Last partial update: July 2016 - Please read disclaimer before proceeding

Preventing unplanned teenage pregnancy - a parent perspective

By year 12 at school, about 50 per cent of males and females have had vaginal sex, with about 23 per cent of these teenagers reported that they had consumed excess alcohol at the time. Unplanned teenage pregnancy is a very important health issue in Australia with the potential to cause much long-term emotional suffering. Teenage women who become parents due to an unplanned pregnancy often suffer significantly from mental health problems, such as three times the usual incidence of post-natal depression, and social problems, such as reduced opportunities for education and work, and a reduced standard of living. They also have a higher pregnancy complication rate. On the other hand, those teenage women who choose to have their pregnancy terminated can suffer emotional and mental health problems that can persist for years.

While no exact figures exist, it is estimated that about 80,000 abortions occur in Australia each year (about one in five of all pregnancies). The majority occur in young women, especially the early twenties age group. (64 per cent occur in women under thirty). Almost 20 per cent of Australian women will have an abortion at some stage in their lives.

About 20 per cent of Australian women will become pregnant in their teenage years, with the rate being about 44 per 1000 female teenagers per year, and slightly over 50 per cent end in termination. (Interestingly the overall termination rate in Australian women aged 15 to 44 years is not much lower, being about 20 per 1000 women per year.)

This teenage termination rate is the sixth highest amongst 'OECD countries' and does not compare favourably with many other developed countries. For example, the rates for German (5.3 per 1000) and Dutch (3.9 per 1000 per year) teenagers are less than a quarter of those for Australian teenagers (1996 figures). Of those teenagers giving birth in Australia, 90 per cent are unmarried and 60 per cent have no male partner.

As the decision to have an abortion is a difficult one for most women and one that often has long-lasting psychological repercussions, the above statistics represent a huge social and psychological problem facing Australian women.

With the above in mind, it is unfortunate but perhaps not surprising to realise that Australia, unlike many other developed countries, has no major teenage pregnancy prevention initiative. Part of the reason there is no coordinated sex education program lies in the unfounded belief that education increases the likelihood of permissiveness and earlier sexual activity. The opposite is in fact true.

The consequences of this lack of sex education are amply demonstrated by a study recently conducted in Perth that found only 10 per cent of 126 teenage mothers had become pregnant intentionally. Despite this, about 76 per cent were not using contraception at the time they became pregnant and 68 per cent had never spoken to a doctor about contraception.

In the Netherlands, sexual health education campaigns aimed at teenagers have greatly reduced teenage pregnancy and sexually transmitted disease rates and have resulted in roughly 80 per cent of Dutch teens using contraceptives during their first sexual intercourse. This is much higher than in Australia, where the rate is about 50 per cent.

Luckily the message is starting to get through in Australia, with the Victorian Government commencing to formulate a ‘best-practice’ sex education program for schools. However, until such a coordinated program exists, it is up to individual families and schools to educate their teenagers regarding the risks of pregnancy. Do not pretend the traumas associated with teenage pregnancy will not affect your family.

 

 “Contraceptives should be used on every conceivable occasion”
                                                                                     Spike Milligan (1918-2001)

 

There is insufficient room in this web site to provide extensive information regarding the many issues involved in pregnancy prevention. Details regarding this information can be sourced from your GP, your school or the resources listed below. The information provided to adolescents should include the following:

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Some safe sex messages for teenagers

