Sutton and Merton condom distribution policy - Teenage Pregnancy by maclaren1


									            Teenage Pregnancy (TP) Condom Distribution Policy

                    Sutton and Merton Primary Care Trust
                              In Partnership with
        The London Borough of Merton and The London Borough of Sutton

                                               July 2004

In 1999 the Social Exclusion Unit (SEU)1 produced a major report on Teenage
Pregnancy, which demonstrated that the UK has the highest rate of teenage
pregnancies in Western Europe. The report led to the development of a national
teenage pregnancy strategy, which aims to:

       Reduce the rate of teenage conceptions, with the specific aim of halving the
        rate of conceptions among under 18 year olds by 2010 and an interim
        reduction of 15% by 2004.

The London Boroughs of Merton and Sutton responded by producing ten-year local
strategies for the reduction of teenage pregnancies in each borough. Both the Merton
and Sutton strategies follow national guidelines in identifying four main areas for

       Better prevention: sex and relationships education
       Better prevention: contraceptive advice and information services
       Better support for teenage parents
       Media and communications.

This policy aims:
    to provide a framework for the targeted distribution of condoms to vulnerable
      young people aged 19 and under.
    to safeguard professionals and young people engaged in the scheme.

This policy is set within the context of national research that demonstrates that about
a third of under 16s are sexually active. Half of the under 16s and a third of 16 to 19s
use no contraception the first time they have sex2. Teenagers who don‟t use
contraception have a 90% chance of conceiving in a year. New cases of sexually
transmitted infections such as chlamydia and gonorrhoea have more than doubled
over the past six years with the most significant rise amongst young people. Yet
levels of awareness of chlamydia, which can lead to infertility, are extremely low. One
survey suggested that almost three quarters of those aged 16 – 24 had not heard of
the disease (Health Committee – Sexual Health 2003)3.

  Social Exclusion Unit (1999) Teenage Pregnancy, London, The Stationery Office
  Teenage Pregnancy Unit (2000), Key facts and figures for England
  House of Commons Health Committee (2003), Sexual Health, Third report of session, London, The Stationery
Evidence suggests (HDA 2003)4 that various interventions contribute to the reduction
of teenage pregnancies. Among these the following characteristics were found to be

       Focussing on improving contraceptive use and at least one other behaviour
        likely to prevent pregnancy and/or STI transmission.
       Long-term services and interventions, tailored to meet local needs of young
        women and young men, with clear and unambiguous messages.
       Focussing on local high-risk groups.
       Improving inter-personal skills development such as negotiating and refusal
        skills and allowing young people the opportunity to practise these skills.
       Ensuring that interventions are age-appropriate.
       Selecting and training staff who are committed to programme and service
        goals and will respect confidentiality where possible.
       Encouraging a local culture in which discussion of sex, sexuality and
        contraception is permitted.

Extending the availability of condoms to vulnerable young people aged 19 and under
forms an essential part of the „Better Prevention‟ sections of the Sutton and Merton
Teenage Pregnancy Strategies. This target group has been selected on the basis
that that they are less likely to be in a stable relationship, more likely to take risks and
more likely to have unprotected sex. The scheme is intended to complement existing
provision of free condoms within mainstream family planning and sexual health
services. It is not the intention of the scheme that participating organisations will
become the only point of contact for young people to obtain condoms. Participating
organisations are expected over time to signpost young people to mainstream health
services such as family planning and sexual health (GUM) services where longer-
term needs can be met.

The TP Condom Distribution scheme has been drawn up in line with Best Practice
Guidance on the provision of Effective Contraception and Advice Service for Young
People5. This policy complements the Sutton and Merton PCT Public Health Condom
Distribution Policy and should also be read in conjunction with the Sutton and Merton
TP operational policy on condom distribution.

A range of local organisations working with vulnerable young people under the age of
19 have been invited to join the scheme on the basis that they actively support the
right of young people to access sources of information, support and guidance around
relationships and sex, and that they are willing for self-selecting members of staff to
attend a Sutton & Merton TP condom distribution scheme training course. Staff who
have not attended this condom distribution training are not authorised to distribute
condoms within the scheme. Organisations will be expected to adhere to the
operational guidelines laid out in the accompanying document “Sutton & Merton TP
Condom Distribution Scheme Operational Guidelines”.

