Teenage Pregnancy
baseline information:
Conwy
Authors: Kim McInally – Senior Health Development Specialist
Date: 17th April 2014
Version: Final
Publication/ Distribution

Conwy Sexual Health Task Group

Core Aim 3 & 7/CYPP Board and relevant other Core Aim Groups

Conwy East and Conwy West Locality Leadership Teams

Conwy School Nurse lead , Conwy Healthy Schools Scheme Coordinator

Conwy Voluntary Services Council

Public Health Wales North Wales Team

Jiwsi Network
Purpose and Summary of Document:
To support Conwy Sexual Health Task Group to deliver on its priority of
providing appropriate sexual health services for young people up to the age of
25. This document provides an overview of:
 conceptions in young women under 18
 current guidance to reduce teenage pregnancy
 existing service provision and support available to young people in
Conwy
 recommendations for future action
Public Health Wales
1
Sexual Health, Baseline information
Introduction
A key objective in the Welsh Assembly Government’s Sexual Health and Wellbeing Action Plan is to:
“Reduce the number of unintended pregnancies, particularly among teenage
girls”
The Welsh Government’s ‘Sexual Health and Well-Being Action Plan for Wales’1
has made a commitment to drive forward:
“Young people’s entitlement to access educational and health services that
prepare and help them to make responsible decisions about their relationships
and sexual health”
The United Nations ‘Convention on the Rights of the Child’ states that young
people have a right to be listened to and to participate in the decisions that
affect them; this includes being given the necessary information to make
informed choices2.
2
Prevalence of Teenage conceptions
The 2011 Health Behaviour in School Aged Children study showed that in
Wales 38% of girls and 28% of boys aged 16 – 17 years reported having had
sex3.
Early initiation to sexual activity is associated with non-consensual and/or
regretted sex, lack of protection and a higher lifetime number of sexual
partners4.
Most teenage pregnancies are not planned and around 20% of under-18
conceptions are second pregnancies with half ending in abortion.
Teenage pregnancy is linked to health inequality and childhood poverty.
Evidence has shown that teenage pregnancy is related to poor maternal and
child health outcomes. It is associated with poor educational achievement,
poor physical and mental health, social isolation, poverty and related factors.
Children of teenage mothers are at risk of poor health, poor housing, low
educational attainment and lower rates of economic activity in adult life 5.
Sexual health and well-being action plan for Wales 2010-2015, Welsh Government, 2010
http://wales.gov.uk/topics/health/improvement/index/sexualhealth/?lang=en
2 Fact sheet: A summary of the rights under the Convention on the rights of the child, Unicef, (United
Nations Convention on the Rights of the Child (UNCRC),Articles 13,17 and 24)
http://www.unicef.org/crc/files/Rights_overview.pdf
3 Health Behaviour in School aged Children: initial findings from the 2009/10 survey in Wales, Welsh
Government, 2011, Welsh Assembly Government Social Research
4 Sexual Health A Public Health Perspective, Wellings et al., 2006, Open University Press
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Public Health Wales
Sexual Health, Baseline information
The UK has the highest rates of under 18 pregnancies in Western Europe.
During the period 2000 – 2005 there were 28 births per 1,000 women in the
UK compared to the lowest rates in Switzerland and the Netherlands of five per
1,000 women in the same age group.
Wales has a higher rate of teenage conceptions among under 18’s at 35.4 per
1,000 compared to England who have 30.5 per 1,000 (based on data for March
2012)6. Although overall, teenage conceptions have been falling in recent
years, the rate in the UK as a whole remains higher than a number of other
Western European countries including Spain, Belgium, Ireland, France and
Italy7.
Table 1 below shows that teenage conception rates in Conwy have fluctuated
during the period 2001 to 2010. In 2007 and 2008 the rate fell below that of
Wales and continued to fall over the following 2 years (although in 2010 the
rate was slightly higher than the Welsh average as there was a significant drop
in the Wales rate that year). Due to the small numbers involved, this level of
variation is not surprising.
Table 1: Conception rate per 1,000 females aged 15 to 17 years, Wales and Betsi
Cadwaladr University Health Board unitary authorities, 2001-20108
Wales
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
2001
2002
2003
2004
2005
2006
2007
2008
45.5
36.0
44.1
38.3
37.3
38.7
40.6
46.0
34.8
47.0
41.5
40.8
40.4
44.9
45.7
34.0
34.6
53.4
42.8
35.5
55.8
45.0
32.5
38.0
49.3
50.5
37.5
62.2
43.6
31.1
40.5
49.4
44.7
40.5
62.5
45.0
40.9
43.3
52.6
42.6
34.2
58.8
44.9
36.8
49.3
40.2
49.8
41.2
43.9
44.3
41.5
38.1
43.4
48.6
35.8
46.9
Rate per 1,000
2009 2010
40.1
46.8
42.6
41.0
43.6
32.3
44.2
37.7
34.0
33.7
38.7
35.2
37.8
42.8
Source: Office for National Statistics (ONS)
Table 2 below shows that teenage conception rates in females under 18 in
Conwy was lower in 2011 than in 2010 and was below that of north Wales.
Although the rate is lower than the north Wales average there is still scope to
reduce the rate further and as a result decrease potential negative health
consequences for young people in Conwy.
5
6
Teenage Pregnancy Strategy: Beyond 2010; Department of Health,2010
Office of National Statistics (ONS)
UNICEF Office of Research. Child well-being in rich countries. A comparative overview.
Innocenti Report Card 11. Florence:UNICEF Office of Research;2013. Available at:
http://www.unicef-irc.org/publications/pdf/rc11_eng.pdf
8
North Wales Health Profile; Jones C, Attenstat R,et al,2013, Public Health Wales
http://www.google.co.uk/search?hl=enGB&q=Conception+rate+per+1,000+females+aged+15+to+17+years,+Wales+and+Betsi+Ca
dwalader+University+Health+Board+unitary+authorities,+20012010&gbv=2&sa=X&as_q=&spell=1&ei=ikhxUtvyBMeBhAeY1YHoDg&ved=0CBgQBSgA
7
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Public Health Wales
Sexual Health, Baseline information
Table 2: Conceptions in females under 18 years, 2011 in Conwy compared to North
Wales
North Wales
Conwy
Number
441
70
Rate per 1000
36.2
34.2
Source: Wales Government (Stats Wales)
Table 3 below shows however that teenage conception rates in females under
16 in Conwy was higher in 2011 than that of north Wales highlighting an area
of concern.