  • Decide on your sexual limits: Think ahead about your ‘sexual activity limits’ and how they can be enforced without harming relationships. Abstinence is a very reasonable option for those who wish.
  • Plan strategies to help avoid exceeding sexual limits.Teenager girls can:
    • Talk about feelings / limits with their boyfriend / girlfriend and emphasise that self-respect is an important issue for them.
    • Plan ways of avoiding getting into difficult situations. Parents can be a help here.
    • Have prepared refusal strategies for ‘difficult situations’ should they occur. Most people will respect the right of other to limit their sexual activity. However, this is not always the case and if problems arise, then tactics such as saying that they need to go to the toilet or feel like vomiting, or, for females, that they have their period, can be helpful.
  • Keep a clear mind. The ability to keep to planned sexual activity levels and implement planned refusal strategies requires clear thinking. This can only be achieved in the absence of illicit drugs and significant amounts of alcohol.
  • Be aware of strategies to avoid drink spiking / date rape. (See Teenagers - Getting home safely section)
  • Always use condoms without exception. Condoms are vital for protection from sexually transmitted diseases and provide reasonable contraception for people having very occasional sexual intercourse. However, alone they are not really adequate contraception for people who are having sex regularly and some other more reliable form of contraception needs to be used AS WELL.
  • Be aware of emergency contraceptive options should you need them. (See section on unplanned pregnancy in the contraception section.)

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Contraception

This topic is dealt with in detail in the section on contraception. See section on Contraception.Below is a list of suitable contraceptive alternatives and a few notes on the use of the Pill in young women.

The best contraceptive choices for adolescents and younger women

The Pill in adolescence and young adulthood

Acne and to a lesser extent hirsutism (excessive facial hair growth) can be problems in adolescents and selecting a pill with a progestogen that has anti-androgenic (anti male hormone-like) effects can help these problems and indeed, the COCP is sometimes prescribed primarily for this purpose. The results, however, are somewhat unpredictable. The best progesterone for this purpose is cyproterone, usually used in a dose of 2mg in each tablet. It is, however, more likely to cause weight gain, breast tenderness and mood disturbances including mood swings and depression. If these side effects are a problem, then alternative progestogens include gestodene, desogestrel and drospirenone.

It generally takes about three months of treatment with the COCP for improvement in acne to occur.

Another important consideration for all women is mid-cycle bleeding and this is a common reason for younger women to stop taking the COCP. This can usually be prevented by not having too low a dose of oestrogen in the COCP and thus most younger women are prescribed COCPs with medium doses of ethinyloestradiol (the most commonly used oestrogen) of 30 to 35 micrograms in each tablet. The side effects of oestrogen are less of a problem in younger women and thus this dose of oestrogen is not a problem. In older women it is better to try to use the smallest dose of oestrogen possible.

Combined pills containing cyproterone acetate
(Brand names: Brenda 35-ED, Diane 35-ED, Juliet 35-ED). All these COCPs contain 35 micrograms of eithinyl oestradiol.

Combined pills containing drospirenone
(Brand names: Yasmin, Yaz) The COCP ‘Yasmin’ contains 21 active tablets with  30 micrograms of eithinyl oestradiol and the non-steroidal progesterone drospirenone. The COCP ‘Yaz’ contains 24 active tablets with  20 micrograms of eithinyl oestradiol and the non-steroidal progesterone drospirenone.
As well as reducing unwanted acne and facial hair, drospirenone also has a mild diuretic effect which helps reduce fluid retention symptoms associated with premenstrual syndromes, and is associated with less weight gain, which is a common side effect of the COCP.

Other delivery options for hormone contraceptive
Remembering to take a tablet each day is difficult for everyone and the hectic life that  young people lead means they have a high incidence of forgetting medication. An option is to use longer acting delivery options, such as skin patches than need nly be applied once a week or vaginal rings that are inserted once a month.

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Emergency contraception - When uncertain about contraceptive protection during intercouse, consider using it.

Not uncommonly, a woman is aware that she is not covered regarding contraception when she has had sexual intercourse. This opportunity to prevent unplanned pregnancy should not be ignored with the hope that all will be well. Emergency contraception is freely available in Australia from pharmacies and a doctors prescription is not needed. It works for up to five days following the unprotected sexual intercourse and has almost no side effects. (It is NOT just a morning after pill.)

What is emergency contraception?

