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.

This is a very interesting thread. Dworkin when you said 'Also implants are well known to reduce sexual desire in women', how do you know this? Do you have a link to evidence, or somewhere I can look for some? I have never seen it mentioned in connection to implants, yet it seems to be true, in the couple of young women I know with an implant.

So maybe the nurse didn't feel like a balanced conversation or maybe she is a bit rubbish or sees the implant as progress, who knows. There will be policy behind this too but that doesn't take precedence over the established rules that govern hcps interactions.

I think the implant is a long way from the norm and it is certainly not the cause of an upswing in stis. There are many tens who eshew hormonal contraception often only too aware of weight/skin changes as possible side effects.

If implants do reduce teen pregnancy then it could be argued that they have done a group of young girls a huge favour. The physical risks to mother and baby, the risk of ss intervention/ care proceedings, the reduced economic power and potenial dependence issues, the damage to education prospects are very real.

Sq, not necessarily the same girls! There are groups I know who are never drunk but who do have sex usually outside of their faith and community group- these were the girls I was thinking of although there are many teens who don't want to risk parents finding out in less obviously contentious circumstances.

It is easy for us to critisize school nurses for offering contraceptive implants to teens. But i have seen another side of this through working with inner city family planning projects in the US in Baltimore. The most effective way out of poverty for young inner city women was NOT to get pregnant at a young age.

This meant that they were more likely to stay in school, finish their education, get a decent job and move out of the poverty stricken environment they were bought up in. By delaying pregnancy until a later age they had far more chance of being in a stable relatonship with a partner. FP nurses in these projects were positive about implants because of their efficacy. they still advocated condoms for STD protecton, but at least they were offering young women the near certainty they wouldnt have an unwanted pregnancy. Yes the drugs aren't perfect in tems of side effects, but they offered young women in the inner city cycle of poverty and teenage pregnency a better chance of a route out.

FWIW the bush administration got elected and then pulled most of the funding for these projects. But thats a whole different topic

Is all this to do with being PC, and not saying: if you have a secure, supportive and financially comfortable family around you, an accidental pregnancy may be a happier outcome for you than a 3-year implant whose long-term health impact is unknown - but is probably not good and likely includes an increased risk of breast cancer?

I would hope it's not a more sinister eugenics-type agenda. I take the point above about single mums.

I don't think it is about being pc at all, the implant isn't a substandard product for an excluded social group. Many capable women choose it as suiting them, others make different choices...

Eugenics? How?

Surely it is being presented as the least worst choice for teens who can't control themselves?

And the long-term effects on the fertility of such teens isn't known, is it?

It's one thing for the girls to walk up to a GP/hospital/walk in centre/family planning clinic and ask for contraception but to keep it confidential. But if they are having a device/drug at school administered, the parents should be informed that this service is available - if they want to opt out, the girls have to be referred to have it done in an NHS clinic/hospital. I don't expect my child to turn up for maths, science and netball, and have her sent home with project work - and a pharmaceutical that can have serious side effects - from cramps to anaphylaxis. That is a conflict of interest. 13 to 14 year olds have the right legally to walk into a hospital or clinic and demand treatment, including contraception, if they are Gillick competent - they understand what the treatment is for, the pros and cons of taking it and the options available. In other words, they understand the information like an adult. But not if the setting is a school. And responsible clinics and GPs would also be automatically advising young girls about condoms, STDs, cervical smears at the same time. Would a school nurse have time to fit all that in?

It doesn't sound as if we can opt out, though, Kipperandtiger - short of telling our dc to steer clear of the school nurse.

It does bother me that one person's conviction that implants are the solution to everything is going to be pushed to every girl in the school - with no balancing medical opinion saying "other contraceptive options are available".

The least worse option? When I had mine fitted over, God well over 15 years ago I choose it as the best option not the least worse. For you it seems it is an option you wouldn't pursue, you are not alone on this. There are many women and girls who prefer not to use hormonal contraception, for those who do there is a lot of data available and all licensed products have been researched as well as any other medicine. Fertility is rarely affected by implants, the pill and injection and most rarely of all in the young. There are questions over whether injections or implants are appropriate for older women to use when only looking for temporary cover whilst spacing children.

I can't see that what worries you is likely to happen, it has already been explained why hcps work separately from schools and are obliged to discuss options and side effects.

As for the idea that schools aren't good venues for hcps, it is outreach part of removing barriers between potential services users and health care that can improve their lives. The NHS has many mobile units offering support with all sorts of health related concerns.

Being competent to assess your own contraception needs doesn't mean that you will have been proactive in managing your own sexual health, and we know that the lowest social and economic groups are the least likely to seek care. It makes it more necessary that these groups are reached through better targeting of services.

Elastamum your experiences sound rich and mirror what I have seen, such a shame the funding went. I find it hard not to associate reduced funding for out reach, for teen sexual health with right wing politics.

But can you see, Readyveg, that if you have a school nurse who really cannot see anything wrong or problematic with implants, then they will be pushed over and above other forms of contraception?

and if there is a hcp who is unable to have the expected conversations about benefits, risks and side effects then they are performing their role poorly. There are people in all jobs who are crap the system hopefully weeds them out, complaints from those badly served by them will be acted on.

The opinion of the nurse on implants is irrelevant, she still has to share accurate information. It is often the case that a conversation about the features of contraception that would be found most useful by the yp lead to the longer lasting forms.

Your child isn't going to be poached from their maths lesson and inserted with contraception that they have not chosen.

But who defines "expected conversations"? Who monitors what the school nurse is doing?

