BMJ. 2000 Aug 19-26;321(7259):486-9.
Consultation patterns and provision of contraception in general
practice before teenage pregnancy: case-control study.
Churchill D, Allen J, Pringle M, Hippisley-Cox J, Ebdon D,
Macpherson M, Bradley S.
Division of General Practice, University of Nottingham Medical
School, Queen's Medical Centre, Nottingham NG7 2UH, UK.
dick.churchill@nottingham. Ac.uk
Objectives:
To determine patterns of consultation in general
practice and provision of contraception before teenage
pregnancy.
Design:
Case-control study, with retrospective
analysis of case notes.
Setting:
14 general practices in Trent
region. SUBJECTS: 240 registered patients (cases) with a
recorded conception before the age of 20. Three controls per
case were matched by age and practice.
Main Outcome Measures:
Consultations in general practice and provision of contraception
in the 12 months before conception and recorded provision of
contraception at any time before conception.
Results:
Overall,
223 cases (93%) had consulted a health professional at least
once in the year before conception, 171 (71%) had discussed
contraception in this time, and 121 (50%) had been prescribed
oral contraception. Cases were more likely to have consulted in
the year before conception than controls (odds ratio 2. 70, 95%
confidence interval 1.56 to 4.66). Most of the difference was
owing to consultation for contraception. Overall, 53 cases (22%)
resulted in a termination of pregnancy. Cases whose pregnancy
ended in a termination were more likely to have received
emergency contraception than either their controls (3.21, 1.32
to 7.79) or cases resulting in other outcomes (3.01, 1.06 to
8.51).
Conclusions:
Most teenagers who became pregnant attended
general practice in the year before pregnancy, and many had
sought contraceptive advice. The reluctance of teenagers to
attend general practice for contraception may be less than
previously supposed. The association between provision of
emergency contraception and pregnancy ending in termination
emphasises the need for continuing follow up of teenagers
consulting for this form of contraception.
PIP: In western Europe, UK has the highest teenage pregnancy
rate among 15-19 year olds. Although general practice is one
source of provision of contraception, it has been suggested that
teenagers are reluctant to seek advice because of difficulty in
gaining access and fears about confidentiality. This
case-control study determined patterns of consultation in
general practice and provision of contraception before teenage
pregnancy. A total of 240 cases with a recorded conception
before age 20 and 719 matched controls were identified. Overall,
results show that most teenagers who became pregnant attended a
general practice in the year before pregnancy, and many had
sought contraceptive advice. Cases were more likely to have
consulted a doctor in the year before conception than controls
(odds ratio, 2.70; 95% confidence interval, 1.56-4.66). An
association between provision of emergency contraception and
pregnancy ending in termination was found. This finding
emphasizes the need for continuing follow-up of teenagers
consulting for this form of contraception.
