Emergency Contraception for young people : How to make it safe ?

1. Emergency Contraception for young people : How to make it safe ? E. Aubény French Association for Contraception Broussais Hospital Paris 75014 Dr. E. AUBENY - AFC, Paris

2. Emergency Contraception for young people How to make it safe ? Stastistics show - In European countries the average age of first sexual intercourse is 16 years old - In developping countries often it is earlier It is a fact : adolescents are sexuallyactive Society has to handle itand to help adolescents toprotect againstunwanted pregnancies and ISD Dr. E. AUBENY - AFC, Paris

3. Emergency Contraception for young people How to make it safe ? Adolescence is the age of - Crushes - Living in the present time - Intermittent intercourse - Intercourse under more or less pressure >Unexpected, unprotected sex happens This underlines the importance of post-sex contraception : emergency contraception (EC) Dr. E. AUBENY - AFC, Paris

4. Emergency Contraception for young peopleHow to make it safe ? At adolescence whensexual activity starts - The beliefs concerning contraception are not always accurate: that conception only occurs on the 14th day of the cycle, there is no risk the first time, etc.. - Problems can arise with contraceptive methods - difficulties in using condoms correctly - contraceptive pills forgotten This underlines the importanceof post-sexcontraception : emergency contraception (EC) Dr. E. AUBENY - AFC, Paris

5. Emergency Contraception for young people How to make it safe ? If emergency contraception is so important for young people, to be used effectively it should be easily and rapidly accessible How to make it very easily accessible in a safe way ? Dr. E. AUBENY - AFC, Paris

6. Emergency Contraception for young people How to make it safe ? Propositions for easy and safe accessibility 1)Preventive information and prescription should be offered when contraceptive advice is being given, especially for condom and pill users • There should be no more frequent use of EC*as a means of birth control • The young people should notabandon regularcontraception* *A.Glasier study U.K. Dr. E. AUBENY - AFC, Paris

7. Emergency Contraception for young people How to make it safe ? 2)TwoFrench initiatives for young people giving rise to easy and safe access to emergency contraception Dr. E. AUBENY - AFC, Paris

8. Emergency Contraception for young people How to make it safe ? 1) Levonorgestrel EC is legally provided free of charge by high school nurses (2000) - The nurse can provide levonorgestrel EC free of charge in cases of emergency, if it is impossible to have an early appointment with a doctor or to go to a pharmacy (rural area) - But also at the same time they must give advice to students about regular contraception Dr. E. AUBENY - AFC, Paris

9. Emergency Contraception for young people How to make it safe ? Levonorgestrel ECis legally delivered free of charge by high school nurses (2000) • Since 2000, each year (figures are stable) 15 000 students ask for levonorgestrel EC • 10 000 receive it, preventing unwanted pregnancies • 5 000 have no need of it (they have another problem) • This allows discussionsbetween nurses and their studentson contraception and on any sexual problem Dr. E. AUBENY - AFC, Paris

10. Emergency Contraception for young people How to make it safe ? 2) Levonorgestrel EC provided free of charge in pharmacies for minors In 2000 a law allowed levonorgestrel EC to be distributed in pharmacies to everybody without a doctor’s prescription and free of cost for minors (other patients must pay, they are reimboursed only if they have a doctor’s prescription) Dr. E. AUBENY - AFC, Paris

11. Emergency Contraception for young people How to make it safe Levonorgestrel EC provided free of charge in pharmacies for minors • Minors just need to request it : there is no identity control • Pharmacists - must advise minors about EC and regular contraception - must give them a leaflet about EC made by pharmacy Direction - pharmacists give free of charge EC to minors and are refunded by Health Assurance Dr. E. AUBENY - AFC, Paris

12. Emergency Contraception for young people How to make it safe ? Levonorgestrel EC provided free of charge in pharmacies for minors • 8 000 minors receive it each month. Figures are stable except in August (vacation time) • But there are some problems : Pharmacists are anxious about giving advice to young people and the young people consider the pharmacists too judgemental ! some prefer to pay to avoid this kind of lecturing... Dr. E. AUBENY - AFC, Paris

13. Emergency Contraception for young people How to make it safe ? There are two beneficial consequences in France of these two mesures for young people Dr. E. AUBENY - AFC, Paris Dr. E. AUBENY - AFC, Paris

14. Emergency Contraception for young people How to make it safe ? 1) Recognition of teenagers sexuality Levonorgestrel EC delivered by high school nurses and without charge in pharmacies for minors - opened the discussion about teenagers sexuality and contraception in the society - obliged its recognition This recognition is the best way to prevent abortion and ISD among adolescents: They are no longer too inhibited to seek advice about these problems and they can get reliable information Dr. E. AUBENY - AFC, Paris

15. Emergency Contraception for young peopleHow to make it safe ? 2) Involvementofnew healthprofessionals in contraception • Pharmacists • High school nurses This arouses their interest in regular contraception. Themajority are very pleased to be given thisresponsibility and to be involved in the contraception development Dr. E. AUBENY - AFC, Paris

16. Emergency Contraception for young peopleHow to make it safe ? In conclusion Emergency contraception • is very usefulfor young people who frequently have problems using regular contraceptive methods • should be easy for them to obtain • provides the opportunity to give adviceto young peopleand to guide them towards regular contraceptive use • allows them to speak about their sexual problems and to receive advice about these Dr. E. AUBENY - AFC, Paris