Contraception and pregnancy
At some point in their teens most of the young women we talked to said that their doctors had raised the subject of contraception and pregnancy. If they were not yet sexually active - or if their mum was in the room - this was sometimes could be rather embarrassing. It does not seem to be easy for doctors to get the timing right for these chats - one young person thought that she had been a bit young at 14 years old, a 17 year old said no one had yet raised it with her and a 23 year old thought she was still too young to think about such things. Routinely seeing young people without their parents for part of consultation time can avoid uncomfortable conversations in front of parents. Many clinicians are being advised that discussing sexual health and family planning issues, in relation to chronic health conditions or disabilities, is an essential part of preparing young people for their future move to adult health services.
The young people interviewed usually understood that there were reasons why they needed to be particularly careful about the timing of any pregnancy - and felt it was better to be told this too early than too late. By age 14 most young people will have received at least some sex education in school. It is also to inform young people before they become sexually active, so that when the first time comes they are empowered to make more appropriate choices.
Young women often know that antibiotics can affect the oral contraceptive pill (the pill) and had been warned to use additional contraception - such as condoms - while they were using antibiotics. One said that the discussion about contraception and medication was one of the main differences between the child and adult services. Another said that since she was about 17 years old she was asked at every consultation whether she was planning to start a family.
Some medications can have a harmful effect on the unborn baby if you take them when you are pregnant. Young women with epilepsy talked about the effects of medication on their fertility, pregnancy and in particular, about the risk of having an abnormal baby. There are some forms of progestogen only contraception that are affected by anti-epileptic medications, such as implanon or the depo provera injection. Girls were often told by their consultants about potential risks, the importance of using contraception appropriately and the need to talk to their doctors if they decided to start a family so that they could plan changes to their treatment.
Some people had been told that they needed to take particular care before becoming pregnant. Girls with cystic fibrosis (CF) were advised that their partner should have a genetic test to check that they too did not carry the gene for CF. Genetic counselling is widely recommended for young people with many inherited conditions, when they were thinking of starting a family. If both mother and baby had CF there would be a danger that they might 'cross-infect' one another.
Young women were told that they would need to make sure that they were as healthy as possible before becoming pregnant, because pregnancy puts a strain on any woman's health. Parents too could be worried: a mother who dearly wanted to be a grandmother was very concerned about how daughter's health would be affected by the pregnancy.
A married 23 year old with CF said that having a baby would be 'the icing on the cake' for her and her husband, but felt that some people thought it was irresponsible of her to consider having a baby when she might not live beyond her early 30s.
A woman with chronic pain said that she and her husband had been on a roller coaster ride over whether she might be able to have a baby. They thought they would not be able to have a pregnancy without medical help. They felt that they could not bear the financial and emotional costs of infertility treatment.
A young woman with diabetes was told that there was no reason why she should not have a baby although she would need extra care. She was advised to raise the question with her doctors again and told that new research on diabetes and pregnancy is coming out all the time.
For more about sex and contraception see Youthhealthtalk - Sexual health of young people.
Last reviewed April 2010.
Last updated April 2010.