The WHO are currently preparing updates to its Medical Eligibility Criteria for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use, which will be finalized in 2014, and are soliciting feedback from various stakeholders in the field of family planning to inform this process. The goal is to ensure these guidelines remain relevant to family planning policies, programmes and service delivery. To that end, they have created a survey to help prioritize topics to review and to determine which new information to add to the guidelines. In addition they welcome other suggestions on how to improve the guidelines.

If you are familiar with the Medical Eligibility Criteria for Contraceptive Use or the Selected Practice Recommendations for Contraceptive Use fill out the survey and give your suggestions for the next edition.

New RCN publication:

‘A Framework for Sexual Health Improvement in England’ sets out the government’s ambitions for improving sexual health.

Designed to be used by local organisations when they are looking at how best to provide sexual health services in their area. This includes the need for:

• a fall in the number of unwanted pregnancies
•  greater efforts to prevent STIs and HIV
•  an increase in the number of people in high-risk groups being tested for HIV
• building an honest and open culture where everyone is able to make informed and responsible choices about relationships and sex
• making sure that all people have rapid and easy access to appropriate sexual health services
• offering counselling to all women who request an abortion so they can discuss the options and choices available with a trained counsellor

Responses to ‘Framework for Sexual Health Improvement’.

 The Sex Education Forum, based at leading children’s charity The National Children’s Bureau, welcomed the publication of the government’s strategy for improving sexual health and its focus on preventative measures, such as good quality sex and relationships education (SRE). However, more needs to be done to ensure all schools step up to the mark, in providing the information, support and advice that children want and need.

FPA welcomes the Government’s long-overdue publication of its Framework for Sexual Health Improvement in England document, which finally provides guidance to local government to help ensure that the nation’s sexual health improves.

Although we support the Government’s formal endorsement of the need to improve areas of sexual health like sexually transmitted infection (STI) and teenage pregnancy rates, we are acutely aware that there is absolutely no guarantee that local councils will actually act on this guidance.

We know from our Unprotected Nation report, released in January, that if the situation worsens, and local government chooses not to invest in sexual health services, the additional cost to the economy is likely to be over £135 billion over the next few years.

Brook

Responding to the publication of A Framework for Sexual Health Improvement in England Simon Blake OBE, Brook’s Chief Executive, said:

“We are pleased that the Framework for Sexual health has been published just in time for the move to local authorities and that there are clear aspirations for the improvement of young people’s sexual health, in particular that all young people have access to confidential services and support.

“We are also pleased to see the ambition that all children and young people should receive good quality Sex and Relationships Education (SRE) at school which we know is vital in preventing abuse and exploitation and promoting positive relationships. However, this ambition will never be realised whilst the Department for Education fails to ensure that every school is required to deliver a comprehensive programme of SRE.

“As we move towards 1st April we look forward to working local authorities to realise these ambitions and improve young people’s lives.”

FAMILY PLANNING 2020 names Director of the global partnership

The Family Planning 2020 (FP2020) Reference Group announced that long time global advocate for family planning and reproductive health Valerie DeFillipo has been named Director of the global partnership. FP2020 builds on the partnerships launched at the London Summit on Family Planning. It will sustain the momentum from London and ensure all partners are working together to achieve and support the goals and commitments announced at the Summit.

JFPRHC is looking for a dynamic reader to take on the role of social media editor

The Journal already has a strong readership and offers online features such as a blog, podcasts, Facebook and Twitter.  This new post has been created to assist the editorial team in improving the journal’s interactivity and web presence via these and other social media, by promoting the journal’s content as well as helping its core readership to stay up to date with news and developments in the field.

You should be educated to degree level with knowledge of the journal’s subject area. Some experience of science communication and/or web content management systems such as Twitter, Facebook andWordPress would be preferred, but the main criteria for the successful applicant will be enthusiasm for the subject area, creativity, and an interest in using new technologies to disseminate scientific research.

The role would be ideally suited to a junior researcher or practising clinician. The full advert, and how to apply, is available at: http://jfprhc.bmj.com/site/misc/JFPRHC%20Social%20Media%20Editor%20advert%20Feb%202013.pdf

Sexual Health Commissioning

the Local Government Association and Public Health England have produced a document of FAQs. They address a number of transitional issues relating to the transfer of responsibility for commissioning sexual health services to local government.  In addition to these FAQs the Department of Health will shortly publish guidance on local government’s mandatory responsibilities for sexual health.

