Page last updated at 00:50 GMT, Saturday, 13 December 2008

'We want real contraceptive choices'

By Jane Elliott
Health reporter, BBC News

Rhiannon Holder
Rhiannon wants better choices for women

Rhiannon Holder is a woman on a mission - to empower Britain's young women about their contraceptive choices.

She says that despite there being 14 kinds of contraceptive options on offer, many young women are being offered little or no choice.

And she says many GPs are reluctant to look further than the "old favourites" of the pill and condoms.

Rhiannon, a 21-year-old student, uses the contraceptive implant herself, as well as condoms to prevent sexually transmitted infections.

She says that, because the implant is 99% effective in preventing pregnancy and is an easy no-fuss method to use, it would be a popular choice with young people like herself.

Long acting contraceptives

The implant is a small, flexible tube - inserted under the skin in the upper arm - which slowly releases the hormone progestogen.

But Rhiannon, a member of the teenage pregnancy independent advisory group, which monitors teenage pregnancy strategy and informs the government about young people's experiences, said the choices are simply not being offered.

It is about giving people the choice
Rhiannon Holder

"I got my implant less than a year ago. I think for me it was one of the most reliable methods of contraception as far as preventing pregnancy goes," she said.

"It lasts for three years and there is no user error.

"Condoms and the pill are great and it is not about replacing them, but they are only great if they are used correctly.

"Young people do get drunk, they do go out and party and they do get in late. If people are going to get drunk they do run the risk of getting pregnant.

Choice and practicality

"It does not matter how organised you are, it is easy to forget your pill.

"I lead a hectic lifestyle. I am always doing stuff, always going places.

"The doctor offered me the pill, but I was empowered and knew my facts: I could say the implant lasts longer, and there is no user error. I could say I want this, but young people need to have that knowledge to ask for the choices."

Art work showing contraceptives. Pic caption: David Mack/SPL
Women are not offered a range of contraceptives

Britain has one of the highest teenage pregnancy rates in Western Europe and earlier this year the government ploughed an extra 26.8m into improving access to contraceptives.

NICE (National Institute for Health and Clinical Excellence) guidelines were published in 2005 which highlighted that if 7% of women switched from the contraceptive pill to Long Acting Reversible Contraceptive (LARC) methods - the coil, hormonal injection, and contraceptive implant - the NHS could save around 100m through reducing unintended pregnancies by 73,000.

But Rhiannon, who has acted as a "mystery shopper" for local authorities to test GP contraceptive advice, said she found this was not happening.

"I do a lot of mystery shopping, where I go out to clinics to ask for contraceptives and feel the implant is not well promoted," she said.

"I would go in and pretend I was having problems with condoms and still the doctors would not offer the long-term contraceptives.

"If you ask for it you can get it, but young people often do not know about it. If you don't know about it you are not going to use it so it needs more promoting."

Better education

Dr Ann McPherson, member and recent chairwoman of the Adolescent Advisory Group of the Royal College of GPs, agreed: "Unfortunately GPs are not always offering a full range of different contraceptive methods to people when they ask for information about contraception.

"Sometimes this may be because they are not trained to provide the method - for example to fit a coil, insert a contraceptive implant or fit a diaphragm.

"However, in those cases they should tell women about the options and steer them to a local family planning clinic or another doctor where the full range of methods are available.

"It is very important that primary care trusts make sure that there are clinics in their area that do offer the full range and that GPs should advertise what they do and don't offer.

"Just prescribing the pill is not good enough."

A spokeswoman for the Family Planning Association agreed that women should be offered all the options.

"As far as we are concerned it is really important that women are offered all 14 forms of contraception and aren't just offered one or two.

"The pill is the most commonly used form of contraception, but it is interesting from this whether that is because it is the most commonly offered one."

The Department of Health too supports the idea that offering women as much choice as possible is key to reducing unwanted pregnancies.

"We want to ensure that women are offered a full range of contraception choices, including LARC so that they can best choose what will be best for their circumstances," a spokesperson said.

"LARC can particularly suit women at high risk of unintended pregnancy."

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