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:

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.

WHO updated policy on safe abortion

The WHO has announced the iminent publication of the second edition of ‘Safe abortion: technical and policy guidance for health systems’

http://www.who.int/reproductivehealth/publications/unsafe_abortion/9789241548434/en/

DH releases abortion statistics, England & Wales: 2011

The main findings of the newly released abortion statistics are:
•    The total number of abortions was 189,931, 0.2% more than in 2010 (189,574) and 7.7% more than in 2001 (176,364).
•    The age-standardised abortion rate was 17.5 per 1,000 resident women aged 15-44, the same as in 2010, but 2.3% higher than in 2001 (17.1) and more than double the rate of 8.0 recorded in 1970.
•    The abortion rate was highest at 33 per 1,000 for women aged 20, the same as in 2010 and in 2001.
•    The under-16 abortion rate was 3.4 per 1,000 women and the under-18 rate was 15.0 per 1,000 women, both lower than in 2010 (3.9 and 16.5 per 1,000 women respectively) and in the year 2001 (3.7 and 18.0 per 1,000 women respectively).
•    96% of abortions were funded by the NHS.  Over half (61%) took place in the independent sector under NHS contract, up from 59% in 2010 and 2% in 1981.
•    91% of abortions were carried out at under 13 weeks gestation.  78% were at under 10 weeks compared to 77% in 2010 and 58% in 2001.
•    Medical abortions accounted for 47% of the total, up from 43% in 2010 and 13% in 2001.
•    2,307 abortions (1%) were carried out under ground E (risk that the child would be born handicapped).

Non-residents:
•    In 2011, there were 6,151 abortions for non-residents carried out in hospitals and clinics in England and Wales (6,535 in 2010).  The 2011 total is the lowest in any year since 1969.

FPA reacts to the release of abortion statistics

Julia Bentley, Chief Executive, welcomed the decrease in abortions for under 16s and under 18s alongside a very small increase in the total number overall while highlighting the worrying trend in restrictions to contraceptive service provision.

New data show STI diagnoses on the rise in England

Figures released by the Health Protection Agency (HPA) show new sexually transmitted infection (STI) diagnoses rose by 2% in England in 2011, with nearly 427,000 new cases, reversing the small decline observed the previous year. Young heterosexual adults (15-24 years) and men who have sex with men (MSM) remain the groups at highest risk. More

Joint statement from FPA and Brook on STI data 

In a joint statement the sexual health charities said: “This is a worrying reverse trend. It demonstrates exactly why safer sex messages and campaigns that young people and gay men will listen to and take action on, are absolutely necessary. Testing and treatment services are vital, but alone they are not enough to change people’s behaviour. The impact of the government’s disinvestment in campaigning around safer sex and sexual health reflects in today’s statistics. Yet again we see more data illustrating why there is an urgent need for statutory sex and relationships education in schools alongside sustained investment in sexual health services.”

WHO: Urgent action needed to prevent the spread of untreatable gonorrhoea

Millions of people with gonorrhoea may be at risk of running out of treatment options unless urgent action is taken, according WHO. Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics – the last treatment option against gonorrhoea. Every year an estimated 106 million people are infected with gonorrhea, which is transmitted sexually. More:

Policymakers Recommit to Unfinished Agenda of Landmark Cairo Population Conference

In Istanbul, on 25 May lawmakers from 110 countries reaffirmed their support to the principles and goals of the 1994 Cairo International Conference on Population and Development (ICPD), emphasizing their continued centrality to efforts to reduce poverty and safeguard people’s health and rights, including sexual and reproductive health and reproductive rights. Press release

Crucial Issues for Health Joint Strategic Needs Assessments and Local Health & Wellbeing Strategies

Joint Guidance has been published by FSRH, BASHH, fpa, Brook, BHIVA, MedFASH, NAT, THT & NHIVNA to guide and assist Local Authorities who are preparing to commission sexual & reproductive health & HIV services when local government takes up its new public health responsibilities in April 2013.  In the coming months every Local Authority will need to:
- complete a Health Joint Strategic Needs Assessment (JSNA)
- establish a Health & Wellbeing Strategy & investment plan
- prepare to commission public health services.

FSRH response to APPG inquiry

The Faculty has published its response to the APPG on SRH inquiry into restriction on access to contraceptive services as outlined in the blog of 20th April.

Workforce Census 2012

Service representatives are directed to the Faculty Workforce Census for 2012. Forms are available online via the FSRH website and need to be completed by 30th June 2012.

GMC Fitness to Practise reforms

From 11 June 2012 the Medical Practitioners Tribunal Service (MPTS) will be the new impartial adjudication service for the medical profession in the UK. The MPTS will hear all fitness to practise cases about doctors and makes decisions on what action is needed to protect patients, if any. The MPTS is part of the GMC, but it is operationally separate from the GMC’s work in investigating complaints about doctors and presenting cases at hearings. Complete guide to the MPTS available from FSRH website.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16^th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .