CONTRACEPTIVE SERVICES FOR TEENAGERS - DO WE NEED FAMILY-PLANNING CLINICS

Objective-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. Design-Cross sectional study with routinely collected data from family planning clinics and family health services authorities and published data on births and abortions. Setting-Eight health districts in the former Oxford region. Subjects-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. Main outcome measures-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. Results-In comparisons between districts the percentage of all users of contraceptive services who attended a clinic varied fi om 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. Conclusion-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.