Table 3: Conceptions in females under 16 years, 2011 in Conwy compared to North
Wales
North Wales
Conwy
Number
330
17
Rate per 1000
6.1
8.9
Source: Wales Government (Stats Wales)
At ward level within Conwy, there are five wards where conception rates per
1,000 females aged 15-17 years were statistically significantly higher than
Wales between 2005 -2010; Crwst, Glyn, Llysfaen, Mochdre, Pant-yrafon/Penmaenan9 (Appendix 1). Although this data highlights some potential
target areas, caution should be applied when considering health improvement
measures based on this information alone, due to the small number of
conceptions involved in this age group. An additional consideration is the
importance of ensuring that services/interventions are accessible to all young
people in the county.
The Office for National Statistics 2012 midyear population estimates for
England and Wales show 3,999 females in Conwy aged between 13-18 years.
Conwy Unitary Authority has the highest proportion of under 18 year olds in
north Wales (21.4%) compared with 21.0% in Wales as a whole10.
Table 4 below shows the number of young people in Conwy aged 13-18 years
by locality area.
Ward-level teenage conceptions in 2005-10 in Betsi Cadwaladr UHB; Hickey D, Arthur J,
Gartner A, 2012,Public Health Wales Observatory
10
Atenstaedt R. et al, Profile of North Wales, Public Health Wales
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Public Health Wales
Sexual Health, Baseline information
Table 4: Conwy population figures for 13 to 18 year olds by locality
Conwy West Locality
F
M
13
310
322
14
314
327
15
352
380
16
348
377
17
339
370
18
358
358
2021
2134
F
M
13
307
336
14
325
318
15
330
330
16
329
403
17
356
389
18
342
372
1989
2148
Total
Conwy East
Total
Total
4155
4137
8292
Source: Betsi Cadwaladr University Health Board (Exeter System)
2.1 Abortion Data
Table 5 shows that all abortion rates within North Wales are higher than the
Wales rate of 12.7 per 1,000 females under 18, with the exception of
Gwynedd.
In Conwy, the abortion rate is 13.2 per 1,000 females aged under 18.
Table 5: Number and crude rate of legal abortions by area of residence, females
under 18, 2012
Number and crude rate of legal abortions by area of residence, females
under 18, 2012
Local authority
Number
Crude rate per 1000 females1
Isle of Anglesey
15
13.2
Gwynedd
24
11.7
Conwy
27
13.2
Denbighshire
27
15.0
Flintshire
40
13.8
Wrexham
36
16.1
Wales
702
12.7
Produced by Public Health Wales Observatory, using Abortion Statistics (DoH)
1
Rates for under 18 are based on mid-2011 population estimates for 15-17 years.
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Sexual Health, Baseline information
Around half of conceptions to under 18 year olds in England and Wales (based
on 2011 data) led to a legal abortion. Over the last two decades this figure has
generally increased for all women aged under 20.11
Actions to reduce conceptions in females under 18 will serve to decrease
numbers of terminations and associated negative health consequences.
3
‘Best Practice’
NICE (2007) PH3 ‘Prevention of sexually transmitted infections and under 18
conceptions’12, sets out what needs to be done to prevent under 18
conceptions. The guidance focuses on one-to-one interventions that aim to
address the personal factors that influence an individual’s sexual behaviour.
Recommendations 1-5 focus on male and female behaviours. Recommendation
6 focuses on vulnerable young women under 18 years who are already
mothers. This guidance is particularly intended for health professionals trained
in sexual health, such as those who work in:
• General practice
• Genito-urinary medicine (GUM)
• Community health services (including community contraceptive services,
midwives, health visitors)
• Voluntary and community organisations
• School clinics
• Health Board commissioners
• Youth workers
• Pharmacies
NICE recommend a clear focus on those most at risk such as young people
from disadvantaged communities and ‘vulnerable’ young people who are at risk
of becoming teenage parents. This includes children in care, young people who
have low aspirations and are not in employment, education or training (NEET)
and children with poor attendance and low attainment at school. An emphasis
has been placed on a prevention methodology using one-to-one structured
advice and discussion. Early identification of pregnancy is crucial in providing
appropriate support.
NICE (2005) CG30 ‘Long Acting Reversible Contraception (LARC)’13, states that
increasing the uptake of LARC methods will reduce the numbers of unintended
McLaren E, Statistical Bulletin - Conceptions in England and Wales, 2011,Office for National
Statistics http://www.ons.gov.uk/ons/dcp171778_301080.pdf
12 National Institute for Health and Clinical Evidence (NICE), ‘One to one interventions to reduce the
transmission of sexually transmitted infections (STIs) including HIV, and to reduce the rate of under 18
conceptions, especially among vulnerable and at risk groups’, 2007. Available at:
http://www.nice.org.uk/nicemedia/live/11377/31899/31899.pdf
13 National Collaborating Centre for Women’s and Children’s Health commissioned by National
Institute for Health and Clinical Evidence (NICE), 2005 update 2013. ‘Long-acting reversible
11
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pregnancies improve services by giving women more choice and is more cost
effective. The guideline covers detailed best practice advice for all women
including those with specific issues such as HIV, those with learning or physical
disabilities and under 16s.
A review of available evidence to support NICE guidance identified that the
following characteristics contribute to providing effective sexual health services
for young people14:








Focusing on improving contraceptive use for both males and females and
at least one other behaviour likely to prevent pregnancy and/or STI
transmission, including interpersonal skills development – such as
negotiating and refusal skills
Long-term services and interventions, tailored to meet local needs of
young women and young men, with clear and unambiguous information
and messages
Making the most of opportunistic contacts with young people to provide
education and information
Ensuring that services are accessible to young people –in terms of
location, opening hours, disabled access etc.