It is acknowledged that other organisations may wish to participate in the scheme.
However resource limitations mean that additional organisations will be required to
apply through the local Teenage Pregnancy Partnership Boards. Organisations will
be discouraged from receiving free condoms from different PCT sources.
 HDA (2003) Teenage Pregnancy and Parenthood: a Review of Reviews Health Development Agency
 Teenage Pregnancy Unit (2000) Best Practice Guidance on the provision of Effective Contraception and
Advice Services for Young People, Department of Health
The legal framework
The current legal framework already allows professionals working with young people,
including under 16‟s, to provide information about contraceptive methods and the
importance of using condoms to protect against sexually transmitted infections.
Organisations within the TP condom distribution scheme will be supported to ensure
that information provided is accurate, up-to-date and includes information about local
services. Advising individual young people on the suitability of a particular
contraceptive method is not however within their roles and the young person should
be referred to a local agency, such as the family planning service, for advice.

There is no law to prevent under 16‟s from buying condoms from pharmacies or
vending machines, nor any restricting the seller. In addition there is no law preventing
professionals such as youth workers, Connexions PA‟s, social workers and outreach
workers from providing confidential sexual health advice and giving out condoms to
individuals or to groups of young people under 16, including those under 13, where
they are working to protect the child‟s physical safety, protect them from a sexually
transmitted infection, prevent the child becoming pregnant or to promote their
emotional well-being by the giving advice.

The TP condom distribution scheme takes into account the Sexual Offences Act
2003, and a clear understanding of the law concerning consent and of the
implications for child protection is required of all agencies participating in the scheme.
Under the Sexual Offences Act 2003 a child under 13 does not, in any
circumstances, have the legal capacity to consent to any form of sexual activity. It is
illegal for a person of any age, including a person under the age of 16, to engage a
young person under 16 in any form of sexual activity. However it is not intended that
young people should be prosecuted where the sexual activity was entirely mutually
agreed and non-exploitative. So for example, where the young people are close in
age and the sexual activity is mutually agreed a prosecution may be less likely than if
one person is much older than the other. Where both young people concerned are
particularly young, for example, under 13, it is considered more appropriate to draw
the children to the attention of social services. The way in which the law will be
interpreted applies equally to males and females whatever their sexual orientation.

The scheme operates within the existing confidentiality guidelines of the participating
organisations. However, participating professionals must respect the right of young
people to confidentiality when discussing contraception and when distributing
condoms as part of the scheme. This means that professionals will not pass any
information on to other professionals or enquiring persons except to protect the
young person or someone else from serious harm. Confidentiality, for example, will
be broken where a young person discloses abuse or may be in need of medical
assistance. In this case the professional is expected to discuss this with the young
person in question first. Professionals are encouraged to use the following or
equivalent phrase when young people access condoms through the scheme:

     “We will not pass information about you to anyone else. The ONLY reason
     we might have to pass on information would be to protect you or someone
     else from serious harm. We would try to discuss this with you first”.

Child Protection
When a young person is under 16 and sexually active, staff should consider the
possibility that the young person may have been, or may be going to be, sexually
abused or exploited. In any situation where there are concerns, staff members
involved in the care of the young person should follow their organisation‟s child
protection procedures. They may wish to first discuss their concerns with their line
manager. The presence of any of the following are reminders to staff that they should
consider the possibility that non-consensual sexual activity may have taken place or
be taking place:
    History of physical or sexual abuse
    Partner more than 3 years older than the client
    Low self-esteem
    Learning difficulties
    History of social services care
    Communication difficulties
    Early age of first intercourse.

Child prostitution and young people at risk of sexual exploitation, is now classified as
a form of sexual abuse.

Monitoring and Evaluation
To qualify for continuing participation in the scheme organisations must provide
regular monitoring information using standardised forms.

Promoting the Scheme
Participating organisations will be required to advertise the condom scheme in an
appropriate manner within their organisations, either through posters supplied by the
scheme or by the wearing of a sticker indicating that condoms are available through
their outlet. They are also expected to publicise their involvement in the scheme by
referring to it in relevant policies and procedures.