In my area idohopenot it's a specific Sexual health team who work with young people and train other professionals. Although how long they'll keep their jobs is anyone's guess.

idohopenot - yes, that would be a big concern. Perhaps parents of adolescent daughters should ask the school headteachers if a meeting can be scheduled with their school nurse to ask what sort of advice is given at contraception consultations (and whether a sexual health specialist (nurse or doctor) sees the pupil) to cover advice from STDs/HIV/cervical cancer/HPV vaccination/smear tests and not just contraception.

I was on hormonal contraception from the age of 13 to 30 (when I started TTC), firstly on the pill at my parent's request as I was having very debilitating periods affecting my education (I didn't start having sex until some 4 years after starting the pill), then later on the implant. At the time, I thought hormonal contraception was fabulous. Seemingly I had few side-effects and it was really suitable for long-term relationships, which applied to most of my adult life (I used condoms in addition at other times).

However, once I came off it all and had children, I never went back on it, and it's only now - 6 years free of hormonal contraception - that I realise the minor side-effects it had. It's possible of course that some of this could be do to the effects of having children; I'll never know in all reality. But I believe that most of the minor niggles I had before were due to hormonal contraception. I will never go back to it again, and I would counsel my DD to avoid it too, although obviously it would be her body and her choice.

I have some sympathy with the school and HCPs. Fact is that too many parents aren't talking to their children about sex, stis and contraception in practical terms, let alone more 'abstract' ideas such as consent and coercion. HCPs are just trying to pick up the pieces. However, I agree with SaF that the best way to deal with this is to start ramming home consequences for boys as well as girls.

It may actually be lying (since the CSA are ineffectual and most NRPs don't pay for their children) but let's include classes on how the CSA works and how much boys will be expected to pay for a child if a girl gets pregnant. Let's have classes about consent in which we name coercion and pressure for what it is and label those who do it as rapists in no uncertain terms. Let's present it as 'how sad are you if you have to pressure a girl into having sex' as much as we do as 'what a horrible, totally unacceptable way to behave'. Let's have more classes like those given to LapsedPacifist's DS. Let's make it clear that STIs affect girls more than boys since they are twice as likely to contract them. Let's make it clear that anyone who doesn't take that seriously could be considered either really stupid or unpleasant, and let's make it clear that refusing to use a condom even when a girl has 'taken care of' the pregnancy risk, is a form of coercion, so even though a girl may be willing to have sex in principle, it is still a form of rape - rape of a girl's health.

It may seem harsh, but it can be done in a fun way and should surely be carried out before all but a tiny minority are having sex anyway - so that no one would feel personally attacked by any of this but be fully aware before they start having sex.

i agree with all that sunshine - no big surprise.

i also think we need to talk clearly with girls about feeling like you have to have sex and that you can't/shouldn't say no if you don't want it or if you do want it feeling like you can't/shouldn't insist on a condom. we need to talk to them about how as you get older you get more assertive and in that assertion and taking control of things sex becomes more pleasurable - that it's not possible to really enjoy sex when you aren't even sure if you want it or able to be confident in asserting what you do and don't want to do and doing so in a safe way re: using condoms. we need to encourage girls to fess up to that ambiguity and discuss it and encourage them, and they each other, to see themselves as more in control and confident and assertive about their boundaries.

i believe girls suffer that ambiguity and lack of assertion in silence because it appears that everyone else is all confident and fine about it. there are too many women who look back on sex that they didn't really want when they were young and a period of ambiguity about it all in their youth and only really discover their assertion and with it enjoyment of sexual activities later on.

i realise this doesn't apply to everyone and many will come on saying they loved sex as a teen etc but i've met a lot of women who've said these things and for whom sex as a youngster (particularly those who were vulnerable to predatory older men due to lack of parental supervision or care) was a sort of silent witnessing of something happening to them rather than something they were doing and taking an active part in.

and i think a part of that is to stop presenting 'sex' as if only PIV was sex. looking at sex as a spectrum of activities that can be partaken in without necessarily having to have PIV. we present it as such a fait accomplis that if you want to go further than snogging you will have penetrative sex. we need to encourage the idea that you can have oral sex or any manner of sexual play without it having to end up in PIV. this would help boys too and start getting rid of the idea that a woman who got into a man's bed and was engaging in sexual activiites doesn't have the right to then say no to PIV and doesn't get taken seriously as having been raped when she does say no and is ignored.

Excellent posts sunshine and saf.

Just caught up with the thread. I think classes on the CSA sound ace.

LapsedPacifist do you know if your DS's school arranged that training internally or if there was an external organisation that came in? If so, and you know the organisation's name, I'd really appreciate you posting it or PMing me with it, as it sounds like they are doing good stuff.

If this is as presented then it's a awful. Get the teens ready for sex. Forget disease, just make sure they don't trap the man by becoming pregnant. Sickening

Thanks for those great posts, Sunshine and SAF. So much info on here. I think Swallowedafly's last post is very very helpful to boys, as well. They are under ludicrous pressure to lose their virginity through PIV; and that pressure is terrible training for a male lover.

I work with young people and had a chat with 3 lads I was working with about such things only recently. I was driving them home from an activity in my car, and one of them asked the other if they knew a certain girl who was a 'slag'. I challenged the remark, and it developed into a brilliant conversation, which culminated in one of them asking, earnestly, how he can be sure that what he is doing is nice for the girl he is with.

I think having adults around them that are able to talk about this stuff with them with no embarrassment and up to date knowledge is essential - and they are often too embarrassed to share that stuff with their parents. I also think that they're happier talking about this stuff in smaller groups and one to one. I think that having an outside agency coming in to schools to do some proper discussion based work around this stuff, with the content being open for parents to peruse and opt in/out of would be ideal.