Sexual and reproductive health

Introduction

The Government Framework for Sexual Health Improvement in England (2013) reports that most people become sexually active and start forming relationships between the ages of 16-24 years.

Regrettably, sexual health can be surrounded by stigma, prejudice and discrimination which makes it difficult to access information and openly discuss issues which affect both individuals and communities.

Young people in this age group have significantly higher rates of poor sexual health, including sexually transmitted infections (STIs) and abortions, than older people. However, sexual health is more than sexually transmitted infections such as HIV or Chlamydia.  Sexual health also refers to the emotional and physical aspects of sex, sexuality, sexual activity and relationships:

  • reducing the risk of unintended pregnancy
  • having the knowledge, resilience and choice whether or not to have sex
  • being able to express sexuality, without fear of exploitation, oppression, physical or emotional harm
  • knowing who to go to access non-judgemental, confidential sexual health advice and treatment including contraception and termination services

Key inequalities and risk factors

  • Gender - Young men’s perspectives on issues such as relationships, consent, contraception and infections can differ from those of girls, so the views and needs for services for young men and women must be acknowledged and addressed in different ways.  The NHS Choices website publishes pages specifically for young people.
  • Disability - More work is required to both understand and address the sexual health needs of young people with learning and physical disabilities, with evidence reporting lack of information on parenthood, birth control, and sexually transmitted diseases.
  • Sexuality - Lesbian, gay, bisexual and trans (LGBT) young people experience a number of health inequalities that are often unrecognised in health and social care settings.
  • Culture - There is potential for cultural differences in sexual health outcomes and where local cultures require a female GP to offer this service GPs with a special interest to deliver these services or outreach nurses are preferred.
  • Deprivation - Practices in Berkshire which issued the greatest rate of emergency hormonal contraception (EHC) had high levels of deprivation.
  • Vulnerable children - Children with poor self-image, self-esteem or attachment issues such as looked after children are also at higher risk of sexual exploitation.

Alcohol and drug use - Framework for Sexual Health Improvement in England (2013) highlights the following research findings relating to alcohol consumption resulting in:

  • lower inhibitions and poor judgements regarding sexual activity, vulnerability and risky sexual behaviour, such as not using contraception or condoms
  • increased likelihood that they will have sex at a younger age, and alcohol misuse is linked to a greater number of sexual partners and more regretted or coerced sex
  • increased the risk of sexual aggression, sexual violence and sexual victimisation of women

Facts, figures and trends

Awareness and trusted sources

Results from the 2013 Berkshire-wide young people’s sexual health survey (14-24 year olds) (accessed 28 April 2016) showed that:

  • 32.5% of respondents would prefer to look on a website for sexual health advice, 14.4% would prefer a sexual health clinic and 10% would not need advice
  • 20.7% of respondents would prefer to source condoms from a pharmacist, 20% from a sexual health clinic, 17.4% from drop in clinics outside of school, 16.6% in school/college and 12.5% from a doctor’s surgery
  • 55% of respondents would go to a pharmacist for emergency contraception first followed by a sexual health clinic, whilst 7% would definitely not use a pharmacist. 28% of respondents would consider a drop in clinic outside of school or a GP. 52% thought emergency contraception could only be taken the day after sexual intercourse
  • 34% would prefer to go to a doctor for an STI test and 28.5% would prefer to go to a sexual health clinic. 11% would go to a drop in clinic and 8.5% would buy online test kits
  • Respondents preferred to access sexual health services on Friday and Monday (27% each) and a Saturday (24%)
  • Respondents preferred to access sexual health services between 5pm and 7pm (23.8%), followed by 3pm-5pm (21%), 7am-9am (20%) and 11am-1pm (11%)

Although the number of young people surveyed was 200, the feedback was consistent across Berkshire, so the findings are considered to be robust.

All schools delivering sex and relationships education are required to ensure that their pupils receive high-quality, age appropriate information on the importance of good sexual health.  Evidence shows that information received in schools can have a positive impact on sexual health outcomes.  In addition to more trained contraceptive nurses/GPs to work in the sexual health drop-ins offered to young people, increased school nursing services would help support health promotion and prevention role in schools.

Details on the current support offer for sexual health in Bracknell Forest is available on the Bracknell Forest Council website.

Chlamydia

Young people are amongst the most sexually active age groups and are at highest risk of chlamydia, particularly young women:

A major issue is that chlamydia is asymptomatic, meaning that people are not always aware that they have it and therefore without symptoms, they are not prompted to seek medical help. 

