It has been a busy and eventful year in sexual and reproductive health:

January

saw the launch of the new-look Journal of Family Planning & Reproductive Health Care as it joined the BMJ family. Readers will have noticed many improvements, not least the website and early online publishing.

February

The joint Faculty / e-Learning for Health, e-SRH, was named winner in the e-Government National Award: excellence, Learning & Skills section (now renamed UK Public Sector Digital Awards)

March saw the MDU statement: GPs need suitable training to fit contraceptive implants

April saw the Faculty response to EC being made available through pharmacies in Wales

May saw the publication of the new Missed Pill Recommendations

June

saw Chris Wilkinson become the newly elected President of the Faculty and in
July his appoinment was acknowledged in BMA News

August

saw the publication of the Emergency Contraception Guidelines

September saw the publication of the amended Drug Interactions with Hormonal Contraception and the launch of this Blog !!

October saw the publication of the Combined Hormonal Contraception Guidelines as the world population broke the 7 billion mark.

November
saw the CEU being awarded NHS Accreditation for its guidelines and the publication of the Service Standards for SRH

December
saw the 23rd World AIDS Day with the theme: Getting to Zero

And so to 2012 – wishing all our readers a Happy New Year

Following publication of the extended analysis of the Danish Cohort Study on VTE risk (with combined oral contraceptives with different progestogens and oestrogen doses) in the BMJ and the rapid responses since, Shapiro S and Dinger J have now produced a Commentary for the January 2012 edition of the Journal of Family Planning and Reproductive Healthcare (JFPRHC). This is now published at BMJ Online First.

To accompany the commentary Anne Szarewski, Editor in Chief of the JFPRHC writes

VTE and the Pill … again

The re-analysis of the Danish Cohort Study has recently been published in the British Medical Journal (BMJ). Unfortunately, there are still many methodological issues with it, as discussed in this commentary by Dinger and Shapiro. They also point out that the important analysis that was actually requested by the regulatory authority (but not published in the BMJ paper) showed no difference in risk between combined oral contraceptives.

FSRH Workforce Planning Committee

The Faculty has vacancies for 2 members on its Workforce Planning Committe (1 associate member and 1 diplomate, member or fellow). Details available on the Faculty website.

2 New Publications for Nurses -

as reported by Wendy Moore, Vice Chair of the Faculty Associate Members’ Working Group

RCN Competences for nurses undertaking bimanual pelvic examinations

Nurses working in sexual and reproductive health are increasingly extending their role, benefitting both the nurses and their client groups. The ability to carry out pelvic and bimanual examinations is now a key requirement for nurses working in these specialisms in primary, secondary and community care. The purpose of the competency framework is to ensure that women requiring a pelvic exam are cared for safely and that training and assessment processes are in line with local guidance.

RCN Competences for nurses assessing and counselling women who request and/or receive long-acting reversible methods of contraception (LARC)

Aimed at sexual and reproductive health practitioners this new set of competences is aimed at nurses who are assessing and counselling women who have requested or received long-acting reversible methods of contraception (LARC). The purpose of this competency framework is to ensure such women are cared for safely and helps professionals to identify their training needs, ensuring they have the skills and knowledge to undertake the delivery of contraception services competently and safely.

And finally we hope that reports from America that Apple’s new voice recognition software, Siri, is anti-abortion are exaggerated – the ‘tech’ giant says it will improve the software’s unintentional omissions so that it doesn’t say it cannot find abortion clinics. Knowing the age we live in we suspect this ‘issue’ will run for a while in blogs and tweets around the world.

On the 23rd World AIDS Day

As part of a piece in the Chelsea & Westminster GP Newsletter, Consultant Rachel Jones and Specialist Registrar Michael Rayment write of the situation in the UK:

Treatment is freely available, but is limited to those who know their HIV sero-status.  The HIV epidemic in the UK continues to grow, and the fraction of undiagnosed HIV remains frustratingly constant.  The number of people living with HIV in the UK is estimated to be 91500 in 2010. There were an estimated 6660 new HIV diagnoses in the last year alone.  In men who have sex with men, there were 3000 new diagnoses – the highest ever annual figure recorded in this risk group.  An estimated one in four of all individuals with HIV infection remains unaware of their sero-status.  Of those newly diagnosed, half were diagnosed with CD4 counts below 350 cells/μl, the current threshold for the initiation of antiretroviral therapy. Of the 680 people with HIV who died in 2010, two thirds had been diagnosed late.