Ensuring staff are appropriately trained and committed to the needs of
young people
Working with teenage ‘opinion leaders’ and peer group influences
Age appropriate services with education/information available before
young people become sexually active
Joining up services and interventions aimed at preventing pregnancy and
working in partnership with local communities.
NICE (2014) PH51 ‘Contraceptive services with a focus on young people up to
the age of 25’ 15is for NHS and other commissioners, managers and
practitioners who have a direct or indirect role in, and responsibility for,
contraceptive services This includes those working in local authorities,
education and the wider public, private, voluntary and community sectors. It
may also be of interest to young people, their parents and carers and other
members of the public.
NICE says that young men and women should be given advice and information
on all types of contraception to help them choose the best method for their
contraception - the effective and appropriate use of long-acting and reversible contraception’.
Available at: http://www.nice.org.uk/nicemedia/live/10974/29912/29912.pdf
14
Update on review of reviews on teenage pregnancy and parenthood - submitted as an addendum to the first evidence
briefing 2003; Trivedi D, Bunn F, Graham M, Wentz R, 2007, University of Hertfordshire
http://www.nice.org.uk/nicemedia/pdf/TeenagePregnancyUpdateReviewFeb08.pdf
NICE (2014) PH51 ‘Contraceptive services with a focus on young people up to the age of
25’. Available at: http://guidance.nice.org.uk/PH51/Guidance/pdf/English
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needs and lifestyle. This makes it more likely that contraception will be used
effectively.
The recommendations emphasise the need to offer additional tailored support
to meet the particular needs and choices of those who are socially
disadvantaged or who may find it difficult to use contraceptive services.
The 12 recommendations include advice on:






How to asses local need and commission comprehensive services
Offering culturally appropriate, confidential, non-judgemental, empathic
advice tailored to the needs of the young person
Ensuring young people understand that their personal information and
the reason why they are using the service will be kept confidential
Providing contraceptive services after pregnancy and abortion
Encouraging young people to use condoms as well as other forms of
contraception
How schools and other settings can provide contraceptive services
The correlation between sexual activity and use of legal and illegal substances
cannot be overlooked. Alcohol was identified as the main reason for first sexual
experiences for 20% of young men and 13% of young women aged 14-20
years.16 The 10 year Substance Misuse Strategy for Wales, 2008 - 2018
‘Working Together to Reduce Harm’17 contains an action to link the prevention
of alcohol misuse with sexual health. Alcohol Concern Cymru has expressed
serious concern about the link between drinking alcohol before sexual activity
and not using contraception. Conwy & Denbighshire substance misuse action
team have commissioned a children & young people’s substance misuse
service delivered by Barnardos Cymru.
4
Sexual Health Targets
There are no specific targets to reduce teenage pregnancy in Wales; however it
is one of the ten priority areas identified in Our Healthy Future18.
The Wales wide ‘Empower to Choose’ Project led by Public Health Wales, aims
to reduce the overall teenage conception rate by 10%, assuming a sustained
50% reduction in repeat teenage conceptions as a result of promoting the
uptake of LARC methods19.
Factsheet-Young People and Alcohol ; Alcohol Concern, 2011
Working Together to Reduce Harm; Welsh Assembly Government,2008
http://wales.gov.uk/dsjlg/publications/commmunitysafety/strategy/plane.pdf;jsessionid=07F2F1E135077
B50D77DAF201BFFC1A3?lang=en
16
17
Our Healthy Future; Welsh Assembly Government,2009
http://wales.gov.uk/topics/health/cmo/healthy/?lang=en
19
Empower to Choose; Public Health Wales, 2012
http://www.wales.nhs.uk/sitesplus/888/page/59785
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5
Sexual Health, Baseline information
Current services contributing to the reduction of
Teenage pregnancy in Conwy
Please note: All services are subject to change – the information below is
correct at time of writing.
5.1 Sexual Health Clinics
There are 2 sexual health clinics in Conwy that operate in Colwyn Bay Hospital
on Tuesday from 9.30 a.m. – 7.00 p.m. and Llandudno Hospital on Thursdays
from 1.30 – 3.30 pm (Appendix 2). In addition Ysbyty Gwynedd and Ysbyty
Glan Clwyd District General Hospitals also operate sexual health clinics that are
open to all residents across North Wales although accessing these would most
certainly be an issue for young people living in Conwy in terms of transport
(see Appendix 1 for operating details). They all offer a full range of sexual
health services including testing for sexually transmitted infections (including
HIV test), all methods of contraceptives including EHC, pregnancy testing,
Hepatitis B vaccinations, advice, support, unplanned pregnancy counselling
and referrals for termination of pregnancy and sexual assault. Verbal
information is supported by written literature purchased from the Family
Planning Association. Welsh Government has produced bi-lingual information
on LARCS but it is not clear how widely these are being used. This service is
provided for both males and females of all ages.
There is evidence that overall across Wales the number of under 16 year olds
attending NHS community clinics has fallen considerably. A recent report by
Welsh Government on NHS Community Contraceptive Services in Wales 201213 shows that attendances in this age group have dropped by 40 % since
2002/3. More than half of men attending clinics were under 20 years old20.
5.2 Empower to Choose
The 'Empower to Choose Project' is a Wales wide intervention to reduce repeat
teenage conceptions by encouraging the uptake of long acting reversible
contraception (LARC). The focus is on preventing unplanned second
pregnancies for young women under 18, by providing access to contraceptive
advice, support and follow-up as part of their care at the end of their first
pregnancy.
Health professionals in Conwy who are involved in the care of teenagers who
have become pregnant on or before their 18th birthday have been sent
information to implement the training locally. The lead for this project in north
Wales is currently being reviewed within BCUHB.
NHS Community Contraceptive Services in Wales, 2012-13, Knowledge and Analytical
Services: Welsh Government, November 2013
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A report has been published on the Empower to Choose uptake and outcome
figures across Wales between 1st April 2012 and 30th September 2013; figures
are available for the BCUHB area.21
The Empower to Choose programme is being delivered to 67% of recently
pregnant teenagers in north Wales for whom forms were returned (up from
29% mid 2012).
