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40 years of innovation in sexual and reproductive health

30 Aug, 12 | by shellraine, e-Media Editor

WHO – 40 years of innovation in sexual and reproductive health

A comment piece in The Lancet by past and present directors of WHO’s Human Reproduction Programme (HRP) discusses the achievements of the Programme since it was established in 1972.

Online First – Evaluation of a community pharmacy delivered oral contraception service

“Anything for the weekend … and beyond, madam?” Community pharmacies increase oral contraceptive uptake

Parsons et al.’s evaluation of a community pharmacy delivered oral contraceptive (OC) service is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Between 2009 and 2011, seven specially trained pharmacists at five pharmacies in South-East London provided OCs under a Patient Group Direction (PGD) during 741 client consultations. The evaluation showed that trained pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need. Nearly half of all consultations occurred following emergency hormonal contraception supply, and nearly half of clients receiving an initial supply of OCs were first-time Pill users. Based on satisfaction questionnaires from a small sub-group, most clients valued this service, were happy about privacy, and would recommend it. Although the primary aim was to reduce teenage pregnancy , and nearly a quarter of clients were aged <20 years, the study shows that women aged 20+ years also require this service and should not be overlooked when formulating policies for service provision.
summary by Walli Bounds, Associate editor

Infertility: Survey shows nearly half of all GPs lack knowledge

Results of a comprehensive patient survey by the National Infertility Awareness Campaign (NIAC) shows that GPs need to be better informed about infertility treatment, including IVF, and the options available when the commissioning of IVF switches to local commissioning groups next year. The NIAC survey found that nearly 50% of GPs lacked the necessary knowledge of infertility and the treatment options available to provide an effective service. This could explain why some patients with fertility issues perceived their GPs as unsympathetic.

Calling All Baby Boomers: Get Your Hepatitis C Test

A report issued by the U.S. Centers for Disease Control and Prevention (CDC) recommended that all Americans born between 1945 and 1965 be tested for the hepatitis C virus (HCV). An estimated 2.7 million to 3.9 million people in the United States are infected with this liver-damaging—and sometimes lethal—virus, and many do not know they carry it. CDC calculates that roughly 75% of those infected are baby boomers: 3.25% of people born in that “birth cohort” test positive for HCV, which is five times higher than the rate in adults born before 1945 or after 1965. CDC has determined that universal testing of baby boomers is the most cost-effective strategy for detecting undiagnosed HCV infections.  As reported in Science

New lab for HIV research

The Indian Government has opened the new $12 million HIV Vaccine Translational Research Laboratory in New Delhi. The new Laboratory will aim to recruit around 30 scientists with the goal of creating a new vaccine against HIV, and will work in collaboration with the International AIDS Vaccine Initiative.  As reported in Science

Fertility Issues

6 Aug, 12 | by shellraine, e-Media Editor

IVF twins: buy one get one free? (Mittal)  (published online 18 July)

The aim of IVF treatment should be to achieve a full-term singleton birth. This article explores the tensions that exist between IVF provision and the elective single embryo transfer (eSET) policy. The authors present a balanced contemporary review describing why twin pregnancies are undesirable yet may be a risk couples are willing to take. They go on to discuss the issues faced when considering strategies to reduce twin pregnancies and the tensions that exist with the eSET policy. Blanket eSET implementation appears not be a simple answer to avoid twin pregnancies. from Scott Wilkes, Associate Editor

1 in 7 couples in the UK have infertility problems

Most people growing up assume that, if and when they want children, they will be able to have them. They don’t expect to have problems with fertility, and assume that, if they do the wonders of modern fertility treatments, such as IVF and ICSI (intra-cytoplasmic sperm injection) will be able to solve them. However, in contrast to this, background figures point to 1 in 7 couples in the UK having fertility problems. This is according to new research published by the Health Experiences Research Group at the University of Oxford and available from healthtalkonline. The research team was founded by Ann McPherson (who sadly died in May 2011) and headed by Sue Ziebland and Louise Locock.

