Young people and 'repeat abortion'

Thanks to a small grant from the European Society of Contraception and Reproductive Health we have been able to undertake a project looking into repeat unplanned conceptions amongst young people in London. This blog gives an overview of what we found out from our workshops with young people in Croydon.

Readers of this blog will probably already know that a third of women in Britain experience abortion. What you might not know is that over a third (37%) of those accessing abortion have already had one or more terminations. Recent statistics for England and Wales show that in 2013 27% of abortions to women aged 25 and under were ‘repeat abortions’. In Croydon, 50% of abortions (for all ages) were ‘repeat’ procedures.

The Telegraph claims the statistics show that women are having ‘lifestyle abortions’ and ‘using abortion as a contraceptive’. But what’s the real story? Why do some people have more than one abortion? Is it a problem? If so, when and why? We produced this document, Frequently Asked Questions about Repeat Abortion, to try to answer some of these questions and to offer recommendations for professionals supporting young people to prevent unwanted pregnancies. It’s free to download so please do have a read, and pass on to your colleagues. 

There are of course a number of factors which might contribute to someone experiencing one or more unplanned pregnancies – including failure rates of contraceptive methods. For example, the pill and the condom, the two most popular methods of contraception, come with actual-use failure rates of 8% and 15% respectively. In order to get young people’s input with the project we carried out workshops and focus groups in Croydon.  We talked about the fact that pills and condoms are the most common forms of contraception for young people and discussed some of the problems they might have in using these methods effectively:

“Pills - sometimes you don’t remember to take them. You have to take it at a certain time...so if you don’t actually remember to take it, you’re kind of unprotected.”

“As a female, you might not know how to put on a condom for instance, yeah I know it sounds really silly but let’s say you get to do the deed, you might not actually know how to put on a condom and stuff, and you kind of feel a bit stupid asking.”

“A lot of my friends didn’t (carry condoms) when we were younger, because no one wanted to be called a slag...you’ve been out with your boyfriend and you pull out a condom, he’s gonna think ‘Oi, you’re ready!’ Nah, he might not be thinking that, but in your mind you could possibly think it. 

He’s probably thinking, ‘Ah, I’m well up for this!’ But like it would be a bit embarrassing.”

Many of the young people formed opinions about contraceptive methods based on the experiences of their friends, often expressing an objection to LARC methods, seeing them as ‘invasive’:

“My friend’s got it (the implant) yeah, and I went with her and it’s horrible. It’s like this massive thing yeah, and to get it out she has to have an operation, she cuts it open, urgh, it’s horrible. Like, you can feel it.”

“I know it sounds silly, and you’re probably gonna laugh but it reminds me of something out of a movie, like an alien movie, you know like when they put things under your skin! The fact that you can feel it, in your day to day life, just, I don’t like that thought.”

“I went to the clinic with my friend, she got that (IUD) and the curtain was there - she was on that side and I was on this side, and I could hear her like ‘owwwww’!”

“And you have to be on your period to have it done don’t you, that’s what they said to my friend.  And I was like, dignity?! Come on!”

The young people (who were 16+) said that their school education had lacked details on the full range of contraceptive methods:

“Whenever you had any lessons at school it was always about condoms or the pill, it was never anything else about any other contraceptions.”

“When you’re at school, there’s not enough. All you hear about is the pill, not the implant or the injection, I never heard of that until a couple of years ago and I was like ‘what’s that?’. But then you are put off as well, by other people’s stories – of when they’ve put it in and you’re like, ‘Oh god, that doesn’t sound very nice’.”

These young people made various suggestions for improving knowledge about reproductive health and the range of contraceptive methods available:

“Make it less scary... if you see a picture like that (diagram of IUD), like they need to draw it to scale maybe! You know when you look at that, even though it’s small, in your mind, you’re gonna think, oh my god it’s massive...instead of drawings (you need) an actual picture of what it actually looks like. Cos you wouldn’t know what it looked like until you actually went there would you?”

“Maybe nurses do talks or something about how they put it in, ‘cause someone like me, could never do that ‘cause I’d just cry my eyes out. I’m really squeamish.” 

“I feel like there should be more talks within schools, about different types, like it is only condoms and the pill that are discussed.”

“Tell teenagers about contraception through videos, so they can just watch it – when people give me leaflets on the street I just throw them away, or just put it in my bag and it will stay in there for like a year! Whereas if, I don’t know, there was like pop up ads or something .”

“A video to show in schools, ok, these are the different types of contraception. These are the facts.”

So young people are telling us that they would like more practical demonstrations of contraceptive methods – we’ve certainly had positive reactions when using the FPA’s contraceptive display kit, which allows young people to see and touch different methods. There is also the suggestion that educators use more videos – and since we know young people respond to other people’s experiences, how’s about a UK version of these Bedsider videos? Someone fund us and we’ll do it!

For more information on young people and repeat unintended conceptions have a look at EFC's own research from 2007 and Hoggart and Phillips' 2010 research report.