Betsi Cadwaladr University Health Board provided returns for 275 out of an
expected 662 under18 pregnancies in the last 18 months. This was the largest
number of returns in Wales numerically but, at a rate of 41% indicates room
for improvement. A return rate of 100% should be aimed for.
10% of BCUHB’s recorded teenage pregnancies are in the looked after young
women or those with previous engagement with looked after children (LAC)
teams. This has long been suspected but is the first time that the
disproportionate vulnerability of looked after children to early pregnancy has
been quantified. These figures highlight the need for targeted work with
‘Looked After’ children and young people both in terms of ensuring they
receive SRE and that they have easy access to sexual health services.
5.2 C-Card (Condom Distribution) Scheme
The C-Card Scheme offers a service to young people aged 13-25 years from an
appropriately competent person who has been trained using nationally agreed
standards. It offers free confidential sexual health advice and free condoms to
young people who sign up to the scheme.
There are currently three C-Card outlets in Conwy (Appendix 3). They operate
from Coleg Llandrillo, Rhos-on-Sea, Communities and Bay Learning Centre and
Llandudno Hospital Minor Injuries Unit (MIU).
In addition the following
organisations run the C-Card scheme solely for their own service users –
Conwy Youth Justice Service and The Bell Hotel Homeless Hostel.
Table 6 below shows the number of times the C-Card scheme was accessed
overall by young people in Conwy during the period April 2013 to November
2013 by gender and age.
The scheme was used by young people between the ages of 16 – 25 indicating
that these figures relate to attendees of Llandrillo Menai Group. The figures
show that condoms were distributed to more males (59%) than females
(41%). The table does not however take into account that the same individuals
21
Empower to Choose Uptake of Long Acting Reversible Contraception in Pregnant Teenagers,
April 2012 to September 2013:Public Health Wales available
at:http://www.shnwales.org.uk/Documents/485/Empower%20to%20Choose%20April%20201
2-September%202013.pdf
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could be using the service more than once. A total of 3002 condoms were
issued between April 2013 and February 2014, however as condoms are issued
according to age and assessed need it does not show how many condoms are
being obtained by each individual.
Table 6: C-Card Scheme Overall Data – 2013 - 14
Month
Male
Female
Age 13
Age 14
Age 15
Age 16
Age
17-25
April
May
June
July
August
September
October
November
December
January
February
March
Total
TOTAL
2
19
22
0
0
37
9
35
8
9
1
0
141
8
13
8
0
0
7
15
23
3
17
4
0
98
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
0
6
4
19
3
19
9
0
64
9
31
28
0
0
38
20
39
16
37
22
0
240
0
Total No.
Condoms
issued
100
290
412
0
0
336
310
532
210
512
300
3002
239
Table 6 also shows that the highest numbers of condoms were distributed in
November and January. There were no condoms distributed during July and
August when the college is closed and the lowest numbers of condoms were
distributed during April and December again, coinciding with Easter and
Christmas holiday periods. It is not known if young people access condoms
outside of the college setting and if so where.
Table 7 below indicates the number of New Users to the Scheme (New Cards
Issued) and young people who have returned to use the scheme each month.
However, the same individual could be issued with more than one card during
this period. For example, their original card may have been lost and a
replacement issued. The table shows that 74% of new users return to access
condoms more than once. The highest numbers of cards issued are in
September and November; they fall during April and June.
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Sexual Health, Baseline information
Table 7: Numbers of new C-Cards issued to users of Conwy C-Card Scheme and
numbers of young people returning to use the scheme using their existing C-Card
April 2013-February 2014
Month
April
May
June
July
August
September
October
November
December
January
February
March
Total
New cards
Issued
5
19
8
0
0
41
18
39
11
11
11
0
163
Returners
4
22
22
0
0
2
10
19
8
14
20
0
121
Table 8 below shows the number of new users to the C-Card Scheme, by
gender. It shows that almost twice as many new cards (67%) were issued to
males than females (33%). The highest numbers were during September when
college re-opens following the summer holiday and new students are engaging
with college services. The data available currently suggests that Llandrillo
Menai Group is the main provider of the C-card scheme in Conwy.
Table 8: New C-Card Scheme cards issued between April 2013 and February 2014
Male and Female
New Cards Issued
each month
Male
Female
Total
April
May
June
July
August
September
October
November
December
January
February
March
Total
8
8
6
0
0
35
9
26
11
5
11
0
119
11
11
2
0
0
6
9
13
0
6
0
0
58
19
19
8
0
0
41
18
39
11
11
11
0
177
An accreditation system has been introduced in Wales to accompany the
standards for the delivery of C-Card schemes. In addition, a national data base
is available for monitoring, generating reports and keeping on line records of
all interactions with young people. These developments are designed to
increase accessibility and availability of condoms for young people and to
ensure that a consistent service is provided for all young people in Wales.
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The Llandrillo Menai Group who operate the C-Card scheme at their Rhos-on
Sea site in Conwy were the first group in North Wales and the sixth group in all
Wales to receive accreditation to the National C-Card Standards on 3rd March
2014. They are the only FE College to be treated as an individual scheme.
5.3 General Practice Service Provision – Conwy
A recent mapping exercise of GP practice sexual health services was
undertaken by Public Health Wales in Conwy. There were 10 replies to a
questionnaire out of a possible 25. It found that the contraceptive pill, mini pill
and Depo-Provera injection are available in all GP practices that replied.
However, not all GP practices provide long acting reversible contraception
(LARCS). NICE include copper intrauterine devices (non hormonal) and three
progestogen-only methods of contraception (intrauterine system, injectables
and the implants) in the category of LARC. NICE recommendations state that
IUDs can be used by adolescents.
Accreditation is required to fit and remove LARC devices. Of the 10 GP
practices who replied to the questionnaire, four (40%) had at least one GP
accredited to fit and remove subdermal implants and seven (70%) had at least
one GP accredited to fit and remove intrauterine devices. One of the
respondents (10%) in Conwy had at least one practice nurse accredited to
remove LARCs and Intrauterine devices. Although it is acknowledged that only
40% of GP practices replied to the questionnaire in Conwy, these figures would
indicate that training for accreditation among GPs and practice nurses to fit
and remove LARCs would increase accessibility.
The questionnaire asked if patients are referred out of practice for LARCS in
some circumstances. Three practices (30%) did not refer patients elsewhere
for LARCs, however six GP practices (60%) referred patients on to Family
Planning clinics, Colwyn Bay Hospital and Ysbyty Glan Clwyd. The latter is out
of county and as previously mentioned would have implications for young
people with regard to access in terms of travel to and from the hospital.
Information provided indicated that there are no sexual health clinics located in
GP practices specifically targeted at young people. Young people are rarely
involved in service development and very few GP practices include the specific
needs of young people in their staff training programme. Eight out of ten
(80%) practices supply condoms to young people; however it is not clear how
this is funded. Emergency Hormonal Contraception (EHC) is prescribed in six of
the ten practices (60%) who replied to the questionnaire in Conwy.
It should be noted that sexual health service provision for young people in GP
practice is accessible only by appointment during surgery opening hours
Monday to Friday.
Date: 17/4/2014
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5.4 Emergency Hormonal Contraception (EHC)
The EHC service is provided in 25 of the 28 community pharmacy premises in
Conwy (Appendix 4). Known as ‘the morning after pill’, it is normally provided
up to 72 hours (3 days) after sexual intercourse, however accredited
pharmacists have discretion to provide it up to 96 hours (4 days) after sexual
intercourse if the client cannot attend a clinic for alternative treatment.
It can be provided free of charge to young people from the age of 13 who are
considered ‘Fraser competent’.22Levonelle EHC is prescribed under a nationally
agreed patient group direction (PGD) (Appendix 5). Support and advice should
be provided including advice on the avoidance of pregnancy, sexually
transmitted infections (STIs) and advice on regular contraceptive methods.
Where an accredited pharmacist is unavailable, individuals should be
signposted to other appropriate services including their GP or they can
purchase EHC at a cost of at least £25.
Llandudno General Hospital minor injuries unit (MIU) provide access to EHC for
females of all ages during opening hours 8.00a.m. – 10.00p.m.The service was
established as a direct result of the work undertaken by the Team ManagerHealth Visiting and School Nursing-Conwy on behalf of the Conwy West
Locality Leadership team following the identification of a gap in service
provision for young people in their area. Currently there is no data available as
this is a new service.
5.5 Drop-In Clinics
There is a named school nurse in all seven secondary schools in Conwy. As
part of their role a generic drop-in service is available for pupils to access
support on any health issues including sexual health. Five of the seven
secondary schools have agreed for school nurses to extend their role to include
the provision of the C-Card Scheme, EHC (Levonelle) and pregnancy testing as
appropriate. At time of writing, meetings are scheduled with school governors
of the remaining two schools to discuss the possibility of providing the same
service.
All school nurses in Conwy are accredited under the terms of the national PGD
to provide EHC (Levonelle) to young people.
Wrexham, Denbighshire, Gwynedd and Anglesey Local Authorities also work in
partnership with the School Nursing Service to deliver EHC (Levonelle), C-Card
scheme and pregnancy testing at drop-in clinics on school premises.
Llandudno General Hospital minor injuries unit (MIU) also provide a drop-in
service that young people can access outside of school hours between 8.00 am
22
http://www.nspcc.org.uk/inform/research/questions/gillick_wda61289.html
Date: 17/4/2014
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and 10.00 pm as previously mentioned. The service includes the provision of a
C-Card scheme, EHC and pregnancy testing.
6
Location of services in Conwy
The map below shows the location of the following services that contribute to
reducing teenage pregnancy in Conwy:





Pharmacies providing EHC
C-card outlets
Sexual health clinics
Drop-in facility
School drop-n facility
Date: 17/4/2014
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Sexual Health, Baseline information
It shows these in the context of the Welsh Index of Multiple Deprivation
(WIMD) profile as the evidence recommends a clear focus on those most at
risk of teenage pregnancy such as young people from disadvantaged
communities. Fourteen per cent of Conwy’s local areas are in the 10% most
deprived in Wales. These are Llysfaen 1, Abergele Pensarn, Tudno 2 and Glyn
Date: 17/4/2014
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2. In 2011, Conwy had the highest percentage of people living in the most
deprived 20% of lower super output areas (LSOAs)
In Conwy, the areas of deprivation are located mainly along the north Wales
coast it is also important to consider the issue of rurality when considering the
impacts of deprivation; people living in rural areas can be vulnerable to
particular types of poverty such as poverty of participation and access to
services.
In summary therefore, the majority of pharmacies providing EHC are located in
north Conwy mainly in the most populated towns. There are two BCUHB clinics
in the north of Conwy located in Colwyn Bay and Llandudno. Young people
living in the most populated areas of Conwy will have better access to services
than those living in rural communities. Further mapping would identify any
gaps in service provision for young people living in these communities.
7
Discussion
During the period 2001-2010, the conception rate in Conwy per 1,000 females aged 16 –
17 years fluctuated from 38.3 in 2001 to 38.7 in 2010. Teenage conception rates in
females under 16 in Conwy was higher in 2011 than that of north Wales
highlighting an area of concern.
The data shows that although overall conception rates in Conwy are currently
lower than Wales they are still higher than England and Western European
rates; there is therefore scope to reduce these rates further especially among
those under 16 years of age.
Teenage pregnancy is related to poor maternal and child health outcomes
leading to other issues associated with poverty. Twenty per cent of under 18
conceptions lead to a second pregnancy with half of those likely to result in a
termination. Services should therefore be targeted at young people from
disadvantaged communities who are most at risk of becoming teenage
parents. Further exploration is required about how well services are meeting
the needs of young people living in rural areas.
Evidence suggests that increasing the uptake of LARC methods will reduce
numbers of unintended pregnancies. Young people are able to access sexual
health support from their own GP however only a small number of GPs and
even fewer practice nurses are accredited to fit and remove LARCs. Discussion
regarding the possibility of increasing provision of training for primary care
staff to fit and remove LARCs may provide a solution to developing more
appropriate sexual health service provision for young people in GP practices.