ESHRE 2012 Reports highlight fertility issues

UK still trails behind Europe in number of IVF cycles – yet it all started here.

As the number of babies worldwide born thanks to in vitro fertilisation (IVF) – breaks the 5 million barrier for the first time, figures show that the UK is still lagging behind many of its European neighbours in numbers of treatment cycles per year.  A report presented at ESHRE 2012 shows that the UK carries out 879 cycles/million inhabitants per year, which is significantly lower than many other countries including Denmark (2,726 cycles/million), Belgium (2,562 cycles/million) and Slovenia (1,840 cycles/million).

The pioneering treatment, which hit the headlines worldwide back in 1978 with the birth of Louise Brown in Oldham, has dramatically reduced the devastating burden of infertility, benefitting millions of couples both in the UK and worldwide.

However, for thousands of couples here, the dream of having a child of their own remains elusive: many are denied IVF because their Primary Care Trust or Health Board is reluctant to fund sufficient treatment. Around three quarters of all PCTs in England still don’t offer the 3 full cycles of IVF as recommended by the National Institute for Health and Clinical Excellence (NICE).

Leading national infertility charity supports new research on Single Embryo Transplant (SET)

Leading patient charity, Infertility Network UK (IN UK), has backed new research presented at the annual meeting of ESHRE, which shows that a policy of single embryo transfer reduces the risk of perinatal death in infants born after IVF and ICSI.

The report is based on analysis of more than 50,000 births recorded in the Australian and New Zealand Assisted Reproduction Technology Database from 2004-2008, where the introduction of  SET seems to have reduced overall perinatal mortality for IVF and ICSI babies.

Said Clare Lewis-Jones, Chief Executive of IN UK and Chair of Fertility Europe: “We welcome a move towards SET, and this report gives the medical profession more evidence to encourage patients to accept SET, which reduces the risks of multiple births to both mother and babies and gives the best possible outcome – one healthy baby.

“However, it must go hand in hand with full implementation of the NICE clinical guidelines which recommend up to three full cycles of treatment, including any frozen embryo transfers (FET). Other European countries which routinely offer five and six cycles of treatment have successfully implemented SET, and it is high time that patients in the UK are offered access to the level of treatment recommended by NICE nearly eight years ago!

“Many PCTs here still fall short of the recommendations and it is totally unacceptable and unethical for some PCTs to offer only one cycle of treatment and not to include FET for patients.”

SRH News from American Journals

1 Jun, 12 | by shellraine, e-Media Editor

Effectiveness of Long-Acting Reversible Contraception

From the New England Journal of Medicine: A large (7486 paticipants) prospective cohort study, by researchers at Washington University School of Medicine in St. Louis, to evaluate contraceptive methods has found dramatic differences in their effectiveness. Women who used pills, the patch or vaginal ring were 20 times more likely to have an unintended pregnancy than those who used longer-acting forms such as an intrauterine device (IUD) or implant.

And from the American Journal of Obstetrics & Gynecology

Rapid repeat pregnancy in adolescents: do immediate postpartum contraceptive implants make a difference?

The purpose of this study in Colorado was to determine contraceptive continuation and repeat pregnancy rates in adolescents who are offered immediate postpartum etonogestrel implant insertion and showed excellent continuation 1 year after delivery; rapid repeat pregnancy was significantly decreased compared with control participants.

Predictors of long-acting reversible contraception use among unmarried young adults

The objective of the study from South Carolina was to improve the understanding of long-acting reversible contraception (LARC) use patterns among unmarried, young adults at risk of unintended pregnancy. LARC use was associated with older age, high IUD knowledge, and earlier onset of sexual activity and concluded that increasing knowledge of IUD among certain groups may improve LARC use among young, unmarried adults and in turn decrease unintended pregnancy.

Knowledge of contraceptive effectiveness

Another study from St Louis, Missouri looking at 4144 women’s knowledge of contraceptive effectiveness and, not surprisingly, showed many gaps.