Reminder to register as stakeholder for NICE Patient group directions Good Practice Guidance

Management of PGDs will change from the 1st April when commissioning of services changes. All those involved in development or use of PGDs can contribute at the  consultation stage by registering as a stakeholder now. Individuals can contribute as service providers.

To register your organisation as a stakeholder send registration details (name of contact, name of organisation, email address) to pgd@nice.org.uk using the subject heading Patient group directions GPG stakeholder registration 2012/13

National Infertility Awareness Campaign Welcomes updated NICE Guideline on Treating Infertility

The National Infertility Awareness Campaign (NIAC) has welcomed the new clinical guideline on the assessment and treatment of couples with fertility problems, published by NICE yesterday but fears remain over its implementation.

People experiencing fertility problems will be able to seek NHS help sooner and get the medical treatment they might require earlier. The updated guideline also includes other specific groups of people for the first time; these include same sex couples, those who carry an infectious disease, such as Hepatitis B or HIV and those who are unable to have intercourse (for example, if they have a physical disability). It also includes updated recommendations for people who are preparing for cancer treatment who may wish to preserve their fertility. However, as NICE clinical guidelines are not mandatory, fears still remain over local implementation as patients may continue to face a ‘postcode lottery’ approach to funding. This coincides with the release of the

Latest UK fertility treatment data and figures: 2010-2011

Published this week by the HFEA – ‘Fertility Treatment in 2011: Trends and Figures’

Education about abortion in the UK is failing young people

A report published by Brook and Education For Choice (EFC) finds that education about abortion in the UK is failing young people.  Some schools are addressing the topic as part of comprehensive sex and relationships education (SRE), but there is evidence of widespread bad practice including medical misinformation being provided by teachers and visitors to schools.  The report pulls together findings from surveys with schools and young people, and an audit of teaching materials used. Young people describe negative experiences of the education they received, and report that some schools are using inappropriate teaching materials including graphic images and distressing, inaccurate video material.

The following Online Firsts have been published

Does a full bladder assist insertion of intrauterine contraception?: a randomised trial (Cameron, Glasier, Cooper,  Johnstone)

Cameron and colleagues set out to answer a simple question: does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful.

Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives (Briggs, Praet, Humphreys, Zhao)

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHC). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had Category 3 or 4 risk factors, particularly BMI ≥35. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower risk alternatives.

Understanding barriers to sexual health service access among substance-misusing women on the South East coast of England (Edelman, Patel, Glasper, Bogen-Johnston)

This interesting article explores why substance-abusing women have problems accessing SRH services in Hastings, UK. Drug use, low self-esteem and previous traumatic experiences all combine prevent women accessing help. This is a qualitative interview study and provides important insights into the care of these women; there are no easy answers but the authors have provided some suggestions as to how practitioners may make the service more accessible.

Coping after recurrent miscarriage: uncertainty and bracing for the worst (Ockhuijsen, Boivin, van den Hoogen, Macklon)

Pregnancy loss is a significant trauma for women, the more so if repeated.  In their study, Ockhuijsen and her colleagues investigated the ways in which women coped in the time after single and recurrent miscarriages and in the difficult period soon after conception while waiting for ongoing pregnancy to be confirmed. They found that coping strategies differed between the two groups of women and they investigated the use of a simple psychological support tool, the Positive Reappraisal Coping Intervention, that may be of help, particularly to those with greater concern for the future following recurrent miscarriage.

The role of ambulatory hysteroscopy in reproduction (Robinson, Cooper, Clark)

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review summarises the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation.