and they suggest that:

The largest barrier rests with us, the healthcare providers: our own HIV testing prejudices need to be broken down.  We need to engage commissioners to develop services and strategies to tackle HIV infection in our community.  A key strength of the pilot studies to date has been the close cooperation between Sexual Health services and local primary and secondary care providers.  We would urge you to work with your local Sexual Health colleagues.  They will be keen to work with you to provide education, support, clinical expertise and guidance to keep this issue high on your local health agenda.  Please engage with us, and Getting to Zero may be a feasible and very real vision here on our own doorstep.

The Health Protection Agency (HPA) recommends ‘universal testing’ for HIV, as they publish new data on 30 years of HIV in the UK.

The British HIV Association (BHIVA), Medical Foundation for AIDS and Sexual Health (MedFASH) and the British Psychological Society launch Standards to ensure high quality support for people with HIV.

Half of the 14 million people living in poorer countries who need HIV drugs get them according to the UNAIDS World AIDS Day Report 2011 – “How to get to zero, Faster, Smarter, Better”

This is the good news. The bad news is that at this crucial time, when the end may be in sight, we also hear that the one thing that will fuel the hoped for future is being cut off:

BMA News warns that Sexual Health is under threat (again).
As councils and private companies take control of NHS sexual health services, are they unnecessarily changing an open-access system that already works wonders?
In the Report, sexual health organisations have expressed grave concerns and a number of clinicians give examples of difficulties already being experienced.

The Global fund to Fight AIDS, TB & Malaria has cut its latest round of funding. In its press release yesterday it states:

A sharply deteriorating economic situation, which is placing severe pressure on donor countries’ budgets, has prompted the Global Fund to revise its forecasts of available resources over the next two years and to take this difficult decision.

The Royal College of Obstetricians and Gynaecologists (RCOG) has, this week, published its revised guidelines on the care of women requesting induced abortion. The recommendations cover commissioning and organising services, possible side effects and complications, pre-abortion management, abortion procedures and follow up care.  A summary of new and improved recommendations and link to Q&A’s are in the RCOG press release.

Medical Students for Choice (MSFC) – based in the US, is a non-profit organisation recognising the need to create abortion providers for tomorrow:  www.medicalstudentsforchoice.org. They aim to try and correct the drastically falling numbers of providers in the US and Canada – 57% of current providers are over 50. This along with targeted violence, restrictive legislation and medical schools not addressing the issue means doctors are qualifying with little knowledge of abortion.

RCOG Honorary Fellowship

Toni Belfield

Our friend and colleague, Toni Belfield, has, today, been awarded an RCOG honorary fellowship in recognition of her long service in the field of contraception and sexual health and passionate dedication to providing accessible, evidence-based information for men and women. Included in the citation Professor Janice Rymer noted responses from colleagues who said Toni is “One of the most knowledgeable people in women’s health” and “Her contribution is always very sound”.  Her many friends in the field know, love and respect her as an ardent advocate for service users (never patients or clients!) and as someone who always keeps us on our toes when it comes to accurate use of terminology – we always fit IUDs never coils! Congratulations Toni.

Take Action! Respond to the PSHE Review – Deadline 30th November

The Department for Education is running a Review of PSHE including Sex & Relationships Education with a view to improving its delivery in state funded schools. You can read the review and respond online by following the link. The British Humanist Association has succintly summarised the situation and the fears of many in its statement to accompany its own response.

The Clinical Effectiveness Unit (CEU) of the Faculty of Sexual & Reproductive Healthcare (FSRH) has achieved NHS Accreditation for the process used to produce its guidelines. The NHS Evidence Accreditation Scheme recognises organisations that demonstrate high standards in producing health or social care guidance. It is stated that users of accredited guidance can therefore have high confidence in the quality of the information. In future all CEU guidance will display the Accreditation Mark.

This coincides with the release of the latest clinical guidance: Combined Hormonal Contraception – an updated and extended version of the previous guidance on combined oral contraception published in 2006. There are now clinical guidelines on the vast majority of currently available methods as well as Drug Interactions, Quick Starting (methods), Emergency Contraception and others for specific, special groups. This is in addition to the UK Medical Eligibility Criteria.

