Clinical update

Contraception

A new NICE quality standard says that women should be told that the coil is more effective than the morning after pill as emergency contraception.

Essential facts

Contraceptive services aim to help men and women choose a method of preventing pregnancy that best suits their needs and lifestyle, making it more likely that contraception will be used effectively. Almost 9 out of 10 women in heterosexual relationships report using at least one method of contraception. An estimated 19% of pregnancies are unplanned, and there were 184,571 abortions in England and Wales in 2014. The conception rate among under‑18s in England and Wales has dropped by 51% since 1998.


Be prepared to help patients make informed choices about contraception Picture: SPL

What’s new

Women should be told that the coil is more effective than the ‘morning after pill’ as emergency contraception, says the National Institute for Health and Care Excellence (NICE). A copper intrauterine device, also known as the coil, is effective for up to 5 days after unprotected sex. The advice is included in a quality standard which sets out the key areas where advice for women regarding contraception needs to improve. Women should be informed about long-acting reversible (LARC) methods such as the coil when asking for contraception, it adds. 

Methods of contraception

Oral contraceptives are the most common form of contraception used by women. Less than 1% of women report using diaphragms and caps. The male condom is another commonly used method in the UK. The effectiveness of oral contraceptive pills and barrier methods depend on their correct use every day or each time the person has sex. The uptake of long-acting reversible contraception has been slowly increasing. 

Causes and risk factors

Research suggests unplanned pregnancy is associated with having sexual intercourse before 16 years of age, smoking, recent use of drugs other than cannabis and lower educational attainment. It was also associated with lack of sexual competence at first sexual intercourse, receiving sex education mainly from sources outside school, and depression.

How you can help your patient

Offer women who request contraception a choice of all methods including LARC. Explain that an intrauterine device is more effective than oral medication when women request emergency contraception. Discuss contraception with women who request an abortion, and within seven days of a woman giving birth. 

Expert comment

Karin O’Sullivan is clinical consultant at the Family Planning Association

‘While nurses are not all going to have a detailed understanding of all contraceptive methods, it is important that they have a sound, basic understanding.

'Nurses need to be aware of common questions that they are likely to be asked and be able to give an overview of the 15 methods that are available. Being aware of local contraceptive services and what they can offer is also important. We know that lots of people don’t know what the options are, especially if women have been prescribed a user-reliant method like the contraceptive pill since they became sexually active. When seeing patients, nurses can make sure they are aware of the method that they are currently using and ask them if they are happy with it. Remember, it’s not just about whether a method is clinically suitable, but whether it is appropriate for their circumstances, which of course may change over the course of their life.’

 


Find out more

RCNi article 

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