Ways to avoid pregnancy besides the keep your legs closed never fail method

Not Just

Pills and Condoms

By Anne Weyman

July 2nd, 2009

GUARDIAN.CO.UK

The vast majority of women

in the UK spend more than 30

years of their lives trying to

avoid becoming pregnant.

Contraception has been available

free from the NHS since 1974 and

today there is a choice of

15 methods,

so it would seem that avoiding

pregnancy should be

straightforward.

Yet the evidence

demonstrates otherwise,

with about one in five

conceptions ending in abortion.

An understandable preoccupation

with the UK’s high levels of

teenage pregnancy has had the

unfortunate consequence of

diverting attention from the

importance of contraceptive

services for women throughout

their reproductive years.

Yet women in their 20s have

the highest abortion rates

and perimenopausal women are

among those who are most likely

to choose an abortion if

they become pregnant.

Public health campaigns at

national and local level have

inadvertently given the message

that condoms and emergency

hormonal contraception alongside

the pill are the main answers:

EHC and the pill to prevent

pregnancy,

condoms to prevent the spread

of sexually transmitted infections

and to prevent pregnancy.

The information provided has often

been simplistic and inadequate.

EHC is a valuable fallback when

continuing contraception has not

been used or has failed,

but it is much less effective than

other methods of contraception.

Similarly, the increase in STIs

has led to an emphasis on the

use of condoms to the exclusion

of other much more effective

contraceptive methods.

The lack of comprehensive

national awareness-raising

campaigns about contraception

is compounded by the fragmented

nature of the services that

women are offered.

Very few primary care trusts

have undertaken a review of

their services or made any

assessment of hidden needs.

The majority of women obtain their

contraception from their doctor,

and GPs mostly prescribe

the combined pill,

which again is not the most

effective method.

In 2005,

guidance from the National

Institute for Clinical Excellence

recommended that long-acting

reversible contraception –

the implant, injection and

inter-uterine methods, (LARC) –

were more cost-effective,

and since then LARC use has

increased slowly.

However,

provision is still patchy,

and many women are being

denied these very effective

methods.

Sadly,

there is a complete lack of

research evidence about women’s

contraceptive preferences and

many women are unable to exercise

an informed choice because they

do not know what is available

and where.

From 2001 women have been

able to buy EHC in community

pharmacies,

and today they are the main

source of this method.

This provision has greatly

increased access but it is not

known whether women actually

prefer to pay £25, or whether

difficulty in accessing free NHS

provision is forcing them to do so.

Last year the government announced

three years’ funding for PCTs to

improve services.

Unfortunately, the additional

funding to trusts is not ring-fenced

and at the end of the first year,

little progress had been seen

at local level.

While most of the money is

to be spent by PCTs,

there will be a national campaign

aimed at young people to raise

awareness of LARC.

Alas,

the vital needs of the majority

of women are again being ignored,

which is not only bad for them

but very shortsighted.

Young people get much of their

information from their mothers,

sisters, aunts and friends.

If older women are

ignored by the campaign,

enduring myths about contraception

may prove more powerful than

the national campaign’s messages.

Another significant change is that,

since April this year,

doctors receive payment for telling

women seeking advice about

contraception about

all the methods.

Some are already seeing an

increased take-up of LARC.

This is a complex area and women

need comprehensive and sophisticated information so that they can make

the right choice for them,

taking into account the pros and

cons of different methods of

contraception,

their relative effectiveness and

how best to reduce the risk of

pregnancy and of contracting

an STI.

Strategic health authorities and

PCTs must recognise that

contraception is central to public

health and wellbeing, and give

it priority.

The government needs to put

in place a national workforce plan

to ensure that the professionals

are in place to provide the service

when and where it is needed.

Women in 2009

should expect no less.

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