Unintended pregnancy and contraception among active-duty servicewomen and veterans

The number of women of childbearing age who are active-duty service members or veterans of the US military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector, or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active-duty and veteran women. Active-duty servicewomen have high rates of unintended pregnancy and low contraceptive use, which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women, and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.

Antenatal sexually transmitted infection screening in private and indigent clinics in a community hospital system

The study aimed to determine whether clinics that serve indigent patients demonstrate equal compliance with sexually transmitted infection testing guidelines when compared with private clinics in North Carolina. They concluded that clinics serving indigent patient populations had a higher compliance with required testing compared to private clinics. HIV testing in the third trimester remains the greatest need for improvement for all practice types.

Another flawed database analysis of VTE risk and hormonal contraceptives

15 May, 12 | by shellraine, e-Media Editor

Lidegaard O, Nielson LH, Skovlund CW, Lokkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ 2012;344:e2990 doi: 10.1136/bmj.e2990 (Published 10 May 2012)

This is basically a companion paper to the one published last year in the BMJ, which concentrated on the Pill and was comprehensively criticised in the January issue of the Journal (Dinger & Shapiro 2012), to which readers are referred, as well as to the Rapid Responses posted on the BMJ website. This analysis, also from the Danish registry looks at the EVRA patch NuvaRing, Implanon and the levonorgestrel-releasing intra-uterine system (Mirena IUS). All the previous issues of confounding, lack of information regarding smoking, BMI, and family history, and not comparing like with like apply here.

It is important to compare new users with new users, as a well-established fact is that the risk of VTE is highest in the first 6 months of use of oestrogen-containing contraceptives. It is therefore important to look at the launch dates of contraceptive products. NuvaRing was launched in Denmark in late 2001 / early 2002, while the EVRA patch was launched there in September 2003. Meanwhile combined pills containing levonorgestrel have been in use since the 1970s, and those containing norgestimate since the mid 1980s. Thus, since the study period began in 2001, all users of NuvaRing and EVRA must have been new users, and so also more likely to be first time users / women with risk factors. Meanwhile, the users of the comparator COCs were more likely to be long term users and therefore at lower risk, since the high risk women in those groups will have been weeded out within the first 6 months of use – before the study began (ie attrition of susceptibles). The effect of duration of use is most clearly seen with NuvaRing in Table 4, where compared with non-users of hormonal contraceptives,  the relative risk becomes appreciably lower with increasing duration of use, declining from 8.36 for <1 year of use to 3.83 for use of 1 to 4 years. In addition, the numbers in each duration category are small, leading to random variability.  For the patch (6 exposed women) and the implant (5 women) not even the overall numbers are adequate.

With regard to the two progestogen only methods under study, not surprisingly neither was associated with a significantly increased risk of VTE – progestogen only methods have not been implicated in VTE risk, since this is related to oestrogen (Reid et al, 2010). Indeed, progestogen only methods are advised for women with risk factors for VTE (Blanco-Molina et al 2012). However, in the abstract, the authors misleadingly state that ‘the relative risk was increased in women who used subcutaneous implants’ and yet their relative risk of 1.4 had confidence intervals of 0.6 – 3.4, ie not even approaching statistical significance.  For the IUS, not only was the relative risk not increased, it was significantly decreased at 0.6 (95% CI 0.4 – 0.8). This has no biological plausibility and simply highlights the lack of credibility of the analysis.

