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CONTRACEPTION;
WHY? WHEN? HOW?
Homeless and Inclusion
Health Conference
DR TONYE WOKOMA
FRCOG MFSRH
Consultant in Sexual & Reproductive Health
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Overview
• Case study
• Sexual health issues
• Contraceptive methods and efficacy
• Barriers and facilitators
© Faculty of Sexual and Reproductive Healthcare
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AB • 37yrs old; 9 children; Substance
misuse • Works as a SW • Buddied into the service • Flexible timing as will not wait to be
seen • PT and implant insertion done. • STI screen done • Declined a smear at this visit • Said of the outreach worker – “she
speaks at our level”
© Faculty of Sexual and Reproductive Healthcare
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‘Vulnerable and Hard to Reach’
Vulnerable
Transient
Marginalised
Refusers
Hidden
Forgotten Populations
Underserved
‘Disadvantaged’
Homeless
Alcohol and drug misuse
Mental health
Asylum seekers and refugees/migrants
Sex workers
Disabled
Young people
Elderly
BME
© Faculty of Sexual and Reproductive Healthcare
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Sexual health Issues
Poorer uptake of contraception/Unintended pregnancy
Poorer antenatal care and pregnancy outcomes
Being involved in the sex industry/at risk of sexual
exploitation
Lower rates of screening
Cervical/breast
Domestic abuse/Rape
STIs and HIV/AIDS
Psychological issues
Sexual assault, exploitation, violence, rape
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How well do they work?
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Accidental pregnancy in first year of typical use
Trussell J. Contraceptive efficacy. In: Hatcher RA, Trussell J, Stewart R. Contraceptive Technology, ed 17. NY: Ardent Media, 1998;800-801
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Barriers to Accessing Services
Negative attitudes of
healthcare
professionals
Location and opening
times of services
Lack of support
Lack of trust
© Faculty of Sexual and Reproductive Healthcare
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Facilitators
respectful treatment of
service users
establishing trust with
service users
offering service flexibility
partnership working with
other organisations
service user involvement
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Decision Making
Allow time
Decision should not be made for her
Women often feel judged
Available options
same as for every one else
support often needed to access
services
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Consultation – Patient Centred
Good communication
Don’t make assumptions.
Be clear and explicit about confidentiality.
Provide information and choice.
Provide structure
Build relationships
Build trust
Be accessible
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Good Practice - Outreach Team
Provide a one stop shop
Accessible locations and flexible hours
Supports reduction of conceptions
to under 18’s,
vulnerable & higher risk groups
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CONCLUSION “Routine service provision should be able to
flex around the expectations, beliefs, needs
and resources of intended service users”