The chlamydia detection rate amongst under 25 year olds is used as a measure of chlamydia control activity. Statistical modelling suggests that 2,300 cases of chlamydia need to be detected per 100,000 population per year to halt onward infection.  However, achieving the minimum detection rate has presented a challenge not just in Bracknell Forest but across the south east and across England as a whole:

Public Health England guidance places the onus on individuals to seek screening from their GP or GUM clinic, particularly if they are sexually active under 25 and on partner change.

Screening is available in all GP practices in the Borough and the borough Young People’s Sexual Health Advice and Guidance team has a range of touch points offering information, advice and screening in a number of confidential settings.

Sexual activity

The British National Surveys of Sexual Attitudes and lifestyles (Natsal) are among the largest and most detailed scientific studies of sexual behaviour in the world. Three Natsal surveys have taken place: Natsal-1 in 1990-1991, Natsal-2 in 1999-2001, and Natsal-3 in 2010-2012 and are supported by a range of infographics.

Natsal-3 findings show that the percentage of people aged 16-24 who had opposite sex sexual intercourse before age 16 was 31% for males and 29% for females. This age category showed the highest rates for both genders out of all ages up to 74:

Credit: Wellcome Trust/Paulo Estriga.

The numbers of people aged 16-44 experiencing a same-sex experience has also increased.

Contraception

Local data on the provision of contraception and contraceptive advice to young people through other community settings, such as the Youth Service is also required in order to understand the picture of access to services outside of sexual health clinics and GP practices.

Services commissioning

The mandatory contraception services for which local authorities are responsible in Berkshire are: school / college based outreach services and contraceptive and sexual health clinics (CASH services).  Bracknell Forest also commissions specialist GPs and outreach nurses who can prescribe and fit long acting reversible contraception (LARC) such as implants, coils, and injections.  

In total, 28 services are commissioned across Berkshire as described in the sexual health needs assessment. A person may visit a GUM clinic anywhere but the local authority in which the person is resident will be invoiced for these additional non-directly contracted services.

Long Acting Reversible Contraception (LARC)

LARC methods, such as contraceptive injections, implants, the intra-uterine system (IUS) or the intrauterine device (IUD), are highly effective as they do not rely on daily compliance and are more cost effective than condoms and the pill.

In Bracknell Forest and Ascot CCG, the 2014 rate of prescribed long acting reversible contraception (LARC) by GP and Sexual and Reproductive Health Services (SRH) is 62.2 per 1,000 population.  The percentage of women aged under 25 choosing long acting reversible contraceptives (LARC) as their main method of contraception at Sexual and Reproductive Health Services in 2014 was 23% which is comparable with the England figure of 20.1%.

Emergency Hormonal Contraception (EHC)

In 2012/13 (financial year), there were 2,926 prescriptions for emergency hormonal contraception issued by general practices across Berkshire. This equates to a rate of 15 prescriptions per 1000 registered women aged 15-44 years although there were wide variations in GP prescription of EHC across the county.

Bracknell Forest Council Youth Service provides 9 young people’s drop-in sessions per week these deliver mainly condoms, sex education, oral contraception with some EHC and pregnancy testing subject to the availability of GP or nursing staff.

Conceptions and abortions

Clinical commissioning groups (CCGs) are responsible for commissioning most abortion services, local authorities are responsible for commissioning comprehensive sexual health services including contraception services and advice, and sexual health specialist services such as young people’s sexual health and teenage pregnancy services, outreach, sexual health promotion and services in schools, colleges and pharmacies. Local authorities need information on abortions to inform the provision of these services.

For data relating to women aged 15-44 please see the sexual and reproductive health in adults chapters.

Conceptions – girls aged 13-15

According to Office for National Statistics data, the under 18 conception rate for 2014 is the lowest since 1969 at 22.9 conceptions per thousand women aged 15 to 17.

Despite a slight increase since 2012, the rate of conceptions per 1000 girls aged 13-15 in Bracknell Forest has fallen between 2009 and 2014 which reflects the regional and national pattern. Data is also available for young women aged under 18 on the Public Health Outcomes Framework.

Conceptions leading to abortions – girls aged 13-15

In 2014, 100% of conceptions in girls under 16 led to abortion in Bracknell Forest.  This is higher than the averages for the south east and England.  It has not been possible to report on figures between 2009 and 2012 for reasons of confidentiality.

