Measuring quality in contraceptive services.

Preventing unintended pregnancies and preserving sexual and reproductive health are of fundamental importance for both public and individual health and well being. Control of fertility is complex (with parenting, education, youth culture, social conditions, and economic circumstances all playing a part), and the provision of effective contraceptive services are obviously important. The task of defining and providing the most effective contraceptive care for those who need it-including young people-is an urgent issue in all countries. A recent issue of Effective Health Care' presented a systematic review of the research evidence on approaches to preventing and alleviating the effects of teenage pregnancy (an edited version of this bulletin is included in this issue of Quality in Health Care2). This review found (in the United Kingdom) a complete lack of controlled evaluations of the effectiveness or cost effectiveness of different approaches to the delivery of contraceptive services to young people. As the United Kingdom has the highest teenage pregnancy rate among 15-19 year olds in western Europe this is an area that should be considered an urgent research priority. Many factors stand in the way of setting up the necessary research work in the United Kingdom. There are perceived difficulties about approaching people to provide information for research into sexual health and behaviour.3 There is a multiplicity of contraceptive providers (both professional and retail) and methods available. Few agreed outcome measurements and quality standards for contraceptive services exist. And, importantly, resources are needed to support such research programmes. But none of these potential difficulties should stop us from tackling the necessary work and a paper from Finland published in this issue of Quality in Health Care4 provides the opportunity to consider our current position. As in the United Kingdom the Finnish healthcare system provides a variety of outlets for professional contraceptive advice and prescription, with specialist clinics, general practitioners and public health nurses in health centres, and non-profit making and private providers. By surveying a large sample of women, selected from the comprehensive Finnish population register Hemminki and colleagues assessed the quality of contraceptive care from the women's experiences of contraceptive services and their knowledge of fertility and contraception. The dimensions of quality used to assess services in Finland offer a model of interest both to providers and commissioners of contraceptive services in other countries. Provision and availability of contraceptive services in the United Kingdom are usually seen in terms of the …