Contraceptive services for teenagers: do we need family planning clinics?
Authors: M. A K Allaby
Journal: BMJ (1995)

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.Cross sectional study with routinely collected data from family planning clinics and family health services authorities and published data on births and abortions.Eight health districts in the former Oxford region.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.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.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.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.A public health physician analyzed data from family planning clinics and family health service authorities and data on births and abortions to learn whether the effectiveness of contraceptive services for adolescents in 8 health districts of the former Oxford region of England is linked to the balance of service provision between general practitioners and family planning services. The data covered 1990-1992. The conception rate:uptake of contraceptive services ratio was used as a means to measure the effectiveness of contraceptive services for adolescents. The proportion of users of contraceptive services who attended a family planning clinic ranged from 38% to 79% among adolescents 13-15 years old and from 14% to 44% among those 16-19 years old. The conception rate:uptake of contraceptive services ratio ranged from 0.1 to 0.36 among adolescents ages 13-15 and from 0.12 to 0.23 among those ages 16-19. This ratio decreased as the proportion of users of contraceptive services who attended a family planning clinic increased among both 13-15 year olds (p = 0.002) and 16-19 year olds (p = 0.04). It varied 3-fold in the 13-15 year old age group and 2-fold in the 16-19 year old age group. An 8-week survey in district E showed that 334 adolescents ages 13-19 attended a family planning clinic. 13% were currently registered with a general practitioner for contraceptive advice. 12% lived outside the district. These findings suggest that contraceptive services for adolescents are more effective in districts where family planning clinics contribute greatly to delivering contraceptive services, especially for adolescents younger than 16, rather than those in which general practitioners provide these services.