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK (Akintomide, Sewell, Stephenson)

What to do now? How women with breast cancer make fertility preservation decisions (Snyder, Tate)

A service-based approach to nurse training in sexual and reproductive health care (Shawe, Cox, Penny, White, Wilkinson)

Increasing male participation in the uptake of vasectomy services (Singh, Mishra, Alam, Pandey)

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia
(Abdala, Hansen, Toussova, Krasnoselskikh, Verevochkin, Kozlov, Heimer)

Plus Organisation Factfiles on Tommys and the College of Sexual and Relationship Therapists (COSRT) by Susan Quilliam and a letter to the editor “Learning from Romanian women’s struggle to manage their fertility” by Ann Furedi following the article in the January Journal

Education for Choice hightlights misleading pregnancy counselling

Education for Choice support young people’s right to informed choice on abortion. They report that Feminist Action Cambridge held a demo in Cambridge city centre to raise awareness of local ‘crisis pregnancy centres’ which they feel are ‘using emotionally manipulative techniques’ and misinformation ‘in order to increase the guilt women might feel at having an abortion.’ They sent mystery shoppers to three counselling centres in Cambridgeshire and found that, at each one, women were being given some kind of false information about abortion and/or subjected to ‘counselling’ which was biased and often based on personal anecdotes.

New NICE Clinical Guideline: Ectopic pregnancy and miscarriage

This clinical guideline offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy and is available from NICE at: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=14000

The Morning After: A Cross Party Inquiry into Unplanned Pregnancy

2020Health.Org report that “Over half of unplanned pregnancies happen because people are not using sufficient contraception, according to a survey by a Cross-Party Parliamentary Inquiry.

Th inquiry, supported by 2020health, into unwanted pregnancies, highlights three main findings:
1.That a large proportion of unwanted pregnancies are happening because people are not using sufficient contraception;
2. That there is inadequate Sex and Relationship Education in schools; and
3. That there is a lack of access to contraception for over 25s.

http://www.2020health.org/2020health/Press/latest-news/Unplanned-Pregnancy-Report.html

ICEC has relaunched its website with easily accessible information on all aspects of emergency contraception worldwide. The map of registration status of EC pills is particularly interesting as is the status and availability database

New IUS launched

Skyla, has gained FDA approval and is due to be launched in the USA next month – the first new device to come to market in 12 years.  Skyla contains 13.5 mg of Levonorgestrel and differs from Mirena in that it prevents pregnancy for 3 years rather than 5 and appears to be aimed at younger women who have not had children.

MEDFASH eBulletin

Read all the latest SRH news here

The following papers have been published at http://jfprhc.bmj.com/content/early/recent

The financial costs to patients of diagnosing and excluding ectopic pregnancy (Unger et al)

In their article, Unger and his colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This paper describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. from David Horwell, Advisory Editor

Despite the best intentions: a reflection on low client numbers for a pilot telemedicine sexual health service (Garrett & Kirkman)

This “Better Way of Working” article describes the outcome of a pilot of a telemedicine sexual health service for rural youth in Victoria, Australia. Despite expecting high client numbers, few used the service. This article explores the reasons for the disappointing usage, and concludes that clinicians’ expertise and passion for improving access to health care may not be enough to guarantee successful design and implementation of the most appropriate service. from Gillian Robinson,  Associate Editor

Uptake and continuation rates of the intrauterine system in a university student general practice population in the UK (Armitage et al)

This is a very simple real-life observational study of a cohort of young nulliparous women in a university-based general practice choosing and continuing with LARCs as their first line method of contraception. This paper compels the reader to offer this ‘fit and forget’ method of contraceptive to our younger population, of course along with all other forms of contraception, as a matter of routine. from Scott Wilkes, Associate Editor

Removal of a fractured Nexplanon^® (Elliman)

In a letter to the editor Alyson Elliman describes removal of a partially fractured, curved implant with no obvious cause and asks if other clinicians have observed anything similar.

NICE Good Practice Guidance: Patient Group Directions is now under development.

This guidance is now in development and due to be published in April 2013

Stakeholder registration is now open.  To register your organisation as a stakeholder* send registration details (name of contact, name of organisation, email address) to pgd@nice.org.uk using the subject heading Patient group directions GPG stakeholder registration 2012/13

*for the purposes of this guidance stakeholders are:

• national patient and carer organisations that directly or indirectly represent the interests of people whose care is covered by the guidance
• national organisations that represent the healthcare professionals who provide the services described in the guidance
• companies that manufacture the medicines or devices used in the area covered by the guidance and whose interests may be significantly affected by the guidance
• providers and commissioners of health services in England, Wales and Northern Ireland
• statutory organisations including the Department of Health, the Welsh Assembly Government, NHS Quality Improvement Scotland, the Healthcare Commission and the National Patient Safety Agency
• research organisations that have done nationally recognised research in the area

See http://www.nice.org.uk/mpc/goodpracticeguidance/PatientGroupDirections.jsp for further information.

