Contraceptive use among women attending an open access genitourinary medicine department

INTRODUCTION

Abortion rates in the UK are rising, especially among women under 20 as demonstrated by the recently published abortion statistics from the Department of Health. ¹ This increase in terminations of pregnancy is occurring despite an increase in reported condom use at first intercourse. ² Contraception is widely available in many health-care settings, yet many women do not use reliable methods. Women who present for repeat terminations have been shown to rely on condoms and have poor uptake of long-acting reversible contraceptive (LARC) methods. ³ Many women who attend genitourinary (GU) medicine clinics for sexually transmitted infection (STI) screening do so because of unprotected intercourse or condom failure. They are, therefore, at risk for unwanted pregnancy if condoms are their only method of contraception. This study was conducted as part of a service evaluation assessing provision for the wider sexual health needs of women attending for screening and treatment for STIs. A questionnaire was used to assess the use of contraceptive methods among female GU medicine attenders.

METHOD

A prospective questionnaire was offered (during the months of March and April 2008) to consecutive, women attenders of reproductive age who were sexually active (during some of this period a Trust patient satisfaction survey was also being conducted and women were not invited to complete our questionnaire on these days).

The GU medicine clinic has open access sessions daily from Monday to Friday and is situated in the middle of the city. There are also 30 contraceptive clinic sessions per week at other venues in the city providing a full range of contraceptive methods. The questionnaire was self-completed and asked what methods of contraception, if any, they used and where they obtained supplies. They were also asked if they wanted further contraceptive advice and where they would like to get contraception in the future.

Approval for this service evaluation was obtained from the Clinical Effectiveness Unit, Southampton City Primary Care Trust.

RESULTS

One hundred and fifty-two women with a mean age of 26 years completed the questionnaire, which represents 17% of the women seen during the study period. One hundred and thirty-three (87.5%) women reported the use of at least one contraceptive method.

Reliable methods were classified as ‘pills’ including all oral hormonal methods, LARCs (injectables, intrauterine methods and implants) and sterilization. Unreliable contraception included condoms only or no method used. In total, 96 (64%) of women reported using a reliable method of contraception. Of these women, 73 (48%) used a pill, 21 (14%) used a LARC and three women had been sterilized. Forty-three (28%) women were relying on condoms for contraception. In this study, 56 (36%) women were not using any reliable method. Overall, 59 (38%) women asked for further contraceptive advice. Of those using an unreliable method, 28 women or half asked for advice. Only 28% (n = 27) of those using a reliable method asked for further advice (P = 0.15). Twenty-three (15%) women were attending a contraception clinic. Eighty-four (55%) obtained contraception from a general practitioner, the rest bought condoms over the counter or relied on the GU medicine clinic for supplies. Forty-three (78%) of the 56 women using an unreliable method asked for further advice and/or future contraceptive provision in the GU medicine clinic.

DISCUSSION

Among this group of 152 women attending for advice and screening in the GU medicine setting, there was an easily identifiable group who did not have a reliable method of contraception and were at high risk of unwanted pregnancy with its accompanying health and social risks.

Reported use of contraception in this study was comparable to women generally in the UK ² except that 43 (28%) of all the women were relying on condoms. This is higher than the reported rate of 18% in 2007, among the UK general population (P = 0.001). ²

Condom use may have been over-reported due to the patient's perceived expectations of health-care professionals in this GU medicine clinic setting. Although only a small number also attended a contraception clinic, many were willing to ask for further advice and would accept contraceptive provision in the GU medicine setting.

A recent statement from the Independent Advisory Group on Sexual Health and HIV listed among other recommendations that young people particularly value contraceptive services in places where they already attend. ⁴ This has tended to be interpreted as in colleges and clubs. However, it is difficult to provide more than advice, pills and condoms in these settings. It would seem sensible and cost-effective to provide a full range of contraception in the GU medicine setting where women in need of advice and provision already attend.