NICE guidance on young people and access to contraceptive services

Today, NICE released evidence-based guidance entitled ‘Contraceptive services with a focus on young people up to the age of 25’, which calls for improved access to contraception for young people. 

The guidance sets out various actions which it suggests will improve young people’s access to contraception, and thus decrease unplanned pregnancies amongst under 25s. As you may know, the teenage pregnancy rate in England and Wales is currently the lowest it’s been since 1969, but still remains one of the highest in Western Europe.

The guidance provides practical suggestions for improving young people’s access to sexual health services such as ensuring that services are:

• Accessible (have flexible opening hours and accessible materials for those with learning difficulties, or for whom English is a second language)

• Comprehensive (give information on the full range of contraceptive options, including the insertion of an IUD as a method of emergency contraception)

• Practical (youth-focused services based in schools and colleges, where young people can access them easily)

• Non-judgemental (staff should be trained and supported to offer impartial information)

We were glad to see that NICE specifically mentions the importance of access to contraception following pregnancy, encouraging professionals to "dispel the myth that there is no need for contraception after an abortion and explain that women are fertile immediately following an abortion." We have long been concerned that the myth that abortion causes infertility, often touted by anti-abortion groups which visit schools, may have an impact on a young woman’s access to contraception following an abortion.

The media reaction to the guidance has been interesting, with some outlets focusing on NICE’s suggestion that emergency hormonal contraception (EHC) be available in advance of sexual activity (rather than just obtained following unprotected intercourse).

The guidance states that "the evidence shows that advance provision of oral emergency contraception does not encourage risky sexual behaviour among young people. Evidence also shows that women who have emergency contraception in advance are more likely to use it, and to use it sooner after unprotected sex. Having emergency contraception on hand does not affect the use of other kinds of contraception."

Certainly, we have heard anecdotally of young women’s difficulty in obtaining the morning after pill. Some pharmacists refuse to give EHC to younger women, or attempt to charge them (at around £20 this can be too much for many teenagers). Some young people living in rural areas might struggle to get hold of EHC, especially in the first 24 hours after unprotected sex, when it is most effective. It makes sense to improve access to EHC for those who need it, to ensure it can be taken when needed, as quickly as possible.

However, some newspapers seem to think that there is a danger young women will ‘stockpile’ EHC. The Telegraph opens with:

“Teenage girls will be able to stock up on the morning-after pill under new NHS guidance which will allow young women to pre-order the drugs, despite Government fears the move will increase promiscuity.”

An interesting concept. These young women, who are seen as too feckless to access contraception before having sex, are organised enough to plan to ‘stockpile’ EHC in advance of having sex. Which is it to be, lazy and incompetent or cunning and prepared?! EHC is a form of contraception, which young people already have free access to. NICE is simply stating that it might be helpful for some young women (particularly those who live in rural areas, perhaps without their own transport) to be able to access EHC in advance, in case they ever need it.

We’re glad to see such sensible, evidence-based guidance being issued, we only wish the media could resist scare-mongering around young people and contraception, and that access to sexual and reproductive health could be rid of such stigma.