Agenda Item: 3
Wirral Primary Care Trust
Sexual Health and Teenage Pregnancy
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.
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:
GUM in the Community
HIV & AIDS
Chlamydia Screening Programme
Brook and Confidential Advisory Service
Health Services in Schools
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
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
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
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
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
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