Contraceptive services for teenagers: do we need family planning clinics?

Abstract

Objective: To determine whether the effectiveness of contraceptive services for teenagers is related to the balance of service provision between general practitioners and specialist family planning services. Design: Cross sectional study with routinely collected data from family planning clinics and family health services authorities and published data on births and abortions. Setting: Eight health districts in the former Oxford region. Subjects: Girls aged under 16 and women aged 16-19 who attended a contraceptive service during 1991-2 or who gave birth or had an abortion during 1990-2. Main outcome measures: Attenders at family planning clinics as a percentage of all users of contraceptive services. The conception rate:uptake of contraceptive services ratio was used as a measure of effectiveness. Results: In comparisons between districts the percentage of all users of contraceptive services who attended a clinic varied from 38% (95% confidence interval 28% to 48%) to 79% (72% to 86%) among 13-15 year olds and from 14% (12% to 15%) to 44% (42% to 46%) among women aged 16-19 years. The conception rate:uptake of contraceptive services ratio varied twofold in the older age group and more than threefold in the younger age group. It was lowest in districts where clinic attenders comprised a large percentage of all users of contraceptive services. Conclusion: Contraceptive services for teenagers may be more effective in districts where clinics play a large part in delivering the service, particularly for girls aged under 16. Key messages Health districts can use the conception rate: uptake of contraceptive services ratio to measure the effectiveness of their contraceptive services for teenagers Districts in which clinics play a major part seem to have a more effective contraceptive service for teenagers than those in which the service is provided mainly by general practitioners Districts that provide only a few clinics and have a high value of the ratio described should consider purchasing additional clinics for young people