Are all school nurses now encouraging teenage girls to have the contraceptive implant?

I used the pill, and condoms (more or less!) from 16. There are different pills out there, when I was young people switched until they found one that suited, or realised they were not suited to hormonal contraception.

Something in your arm, one size fits all, you can't take it out, you don't have to think about it...
Not good.

And actually isn't that the point?
young poeple should have to think about it
Boys and girls both.

What an excellent post from KRITIQ.

IME condoms are promoted ahead of, and alongside, LARC.

The recent media coverage of the 13 year old fitted with an implant gave the impression that 13 year olds are going to be regularly and indiscriminately fitted with implants; this is (again IME) absolutely not the case - it takes a lot of assessment, including risk assessment before a HCP fits such a young girl with an implant. It would be unusual where I work for a nurse, including school nurses, to fit under 15s with an implant.

Whilst I do feel for the issues raised, and will be focussing strongly with my DD on the fact that the only reason to have sex is because you really really want to for yourself, and even then PIV sex is best avoided below the age of 17. I am also very concerned about the STI considerations.

However I think it's misleading to say that the condom is nearly as good a contraceptive as the implant. If 1,000 couples have sex for a year and the woman has an implant then roughly one will become pregnant, maybe none. If they use condoms perfectly then 20 will become pregnant. If they use condoms with a typical rate of human error then 150 will become pregnant. That's not "nearly as good".

Definitely not implants for all.

Ido, I didn't mean to suggest that becoming a mother at 14, 15 or even 16 is automatically catastrophic, particularly if she DOES have support from her family. However, the families that are most likely to be supportive in that way are probably also the ones most likely to talk openly with their children about sex and healthy relationships. They are the ones most likely to have instilled self-respect and respect for others in their sons and daughters so they are perhaps less likely to pressure or be pressured into sex.

The problem is that from my experience, it tends to be the young women who don't have that kind of family support, who don't have the high self-esteem or aspirations for the future, who are most likely to see any attention from a boy as something good, even when it's abusive and controlling, it's these young women who fall pregnant. They can find themselves isolated, unsupported, indirectly excluded from education and least equipped for becoming a parent, and most vulnerable to abuse from a partner during pregnancy and after when they "feel" dependent on them. Their children also aren't going to have the best chances in life.

And, denying them access to reliable contraception also won't protect them from abuse and exploitation by men, won't protect them from STI's and won't prevent them from becoming pregnant in what are unlikely to be ideal circumstances.

Oh, what Saf said.

Kritiq that is a great post.

I am off to bed soon though and there are so many issues. So not going to respond fully now!

one thing we need is to have a situation where every male in the country pays for his children with zero exceptions and non payment is a criminal offense such as non payment of council tax that can be criminally prosecuted rapidly and can incur a prison sentence. make pregnancy have real, tangible, hard consequences on boys as well as girls. so that they both have an interest in preventing it.

do the kind of education stuff that lapsed described above. do boy only sex education and don't shy away from talking about coercion, using condoms, consequences of unprotected sex, respect, self protection etc.

seriously, properly prosecute men who have sex with underage girls - investigate those who are obviously doing so and caution them - don't wait for a girl child to report them. it is often older men who will have sex with girls and have a powerful enough position to refuse to use condoms etc.

stop pushing hormonal contraception when there is a simpler, safer method that can be nearly as effective at preventing pregnancy and effective at preventing the majority of stds.

the constant defeatism means no one even tries imo.

I'm surprised that the school nurse would be "pushing" this or any other form of contraception. I would ask if this were Health Board/Trust policy and take it to a more senior level if I wasn't happy with the answer.

I believe it school nurses and other HCPs should be able to give information, contraception and even referral for termination for a young person without a parent's consent. It would need to be a situation where they were confident the young person was making a fully informed choice, that they had relevant medical history (as a school or GP should,) and that they've encouraged the young person to talk with the parent and/or there's a compelling reason why that is not advisable.

But, there's a conundrum here. I don't work in a school, but some of my work does involve engagement with young women.

• Boys and young men DO pressure girls to have sex, at a younger and younger age. There has always been pressure to have sex with girls as an indicator of masculinity, but imho, that's becoming even more acute.

