Immaculate contraception: better sexual health services

In recent years there has been significant achievement in reducing the number of teenage conceptions, but there are still far too many unwanted pregnancies in women over 20. Has the focus on teenagers distorted delivery? Probably.

There is wide consensus that we need to aid all women to improve their quality of life and minimise their need for abortion by ensuring good access to free, high quality contraceptive care.

The government’s intention of taking a personalised approach to contraception, expected to be set out in its sexual health policy document, is extremely welcome. Only by treating women as individuals, and seeking to meet their needs on a personal basis, will we get the outcomes we all want. 

‘If contraception falls between the gaps then it will be women and their families who suffer’

A health service focused on outcomes, not just activity; quality, not minimum standards; taking a life course approach, rather than focusing on the needs of a high profile few; and, clinical leadership. These are all sound principles which we can support.

Yet sound principles don’t necessarily translate into effective delivery.

Coordination not isolation

Over the past two years the advisory group on contraception has campaigned for health reforms to improve the quality of services delivered for women.

Contraception does not exist in isolation. It is typically delivered in coordination with other aspects of healthcare and women with contraceptive needs often have other issues which need addressing. 

From April, commissioning of contraception will be broken up with core services, delivered through general practice, commissioned by the NHS Commissioning Board; CCGs commissioning contraception provided as part of sterilisation and abortion care, and local authorities commissioning enhanced services in primary care and specialist open access contraceptive services. These will then be outside of the NHS.

If contraception falls between the gaps then it will be women and their families who suffer. Services must be integrated.

The renewed focus on delivering improved outcomes is welcome but how can we make sure the rhetoric of the reforms translates into real improvements in contraceptive services?

The importance of choice

The first step in getting the commissioning of services right is for a comprehensive needs assessment of women present in a borough, using high quality data on outcomes and services. This should look at the needs of the population, rates of unintended pregnancy and gaps in the existing configuration of services. 

This needs assessment should look to ensure women of all ages have access to a range of services, including community and primary care, and services are truly open access. Commissioners must also act on the findings of their needs assessment and recognise that cutting contraceptive services is a false economy.

‘Service users must be given accessible information about the different methods they can choose

Meaningful and informed choice remains essential. Why? Because if people do not feel services meet their needs and wishes then they will simply choose not to use them. Service users need good quality information to base their decisions on. Specifically, they need to know how, where and when they can access support and advice on contraception.

Service users must also be given accessible information about the different methods they can choose from, with details about use, possible side effects and failure rates to allow them to make an informed decision about what will suit them best, as well as where they can access services that provide different methods.

Real improvement

‘Embedding the principles set out in this article into policy could help deliver real improvements in contraceptive outcomes’

While diversity of provision is to be encouraged, it will only work for contraception if services maintain consistently high standards. There has already been good work undertaken to develop standards, including by the faculty of sexual and reproductive healthcare at the Royal College of Obstetricians and Gynaecologists. Its recommendations should inform the development of the quality standard for contraceptive services, which will be the cornerstone of efforts to improve the quality of care.

With the standards available, commissioners must ensure that services have the capacity to deliver effective training for healthcare professionals to the needs of women in their area.

GPs provide the majority of routine contraceptive care and an increasing number have been commissioned to provide enhanced contraceptive services which are a vital part of improving access. Prioritising access and increasing the uptake of long acting methods in general practice is just as important as open access in specialist services.

Here we have sought to make the case for delivering high quality contraceptive services in the new health system. It is now a question of turning this vision into reality. The government’s sexual health policy document has been delayed for over 19 months, despite its importance in setting the national vision for sexual health services.

Embedding the principles set out in this article into the policy document and the broader reforms could help to deliver real improvements in contraceptive outcomes that have failed to materialise before. For the sake of women, let’s hope this happens.

Dr Anne Connolly is a GP at Ridge Medical Practice and clinical lead for women’s and sexual health at NHS Bradford and Airedale; Ann Furedi is chief executive at the British Pregnancy Advisory Service; Baroness Gould is chair of the all party parliamentary group on sexual and reproductive health in the UK and co-chair of the Sexual Health Forum; Natika Halil is director of information at the Family Planning Association; Ruth Lowbury is chief executive at the Medical Foundation for HIV and Sexual Health; Tracey McNeill is international vice president and director of UK and West Europe at Marie Stopes International; Dr Jill Shawe is a specialist sexual and reproductive health research nurse at the National Association of Nurses for Contraception and Sexual Health; Dr Connie Smith is a consultant in sexual and reproductive healthcare; Dr Anne Szarewski is a clinical consultant and clinical senior lecturer at the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine and associate specialist at the Margaret Pyke Centre; Dr Chris Wilkinson is lead consultant at the Margaret Pyke Centre

All the authors are members of the Commons health committee advisory group on contraception