The two sexual health clinics in Colwyn Bay Hospital on Tuesday 9.30 am -7.00
pm and Ysbyty Llandudno on Thursday 1.30 pm – 3.30 pm are core funded,
long term and staff are appropriately trained. However, they are not
Date: 17/4/2014
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geographically accessible to all young people who live in the county. Overall in
Wales, numbers of young people under 16 using sexual health clinics have
declined. Young people should be seen as equal partners in developing sexual
health services and their views should be sought to determine the way forward
in developing appropriate sexual health services in Conwy.
Young people aged 13 and over are able to access free Emergency Hormonal
Contraception from 25 pharmacies in Conwy. This provides a substantial level
of local access to young people as long as an accredited pharmacist is on site
at the time of visit. If not they may be asked to pay at least £25 for the
product and thus put it out of reach of many. The national Patient Group
Direction (PGD) for pharmacy EHC contains clear referral procedures to sexual
health clinics or GPs, however these may not be available at the time the
young person is requesting help. There are also potential issues related to
pharmacy counter staff having received appropriate training to implement this
guidance. Further discussion is required to strengthen this service in meeting
the needs of young people in the absence of an accredited pharmacist.
Sexual activity among teenagers is often unplanned and therefore the need for
emergency contraception may be outside clinic times or pharmacy opening
hours. The minor injury clinic in Llandudno is providing an extension to EHC
and condom provision until 10.00 p.m. 7 days a week. This service is relatively
new and therefore data is not currently available to establish the level of
access to the service by young people.
All school nurses within Conwy are accredited under the terms of the national
PGD to provide EHC to young people. All Conwy Secondary schools have
agreed in principal to the provision of sexual health services for young people
within health drop in clinics on school premises. The School nursing service has
secured funding from the Well Being activity grant for 2013-14 for teenage
pregnancy testing kits to be used within the school setting; this will be
evaluated to inform a North Wales approach.
The C-Card scheme has a limited number of outlets within Conwy apart from
Llandrillo Menai Group, therefore an opportunity exists for the scheme to be
expanded and made more widely available particularly outside of college
opening times. There is scope to explore how these services could be
developed by consulting with young people locally and initiating discussion with
key partners including local authority, leisure centres, primary care providers
and MIUs.
In gathering the information in this report, it has become evident that
improved communication relating to sexual health services for young people
among service providers in the county would reduce uncertainty about what is
currently available. Information about services and any changes to delivery
needs to be updated frequently therefore discussion with key partners about
how this could be coordinated and communicated appropriately is required.
Date: 17/4/2014
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Alcohol has been identified as one of the main contributing factors for first
sexual experience and serious concern has been expressed about the link
between drinking alcohol and lack of contraception use. Links should be
established with local children and young people’s substance misuse services
to explore solutions to issues of rurality and access to contraception services.
8
Recommendations
Locality Group Actions
1. Explore how EHC and condom provision can be extended within GP
practices
2. Increase training opportunities for GPs and Practice Nurses to fit/remove
LARCs
3. Monitor and evaluate the EHC and C-Card provision provided at
Llandudno General Hospital Minor Injuries Unit to inform current and
future development
4. Produce and disseminate a briefing for community hospital staff to
ensure that staff at all levels are aware of the EHC provision and correct
procedures for signposting to the service
Health Board Actions
1. Consult with young people in Conwy to ensure that services are provided
at a time and place that is accessible to all young people in the county
particularly those in rural areas, and that information about the location
of services is communicated appropriately
2. Improve young people’s access to NHS sexual health clinics in Conwy by
ensuring that the service is adequately and appropriately advertised to
young people and explore the reasons why numbers of young people
using the service have fallen in recent years
3. Ensure that all EHC participating pharmacists are displaying signs, have
received appropriate training and are providing relevant and up to date
information/referral where appropriate to young people accessing the
service
4. A monitoring and evaluation system should be agreed and put in place
with regard to sexual health services provided by schools nurses with
health drop in clinics on school premises ; this can be used alongside
Date: 17/4/2014
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Sexual Health, Baseline information
evaluation from the Well Being activity grant for 2013-4 for teenage
pregnancy testing kits to inform future development of this approach
5. Improve current monitoring systems of the C Card scheme using the all
Wales data base with a view to contributing to the achievement of
accreditation in north Wales
Local Authority
6. Make sure that sexual health information for young people in Conwy is
up to date by checking local young people’s websites and other
information
providers
(e.g.
Family
Information
Service)
and
strengthening communication systems, consider how social media can be
used as a way of reaching out to young people
7. Explore opportunistic methods of addressing alcohol use during contacts
made with young people on matters related to sexual health. For
example, links should be established with the children and young
people’s substance misuse services (provided by Barnardos Cymru) to
ensure that alcohol and sexual health are linked when addressed with
young people.
8. To support the achievement of the tackling poverty indicator to reduce
‘teenage conceptions’, ensure the Conwy Building Resilient Communities
& Tackling Poverty board and Core aim 7 are aware of the Conwy Sexual
Health Group and seek opportunities within relevant programmes (e.g.
Communities First, Families First and Flying Start) to ensure early
intervention and support for young people most at risk of pregnancy,
targeting in particular those under the age of 16 and ‘looked after’
children.
9. Target sex and relationships education and sexual health advice
(including the use of LARCs) at the ‘at risk’ groups, such as NEETs,
young people excluded from school, children in and leaving care, young
people under the age of 16 and those in supported housing.
10.
