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					                                                                             Agenda Item: 3
                                                                            Ref: W08-09/003
                                Wirral Primary Care Trust

                       Sexual Health and Teenage Pregnancy

Introduction

1.     The World Health Organisation (WHO) defines sexual health as ‘a state of physical,
       emotional, mental and social well-being related to sexuality: it is not merely the absence of
       disease, dysfunction or infirmity’. It maintains that sexual health requires a positive and
       respectful approach to sexuality and sexual relationships, as well as the possibility of having
       pleasurable and safe sexual experiences, free from coercion, discrimination and violence. It
       is clear therefore that access to good advice and methods of contraception are crucial to
       good sexual health. Contraception is also one of the crucial components in reducing
       unwanted pregnancies and abortion.


Background

2.     The National Strategy for Sexual Health and HIV published by Department of Health in
       2001 recognised that the consequences of poor sexual health can be serious leading to,
       amongst other outcomes, unintended pregnancy and abortion. It also pointed out that there
       was a clear relationship between poor sexual health, poverty and social exclusion and that
       there have been longstanding variations in the quality of sexual health services across
       England. The Strategy highlighted that poor sexual health is not equally distributed among
       the population with the highest burden being borne by women, gay men, teenagers, young
       adults, and black and minority ethnic groups.


Purpose of this report

3.     The purpose of this report is to update the Board on the progress of prevention and
       treatment programmes and initiatives relating to sexual health and reducing teenage
       conceptions. Included are brief items on:

              Teenage conceptions
              GUM in the Community
              HIV & AIDS
              Contraception
              Chlamydia Screening Programme
              Brook and Confidential Advisory Service
              Health Services in Schools
              Abortion

4.     This report should be considered in the context of the following PCT indicators:

              100% access to genito-urinary medicine (GUM) clinics within 48hrs
              Reducing prevalence of Chlamydia in the under 20 population (new)
              Increasing the percentage of abortions carried out under 10 weeks
              Improving access to and choice of contraception offered by the PCT (new)
              Halve the under 18 conception rate by 2010 from 1998 baseline
              Increase the uptake of Chlamydia screening from 15% of target population age 15-
               24 (07-08) to 17% of target population (08-09).




Sexual Health and Teenage Pregnancy: Board Meeting 8 April 2008                                  1/4
Wirral PCT                                                                           Agenda Item: 3
                                                                                    Ref: W08-09/ 003
The bad news:

5.     The percentage reduction in teenage conceptions between 1998 and 2006 is -6.5%.

6.     The 2006 Abortion Statistical Review reported a 4% increase (all ages and gestations) over
       2005; this equates to the national and regional percentage increase. In 2006 there
       were1,039 abortions to Wirral women, a rate of 20 per 1000 women resident aged 15-44.
       This is a little higher than the 2006 England rate of 18.5 per 1000 and the north–west rate of
       17 per 1000. In the same year, 22% of all abortions in the Wirral under-25 population were
       to women who had a previous abortion. This compares with 24% for England and 21% for
       the north-west in the same age group.

7.     Local calculations for abortions among 13-15 year olds from 2006 abortion data show that,
       out of 65 conceptions in this age group, 72% led to abortion.

8.     The number of Wirral residents testing positive for HIV has almost doubled in 5 years, rising
       from 66 confirmed cases in 2002 to the current total of 129 for 2007. The predominant
       mode of exposure for those accessing treatment in Wirral is through men who have sex with
       men and describe themselves as ethnically White. The increase in diagnoses is in line with
       national trends.

The good news:

9.     99.5% of all patients were seen or offered to be seen within 48 hours at GUM during 2007-
       8. Within the North West, the PCT is in the top 10%.

10.    76% of all Wirral TOPs were carried out in under 10 weeks in 2006, the highest in the north-
       west, compared to a national figure of 64.9% and north-west figure of 61%.

11.    Wirral Chlamydia Service had achieved 11.4% of the 15% screening target by Dec 2007.
       The service is recognised as one of the top performing services in the country.


Progress towards addressing targets and improving sexual health

12.    The Wirral Teenage Pregnancy Steering Group and the Wirral Sexual Health and HIV
       Modernisation Team work jointly to address the challenges that have been identified. This is
       co-ordinated through two strategic action plans. Some of the key developments recently
       achieved are detailed below.

13.    Teenage pregnancy: Since the launch of the Teenage Pregnancy Strategy, Wirral has
       seen an overall decline in the under 18 conception rate. However, in the last three time
       periods, the teenage conception rate has risen and Wirral now has a higher rate than for
       Merseyside and the North West. Reducing teenage conceptions is complex with many
       issues of self esteem, aspiration and risk taking behaviour involved. To address these, the
       Teenage Pregnancy Steering Group in Wirral has prioritised its strategic plan and
       partnership actions are focussed in these areas. Priorities include increasing provision of
       long acting reversible contraception (LARC), provision of sexual health information and
       services where young people most need them, improving sex and relationship education
       and developing improved information and intelligence. For more information see Appendix
       I.