Anne Szarewski, Editor-in-Chief, J Fam Plann Reprod Health Care

Diana Mansour, Consultant in Community Gynaecology and Reproductive Health Care, Head of Sexual Health Services, Newcastle Upon Tyne,

References

Dinger JC, Shapiro S. Combined oral contraceptives, venous thromboembolism, and the problem of interpreting large but incomplete datasets  J Fam Plann Reprod Health Care 2012;38:2–6. doi:10.1136/jfprhc-2011-100260

Reid RL, Westhoff C, Mansour D, de Vries C, Verhaeghe J, Boschitsch E,et al.   Oral Contraceptives and Venous Thromboembolism: Consensus Opinion from an International Workshop held in Berlin, Germany in December 2009  J Fam Plann Reprod Health Care 2010; 36(3): 117–122

Blanco-Molina MA, Lozano M, Cano A, Cristobal I, Pallardo LP, Lete I. Progestin-only contraception and venous thromboembolism Thrombosis Research 129 (2012) e257–e262

NHS flouts national guidance on contraception as cuts bite:

25 Apr, 12 | by shellraine, e-Media Editor

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 UK Sexual Health Awards 2012 winners announced

16 Mar, 12 | by shellraine, e-Media Editor

The celebration, hosted by Nitin Ganatra (Eastenders), to mark the hard work and dedication of people involved in sexual health across the UK took place at Troxy, London. Celebrities, including Janet Ellis, Zoe Margolis, Sharon Marshall, Johnny Partridge and our own Susan Quilliam and Alison Hadley were in attendance to show support and present awards to:

Sexual health professional of the year: Kay Elmy, Peterborough Contraceptive and Sexual Health Service.
JLS young person of the year: Azizi Kosoko, Terrence Higgins Trust.
Rosemary Goodchild Award for excellence in sexual health journalism: Sophie Goodchild for her article ‘Free love: what happened to AIDS?’  Men’s Health magazine.
Adult sexual health service/project of the year: ‘Morning-after-pill in the post’ campaign, bpas.
Young people’s sexual health service/project of the year: Sheffield Open Doors, Sheffield Contraception and Sexual Health Service, School Nursing Service and the Young People’s Drug and Alcohol Service.
Pamela Sheridan Award for Innovation in SRE: Shropshire Respect Yourself Relationship and Sex Education Programme.
Lifetime Achievement in sexual health award presented to Professor Michael Adler CBE.

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Research highlights risks with current tests for Chlamydia trachomatis

“Researchers, from the University of Southampton and the Wellcome Trust Sanger Institute, have discovered that Chlamydia is much more diverse than was previously thought. Using whole genome sequencing, the researchers show that the exchange of DNA between different strains of Chlamydia to form new strains is much more common than expected.”  Current clinical tests only give a positive or negative result and can not identify different strains.  In clinical practice those found to be chlamydia positive after treatment were assumed to have been re-infected but this may not be the case.  Up until now antibiotic resistance has not been seen in humans only in the laboratory but current tests would be unable to demonstrate this if it did occur.

New BASSH Patient Information Leaflets

The BASSH Clinical Effectiveness Group (CEG) has produced new patient leaflets on Safer Sex, Epididymo-orchitis and Gonorrhoea. These are available from their website along with details about up-coming events as well as news and other guidelines.

GMC seeks views on proposed changes to the way doctors are assessed for GP or specialist registration through the ‘equivalence’ or CESR/CEGPR route to registration

Information and access to consultations are via the GMC e-consultation website.

 

Faculty News

10 Feb, 12 | by shellraine, e-Media Editor

Amendments to FSRH Guidance Documents: Drug Interactions and Emergency Contraception
Drug Interactions (2011): Page 9 of the original version of this CEU Guidance Document (issued in January 2011) incorrectly stated that the interaction between lamotrigine and combined hormonal contraception (CHC) only applies to lamotrigine monotherapy. CHC also reduces lamotrigine levels when lamotrigine is combined with antiepileptic drugs that
do not alter its metabolism.

Emergency Contraception (2011): The original version of this CEU Guidance Document (issued in August 2011) contained some inconsistencies that the CEU has corrected in this version. These amendments are as follows: additional recommendation regarding offering a Cu-IUD to eligible women presenting between 0 and 120 hours of UPSI or within 5 days of expected ovulation added (pages ii and 8); references 12 and 13 updated (page 11); and acknowledgement of chart designer added to Appendix 2 (page 15).