Expand the scope of the C-Card scheme in Conwy in consultation
with young people and consider options to improve access to the C-Card
scheme for young people during school/college holiday periods
Date: 17/4/2014
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Page 20 of 41
Gw ynedd
00NCSP
Porthmadog-Tremadog
Gw ynedd
00NCSQ
Pw llheli North
00NCSR
Pw llheli South
Gw ynedd
00NCST
Seiont
Gw ynedd
00NCSU
Talysarn
-
Teigl
-
Gw ynedd
00NCSX
Traw sfynydd
-
Public
Health Wales
Gw ynedd
APPENDIX
1 00NCSW
Gw ynedd
Sexual Health, Baseline information
-
No sig. difference
Gw
ynedd
00NCSY
Tregarth
& Mynydd
Llandygai wards in Betsi
Conceptions
in females
aged under
18 years,
2005-2010,
Cadwaladr
University
Health Board,
statistical significance of rates per 1,000
Gw
ynedd
00NCSZ
Tudw eiliog
females
compared
Gw
ynedd (aged 15-17)*
00NCTA
Tywto
yn Wales
No sig. difference
Gw ynedd
00NCTB
Waunfaw r
Local Authority
Ward Code Ward Name
Isle of Anglesey
00NAMA
Aberffraw
Isle of Anglesey
00NAMB
Amlw ch Port
Isle of Anglesey
00NAMC
Amlw ch Rural
Isle of Anglesey
00NAMD
Beaumaris
Conw
Isle ofyAnglesey
00NENY
00NAMF
Caerhun
Bodorgan
Conw
Isle ofyAnglesey
00NENZ
00NAMG
Capelulo
Braint
Conw
Isle ofyAnglesey
00NEPA
00NAMH
Colw ynran
Bryngw
Isle ofyAnglesey
Conw
00NAMJ
00NEPB
Brynteg
Conw y
Isle ofyAnglesey
Conw
00NAMK
00NEPC
Cadnant
Craig-y-Don
Isle ofyAnglesey
Conw
00NAML
00NEPD
Cefni
Crw st
Isle of Anglesey
00NAMM
Cw m Cadnant
Isle of Anglesey
00NAMN
Cyngar
Isle of Anglesey
00NAMP
Gw yngyll
Isle of Anglesey
00NAMQ
Holyhead Tow n
Isle of Anglesey
00NAMR
Kingsland
00NAMS
Llanbadrig
Isle ofyAnglesey
Conw
00NAMU
00NEPL
Llanddyfnan
Gow er
Isle ofyAnglesey
Conw
00NAMW
00NEPM
Llaneilian
Kinmel Bay
Isle of Anglesey
Conw y
00NAMX
Llanfaethlu
Conw y
Isle of Anglesey
00NAMY
Llanfair-yn-Neubw ll
Isle of Anglesey
00NEPP
00NAMZ
Llanfihangel Ysgeifiog
Isle of Anglesey
00NANA
Llangoed
Isle of Anglesey
00NANB
Llanidan
Conw
Isle ofyAnglesey
00NEPT
00NAND
Llysfaen
London
Road
Conw
Isle ofyAnglesey
00NEPU
00NANE
Marl
Maeshyfryd
Isle ofyAnglesey
Conw
00NANF
00NEPW
Mechell
Mochdre
Isle ofyAnglesey
Conw
00NANG
00NEPX
Moelfre
Mostyn
Isle ofyAnglesey
Conw
00NANH
00NEPY
Moraw
Pandyelon
Isle of Anglesey
Conw
y
Gw ynedd
Conw y
Conw y
Conw y
Conw
Isle ofyAnglesey
Conw y
Conw y
Conw y
Conw y
Conw
y
Isle of Anglesey
Conw
Isle
ofyAnglesey
continued
Conw y
Conw y
Conw
Isle ofyAnglesey
00NCTC
00NENT
00NENU
00NENW
00NENX
00NAME
00NEPE
00NEPF
00NEPG
00NEPH
00NEPJ
00NEPK
00NAMT
00NEPN
00NEPQ
00NEPR
00NEPS
00NANC
Y Felinheli
Abergele Pensarn
Betw s-y-Coed
Betw s yn Rhos
Bryn
Bodffordd
Deganw y
Eglw ysbach
Eirias
Gele
Glyn
Gogarth
Llanbedrgoch
Llanddulas
Llandrillo yn Rhos
Llangernyw
Llansanffraid
Llansannan
Llannerch-y-medd
00NANJ
Parc a'r Mynydd
Isle of Anglesey
00NANK
Pentraeth
Isle of Anglesey
00NANL
Porthyfelin
Isle of Anglesey
00NANM
Rhosneigr
Isle of Anglesey
00NANN
Rhosyr
Conw
Isle ofyAnglesey
00NEQE
00NANQ
Tow yn
Tudur
Conw
Isle ofyAnglesey
00NEQF
00NANR
Trefriw
Tysilio
Isle ofyAnglesey
Conw
00NANS
00NEQG
Valley
Tudno
Conw y
Conw y
Conw y
Conw
Isle ofyAnglesey
00NEPZ
00NEQA
00NEQB
00NEQC
00NEQD
00NANP
Pant-yr-afon/Penmaenan
Penrhyn
Pensarn
Pentre Maw r
Rhiw
Trearddur
Stat. significance compared to Wales
-
Sig. high
--No sig. difference
No sig. difference
No sig. difference
No sig. difference
Sig. high
-No sig. difference
No sig. difference
No sig. difference
Sig. high
--No sig. difference
-No sig. difference
--Sig. high
No sig. difference
Sig. high
Sig. high
No sig. difference
No sig. difference Sig. high
No sig. difference
No sig. difference
No sig. difference
No sig. difference
No sig. difference
No sig. difference
--No sig. difference
Conw y
00NEQH
Uw ch Conw y
Conw y
00NEQJ
Uw chaled
Denbighshire
00NGNK
Bodelw yddan
No sig. difference
Denbighshire
00NGNL
Corw en
No sig. difference
00NGNM
Page
21
No sig. difference of 41
Denbighshire
Date:
17/4/2014
Denbighshire
-
00NGNN
Denbigh Central
DenbighVersion:Final
Low er
Denbighshire
00NGNP
Denbigh Upper/Henllan
No sig. difference
Denbighshire
00NGNQ
Dyserth
No sig. difference
Public Health Wales
Sexual Health, Baseline information
Notes:
These data need to be interpreted with extreme caution due to small numbers and population
sizes, and variation in population between wards (electoral divisions). The ONS have
suppressed data where counts were fewer than 5 in either of the three-year periods available.
For more robust analysis six years of data have been combined.
Rates and numbers of conceptions are subject to strict conditions of supply by ONS and cannot
be shared outside of Public Health Wales or reproduced in documents/via the internet. The
information in this document has specifically been prepared in a format that can be shared
with external partners.