There are two types of medicayion that can be taken as emmergency contraception

1. Levonorgestrel (a type of progesteron hormone)

This is basically a special dose of a type of progesteron hormone called Levonorgestrel that a woman can take to reduce the chance of becoming pregnant following unprotected sexual intercourse. This includes rupture of condoms or taking the pill incorrectly as well as having intercourse without any contraception. It is important to realise that, while pregnancy is more likely when sex occurs at certain times during the menstrual cycle, a woman can become pregnant at almost any time, even when sex occurs during menstruation. Thus, emergency contraception needs to be considered any time unprotected intercourse occurs.

Emergency contraception comes pre-packaged and consists of two pills containing a large dose of a progestin hormone. There are two brands, Postinor-2 or Levonelle-2, and both are available over-the-counter from any pharmacy. It does not require a doctor’s prescription.

The two pills are usually taken 12 hours apart, with the first one being taken as soon as possible after the unprotected sexual intercourse occurred. (There is evidence that taking both together is equally effective.) The closer emergency contraception is started to the episode of unprotected sexual intercourse the more effective it is.  However it will work up until about 5 days after. Thus, the term ‘morning after pill’ that is commonly used to describe emergency contraception is quite misleading.

Emergency contraception works in two ways.

  1. In women who have not yet released an egg (ovulated) during the cycle, it acts to delay ovulation until after the sperm from the sexual contact have gone, thus preventing egg fertilisation.
  2. Where ovulation has already occurred, it is thought to act by prevent preventing the fertilised egg from implanting in the uterus.

Overall, it prevents about 87% of pregnancies occurring while giving few side effects. (It can cause irregular bleeding.) The menstrual period following taking emergency contraception should occur at the expected time and if it doesn’t a pregnancy test should be done. The woman should continue her usual form of contraception during the cycle that the emergency contraception is taken in. This includes the pill.

The cost is in the region of $20 to $30.
Medical practitioners can provide this form of medication from samples they have of the mini-pill, but the progesterone dose in the mini-pill is quite small and two doses of 25 tablets are required to replicate the dosage provided in the commercially available emergency contraception preparations.

2. Ulipristal (brand name is EllaOne)

This new medication (introduced in 2017) is more effective than Levonorgesrtel. It can be used to protect against pregnancy for up to 5 days after intercourse but is best used as soon as possible. It is taken as a single 30mg dose (tablet) and s also available from pharmacies without a doctor's prescription. This medication should not be taken twice in one cycle and it should not be taken with Levonorgesrtel. Hormonal contraception should not be taken within 5 days of taking Ulipristal. The side effects are similar to Levonorgesrtel; mainly headache, nausea, abdominal pain and dysmenorrhea (period-like pain).

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Unplanned pregnancies

Unplanned pregnancies are common. They occur for many reasons and to women from all walks of life and of all child-bearing age groups. (About 15% of women presenting for termination are over 35 years of age.) No method of contraception is perfect.

How do I find out that I am pregnant?

Generally the first sign a woman notices is missing a menstrual period. (Occasionally women can still have light periods early on in a pregnancy.) Other symptoms of pregnancy include nausea or vomiting, breast enlargement / soreness, tiredness and dizziness, but often none of these symptoms are present early on.

A pregnancy test using a urine sample is the best way to diagnose pregnancy and it is usually positive a few days after a missed period. The test can be done by your doctor, at a Family Planning Clinic or by using a test purchased from a pharmacy.

If you suspect you might be pregnant it is best to find out definitely as early on as possible as this gives you more time to consider your options.

What to do?

Confirmation of an unplanned pregnancy is a huge issue for all women and one that every woman has their own response to. Most women will usually want to discuss their problem initially with a partner, a close friend or relative.

There are many issues that need to be discussed and it almost always helps to also discuss these with a health professional who is experienced in this area. This is best done sooner rather than later as the additional information gained can help clarify issues and assist with planning. (Below is a list of organisations and people who are in a position to be of help and offer support during what can be a very difficult time. Making contact early on is by far the best policy.)