Policy Development
This policy was written by Sutton and Merton PCT‟s Teenage Pregnancy Co-
ordinators in partnership with the Development Manager for Family Planning and
Sexual Health and Health Improvement Manager, Public Health Directorate.
Stakeholders from both boroughs were involved in the consultation process which led
to the development of this policy, and it has been agreed by Sutton and Merton TP
Partnership Boards.

Signing up to this policy will be a condition of participation in the scheme. All
managers of participating agencies will hold a copy of the policy and it will be given to
all professionals attending the condom training. Copies are available to other
interested parties on request.

Policy Review
This policy will be reviewed on an annual basis by the condom distribution scheme
steering group and through feedback provided by participating organisations.
Feedback from young people accessing condoms through the scheme will also form
an essential review mechanism.

Date of Next Review:        January 2005

        Teenage Pregnancy (TP) Condom Distribution Scheme

                            Operational Guidelines
                                   January 2004

This scheme is intended to formalise current condom distribution to vulnerable young
people aged 19 and under in the London Boroughs of Sutton and Merton. These
operational Guidelines should be read in conjunction with the Teenage Pregnancy
Condom Distribution Policy.

Organisations working with vulnerable young people who are involved in the current
scheme will be asked to sign up to the revised policy and guidelines.

For monitoring purposes each participating agency has a centre code. The centre
code for your agency is:                       Please insert your centre code on all
monitoring cards. Each participating agency has one or more named leads
responsible for overseeing the condom distribution scheme, including collecting
monitoring information and ordering supplies. The named lead for your agency is:

Promoting the Scheme
Participating organisations are required to advertise the condom scheme in an
appropriate manner within their organisations, either through posters supplied by the
scheme or by wearing a sticker indicating that condoms are available through their
outlet. Organisations should endeavour to promote the scheme alongside other
health issues and to include a visible confidentiality statement on appropriate notice

Training requirements
All professionals wishing to distribute condoms from within their agency must have
attended the mandatory condom distribution training course before they can give out
any condoms to young people through the scheme.
Condom distribution
Young men and women aged 19 and under who live, study or work in the boroughs
of Merton or Sutton are eligible to access condoms through the scheme. Condoms
can be offered in both one to one and group work situations. Young people over the
age of 19 should be encouraged to get their free condoms from another local source
(e.g. family planning clinics).

As a trained professional you are required to provide a short consultation about
sexual health and condom use, including a condom demonstration and how to
access emergency contraception in case of condom breakage. The young person
can then be given:
    A selection of condoms (maximum of 10) in an unmarked paper bag
    Lubrication sachets
    Check It Out! leaflet about local sexual health services
    Other information leaflets as appropriate.
Young people should be encouraged to use some of the condoms provided to
practise correct usage.
Child Protection Procedures
If a young person discloses information indicating abuse, coercion or exploitation,
this disclosure must be discussed with your line manager and/or a named lead for
child protection. The young person should be informed that advice will be sought
from others and confidentiality may be breached.          In such circumstances,
confidentiality can be breached even if the young person does not give consent as
the need to protect from serious harm is paramount and supersedes all other
considerations. However, the aim always should be to gain the consent of the young
person, wherever possible, based on a clear understanding of the reasons for the
practitioner's concern and proposed action.

If contacting your named lead for child protection, it is helpful to have gathered the
following details:
     Name of young person
     Date of birth
     Address including postcode
     School or college
     Name and contact details of allocated social worker, if the young person has

Monitoring and ordering further supplies
Professionals will be provided with monitoring forms. They will be expected to
complete these forms every time they register a new client or provide condoms to an
existing client.

Monitoring information provided by each centre will only be used to inform the future
development of the condom distribution scheme and linked services. Data from each
centre must be collated by the named condom distribution lead for your agency each
time further condoms are ordered. Organisations not sending in this monitoring
information with their order will not be sent further supplies. Completed order- forms
should be sent to:

Clare Philp
The Public Health Resource Service
Deas House, Nelson Hospital
Kingston Road, London, SW20 8DB
Fax Number: 020 8715 2778
Tel: 020 8251 0582

For more information about the scheme please contact:

For Merton:                                   For Sutton:
Kate Jezernik                                 Gill Mullinar
Merton Teenage Pregnancy Coordinator          Sutton Teenage Pregnancy Coordinator
Tel: 020 8687 4733                            Tel: 020 8770 8433
E-mail:      E-mail:


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