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Abortion & STI data published

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

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

 

News items from April

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

Better access to birth control would reduce stress on global resources

as reported by Nigel Hawkes in the BMJ. The rich should consume less and the poor should procreate less, says the Royal Society in a new report. The report was produced by a working party chaired by John Sulston, who headed the UK part of the Human Genome Project, and took 21 months to research and write.

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: 16th 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 .

Review of the year 2011

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

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

World AIDS Day 2011

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

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 co
uncils 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.

RCOG – Abortion Guidelines & Honorary Fellowships

25 Nov, 11 | by shellraine, e-Media Editor

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.


HPV Vaccine – Breaking News

25 Nov, 11 | by shellraine, e-Media Editor

Gardasil to be used in the UK HPV vaccination programme from September 2012

Posted by Anne Szarewski, Editor in Chief, JFPRHC

The Department of Health made the announcement this week, though it was an inevitability, since there was only one vaccine being considered. GSK had made the decision not to participate in the tender process back in September, but the DH perhaps wanted to make sure that this year’s school vaccination schedule was not derailed by parental confusion – by now most girls in this year’s programme will have had their first two vaccinations of Cervarix.

While Gardasil offers protection against genital warts, which Cervarix does not, Cervarix has been shown to give greater protection against cervical cancer, due to its much greater cross protection against non-vaccine HPV types. Indeed, this was acknowledged in the recent paper by Jit et al (BMJ 2011;343:d5775 doi: 10.1136/bmj.d5775).

However, there has been mounting pressure for protection against genital warts, so this outcome will be welcomed by many, especially our colleagues in GUM. However, if discussing the decision with parents who may be worried that their daughter was ‘given the wrong vaccine’ we can reassure them that by having Cervarix, those girls will have had the benefit of greater protection against cancer. It is a shame that one has to choose: I have long suggested that a potential solution would be to vaccinate girls with Cervarix and boys with Gardasil, which would give herd immunity against warts, offer protection to MSM and still allow girls the better cancer protection.

Faculty Gains NHS Accreditation for Guidelines

11 Nov, 11 | by shellraine, e-Media Editor

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.

Risk of VTE with combined oral contraceptives

4 Nov, 11 | by shellraine, e-Media Editor

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.

Surveys & Statistics

21 Oct, 11 | by shellraine, e-Media Editor

SHout Loud

(Sexual Health Out Loud) is a website based on a partnership between Terrence Higgins Trust, FPA, African Health Policy Network, National AIDS Trust, MedFASH and Brook. It aims to provide information about sexual health by geographical area. It is conducting 2 surveys, one for service users and one for service providers with the aim of monitoring changes in service delivery in light of funding difficulties.

Did you see the on-line poll on the front page of the Journal website? It asked for your views on the hot topic of whether to routinely offer local anaesthesia to women undergoing IUD/IUS insertions. Though many people have accessed the page not many took the time to answer the question. This issue has caused much discussion as you may have seen in the last 3 issues since the original letter from Dr Sam Hutt in January. To answer now, please click on the image to the left.

Sexual and Reproductive Health Activity Dataset,

aka SHRAD replaced the KT31 which is/are due to ‘retire’ in 2013. How are you coping with the new way of collecting our activity data? The latest edition of the SHRAD newsletter (no 5) is now available via the Faculty website.

And in the News

The GMC has announced a consultation on 2 future pillars of medical professionalism: CPD and revalidation. More info and access to the consultation on the GMC website.

Around the Globe

13 Oct, 11 | by shellraine, e-Media Editor

The latest edition of the American Journal of Obstetrics and Gynecology includes a supplement entitled: A Hormonal Contraception Update: A Decade of Innovation & Transformation.

In addition AJOG published (online 11th July 2011) a study on the impact of long-acting reversible contraception on return for repeat abortion by Rose S B and Lawton B A. The objective of the study was to determine the rate of return for repeat abortion in relation to postabortion contraceptive method choice 24 months onward from an intervention study.  Its conclusion states: “This study provides strong support for the promotion of immediate postabortion access to LARC methods (particularly intrauterine devices) to prevent repeat abortion.”

September saw the European Society of Contraception (ESC) hold its 11th Seminar in Kaunas, Lithuania. One of the most notable features was the number of participants for a regional symposium  – 533, with the majority being from Poland and Latvia. A number of our colleagues from the UK were involved in either presentations or workshops: Dr Sarah Randall, Dr Anne Webb and Dr Simone Reuter. In addition there was a Board of Directors’ meeting which involved the 2 UK representatives, Dr Meera Kishen and Shelley Mehigan.

Kaunas itself was fascinating for its combination of old and new: elements left over from its communist-dominated past with many crumbling, abandoned buildings and its, especially young, people who are trying to adapt to a new world with western influences. This was particularly evident in the apparent twin obsessions of pizza and eating outside – as well as this may work if the pizzas are made in the Italian way and the cafes are in the Mediterranean it suffers a little in translation to a chilly Baltic state with locally made fare.  This was partly corrected by an apparent benefit to the local blanket industry!

The next full Congress will be in Athens in June 2012.

Meanwhile at home:

Have you completed elements of the new DFSRH: e-SRH; Course of 5; Clinical Exerience and Assessment; e-Portfolio or the LoC SDI or IUT? The Faculty would like to hear from you. They have commissioned an independent review by Professor Ed Piele of the University of Warwick. Visit the Faculty website to give your feedback on your experiences.

UK Agony Aunts bed-in to make sexual health a priority -

What would be the correct, collective noun for a group of agony aunts?

Well in this case it could be a ‘bedful’ or maybe a ‘boudoir’ as 8 of the UKs finest gather to add their support to a group of sexual health charities – Brook, FPA (Family Planning Association), Terrence Higgins Trust, and MedFASH – calling on the government to protect sexual health services as many have seen reduced funding lead to cuts in vital services. This at a time when:
i) a survey by Brook confirms that only 6% of children learn the facts of life from their parents – the internet, TV and friends being the usual source of information (sometimes misinformation) and
ii) the House of Lords HIV and Aids Select Committee report last month found efforts to control the spread of HIV are woefully inadequate as £2.9m is spent on prevention compared with £762m on treatment.

Fiction Book Reviews

Have you enjoyed reading the fiction book reviews in the Journal? Did you agree with the reviews this time of The Room by Emma Donaghue and The Hand That First Held Mine by Maggie O’Farrell? The book for January 2012 will be Pain of Death by Adam Creed (Faber & Faber).

Latest from JFPRHC

Latest from JFPRHC