Contraception &

Womens Health

Learning Outcomes
1.

Describe the sexual behaviour and contraceptive use,

including condom use, among adolescents and young
adults.

2.

To be aware of the legal issues concerning the

provision of contraception to adolescents.

3.

Outline the efficacy, benefits and disadvantages of the

various contraceptive methods.

4.

Describe the issues surrounding the use of emergency

contraception. Is it effective in reducing unintended
pregnancy rates or sexually transmitted disease
rates?

5.

Describe the issues surrounding adolescent

Contraception for Adolescents

The mother of a 15 year old patient is repeatedly

ringing the medical practice and demanding to
know whether her daughter has consulted a GP
at the practice, and the reasons why, wanting to
speak directly with the GP. The mother suspects
that the GP has prescribed the oral contraceptive
pill for her daughter. The GP receives a letter
from the mother requesting a copy of the
daughters medical records.

Two weeks earlier

Sarah, 15 years old, attends her family GP
requesting contraception. She has no significant
past history or family history and has yet to
become sexually active. She has come with a
girlfriend from school and has asked the GP not
to tell her mother about the appointment.

On further questioning Sarah says she has been with her

current boyfriend for 2 months and knew they were going
to have sex soon so she wanted to do the right thing and
make sure she was protected. While she was aware of
the need to use condoms from the sex education classes
she had at school she also wanted to get the pill just to be
sure she didnt fall pregnant.

She begs the GP not to tell her parents as they are very
religious and she is scared about what they would do if
they knew she was going to have sex.

After further discussion, the GP feels Sarah is a responsible

girl who is well aware of the potential repercussions of
unprotected sex.

After taking Sarahs blood pressure she prescribes Sarah a

low-dose combined oral contraceptive and explains how to
use it correctly and when she will be safe from a
contraceptive point of view. Sarah is given a follow up
appointment for 2 weeks. She is also given information on
safe sex, emergency contraception and contraception in
young people.

Are there any legal issues prescribing to

consider when prescribing the pill to
adolescents?

Do most young women see their doctor

BEFORE commencing sexual activity?

Mature Minor OR
Gillick Competent

Discuss
What criteria is applied to assess the
adolescent?
Does it just apply to the prescribing of
contraception?

Contraceptive Methods

List the different contraceptive methods and

rank them in order of efficacy

Continued use of the

combined oral
contraceptive pill
rather than long-acting
reversible
contraception [LARCs],
suggests an ongoing
need for emergency
contraception as a
result of poor
adherence to shorter
acting methods

Why is the uptake of LARCs so low in

Australia?

Only 15.4% of contraception

consultations with GPS were
related to LARC methods used by just 6.5% of women
using contraception in
Australia

Lag in accurate knowledge

among providers

Insufficient training in LARC

insertion

Women have little awareness

of the benefits

Misperceptions about IUC

methods focus on the risks of
infection and infertility based
on the memory of older
devices

Lets talk Double-Dutch

Protection from both pregnancy and sexually

transmissible infections (STIs).

 Emergency Contraception

Sixteen year old Amanda presents to see if she

could get the morning after pill which her
girlfriend had told her about. She didnt know
exactly what it was and if she could still take it
because it was now the afternoon and not the
morning after and anyway she has had
unprotected sex more than once in the last
couple of days.

This was Amandas second sexual partner after having

become sexually active 6 months earlier. She has been
with this partner for 3 months. After they had had sex
several times and she knew they were together she
decided to start the pill. This problem has arisen because
she forgot to take two tablets in the second month of
taking the pill. She had tried to mention condoms to him a
couple of times but he had only mumbled something back
about the fact he hated wearing them. She didnt press
him further because I was scared hed leave me for
someone else; he only has to click his fingers and girls
come running.

Unintended Pregnancies in Australia

~ 80 000 pregnancy terminations each year in Australia

Half of unintended pregnancies are attributable to failure

of contraceptive methods

Teenage pregnancy rates sitting at 16.1 babies/1000

women[2012]

Australias rates are high compared with other countries

Unintended Pregnancies
What are the barriers to reducing rates?

Unintended Pregnancies
What are the barriers to reducing rates?
Lack
of
confid
ential
sexual
health
advice

Lack of
universal
access to
contraception
bulk
billing
is
unava
ilable

family
planni
ng
servic
es
hundr
eds of
kms
away

concer
ns
about
confid
entialit
y,
privac
y and
judgm
ental
attitud
es

limite
d
numb
ers of
GPs &
long
waitin
g
times
for
appoin
tment

newer
contrac
eptives
are not
subsidi
sed by
the PBS

Unintended Pregnancies
What can we do?
emerg
Subsid
ised
access
to
newer
contra
ceptiv
e
metho
ds

Teleph
one,
ehealth
& web
based
faciliti
es for
sexual
health
consul

ECP
options
subsidis
ed or
free for
women
who are
socioeco
nomicall
y
disadvan
taged

ency
contra
ceptio
n to be
availab
le offtheshelf
(rather
than
overthecounte
r)

assista
nce
with
pregna
ncy
termina
tion

public
information
campaign
should
training address the
health misconcepti
ons
nurses

&
practice
nurses
to
provide
contrac
eptive
informat
ion and
insert
long
acting
method
s

increase
d uptake
of LARC
methods

Emergency Contraception

The potential for

emergency contraception
(EC) to reduce the rate of
unwanted pregnancies is
still unrealised

The emergency
contraceptive pill (ECP)
has been available over
the counter (OTC) to
Australian women from
pharmacies for almost a
decade. Yet the rate of
unplanned pregnancy
remains high

Nearly half of all

Australian women of
reproductive age have
experienced an
Should
unplanned pregnancy
- emergency contraception be provided in advance?