The CEU was launched in 2002 and after initially being based in Aberdeen transferred to Sandyford in Glasgow in 2008. The director of the current unit is Dr Louise Melvin and its main tasks are producing evidence based guidance, new product reviews and running the Members Enquiry Service.

Clinical guidelines that are evidence-based are an important element of current clinical practice and underpin clinical competence and governance. Along with training they have the potential to raise standards and improve quality of care, though as their name suggests they are intended to guide clinical care not replace clinical judgement as they are applied to general situations rather than to individuals.  In sexual and reproductive health care CEU guidance and FSRH training is increasingly seen as the gold standard by which clinical care is likely to be judged. An example of this was seen earlier this year in a statement from the MDU in response to an increase in the number of claims related to problems with subdermal implants by GPs. The statement stresses the need for, particularly, GP members to ensure they have appropriate training and should ideally hold a Letter of Competence from the Faculty.

Readers are signposted to the Rapid Responses at BMJ Online following last week’s publication of an extended analysis of the Danish Cohort Study on VTE risk with combined oral contraceptives with different progestogens and oestrogen doses.

Volunteers required for CEU guidance
The CEU are looking for volunteers to be involved in the development of the next 3 guidance documents:
Contraceptive choices for women with cardiac disease; Intrauterine contraception; Progestogen-only implants. Details available via the Faculty website.

Young men and contraception  [Brown, published Online First 1 November 2011]
It is rare to see a study looking at young men and their contraceptive views. This pilot study indicates that engaging with young men may be a challenging task. Getting them to talk about contraception and responsibility will be even more so. The young men who participated in the pilot were willing to consider shared responsibility for contraception when talking with the researcher about their contraceptive choices. How these young men view women who take charge of their sexual health reveals a lot about the dynamics of relationship forming and the confusion around contraceptive responsibility felt by young people.
Neelima Deshpande (Associate Editor, JFPRHC)

Brook and FPA launch UK Sexual Health Awards to reward innovation and creativity in sexual health work. There are 6 categories for nominations which close on 31 December. Open to professionals, writers, young people or projects the first awards ceremony is to be held in March 2012, hosted by Davina McCall. Click on the image for more information.

My aim is to bring you news, views and information in the field of contraception and sexual health – some of which you may have seen and some not. I hope that as well as highlighting articles and issues from our journal this will signpost current issues and initiatives from the UK and around the world.

It has been an eventful year in contraception with a number of changes for clinical practice and over the coming weeks I will revisit the most important of these.

A round-up of some recent news items includes:

Mary Robinson calls for more funds for Family Planning.

As world leaders collected at the UN in New York last week Mary Robinson, the first woman president of Ireland (1990-1997), UN High Commissioner for Human Rights from 1997-2002, and chairwoman of the Global Leaders Council for Reproductive Health called for them to make good on their promise of 17 years ago at the UN International Conference on Population and Development in Cairo, when they agreed to make contraceptive services available for women all over the world by 2015. http://www.newsday.com/opinion/oped/robinson-more-funds-for-family-planning-1.3187083

WHO Medical Eligibility Criteria for Contraceptive Use 4^th ed wins first prize in the BMA Book Awards (O&G category).

The WHO MEC are the basis from which the UK MEC were developed and underpin clinical practice in contraception and sexual health. The most recent version of the UKMEC was published 2009:http://www.fsrh.org/pdfs/UKMEC2009.pdf

Medscape Education Clinical Briefs report a pooled analysis of 2 studies which seem to demonstrate that Intrauterine Devices Lower Cervical Cancer Risk. This involved 10 case-control studies done in 8 countries, and 16 studies of HPV prevalence from 16 countries looking at risks for cancer of the cervix and HPV in IUD users. http://www.medscape.org/viewarticle/749724?src=cmemp

In Rwanda, Africa’s most densely populated country, men are being encouraged to have vasectomies. The no-scalpel procedure is being offered for free according to a report in the Independent Newspaper on 7^th September.

Unapproved emergency birth control medicine in U.S. may be ineffective and unsafe. In July the FDA issued a warning to consumers not to buy a product named Evital as they may have been counterfeit. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm265847.htm

I welcome comments from readers and will publish those that I feel will be helpful to others.