Ultimately there are four options available to the woman.

The web site www.reachout.com.au is a helpful source for more information about these options. However, in the end it is the woman’s choice and she needs to be sure that the decision is the right one for her. 

Contacts

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Termination of the pregnancy (abortion)

Terminations are legal in all states of Australia under certain circumstances. About 80,000 pregnancies are terminated in Australia each year, mostly surgically but there soon will also be the option of termination using the medication Mifepristone (RU486). In both instances, the object is to clear out the contents of the uterus (womb).

Surgical termination

This is a relatively easy procedure up until the pregnancy is 12 weeks, although all medical procedures carry some risk. This is the safest time to have a termination. (The length of the pregnancy is measured from the beginning of the last menstrual period the woman had.) Surgical termination involves applying gentle suction (using a small plastic tube) to the inside of the uterus to remove the contents and the superficial lining tissue. This is usually done under light sedation or general anaesthetic, meaning that the woman is ‘asleep’ at the time. After 12 weeks the procedure becomes progressively more difficult and there are deadlines past which it is illegal to perform terminations. All surgical terminations should be carried out by suitably qualified medical doctors in a hospital or specialist clinic. The procedure generally takes about 15 minutes

What happens on the day of the surgical termination?
The procedure will be done in a specialist clinic or hospital and you will need to be fasting (nothing to eat OR drink) for about eight hours before. It is best to go with a trusted friend or relative who can help you with what is often an emotionally taxing experience and will be able to get you home again. (When done before 12 weeks it is a day-only operation.)

After the procedure
The woman is usually given a course of antibiotics to help avoid infection. She should expect some pain and bleeding following the procedure but this should only last a day or two and should not be excessive. If symptoms are more severe or get worse rather than better then a doctor should be contacted immediately. The most common complication of termination is infection and symptoms of infection also need to be looked for, including pelvic pain, vaginal discharge (often blood stained), fever and generally feeling unwell. If you are worried see your doctor immediately. Do not wait for your two week check up. A rare but serious complication is perforation of the wall of the uterus during the procedure. This causes symptoms very soon after the procedure, including significant pain that persists and bleeding. Significant pain after the procedure needs to be assessed by a doctor immediately.

Two week check up:
A check up two weeks after the procedure is necessary to ensure recovery has completed and there is no evidence of infection. At this time future contraception should be discussed. (This may already have been addressed.) It is also a good time to talk about how you are feeling. While most women are coming to terms emotionally regarding having a termination after a few weeks, some have continuing concerns that affect their everyday lives. If this is the case, the two week check up is a good time to talk about the need for further counselling. (You can also approach your local doctor regarding this.)

There are rarely any long term physical consequences from having a termination and it should not affect future fertility.
  

Medical termination of pregnancies using Mifepristone (RU486) – ‘Soon’ to be an option for Australian women

RU486 is a synthetic steroid developed from the progestogen norethisterone, which is a compound often used in the combined oral contraceptive pill (‘The Pill’). It has now been used for medical abortions by 2.5 million women in the USA, Europe and New Zealand over the last 20 odd years. At present it is only just being introduced in Australia and at present its use is very restricted. (Medical abortions have been done in Australia using other medications for some time.)

How does RU486 work?

RU486 works by binding to progesterone receptor sites in the woman’s body, thus inhibiting the action of progesterone (which is produced in the woman’s ovaries early on in the pregnancy). In the early stages a pregnancy requires high levels of functioning progesterone to survive and Ru486 prevents access to this hormone. It also increases the contractility of the uterus’s muscle, making abortion more likely to occur. Generally, a prostaglandin called misoprostol is given 48 hours after the RU486 to increase uterine contractions further and about 90% of women who successfully miscarry do so within six hours of its administration. The dose of RU486 that is usually prescribed is 200mg and the dose of misoprostol is 800mg. (The misoprostol is usually given vaginally to reduce side effects.)
Several consultations are often required and in some countries an ultrasound is done before RU486 is administered to ensure an ectopic pregnancy is not present as RU486 does not terminate ectopic pregnancies.