Philippine Government finally passes Reproductive Health Bill after 14 years.

This is a huge victory in the Philippines for access to maternal health services, family planning, and sex education. The reproductive health bill gives the national government the mandate to make reproductive health services accessible to poor families through information and education and the provision of free contraceptives.

The Medical Foundation for HIV and Sexual Health is 25 yrs old (rebranded as MEDFASH). Established in 1987 by the BMA, as an independent foundation, with the aim of improving knowledge and understanding of HIV among health professionals it has grown and spread to encompass all aspects of sexual health.

As part of this celebration the foundation has a new website and has launched its Sexual Health & HIV Policy eBulletin.  MEDFASH Chief Executive, Ruth Lowbury, introduces the eBulletin: it is designed with local sexual health and HIV commissioners and providers in mind. It will give a concise and regular round-up of emerging policy developments, relevant evidence updates and available tools and resources across the field of sexual and reproductive health and HIV. It will also consider the impact the change agenda is having on this area of healthcare through a series of eFeature articles and interviews with those working at both national and local levels. This is particularly useful now at a time when service delivery is changing and many of us will be involved with new (and possibly challenging) ways of working and new communication channels.

Amonst other things the first issue includes: transfer of sexual heath services to local authorities; local transition arrangements; re-tendering of GUM services; Healthwatch England (the new consumer champion for health and care in England); HIV treatment for overseas visitors.

Highlights from this issue include:

The effects of childhood sexual abuse on women’s lives and their attitudes to cervical screening

This commentary by Sarah Kelly is the and available free.

Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study

This   article by Cadman et al. explores the barriers that women who have been sexually abused experience in accessing cervical screening.

Effect of domestic violence on contraceptive choice

This study from Nicaragua looks at the impact of intimate partner violence (IPV) on the choices that women make about their contraception.

Cervical screening among migrant women in London

A qualitative study exploring attitudes towards participation in the UK’s National Health Service Cervical Screening Programme (NHSCSP) amongst Central and Eastern European migrants throws some light on the reasons for variations in their participation.

Accessing referral for abortion in the USA

Dodge et al. have investigated the readiness of services that do not provide abortion to offer referral to other services.

Contraception challenges in Lesotho – not so different from the UK

In his 2011 Margaret Jackson Prize Essay, Nic Robertson gives readers a fascinating insight into the challenges facing contraception services, and problems encountered with use of current contraceptive methods, in Lesotho.

Private vs public abortion providers: implication for abortion stigma

This personal view article is written by a health professional who has experience of abortion services in both the private and public sectors in Australia and the UK. The contrast is worrying and raises a number of issues, especially since the political climate around abortion services generally seems to be becoming more, rather than less, conservative.

Patients’ thoughts and concerns about psychosexual therapy

Having previously considered the experiences of psychosexual therapists, the Journal’s Consumer Correspondent, Susan Quilliam, now explores what patients themselves think ‘psychosexual support’ might entail and identifies some of the questions they may voice in the consulting room.

Plus Letters to the Editor include:

Pitfalls of adapting emergency contraception CEU guidance

Entonox^® analgesia for IUD insertions and removals

Allergy to Nexplanon^®

Link to the Journal

  WHO Guidance – Safe abortion: technical and policy guidance for health systems

The second edition of this guidance has now been published and is available from:  http://extranet.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf

  RCOG – The Initial Management of Chronic Pelvic Pain,  (Green-top 41)

New guidance published in May available from: http://www.rcog.org.uk/womens-health/clinical-guidance/initial-management-chronic-pelvic-pain-green-top-41

RCN – SDI and IUT Accreditation Guidance Documents – Sixth Edition

Accreditation, which is valid for 5 years costs £360 for members and £480 for non-members – re-accrediation is £180 and £240.

Available from: http://www.rcn.org.uk/development/learning/accreditation/LARC_accreditation

“Don’t go in without a skin”

Online condoms and lubes provider the Freedoms Shop (Central & North West London NHS Foundation Trust) has teamed up with Terrence Higgins Trust to launch the Summer Lovin’ campaign – urging gay men across London to use condoms – with a new online health resource. The downloadable resource brings together stacks of health and sexual safety information, presented in a cheeky, accessible way, while Freedoms is providing a half price condoms