Contraception – arguably one of the most pressing issues in today’s rapidly increasing worldwide population. With teenage pregnancy still a very common occurrence and reports of young adults believing that they can have unprotected sex with no consequences based on several dubious assumptions, the need for proper teaching and instruction has never been higher. So the million dollar question is – who should be responsible for imparting this information? And why is it so important? A study by The Nuffield Trust details the impact of teen pregnancy:
“The majority of teenage pregnancies are unplanned and around half end in an abortion. Research has shown that teenage pregnancy is associated with poorer outcomes for both young parents and their children. Teenage mothers are less likely to finish their education, are more likely to bring up their child alone and in poverty, and have a higher risk of mental health problems than older mothers. Infant mortality rates are 60% higher for babies born to teenage mothers. As children they have an increased risk of living in poverty and are more likely to have accidents and behavioural problems.”
The ease of availability of condoms makes them the number one contraceptive choice for lots of young people. But is their academic education up to the challenge of understanding why and how they should be used?
Well, who remembers sex ed at school? Usually a red-faced teacher mumbling at the front of the class and trying to teach a roomful of children about the necessary whilst they can’t stop laughing at ‘penis’ and ‘vagina’, never mind apply themselves to putting a condom on a banana. Not ideal is an understatement and when it comes to something as important as using condoms correctly, it’s vital to get the message across: they protect against pregnancy, they protect against STIs and they’re a non-invasive form of contraception that it is easy to get hold of. And it’s precisely because they are easy to get hold of that people must know how to use them. It’s a sort of go-to option for lots of people, and especially among those who are younger. Shops, chemists and petrol stations, amongst others, sell them and you can get them for free from sexual health clinics. Using one of these rubber inventions correctly is probably number one on the list of things that young adults need to learn as they embark on their sexual lives. So getting the hang of both theory and practice is Very Important Indeed.
Current provisions.
There is a wide network of clinics specialising in sexual health which are often walk-in ones. They offer anonymity for the most part and deal with all types of sexual health issues day in, day out. It’s easy to see why teenagers like this approach; it’s a simple access one-stop shop. But if there are any complex issues, this method starts to fail. There is sometimes a GP on-site but they aren’t often available for immediate appointments, plus they aren’t needed to sign prescriptions for standard contraception because with the rise of the Nurse Practitioner who are able to do this themselves. BUT – whilst they might know all about conception and fertilisation and the different options for safe sex, they may not be able to give in-depth explanations for those who come in for a reason that’s slightly outside of the usual condom/pill box.
There is increasing pressure for GPs to take over the reins of this particular horse. because there are issues which are vital to understand which are better coming from a GP. For example:
- - Detailed advice about the pill and the pros and cons of which one is most suited to the individual. There are both long term and short term risks with starting the pill which many people aren’t aware of and a GP is in a better position to discuss this. For example: there is a rise in the risk of DVT and PE (known together as venous thromboembolism or VTE) with the oestrogen and pills are available with low, medium and high levels of oestrogen. Meanwhile, the mini pill (POP) is not associated with VTE risk.
- - Explaining about the different types possibilities such as birth defects which can potentially happen to everyone and the long term repercussions of caring for a baby with a cleft palate, Downs Syndrome, global development delay or severe austism and the level of regular clinical input required.
Other, less complex, reasons include a GP’s generally enhanced knowledge and skill in this particular area. Emotions play a large part in sexual relationships, but so does science which is often less fully understood. A doctor will have ALL of relevant facts at his fingertips to go into the more in-depth stuff in the areas where people can be shaky. You know the kind of thing; when, where and how is an embryo actually formed? Which are the most fertile days for a female? How long can sperm live inside the vagina? How long does it take them to reach the uterus? Is there a risk of birth defects being caused through an error in the replication of cells at conception? It’s not strictly speaking ‘essential’ knowledge, but those, amongst others, are key facts to getting that rounded picture of the situation.
And then of course, there’s anatomy. The human body is a complex piece of machinery and not at all easy to understand. Most of us have a tenuous grip of the major parts of the body but less in-depth information about these major parts. The explanation of these sorts of things will roll off the tongue of a doctor, who will be able to detail extensively all of the different parts of the relevant anatomy if necessary and can explain the more complex whys and wherefores of the complicated processes involved in contraception and sexual health. In fact, a US study details some alarming statistics about using Nurse Practitioner care instead of physicians.
Confidentiality. This is a tricky area, but one of the most important points to understand is that a GP is there not only for information, but for protection. For example, if a thirteen year old girl comes in for contraceptive advice because she’s having sex with her twenty-one year old partner, her doctor will have the enhanced training and experience to report to the relevant child protection agencies.
Not all about the young ones
It’s a common misperception that only teenagers who need contraceptive advice. Divorce is becoming much more commonplace among a younger generation, there are a lot of women becoming single who are still within their fertile years and perhaps not having had to think about contraception in the latter stages of their relationship, are laying themselves open to pregnancy and STIs. In 2017, a report from ELSA found that over 80% of those aged between 50-90 were still sexually active. Such maintained sex lives have previously been linked with healthier aging processes, but the UK has also seen a recent rise in the rates of sexually transmitted infections (STIs) found in older people. The average lifespan is on the rise and medicine needs to keep up with this changing face of society.
So, should it be compulsory for GPs to teach their patients about contraception?
Compulsory might be a bit of a strong term. In other words, should it be a mandatory part of their training and form a significant part of their working life? There are arguments for and against, but the ones against tend to be a bit flimsy. They usually consist of “There are specially trained health professionals to do this exact job” which is akin to saying “There’s McDonalds, why do we need haute cuisine?”
The BMJ has this to say about the matter:
“…. 77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse….being unable to see…. the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead…..”
Therefore, there’s a very persuasive argument that doctors SHOULD automatically be doing more sexual health education than they currently are. Patients want it, some patients actually need it and GPs wouldn’t have to have any extra training to carry it out. NP knowledge only goes a certain part of the way before it hits a brick wall, whereas GPs don’t have that wall.
With all that aside, it’s the availability of contraceptive advice which is most important. Whether a nurse or a doctor, a medical professional is always going to be better placed to discuss and teach than a woefully under-equipped science tutor whose efforts to control and instruct a sniggering class of twenty children will probably have the same success rate as if she were attempting to herd cats.
