26 April 2012

UK: Contraceptive services not reaching all women, audit finds

A new audit of the commissioning of contraceptive and abortion services in England has revealed that a third of women of reproductive age are 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), reports the Journal of Family Planning blog.

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.

NHS flouts national guidance on contraception as cuts bite. Journal of Family Planning blog, 25 April 2012

Over 3 million women do not have access to full contraception services. GP online, 25 April 2012