Adequacy of contraception and missed opportunities for provision in a genitourinary medicine setting

Sexually active women presenting to genitourinary medicine (GUM) clinics are at risk of both sexually transmitted infections and unwanted pregnancies. Emergency hormonal contraception is the only contraceptive service provided in our GUM clinic in Birmingham, UK. We wanted to assess whether contraception use was adequate in women attending our clinic and whether we were missing opportunities to provide more reliable contraception. All new female patients attending the clinic in January 2006 had their notes reviewed to determine current contraception, adequacy of use and contraceptive advice given.

A total of 266 women were eligible for contraception. Overall, 148 (56%) of the women used reliable methods. Fifty-five (21%) women were using no contraception and not planning a pregnancy. The under-20s, over-30s and ethnic minorities were more likely to use inadequate or no contraception.

Almost half (43%) the women attending our GUM clinic had inadequate or no contraception, and in addition documentation of contraceptive advice and further information was poor (5%). Young people and ethnic minorities seem particularly vulnerable and at present we are not addressing their contraceptive needs. We plan to conduct a prospective survey to assess this issue further and address feasibility for an on-site contraceptive service.