Objective: To evaluate and serve the need for contraception in those not using conventional sources of family planning services.
Setting: South London outpatient genitourinary medicine department at King's College Hospital.
Design and subjects: Prospective study of 200 women seen consecutively in the clinic by the same doctor (LM) during 1993. Women at risk of unwanted pregnancy were identified, and offered immediate contraceptive provision or referral.
Results: 15 women (7.5%) were using no contraception, despite being sexually active and not wishing to conceive; of these two presented with an unwanted pregnancy. A further 23 women (11.5%) were not using their chosen contraception effectively, and another 20 women were unclear about contraceptive methods and wanted advice. Young women were most at risk; 14% of those aged 25 years and under were using no contraception. Eight women wished to defer contraceptive advice; of these four defaulted from follow up. Eighteen women (9%) wanted immediate contraceptive supplies. Ten of 18 returned a follow up questionnaire; all these women were satisfied with the contraceptive advice service received.
Conclusions: Absent or ineffective contraception is common in women attending an inner city genitourinary medicine clinic. Immediate provision of contraceptive education, advice and supplies is welcomed by patients.
PIP: The objective was to evaluate and serve the need for contraception in those not using conventional sources of family planning services. In a prospective study a structured interview was held with 200 women seen consecutively by the same doctor during 1993 in the South London outpatient genitourinary (GU) medicine department at King's College Hospital. Of 200 women seen, 94 (47%) were Caucasian, 79 (39.5%) Black Caribbean, 9 (4.5%) Black African, and 18 (9%) were of other origins. The majority were 30 years or younger and sexually active at the time of interview. 15 women (7.5%) were classed as high risk; they were using no contraception. Two of these presented with an unwanted pregnancy. 12 (80%) of the high-risk group were under 25 years old (p = 0.019, odds ratio 5.02). 10% of the women said they had not been sexually active during the last 3 months, 73% said they had been in monogamous relationships, 12.5% said they had had 2 or more regular partners, and 4.5% had had casual partners only. 73 (36.5%) had had at least 1 pregnancy termination. 45 (22.5%) said that they did not want any more children. 23 women (18% of those using contraception) were not using their chosen contraception effectively in addition to the 15 who were completely unprotected. Another 20 women wanted contraceptive advice. 58 women (29%) were unclear about contraceptive methods and needed advice, including the entire at risk group who were using no contraception at all. 18 patients (9%) wanted contraceptive supplies at the first appointment. Eight preferred to wait until a follow up visit, but 4 then failed to return and 3 subsequently declined further contraceptive advice. 10 of the 18 women (56%) given a new method of contraception returned the follow up questionnaire, and all of these were satisfied with the family planning service they had received at the GU clinic. Immediate provision of contraceptive education, advice, and supplies is welcomed by patients.