New Examiners for the Multiple Choice Question Paper (MCQ)
The Examination Committee invites applications to join the MCQ Examiner Group of the MFSRH Panel of Examiners. Applicants should be accredited Members of the Faculty and active clinically in the sphere of the Faculty or, to be Clinicians, of equivalent status, with an interest in Sexual and Reproductive Healthcare but whose speciality is GUM, Public Health Medicine, Gynaecology or Primary Care. Further information and application forms from the Faculty website, closing date 29th February.

Committee Vacancies

  • Clinical Standards: for a doctor and a nurse
  • Workforce Planning: for an Associate member and a Fellow/Member/Diplomate

Information and details of how to apply are available from the committee’s page of the Faculty website

and in other news

Oral Ulipristal Proves Highly Effective for Uterine Fibroids
According to 2 studies published this week in the New England Journal of Medicine the oral selective progesterone receptor modulator, ulipristal, proved highly effective as a treatment for symptomatic uterine fibroids rapidly reducing excessive bleeding and reducing the size of uterine fibroids, and was well tolerated. The drug was approved for emergency contraception in 2010. Known as ella (HRA Pharma) in the United States and ellaOne in Europe, ulipristal works by interrupting ovulation. For emergency contraception, a 30-mg dose is used. By contrast, the newly-published studies tested 5-mg and 10-mg daily doses for fibroid treatment. In one of the studies (placebo-controlled) the drug controlled excess menstrual bleeding in over 90% of cases with a high incidence of amenorrhoea. If and when a product becomes available in the UK (Esmya is already approved and licensed in other countries) the issue of contraception will need to be highlighted to those that might use it because of the interaction with hormonal contraception.

Bits and Pieces

9 Dec, 11 | by shellraine, e-Media Editor

Consultation to lift ban on HIV-positive doctors and dentists:
according to media reports last week the DH is set to launch a consultation on lifting the ban imposed 20 years ago. Many believe the ban to be discriminatory, no longer justified on public health grounds and ignored in most hospitals who reportedly have a ‘don’t ask, don’t tell’ approach. The DH’s own expert group concluded that the risk of infection was in the region of one case in every 2400 years.

Correlation of Age at Oral Contraceptive Pill Start with Age at Breast Cancer Diagnosis
Based on a review of 1010 cases at the Breast Unit in Ashford, Kent and published in The Breast Journal – early view this week, the authors concluded that the age when the OCP was started was positively associated with the age when breast cancer was first diagnosed. They state that this effect may show a causal link but may also reflect other associated lifestyle factors associated with early OCP use.

Faculty Members Questionnaire
The FSRH are conducting a short questionnaire to elicit members’ views of its activities and possible future plans.

Joint BASHH and Faculty Meeting 2012
The next joint meeting between BASHH and the Faculty is being held on Friday 20th January 2012 at the Royal Society of Medicine. The theme for the meeting is ‘Recurring issues in Sexual Health‘ .

Systematic Review of Induced Abortion and Women’s Mental Health Published
The world’s largest, most comprehensive and systematic review into the mental health outcomes of induced abortion was published yesterday by the Academy of Medical Royal Colleges. The review concludes that having an abortion does not increase the risk of mental health problems. The best current evidence suggests that it makes no difference to a woman’s mental health whether she chooses to have an abortion or to continue with the pregnancy.

Should all nuns take the pill?

This was some of the media’s interpretation of an article published at The Lancet – Early Online this week. Britt and Short describe the well known health risks for nuns associated with their life of chastity, first documented in 1713. They also note that despite the roman catholic stance on not using any form of contraception apart from abstinence, dating from the Humanae Vitae document of 1968, this may be possible as the same document also states:

the Church in no way regards as unlawful therapeutic means considered necessary to cure organic diseases, even though they also have a contraceptive effect.

COC / VTE Controversy continues

2 Dec, 11 | by shellraine, e-Media Editor

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.

Latest from JFPRHC

Latest from JFPRHC