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

[idohopenot]

Apparently the dc's school nurse is really keen on them having it, and claims the government wants all school nurses to push it strongly, to bring down the nation's high teen pregnancy rate.

Is this the case in your dc's schools?

I had only heard of it in Southampton, and thought it was a trial, not a new national policy.

Oh, what Saf said.

And also, the implant is done so casually, and you are made to feel slightly mad if you say it might not be great for the girl's health.

You get given the line about pregnancy and termination being catastrophic for a girl, without going into detail about how old the girl is, how healthy, how well supported by her family and so on.

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.

Yes, so it's horses for courses.

Not implants for all, surely?

Definitely not implants for all.

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".

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.

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.

Sidge, admittedly the school nurse I am talking about is not suggesting implants for 13 year olds. But she is saying it is the contraception of choice for older teens (unspecified).

She said they would be screened for unsuitability, but that that would rely on asking the child herself questions.

I meant when I said that nurses operate within usual boundaries that they are not permitted to 'push' a contraceptive option. They are also compelled to go through side effects as part of informed choice. If a nurse doesn't do either of these things with teens whilst assessing them for competence than she is failing in her role and can be reported/sanctioned. Schools have no say in any of this as they are in no way part of the health service so the only over lap tends to be CP issues which are sometimes but not always shared with the CP figure in a school either by a nurse or by ss later.

I have contact with these nurses sporadically primarily through yp I work with and they are usually very professional and a long way from being apologists for male sexual dominance. They work with the yp as individuals and provide information and education alongside contraception.

In terms of what rights I think we have as mothers to know what contraception our daughters are on then I believe we have non. I hope that healthy relationships lead to discussion and dialogue but the principle is established to protect those girls who have no chance of having healthy dialogue about sex and contraception with family members.

Someone asked was the girl I mentioned under the age of consent, no she wasn't and the sex was consensual by legal definitions but representative of changes in our culture that profoundly damage some young women.

Kritiq's post mirrors what I see/think.

Yes Sidge, that's my experience, that condoms are promoted first and foremost, alongside information and support on healthy, respectful relationships. I don't mean to suggest that that's a waste of time - it can make a difference to the decisions young people make about when, how and in what circumstances they engage in sex.

But, it isn't the panacea for all ills, in the same way as the abstinence movement in the US hasn't been (well, actually has lead to an increase in pregnancies and STI's where it's been adopted.)

The fact that young women are in situations where they aren't always in control of when, how and with whom they have sex is part of a wider social, economic and political context where women and girls aren't regarded as being of equal value to boys and men. They are sexualised and objectified and that paves the way for such abuse and exploitation to become almost "normalised," especially by the young people themselves. We absolutely must tackle the patriarchal values and structures that enable this to happen. But in the mean time, surely we also owe it to the young women caught in the middle of it to be able to at least do something to reduce some of the risks they face (even if we may have less chance of reducing the others.)

SQ the pill is still prescribed but for lots of girls they know at the start they will not remember to take it, taht they are too often drunk or drugged for it to be reliable or that they dare not have it in the house for fear of family finding evidence that they are having sex.

So there must be some guidelines for school nurses? And can parents know what to expect from a school nurse, and where they stand?

Generally yes, IME, older teens like the idea of an implant. Most have tried an oral contraceptive pill and for whatever reason wish to try something more reliable. IME the vast majority of teens pay lipservice to using condoms, or if they do use condoms don't trust them enough to protect against pregnancy and want to double up, using hormonal and barrier methods.

We do have to rely on asking the young women themselves about their medical history, but many do bring their mothers with them. Also it's part of the contraceptive assessment for under 16s that they are assessed as being 'Fraser competent' and encouraged to discuss sex and contraception with their parent/s.

REadyveg, when you say "SQ the pill is still prescribed but for lots of girls they know at the start they will not remember to take it, taht they are too often drunk or drugged for it to be reliable or that they dare not have it in the house for fear of family finding evidence that they are having sex." - my point is that that is not all girls. And I know YOU are not saying it is; and yet that does seem to be what our school nurse is saying.

If your child is deemed competent than you have no rights, as far as I am aware, to have any dialogue with hcps about contraception/termination decisions your child has made whether a nurse of any sort or a GP etc has organised these choices for her.

Yes, but there must be a document somewhere which sets all this out?

Idohopenot school nurses are part of School Health Teams, not Education.

Any parent can contact the School Health Service.

However in some areas CASH (Contraception And Sexual Health ) services can be provided to young people in education by other organisations such as Connexions, Get It On, Sex Sense, Outreach services etc.

OK, thanks - so I guess I should try to look up the local School Health Team, which would be part of the NHS.

Yes, if you phone the school office they should be able to give you the number.

The fact that this is a policy rather than an individual decision between a girl and her doctor ought to make it easier to challenge.

I've been googling school nursing, and I still find it very upsetting that this implant is becoming the norm as a contraceptive method for teens. And that my dc will yet again have to dare to be different. And that there will be a lot more STIs around for them to catch.

And as SwallowedaFly said: "the constant defeatism means no one even tries imo".

I haven't read the whole thread but has anyone mentioned Frasier Competency / Guidelines yet? And / or the Gillick case?

I'm trained in sexual health and can issue condoms to the young people I come into contact with without letting their parents know under the council's sexual health policy.

S'cuse typos - bit drunk.

"SQ the pill is still prescribed but for lots of girls they know at the start they will not remember to take it, taht they are too often drunk or drugged for it to be reliable or that they dare not have it in the house for fear of family finding evidence that they are having sex."

I mean, come on, if you're that off your tits while you're that age and living at home then your parents are bloody well going to notice!!! They are going to notice that you are drunk, off your head, whatever. Out all night.