1. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people : How to make it safe ? E. Aubény French Association for Contraception Broussais Hospital Paris 75014

2. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? Stastistics show - In European countries the average age of first sexual intercourse is 16 years old - In European countries the average age of first sexual intercourse is 16 years old - In developping countries often it is earlier It is a fact : adolescents are sexually active It is a fact : adolescents are sexually active Society has to handle it and to help adolescents to protect against unwanted pregnancies and ISD against unwanted pregnancies and ISD

3. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? Emergency Contraception for young people How to make it safe ? Adolescence is the age of - Crushes - Living in the present time - Intermittent intercourse - Intercourse under more or less pressure > Unexpected, unprotected sex happens This underlines the importance of post-sex contraception : This underlines the importance of post-sex contraception : emergency contraception (EC) emergency contraception (EC)

4. Dr. E. AUBENY - AFC, Paris At adolescence when sexual activity starts - The beliefs concerning contraception are not always accurate: - The beliefs concerning contraception are not always accurate: that conception only occurs on the 14th day of the cycle, there is no risk the first time, etc.. - Problems can arise with contraceptive methods - Problems can arise with contraceptive methods - difficulties in using condoms correctly - difficulties in using condoms correctly - contraceptive pills forgotten - contraceptive pills forgotten This underlines the importance of post-sex contraception : emergency contraception (EC) This underlines the importance of post-sex contraception : emergency contraception (EC) Emergency Contraception for young people How to make it safe ?

5. Dr. E. AUBENY - AFC, Paris If emergency contraception is so important for young people, to be used effectively it should be easily and rapidly accessible If emergency contraception is so important for young people, to be used effectively it should be easily and rapidly accessible Emergency Contraception for young people How to make it safe ? How to make it very easily accessible in a safe way ? in a safe way ?

6. Dr. E. AUBENY - AFC, Paris 1) Preventive information and prescription 1) Preventive information and prescription should be offered when contraceptive advice is being given, especially for condom and pill users  There should be no more frequent use of EC*as a means of birth control  The young people should not abandon regular contraception* *A.Glasier study U.K. Emergency Contraception for young people How to make it safe ? Propositions for easy and safe accessibility

7. Dr. E. AUBENY - AFC, Paris 2) Two French initiatives for young people giving rise to easy and safe access to emergency contraception Emergency Contraception for young people How to make it safe ?

8. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? 1) Levonorgestrel EC is legally provided free of charge by high school nurses (2000) 1) Levonorgestrel EC is legally provided free of charge by high school nurses (2000) - - The nurse can provide levonorgestrel EC free of charge in cases of emergency, if it is impossible to have an early appointment with a doctor or to go to a pharmacy (rural area) - But also at the same time they must give advice to students about regular contraception

9. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? Levonorgestrel EC is legally delivered free of charge by high school nurses (2000) charge by high school nurses (2000) Since 2000, each year (figures are stable) 15 000 students ask for levonorgestrel EC 10 000 receive it, preventing unwanted pregnancies 5 000 have no need of it (they have another problem) This allows discussions between nurses and their students on contraception and on any sexual problem

10. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? 2) Levonorgestrel EC provided free of charge in pharmacies for minors In 2000 a law allowed levonorgestrel EC to be distributed in pharmacies to everybody without a doctor’s prescription and free of cost for minors (other patients must pay, they are reimboursed only if they have a doctor’s prescription)

11. Dr. E. AUBENY - AFC, Paris Levonorgestrel EC provided free of charge in pharmacies for minors Minors just need to request it : there is no identity control Pharmacists - must advise minors about EC and regular contraception - must give them a leaflet about EC made by pharmacy Direction - pharmacists give free of charge EC to minors and are refunded by Health Assurance Emergency Contraception for young people How to make it safe Emergency Contraception for young people How to make it safe

12. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? Levonorgestrel EC provided free of charge in pharmacies for minors - - 8 000 minors receive it each month. Figures are stable except in August (vacation time) - - But there are some problems : Pharmacists are anxious about giving advice to young people and the young people consider the pharmacists too judgemental ! some prefer to pay to avoid this kind of lecturing...

13. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? Emergency Contraception for young people How to make it safe ? There are two beneficial consequences in France of these two mesures for young people There are two beneficial consequences in France of these two mesures for young people Dr. E. AUBENY - AFC, Paris

14. Emergency Contraception for young people How to make it safe ? 1) Recognition of teenagers sexuality Levonorgestrel EC delivered by high school nurses and without charge in pharmacies for minors - opened the discussion about teenagers sexuality and contraception in the society - obliged its recognition This recognition is the best way to prevent abortion and ISD among adolescents: They are no longer too inhibited to seek advice about these problems and they can get reliable information

15. Dr. E. AUBENY - AFC, Paris Emergency Contraception for young people How to make it safe ? 2) Involvement of new health professionals in contraception Pharmacists High school nurses This arouses their interest in regular contraception. The majority are very pleased to be given this responsibility and to be involved in the contraception development

16. Dr. E. AUBENY - AFC, Paris In conclusion Emergency contraception Emergency contraception –is very useful for young people who frequently have problems using regular contraceptive methods –should be easy for them to obtain –provides the opportunity to give advice to young people and to guide them towards regular contraceptive use –allows them to speak about their sexual problems and to receive advice about these young people Emergency Contraception for young people How to make it safe ?