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Overview
The right to make choices about reproductive health is enshrined in human rights legislation and the United Nations has committed to 'ensure universal access to sexual and reproductive health-care services' by 2030 (United Nations Sustainable Development).
In the UK, the Family Planning Association was formed in 1930 in the face of criticism from religious groups and the public. Initially, contraceptive advice was available to only married women. Pre-marital contraceptive advice started to be offered in the 1950s and by the 1960s the “pill” was being prescribed in clinics. Family planning clinics did not form part of the NHS and consequently provide universal free contraception until 1974 (The Family Planning Association (FPA), 2020a).
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Management
All women of reproductive age should have access to contraceptive advice. A contraception consultation should consider the following:
- preferred method of contraception
- future plans for having children
- personal beliefs and views about contraception
- attitudes of her partner and family towards contraception.
History taking should assess suitability for different contraceptive methods and include:
- past medical history which should cover clots, breast cancer, migraine with aura, hypertension and obesity
- age
- lifestyle- smoking, shift work
- allergies, specifically latex
- reproductive history- postpartum, breastfeeding and hopes for pregnancy
- medications- including over the counter treatments, particularly enzyme inducers
- possibility of current pregnancy.
The legal age of consent to sexual activity in the UK is 16 years old. A girl under 16 years old can be prescribed contraception without parental consent, provided they are 'Gillick competent' and meet the 'Fraser Criteria'. These criteria originate from a legal challenge in the 1980s exploring contraceptive advice without parental consent
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Treatment
There are a variety of methods of contraception. When discussing efficacy, the terms 'perfect use' and 'typical use' are used. For long acting reversible contraceptives (LARCs), the typical use meets their perfect use, as there is no need to remember to take them or use them properly (NHS, 2021).
Barrier methods
These are:
- Condoms (female and male)
- Diaphragms
- Caps
Consistent and correct use of condoms is the most efficient means of protecting against HIV and other STIs. Whereas there is little evidence for diaphragms and caps in this regard.
Male condoms are 98% effective (82% with typical use) and female condoms are 95% effective (79% with typical use) at preventing pregnancy. Diaphragms and caps, when used correctly, have efficacy of between 92% and 96% respectively with perfect use (around 71 to 88% with typical use) (Faculty of Sexual & Reproductive Healthcare, 2015).
Barrier methods are the only contraceptives
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Resources
References
Faculty of Sexual and Reproductive Healthcare. Clinical Guidance, Barrier Methods for Contraception and STI Prevention. 2015. https://www.fsrh.org/standards-and-guidance/fsrh-guidelines-and-statements/method-specific/barrier-methods/ (accessed 18 January 2022)
Family Planning Association. About Us. 2020a. https://www.fpa.org.uk/about-fpa/ (accessed 18 January 2022)
Family Planning Association. Your guide to contraception. 2020b. https://www.sexwise.org.uk/sites/default/files/resource/2021-03/your-guide-to-contraception.pdf (accessed 1 December 2022)
International Federation of Gynaecology and Obstetrics. Family planning is a human right. 2018. https://www.figo.org/news/family-planning-human-right (accessed 1 December 2022)
NHS Conditions. Emergency Contraception. 2018. https://www.nhs.uk/conditions/contraception/emergency-contraception/ (accessed 18 January 2022)
NHS Conditions. How effective is contraception at preventing pregnancy? 2020. https://www.nhs.uk/conditions/contraception/how-effective-contraception/ (accessed 18 January 2022)
National Institute for Health and Care Excellence. Long acting reversible contraception. 2019. https://www.nice.org.uk/researchrecommendation/uptake-and-acceptance-of-larc (accessed 18 January 2022)
National Institute for Health and Care Excellence. Assessment for contraception. 2021. https://cks.nice.org.uk/topics/contraception-assessment/management/assessment-for-contraception/#issues-to-consider-discuss (accessed 18 January 2022)
NSPCC learning. Gillick Competence and Fraser Guidelines. 2022. https://learning.nspcc.org.uk/child-protection-system/gillick-competence-fraser-guidelines#article-top (accessed 18 January 2022)
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