• Depressingly, I think girls and young women now more than say 10 or 20 years ago feel that they should have sex to be accepted not just by boys but by other girls. Personally, I think increased sexualisation/pornification of society has ALOT to do with that.

• Most boys aren't bothered about contraception. If a girl isn't using it, that's unlikely to make a difference. Condoms are the least invasive form and best protection against STI's but the boy has to agree to use one. Anecdotally, it's couples in stable relationships most likely to use condoms but not those who have more casual sex because they don't feel confident discussing it with someone they don't really know.

• Yes, there are risks with all hormonal and mechanical forms of contraception. There is always the risk of STIs, particularly if you're not using barrier contraception.

• There are also huge risks involved in becoming pregnant at an early age, particularly if continuing the pregnancy to term. These aren't just health risks, but pregnancy can disrupt education, family relationships and alter the course of the young person's life. There's stacks of evidence of poorer outcomes for children of teen parents in general as well.

So, we live in a society that sends the message to girls that they should be available for sex and the message to boys that they are entitled to sex from girls. In that context, young people will be having sex, and exposing themselves to risks.

Do we refuse refuse to provide contraception to girls because that would mean colluding with, if not endorsing their sexual exploitation?

Or, do we offer them only condoms as a contraception and means of preventing STI prevention, knowing that the boy(s) they have sex with in all likelihood will refuse to use them?

Or, do we provide contraception which will carry health risks but at least affords them a means of preventing pregnancy that could drastically alter their health and the course of their life for the worst?

I know it's a Hobson's Choice, but it is a dilemma that HCP's are having to deal with every day.

Ideally, all young people would have good relationships with their parents and be able to talk these things through openly and make supported and informed decisions about their sexual relationships and health. They don't.

Ideally, young people wouldn't feel pressure to have sex when they aren't ready for it and aren't able to make informed choices, but this happens.

Ideally, we wouldn't live in a society that sends out the message 24/7 that girls/women are passive, inferior, sexualised objects and boys/men should be controlling, competitive and assert their masculinity through having sex. But, we do live in that society.

So other than throwing our hands up and saying, "God this is shit," what can we constructively do about it?

surely it must be possible for a parent to see the school nurses notes on their 13yo too?

ok the confidentiality thing means a girl can get an implant at 13 without her mother being informed BUT if the mother then notices the bruising or something and takes her child to the GP and demands it is removed do they have to follow the parent and legal guardians request or ignore her and follow the 3yo child's request to keep it in?

it's massively glossed over, as is weight gain and digestive issues and generally feeling a bit bleurgh. most people don't even realise that their problems with all that were due to the pill/other hormonal contraceptive until they stop taking it.

likewise actually with antidepressant medication which more women than men take. there was a time where all they ever wrote on the side effects was male sexual side effects like delayed ejaculation and erectile dysfunction and no mention of the very common effect of making it damned hard for women to come - anorgasmic effect? i forget the terminology but yes glossed over and not seen as a legitimate reason to change medication or be unhappy with it or not want to use it. it's as if female sexual pleasure is frivolity with no importance but the second a man has problems with his that is serious and ego damaging and must be medicated and dealt with.

readyveg this thread is talking about the school nurse promoting implants to girls. And not talking about condoms.

The girl who had all the pregnancies and was vulnerable. Who was she having sex with, why. I assume she was under 16. Who was she sleeping with and was it entirely consensual and in no way groomed/coerced etc

Incidentally there are school nurses who go in some Catholic schools. The school has no control over the nurse whose practice is governed by the usual ethics and competencies.

As contraception condoms are pretty shit, as a barrier to STDs they are often compromised. They are usually promoted alongside methods of contraception that make the risk of pregnancy very small. If girls want to have sex, if they want the best contraception and choose an implant then I respect their decision.

If they are chaotic and vulnerable then if they choose an implant I hope it helps them through. A girl I worked with recently had 3 pregnancies in a short space of time, one baby and 2 abortions all 3 events profoundly traumatic for her. She has the implants and feels much happier, she wishes she had them earlier and would not equate the possible side effects of removable contraception with the damage from her pregnancies.

Are there bigger issues to be addressed, of course but do i think girls have a choice to choose contraception, absolutely. Is this the one area where i think we should get all paternalistic and over ride consent, never. Is the school nurse the contraceptive trend setter, not usually. It is imperfect but the alternative is worse.