A new contraceptive clinic for teenagers was developed in the centre of Nottingham from 1987 to 1992 and provided care for over 1500 young people in its first three years. Twenty-five percent of clients were aged 16 years and 32% aged 15 or younger. Sixty-seven percent were in full-time education and young unemployed people were under-represented. The majority were young women, who came for routine contraception, usually the oral contraceptive or condom. Seventeen percent came for emergency contraception and 8% for abortion counselling and referral. Over the period 1986 to 1992, data on conceptions for teenage women and women aged over 20 years, who were resident in Nottingham Health district, were compared and when corrected for the estimated population showed that there had been no reduction in teenage conception rates; reasons for this are discussed. The value of conception rates as a measure of quality of sexual health care for teenagers is questioned and other more qualitative methods suggested.
PIP: The Nottingham health district includes the city of Nottingham, surrounding suburbs, and rural communities comprising a total population of 616,400 in 1986. Historically, there has been an high rate of illegitimate births in the district at 260/1000 births, an average unemployment rate 1-2% above the national average, and areas of significant social deprivation. In the attempt to provide much-needed services, a contraceptive clinic for teenagers was developed in the center of Nottingham over the period 1987-1992, providing care for more than 1500 youths in its first three years. The authors report findings from an evaluation of the clinic and its services conducted to determine if there had been any improvement in accessibility to, acceptability of, and effectiveness of contraception as a result of the new and refocused services. A review of the clinical records of all youths who attended the clinic between April 1987 and June 1990 found 1538 individuals aged 12-39 years to have attended the clinic at least once over the period. Only 25 attendees were men, with the majority comprised of young women seeking routine contraception such as oral contraceptives or condoms. 16 year olds were the single largest year age group comprising 25% of all attendees, while 32% were aged 15 years or younger. 67% of the 1402 female attendees aged 12-19 were in full-time education, with young unemployed people underrepresented. 17% came to the clinic for emergency contraception and 8% for abortion counseling and referral. Comparing data on conceptions for these teenage women against data for women older than 20 years also resident in the district found no evidence of any reduction in teenage conception rates. The authors, however, question the value of conception rates as a measure of the quality of sexual health care for teenagers and suggest alternative qualitative-oriented methods.