new audit reveals shocking truth as 3.2m women face restrictions in access to contraceptives or services

A new audit of the commissioning of contraceptive and abortion services in England has revealed a stark picture of inequality in women’s healthcare, with a third of women of reproductive age unable to choose from the full range of contraceptives or services in their local area.

The audit was carried out by the Advisory Group on Contraception – a coalition of leading experts and advocacy groups interested in sexual and reproductive health – through Freedom of Information requests made to Primary Care Trusts (PCTs). The report of the audit findings, Sex, lives, and commissioning: An audit of the commissioning of contraceptive and abortion services in England demonstrates that:

As many as 3.2 million women of reproductive age (15-44) are living in areas where fully comprehensive contraceptive services, through community and/or primary care services, are not provided

• Those PCTs restricting access to contraceptives or contraceptive services had a higher abortion rate than the national average
• Over a quarter (28%) of PCTs responding to the audit did not have a strategy in place or under development to address unintended pregnancy and the need for abortion or repeat abortion

The audit also uncovered evidence of PCTs introducing access restrictions based on cost rather than choice or quality:

• NHS North Lancashire confirmed one method of contraception was not prescribed “due to lack of funding/training for staff”
• NHS Brighton and Hove confirmed that its “GP-led health centre will only prescribe Long Acting Reversible Contraceptive (LARC) methods to residents of Brighton and Hove.  Non-residents attending with a filled prescription for LARC will be provided with a fitting”
• NHS Haringey Teaching said that from the 1 October 2011 “women aged over 25 do not receive contraception pills from the local CaSH [Contraception and Sexual Health] Service; they receive this service from their GP”
• NHS Barnet stated that “In 2010 the PCT introduced a restriction on over 25’s accessing integrated services for generic contraceptive advice… Only patients within this age group who have complex needs can be seen by an integrated service”

Dr Connie Smith, Consultant in Sexual and Reproductive Healthcare, said:

“Contraception is a very personal issue.  What is right for one woman may not be right for another.  That is why the national NICE guidelines on contraception are built around the importance of choice. 

 “PCTs that are restricting choice are getting worse outcomes.  As a result of flouting national guidance, women are paying a big personal cost and the NHS is bearing a huge financial cost.  Unintended pregnancy costs the NHS more than £755 million every year.  For every £1 spent on contraception the NHS saves £12.50, so restricting access and choice is a complete false economy, harming women and the NHS.  Those PCTs with restrictions in place need to have an urgent rethink.”

Dr Anne Connolly, a GP with a special interest in sexual health, added:

“As a GP I know how important it is to get contraception right.  We must take a personal approach to meeting women’s needs and operating a blanket ban on some services or contraceptives goes completely against this. 

 “It is very concerning that so many PCTs have no strategy in place to address unintended pregnancy and that some are introducing restrictions on contraceptives or services.  The Department of Health should urgently publish a sexual health strategy showing how the needs of women of all ages can be met, alongside clear standards about the quality of service women have a right to expect.”

The AGC has made a series of recommendations for how sexual health and contraceptive services could be more effectively planned, commissioned and delivered.  These include:

• The Department of Health should publish its planned sexual health policy document without further delay and ensure that it sets out clearly the expectation for commissioners to commission comprehensive, open access services that reflect a life-course approach for people of all ages
• NICE should prioritise the development of the quality standard on contraceptive services
• Contraceptive services must be commissioned based on the principles of the NHS Constitution. Commissioners should remove any policies or contracts in place which limit an individual’s access to contraceptive services based on reasons of age or place of residence
• Commissioners should ensure that up-to-date strategies are in place to reduce unintended pregnancy, and the need for abortion and repeat abortions, and these strategies should focus on addressing the needs of women of all ages

The All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPGSRH) has launched an inquiry and call for evidence into restrictions in access to contraceptive services.

Examples have already been seen of commissioners cutting prescribing budgets for contraceptive methods to meet targets for savings, with consequences for choice and public health outcomes. In addition the Public Health Minister, Anne Milton MP, in a response to a parliamentary question tabled on contraceptive services, has recently confirmed that the Department of Health has received “representations from clinicians and voluntary sector organisations on the current commissioning of contraception by primary care trusts (PCTs) and access to certain types of contraception by certain age groups”.

On Monday 6 February, the APPGSRH held a meeting to discuss possible restrictions in access to sexual health services to residents-only and to people under 25 years old.  During the meeting members of the Advisory Group on Contraception (AGC) presented the initial findings from a Freedom of Information audit which had found variations in access to contraceptive services and methods.

The APPGSRH expressed concerns at the findings from the audit, in particular:

• Evidence of commissioners restricting access to contraceptive services on the basis of age or place of residence
• The impact that the drive for efficiency savings is having on women’s choice of the full range of contraceptive methods
• Some methods of contraception only being made available with a GP referral
• The impact of changes to the commissioning structures on the continuity and quality of contraceptive care

The APPGSRH is launching this inquiry in the belief that its work can contribute to the debate about how high quality contraceptive services can be delivered in the context of the healthcare reforms; and how access to the full range of contraceptive services and methods can be improved for women of all ages.

The inquiry will bring together further evidence and understanding to the current provision of contraceptive services across the country. It will also look at uncovering examples of good practice in relation to the availability of contraceptive services which can be shared amongst new and emerging commissioners of services.  We are therefore encouraging stakeholders – including commissioners, healthcare professionals and service user representatives – to submit written evidence which will help feed into the inquiry’s discussions.

Call for written evidence

The deadline for written evidence is 5pm on Friday 18 May and submissions should be sent to appg@fpa.org.uk. Submissions should be no more than 2,500 words. For more information click here.

The Course of 5 (C5) is the 2nd stage of the new DFSRH blended learning training package – it provides a link between the theory element (e-SRH) and the practical, clinical assessments (ACP).

What is involved in C5? 5 one-hour, assessed workshops in groups of no more than 4 per facilitator. These are usually offered as a one-day or 2 half day package organised locally by Faculty Registered Trainers. They can also be done as 5 individual sessions.

When can I do this?  C5 cannot be undertaken until you have registered for the diploma and e-portfolio and have completed the e-SRH sessions. It must be passed before moving on to clinical practice.

What is covered? The content is fixed by the Faculty and covers:
Session 1 – Taking a Sexual History and HIV pre test discussion and testing
Session 2 – STI Screening and Testing and Teaching the use of Condoms
Session 3 – Practical Aspects of Contraception – including diaphragm and implant fitting
Session 4 – Young people; Consent, Confidentiality, Fraser Guidelines and Safeguarding children
Session 5 – Managing Sensitive Scenarios – dealing with unwanted pregnancy, psycho sexual problems and referral for sterilisation.

How is it assessed? There are 9 assessment criteria in which you must demonstrate active and appropriate participation in all the sessions.

How do I access a C5? A list of local contact details is available from the Faculty website.

How much does it cost? The courses are costed locally and will vary according to set up.

Where can I get more information? For full details visit the Faculty website training section

I am a nurse – can I do the Course? The simple answer is yes, but it may depend where you live and who is organising C5 in your area. Nurses cannot gain the Faculty diploma but can do the e-SRH sessions and C5. In some areas nurses are using this to access training in SRH and some clinics may then be happy to offer clinical assessment too.