2. The Dutch success explained:
Context
The quality of sex education both within school and the family
The general openness about sexuality and the acceptance of teenage
sexuality as a fact.
The availability and accessibility of primary healthcare services
Less patronizing attitudes of service providers and a tendency of
demedicalisation
Method
high rates of reliable contraceptive use (OC, sterilization)
User
The communication skills of teenagers enabling them to make their own
responsible choices.
High compliance rates (Pearl index of OC for instance 10 times lower
than US)

3. Contraceptive use in The Netherlands/age category
age none CHC* PO IUD steril. condom** other
15–
20–
25–
30–
35–
40–
45–
* combination with condom included; ** condom as contraceptive, not in combination with other method.
CHC=combined hormonal(OC =Nuvaring)
PO=longacting progestagen only(injectables and implants

4. Age Profile OC Use

5. Sterilization in The Netherlands
15-50y: 19.2%
45-49y : 32.0%
15-50y : %
45-50y : 16.6%

6. Subjective reliability estimate (n= 5000)
3.Method actually used
Van Dalen & van Lunsen, 2004, submitted

7. Abortion is there to stay
In an ideal world, contraceptives would be 100% effective, and they would be used correctly every time. But, like most things in life, birth control isn't perfect. Pills are missed; condoms break, are put on improperly, and sometimes are not used at all. And, unfortunately, situations occur in which women are forced to have intercourse against their will.

8. Determinants of inadequate preventive behaviour
Lack of Motivation
Mistakes are Human
(user dependent factors)
3. Bad Luck (100% reliable does not exist) (method dependent factors)
Unexpected sexual encounters
(situative factors)
5. Contextual factors(partner and/or society related

9. 1.Lack of Motivation (user dependent factors-1)
The motivation to use contraception is determined by the fact that it enables sexual activity without fear for pregnancy.
When the expected outcome of sex is not positive, both sexual and contraceptive motivation will be lacking
When expected and/or experienced side effects outweight the benefits contraceptive motivation will decrease and non-compliance will increase
van Lunsen et al ,proceedings ISSWSH 2004

10. 2. Mistakes are Human (user dependent factors-2)
Nobody is perfect
The method is not suitable for the situation (lack of tailor-made approaches)

11. 3. Bad Luck (method dependent factors)
100% reliable does not exist
Irrational subjective reliability assessment

12. 4.Unexpected sexual encounters (situative factors)
Starters
Serial Monogamous Restarters
Substances

13. 5.a. Contextual factors (partner related)
partner communication
lack of male responsibility
partners’ preferences
abusive relationships
partner abandonment and other situations
that turn a desired pregnancy into an
unwanted pregnancy

14. A lack of communication between partners
as well as relational problems negatively
influence consistent use of contraceptives
Women and men who are satisfied with their
relationship more frequently use reliable
contraceptives than those who experience
relational problems.
.Sundby et al.Patient Education and Counseling 1999,38:11-10.
.Ingelhammer I, et al. Contraception 1994;50:

15. 5.b. Contextual factors (society related)
social attitudes about sex
educational climate
patronizing attitudes of service providers
medicalisation
scares
lack of accessible services
limitations in availability of certain methods
lack of availability of emergency contraception
financial barriers

16. Contrary to the belief of many policy makers in more repressive societies a pro-sexual attitude of society, educators and care-givers is one of the major determinants determining the success of prevention programs.

17. Abortionrate/
* pillscare €
NHS * *

18. Abortions/ age category(1992-2000)

19. Frequency/age category(% of total number of abortions)

20. Causes increase in abortion rates since 1996
Increased numbers of non-European immigrants
Decrease OC use related to :
- Negative Publicity on OC’s
- Changed health beliefs and decreased
acceptability of side effects
Changed risk perception/increased risk behaviour (simultaneous increase STD)
Less investments in prevention programs
Changes in refunding system

21. A small decrease in 2003 by: Sharp decrease numbers of new immigrants
Renewed prevention campaigns in schools, media (including several websites) and for special groups