14.    GUM in the Community: During 2007, an open tender exercise was held to recommission
       GUM services. The new service (to be launched 14 April 2008) will provide nurse led level 1
       and 2 GUM services in community venues as well as Arrowe Park Hospital (APH), with a
       choice of day, evening and weekend drop in clinics available which will increase
       accessibility to people in education, training and employment. Follow-on level 3
       appointment clinics will be held at APH. This will see a considerable cost–saving to the PCT
       with continued high performance for the 48 hour access target.


Sexual Health and Teenage Pregnancy: Board Meeting 8 April 2008                                  2/4
Wirral PCT                                                                           Agenda Item: 3
                                                                                    Ref: W08-09/ 003
15.    HIV & AIDS: Increases in diagnoses and changes to the primary routes of transmission for
       HIV have led to a review of how information and services are being delivered. Access
       opportunities for a full sexual health screen including HIV test have been increased and a
       teaching pack has been produced for use in Wirral secondary schools. In addition, a full
       consultation is planned to review the service and support needs of individuals and their
       families living with HIV / AIDs. Terence Higgins Trust (Wirral) have a 3 year Service Level
       Agreement (SLA) with a specific remit to deliver high quality harm reduction and sexual
       health promotion work with the lesbian, gay, bisexual and transgender population as well as
       offering training and expertise to partners.

16.    Contraception: A recent North West audit of Contraception Services (January 2008)
       recommended areas of development to Wirral. These included completing a sexual health
       equity audit to ensure that services and information are being provided according to need.
       In addition, it was recommended that specific consideration was given to the provision of
       contraception services for young people, including increasing availability of long acting
       reversible contraception (LARC). Expanding the provision of emergency hormonal
       contraception was also recommended. Additionally, the need to co-ordinate contraception
       data collection across all service providers was highlighted. All the above recommendations
       are currently being addressed through the work of the Sexual Health and HIV Modernisation
       Team.

17.    Abortion: The two providers of abortion services in Wirral are WUHT (up to 9 weeks and 6
       days) and British Pregnancy Advisory Service (all other gestations and offering patient
       choice up to 9+6). The abortion care pathway has been revised and services are running
       smoothly. However, in order to reduce the possibility of second or subsequent unplanned
       pregnancies, additional services are planned. These include ensuring that all service
       providers offer post abortion counselling and access to contraception information and
       provision, including LARC.

18.    Chlamydia Screening Programme: The target population for this screening programme is
       15-24 year olds. Although the local programme is very successful, the increasing coverage
       target is a challenge. Additional outlets for screening opportunities are continually being
       explored. A new high profile campaign including the development of a web-site to be hosted
       by the PCT is about to be launched. A pilot sexual health drop-in run in partnership with
       Wirral Metropolitan College ‘Room 313’ is also to be continued to increase access to
       screening in an appropriate setting.

19.    Brook and Confidential Adolescent Service (CAS): CAS, funded by Wallasey Locality,
       continues to provide accessible and appropriate sexual health services for young people.
       Feedback is very positive from Wallasey young people. Core services provided by Brook
       are funded by the PCT. From April 2008, additional programmes of work to increase self
       esteem and resilience are being included in the core contract to provide Brook with
       continuity and staff security.

20.    Health Services in Schools: Four secondary schools have signed up to have full health
       services on school premises from September 2008. These will include access to
       contraception (condoms) and emergency hormonal contraception which has previously not
       been available in education settings. This has been made possible by the development of a
       Sexual Health Policy which all organisations aim to sign up to over the summer. This
       includes guidance on the provision of sexual health and relationship advice to children and
       young people by front-line staff, in a context of maintaining the emotional and physical
       health and well-being of Wirral young people. In addition to the policy, a Health Services for
       Schools Charter is being launched in July 2008. All partner organisations, including media,
       faith and school governor representatives will be asked to sign the charter and take part in a
       high profile launch event. The Charter aims to ensure all partners understand the concept of
       providing sexual health services for young people in the context of promoting physical and
       emotional well-being.




Sexual Health and Teenage Pregnancy: Board Meeting 8 April 2008                                  3/4
Wirral PCT                                                                            Agenda Item: 3
                                                                                     Ref: W08-09/ 003
Summary and recommendations

14.    Prioritised plans are in place for improved sexual health and a reduction in teenage
       conceptions. These issues need to continue to be a priority for the PCT, ensuring that they
       are addressed through a wide range of partnerships. Data and intelligence, including public
       consultation, need to be improved so that resources can be utilised where they have
       greatest impact.

Sue Drew
Deputy Director of Public Health

Deborah Williams / Wendy Nulty
Health Promotion Strategy Manager /Health Promotion Specialist – Teenage Pregnancy


To see the appendix please click here




Sexual Health and Teenage Pregnancy: Board Meeting 8 April 2008                                  4/4

				
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