Success rate
The overall success rate depends significantly on when the RU486 and prostaglandin are administered, with earlier administration giving better results. When this combination is taken before seven weeks, the miscarriage rate is about 99%. In this early stage of pregnancy, medical termination is significantly more successful than surgical termination because the foetus is quite small and easy to miss with surgical suction techniques. When the RU486 / prostaglandin combination is taken between 7 and 9 weeks, the miscarriage rate varies from 77% to 91%. If the RU486 has not been successful a week after its administration, then surgical termination is required.

Advantages
It is less invasive and more private as women do not need anaesthetics or hospitalisation. Also, it can be done in country areas provided there is adequate surgical back up if a curette is needed to stop excessive bleeding, a side effect that occasionally occurs. Finally, it can be done earlier in the pregnancy, which is an advantage for women who are certain early on that they want to terminate the pregnancy.

Disadvantages / side effects
As RU486 needs to be given fairly early on it requires the decision to have a termination to be made fairly quickly. This is not always desirable or possible.

Side effects of RU486 include headache, nausea, and lower abdominal pain and cramping and pain, cramps and bleeding are generally more prominent than with surgical termination. Vaginal bleeding always occurs and can be heavy in some women, even to the stage of being life-threatening. (The usual treatment for this is transfusion and surgical curette of the inside of the uterus to remove any remaining conception products and the woman must always have surgical back up in her local area when taking RU486.) Studies indicate that about 2.2 women per 1,000 have heavy bleeding and about 0.5 women per 1,000 require a transfusion. Deaths due to excess bleeding are rare.

Infections also occur, the rate being about 2 per 1,000. Occasionally these can also be serious and there have been fatalities in the USA.
While the possibility of fatalities with RU486 is obviously alarming, the overall death rate with medical terminations (about 1 in 100,000) is significantly lower than the maternal death rate associated with continuing a pregnancy.

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Important adolescent risk taking issues

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Further information on parenting

The Sydney Children's Hospitals Network (includes The Children’s Hospital at Westmead.)

This hospital network's web site (https://www.schn.health.nsw.gov.au) is a great source of information on children’s health topics. It provides fact sheets about many child health issues that are free and downloadable and lists books on most child health topics that have been assessed by members of the medical staff at the hospital. These books are available for purchase from the Kids Health Bookshop at The Children’s Hospital at Westmead (Phone 02 – 9845 3585) or they can be purchased via the ‘e-shop’ on the web site. Any profits go into supporting the work of the hospital.

Further reading regarding teenager sexual health

Sexwise by Dr Janet Hall. Published by Random House Australia.
(What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)

Unzipped by Bronwyn Donaghy. Published by Harper Collins 
(A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)

Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)

Some suggested books on parenting adolescents

What to do when your children turn into teenagers  by Dr D. Bennett and Dr Leanne Rowe (This is a wonderful book that is unfortunately now out of print. Second hand copies may still be available.)

You can't make me  by Dr D. Bennett and Dr Leanne Rowe

I just want you to be happy. Preventing and tackling teenage depression. by Professors Leanne Rowe, David Bennett and Bruce Tonge. Published by Allen and Uwin, 2009.

Puberty boy  by  Geoff Price

Puberty girl  by  Shushann Movsessian

The puberty book  by  Wendy Darvill and Kelsey Powell

Teen esteem by Dr P. Palmer and M. Froehner

Most children suffer anxieties at some time and another book (not on the above list) that is very useful for parents is - Helping your anxious child. A step by step guide for parents. by Rapee, R., Spence, S., Cobham, V. and Wignall, A.New Harbinger, 2000.

 

Further information on sexual health

Sexual health information
www.shinesa.org.au

Family Planning NSW
https://www.fpnsw.org.au

The Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp

 

 

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