Prevention, care and support services

The Garden Clinic is a contraceptive and sexual health clinic (CASH) and Genito-Urinary Medicine (GUM) service hub running at Skimped Hill. GUM provision in the south of Bracknell Forest is via Frimley Park Hospital. Residents in the north of Bracknell access Royal Berkshire Hospital GUM services in Reading.

Rates of diagnosed sexually transmitted infections and HIV testing in Bracknell Forest are shown in the main sexual health section.  This data is not available broken down by age, due to small numbers.

Currently, a full picture of attendances and activity at the Genito-Urinary Medicine (GUM) clinic at Skimped Hill service in Bracknell is not available.  Further work is required to disaggregate available data for Bracknell Forest.

  is the locally commissioned sexual health, information and advice service for Berkshire residents and professionals.  The site can provide information on local services and groups, contraception, pregnancy, STI testing, sex and relationships, keeping safe and emergency help and support for victims of sexual violence.

Want to know more?

There would be great value in promoting strategies that reduce the stigma associated with asking for sexual health advice. This is essential in helping young people to take responsibility for making informed decisions, and there are a number of resources to help achieve this.

Berkshire Sexual Health Needs Assessment (Berkshire Public Health Shared Service, 2013) – the background, national contexts, epidemiology of sexual health covering populations at risk, projections and the corresponding sexual health services relevant to various STI and reproductive issues in Berkshire.

Children’s Safeguarding – help and information for professionals from all agencies and organisations who work with children of all ages who must be aware of child protection and safeguarding issues.

Child sexual exploitation (CSE) - See the child sexual exploitation chapter for information and guidance. 

Female genital mutilation (FGM) - See the FGM chapter for information and guidance. 

Framework for Sexual Health Improvement in England (Department of Health 2013) – Government report setting out information, evidence base and support tools to enable those involved in sexual health improvement to work together effectively towards accessible, high quality services and support.

Good progress but more to do - Teenage pregnancy and young parents (Local Government Association, 2016) – a whole system approach with case studies of successful interventions from across English local authority areas.

Hepatitis B and C; Ways to promote and offer testing to people at increased risk of infection (NICE 2012) – guidance for NHS, local authorities, prisons, immigration removal centres and drugs services, and for voluntary sector and community organisations working with young people at increased risk.

Long acting and reversible contraception (NICE 2005, updated 2014) – an assessment of effective and appropriate use of LARC, consideration of different interventions, information and advice, prescribing, STIs, working with special groups and training for professionals.

Prevention of STIs and under 18 conceptions (NICE, 2007) – assessing, advising and supporting people with STIs.

Sexual and reproductive health profile – Bracknell Forest data and additional information about STI, HIV, reproductive health, teenage pregnancy and association wider determinants of health.  This tool replaces the earlier Sexual Health Balanced Scorecard.

United Kingdom National Guideline on the Management of Sexually Transmitted Infections and Related Conditions in Children and Young People (BASHH, 2010) - recommendations on the assessment, examination, diagnostic tests, treatment regimens and prophylaxis for the effective management of children and young persons under 16 at risk of, or who have, an STI. It offers guidance on consent and confidentiality.

NHS Choices – online information and guidance designed specifically for young people, including emotional, physical and sexual health and wellbeing.

Safer Sex (British Association for Sexual Health and HIV, 2012) - a guide to safer sex to improve sexual health and reduce spread of HIV.

Safer sex guide for men who have sex with men (Public Health North East) – a guide targetted at teenagers and young men to develop awareness, promote safe sex and support emotional and physical wellbeing

Safer sex guide for women who have sex with women – an informative guide for women to inform and reduce rates of STI and HIV infection

Sex and Learning Disability (SCOPE) - information, resources and signposting for people with learning disability.

Supporting public health; children, young people and families (PHE, updated 2016) - guidance to support local authorities and providers in the commissioning and delivery of services across the highest impact health and wellbeing outcomes for children and young people through the 0-19 healthy child programme.

 

This page was created on 2 March 2014 and updated on 7 June 2016. Next review date March 2017.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Sexual and reproductive health in children and young people. Available at: jsna.bracknell-forest.gov.uk/developing-well/children-and-young-peoples-health/sexual-and-reproductive-health-children-and-young (Accessed: dd Mmmm yyyy)

 

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