Date: 17/4/2014
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APPENDIX 2
Sexual Health Clinics - Conwy
Drop in Clinics
Address
Day
Time
Colwyn Bay Hospital
Hesketh Road,
Colwyn Bay, LL29 8AY
(01492) 515218
Tuesday
9.30am – 7.00pm
Llandudno General
Hospital
Clinic B
Hospital Road
Llandudno
Wales
LL30 1LB
(01248) 384054
Thursday
1.30pm – 3.30pm
Ysbyty Gwynedd
Bangor
Penrhos Road,
Bangor.
LL57 2PW. (01248)
385385
Monday and
Wednesday
1.30pm - 4.30pm
Glan Clwyd Hospital
Block 13,
Sexual Health Clinic,
LL18 5UJ
(01745) 534455
Thursday
9.30am – 12.00noon
Glan Clwyd Hospital
Block 13,
Sexual Health Clinic,
LL18 5UJ
(01745) 534455
Friday
9.30am – 12.00noon
Date: 17/4/2014
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APPENDIX 3
C card registration and outlets – Conwy
The following information regarding C-Card Scheme distribution points in
Conwy is available from the Public Health Wales website at:
http://www.wales.nhs.uk/sitesplus/888/page/59781
REGISTRATION
& OUTLET
Coleg Llandrillo
Communities &
Bay Learning
Centre
Date: 17/4/2014
CONTACT NAME
ADDRESS
Gemma Foulkes
Tamlyn Cassidy
Julie Preston
Cara Williams
Suzane Hudson
Kelsey Norkett
Coleg Llandrillo
Cymru, Rhos,
Llandudno
Road,
Rhos-on-Sea,
LL28 4HZ
OPENING
TIMES
Registration &
Outlet
Mon 10.00 11.00am
Thurs 12.301.30pm
47 Conwy
Road,,
Colwyn Bay,
LL29 7AW
Term Times
only
Student
Services
Registration &
Outlet
Student
Services
Mike Thomas
Gemma Foulkes
Version:Final
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APPENDIX 4
1
Community Pharmacy
Conwy Boots UK Limited
2
R Hughes & J H Jones Ltd
3
Lloyds Pharmacy Ltd
4
Lloyds Pharmacy Ltd
5
Pathvalley Limited
6
Boots UK Limited
7
WM Morrison Supermarkets Plc
8
Superdrug Stores Plc
Superdrug Pharmacy 76 Mostyn Street Llandudno
LL30 2SB 01492 874153
9
Mrs AD Swettenham
10
Conwy Boots UK Limited
11
Conwy Boots UK Limited
Swettenham Chemists Craig Y Don Medical Centre
Clarence Road Craig y Don Llandudno LL30 1TA 01492
876562
Boots Pharmacy 20 Rhos Road Rhos on Sea Conwy
LL28 4PP 01492 546220
Boots UK Limited 34 Station Road Colwyn Bay Conwy
LL29 8BU 01492 532392
12
Lloyds Pharmacy Ltd
Lloyds Pharmacy Ground Floor Premises Broadway
Buildings Mostyn Broadway Llandudno LL30 2NL
01492 877040
13
Conwy Asda Stores Ltd
14
Conwy Boots UK Ltd
Asda Pharmacy Asda Superstore Mostyn Broadway
Conwy Road Llandudno LL30 1PJ 01492 864310
Boots Pharmacy Kinmel Avenue Abergele LL22 7LW
01745 832135
15
L Rowland & Co (Retail) Ltd
Rowlands Pharmacy 12 Castle Street Conwy LL32 8AY
01492 592453
16
L Rowland & Co (Retail) Ltd
17
L Rowland & Co(Retail) Ltd
18
L Rowland & Co(Retail) Ltd
19
Conwy Vittoria Healthcare Ltd
20
Conwy Boots UK Limited
21
Conwy Boots UK Limited
Rowlands Pharmacy 7-9 Rhos Road Rhos on Sea
Colwyn Bay Conwy LL28 4PP 01492 547814
Rowlands Pharmacy Castle Pharmacy 113 Station
Road Deganwy Conwy LL31 9EJ 01492 583431
Conwy Rowlands Pharmacy 24 High Street Conwy
LL32 8DE 01492 592418
Conwy
Old Colwyn Pharmacy 397 Abergele Road Old Colwyn
Colwyn Bay Conwy LL29 9PP 01492 516415
Your Local Boots Pharmacy Denbigh Street Llanrwst
Conwy LL26 0LL 01492 640620
Your Local Boots Pharmacy Plas Menai Medical Centre
Penmaenmawr Road Llanfairfechan Conwy LL33 0NY
01248 680623
Date: 17/4/2014
Address
2 Llandudno Road Penrhyn Bay Llandudno Conwy LL30
3HA 01492 549261
Gwynan Edwards Medical Hall Penmaenmawr LL34
6BY 01492 622341
Lloyds Pharmacy The Pharmacy Towyn Road Towyn
LL22 9EP 01745 342001
Lloyds Pharmacy St Asaph Avenue Kinmel Bay Rhyl
LL18 5EE 01745 342178
Cohens Chemists 54-56 Conwy Road Colwyn Bay LL29
7LD 01492 530298
17 Queens Road Craig y Don Llandudno Conwy LL30
1AZ 01492 877029
Pharmacy Seaview Road Colwyn Bay LL29 8DG 01492
534313
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22
Conwy Boots UK Limited
23
Conwy Boots UK Limited
24
Conwy Boots UK Limited
Alliance Pharmacy 9 Victoria Centre Mostyn Street
Llandudno Conwy LL30 2NG 01492 876633
25
Conwy Boots UK Limited
Boots UK Ltd Unit 3 Parc Llandudno Conwy Road
Llandudno Conwy LL30 1PJ 01492 872157
Date: 17/4/2014
Your Local Boots Pharmacy 68 Foryd Road Kinmel Bay
Conwy LL18 5AU 01745 337614
Your Local Boots Pharmacy 9 Bodelwyddan Avenue Old
Colwyn Colwyn Bay Conwy LL29 9NW 01492 515372
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Appendix 5
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