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The UK is initiating a pilot program next year that will allow pharmacists to dispense birth control pills without a prescription. This change will help to address the high rate of teenage pregnancy.

According to the UK Times, the UK has the highest teenage birth rate in Western Europe - figures from the Office for National Statistics show that during 2005, in England, 7,462 girls under-16 became pregnant, and the total number of females under the age of 18 who experienced an unintended pregnancy was 39,683. In comparison, according to the National Center for Health Statistics, in 2006, 6,297 girls under the age of 15 became pregnant in the United States, and the total number of females under-18 who became pregnant was 19,015.

With the implementation of this program, females will be able to have a free consultation with a pharmacist to determine if any health risks are present. The pill will be available over-the-counter to girls under the age of 16 without the need for parental consent. The UK has announced that its government would ensure appropriate training so that pharmacists distribute contraception correctly and as per the prescribed standards.

Over-the-counter contraceptive pills don’t reduce unwanted pregnancies

Though there has been an effort in recent years to make contraceptive pills available over-the-counter, British medical researchers suggested that doing so will not reduce unwanted pregnancies. A researcher from the Royal College of Physicians put forth that it is a lack of daily compliance with taking oral contraceptives which is partly responsible for the high rates of unintended teenage pregnancies in the UK.

Studies have shown that nearly half of all women taking the oral contraceptive pill miss one or more pills in each cycle, and nearly a quarter missed two or more. These women are three times more likely to get pregnant unintentionally than those who take the pill consistently.

The solution to this lies in long acting reversible contraceptives such as the coil, or those which can be placed under the skin or injected. They last between three months and three years, and because they are not dependent on patients taking them correctly, are much more reliable than oral contraceptives.

Contraceptive coils

The word ‘intrauterine’ means ‘inside the womb’. Intrauterine devices (IUDs) are little devices made of metal (usually copper) and plastic, which are inserted into your womb by a doctor to prevent you from getting pregnant. They are almost 98 per cent effective, which makes them not all that far off being as good as the pill. But IUDs are not so easy to insert in young women who have not had children. Also, young, sexually active women must be carefully screened for sexually transmitted diseases (STDs) before having an IUD put in.

IUDs come in several forms: IUCD (intrauterine contraceptive device), coils, loops and copper T. They work partly by thickening the mucus round the neck of your womb (cervix), thus making it difficult for sperm to get through to fertilize an egg.

In the UK about 4 per cent of all sexually active women are using IUDs. They are more popular in Scandinavia, around one in five of all women of reproductive age have IUDs. However, it is unlikely that IUDs will ever be as popular as the pill or the condom.

Associated side effects of IUDs

Standard IUDs tend to make periods heavier, longer and more irregular. They can also cause crampy pain during a period (although this tends to lessen over time). Furthermore, because of the increase in menstrual flow, there is a possibility of developing anemia with the use of IUDs.

Less common problems related to IUDs include:

Expulsion – Few people report that IUDs can come out. So, it is advised to check your vagina to feel for the thread and not the device which would feel heard to touch.

Perforation – Rarely, IUD may perforate the wall of your womb and it is an emergency situation.

Pelvic infection: the risk of pelvic inflammatory disease (PID) is increased, especially if you have more than one sexual partner.

Ectopic pregnancy – IUDs are good at preventing womb pregnancies. So, if a pregnancy occurs, there are chances of it being ectopic.

Depot injection

A depot injection provides long-term contraception and usually involves an injection into the muscle of your buttocks to provide protection. If contraception is needed beyond this time the injection is repeated every 3 months, for as long as needed. There are two types of contraceptive injections. Depo-Provera is the most commonly used contraceptive injection, and contains a progestogen called Medroxyprogesterone acetate. It protects against pregnancy for 12 weeks. The other injection, Noristerat, contains a progestogen called norethisterone enantate and gives contraceptive protection for 8 weeks.

Depot injections work by stopping the expulsion of an egg from the ovary each month. If no egg is present for fertilization by sperm, then a pregnancy cannot occur. If 1,000 women used depot MPA for one year, one or 2 would fall pregnant. This represents a more effective rate of contraception than that provided by the oral contraceptive pill.

Precautions and side effects

  • Following one or more MPA injections, a return to regular monthly periods and ovulation can be delayed for up to 18 months. For this reason, they are not recommended if you want to fall pregnant soon after stopping your contraceptive.
  • Depot MPA can result in altered bleeding such as unpredictable spotting, irregular periods, no periods or, rarely, heavier periods than usual.
  • Other possible side effects of depot MPA include weight gain, headaches and depression.

Implant

The contraceptive implant is inserted under the skin of the inner, upper arm to provide 3 years of contraceptive protection. The doctor removes the implant under local anesthesia after it has been in place for 3 years, or at any time prior to this if the contraceptive effect is no longer required. Normal fertility returns soon after removal of the implant. Providing that the implant is inserted under the skin correctly, this method of contraception is highly effective, with one recent trial that gave a failure rate of less than one tenth of one per cent during the first year of use.

This implant continuously releases a progestogen hormone called etonogestrel, which prevents ovulation occurring each month. It also changes the mucus produced by the cervix, which makes it difficult for sperm to enter the uterus.

Precautions and side effects

  1. If you plan to use this contraceptive option, you need to be comfortable with the idea of having an implant placed under your skin.
  2. Prolonged, irregular or absent periods, acne, weight gain, breast tenderness, dizziness and headache have been reported in some women using implants.

Non-user dependant methods better in avoiding unwanted pregnancies

The availability of the combined oral contraceptive pill without prescription may be safe, but that those using it would not be offered a full range of contraception on every occasion. In fact, they will raise the risk of unprotected sex and sexually transmitted diseases. Researches concluded that increased uptake of reliable, non user-dependent methods has to be the key. Rather than making a potentially unreliable method of contraception more easily available, our best avenue for reducing unplanned pregnancies is to encourage general practitioners to help their patients to make the best choices.

  • contraception.about.com/b/2007/12/13/over-the-counter-birth-control-pills-for-teens.htm
  • www.physorg.com/news149311814.html
  • www.netdoctor.co.uk/sex_relationships/facts/contraceptivecoil.htm
  • www.mydr.com.au/babies-pregnancy/contraception-long-term-options-for-women
  • www.mydr.com.au/babies-pregnancy/contraception-long-term-options-for-women