (a fall of 9.3%).

Among under-16s, some 3,251 pregnancies resulted in abortion - 59.8% of the total. This is down on 60.2% the previous year and 62.5% the year before that.

The figures also revealed that 253 girls under 14 fell pregnant in 2012, fewer than the previous year, with almost three-quarters having an abortion.

  • The guidance – Contraceptive services with a focus on young people up to the age of 25 – is available on the NICE website
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