First APPG inquiry into restrictions in access to contraception reveals shocking findings

A report ‘Healthy Women Healthy Lives’ from the first inquiry by the All-Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG) was launched, examining restrictions on contraceptive services.
Findings show evidence of women being actively restricted from services and methods, with the over 25s bearing the brunt. The inquiry also expressed grave concerns about the fragmentation of NHS contraceptive services which, they concluded, are lacking in the effective strategic forward planning needed for when local authorities take ownership in 2013. “Many of the restrictions we found during the inquiry shocked us,” said Baroness Gould of Potternewton, Chair of the APPG.
Evidence was submitted from service users, sexual health clinicians, sexual health charities, a GP and the Shadow Public Health Minister. Following its inquiry, the APPG has asked the Government to consider its report and publish a response.  
In gathering evidence, the Inquiry uncovered restrictions imposed by primary care trusts on contraceptive services. These include:

• Stopping the over 25s from using community contraception clinics.
• Making referrals for long-acting reversible methods of contraception (LARCs) GP only (so women cannot self-refer as is currently common practice).
• Running contraceptive services on a residents-only basis.
• Only allowing the over 25s to get oral contraception (i.e. the pill) from a GP (not a clinic).

Several areas such as Harringey, Walthamstow, Bristol and Derbyshire were singled out in the report for placing restrictions on services.
The inquiry also investigated how services are shaping up for local authority possession, when they inherit them from the NHS in April 2013.
The APPG concluded that there was little guidance and support for local authority commissioners on how to provide contraception services. Without this, they said, there is the potential to cause real damage to the health of the local population.
As a result, the APPG have made 20 key recommendations to Government and national health bodies all requiring urgent action. Some of which include:  

• Commissioners identified in the report must undertake a review of restrictions and take steps to remove them as soon as possible.
• The Department of Health must publish the sexual health policy that it promised to make public over a year ago.
• Alongside Public Health England, and the NHS Commissioning Board, the Department of Health must give proper and effective clarification on how the mandate of appropriate access to sexual health services is implemented locally.
• The National Institute for Clinical Evidence (NICE) needs to prioritise developing a quality standard on contraceptive services, as work on it has not yet begun.

Baroness Gould of Potternewton also added:
“I urge commissioners to look at whether their contraception provision is meeting women’s needs and for the Government and Public Health England to provide clearer guidance and support on future commissioning.
“Choice and access to contraception is an essential for most women. It enables them to control their reproduction, plan their lives and avoid unplanned pregnancy. Access to contraception services and contraception choice is a necessity, not a luxury. Women’s reproductive health needs to be given much greater priority.”
Dr Connie Smith, Consultant in Sexual and Reproductive Healthcare, said:
“The cost of curbing access to contraceptive services includes unmeasured personal cost to women seeking to control their fertility. Choice, quality and integration go to the heart of what good contraceptive care looks like. Yet the evidence presented to this inquiry shows a broken system which is failing to deliver for women.
“By ignoring the basic right of women to be able to access the contraception of their choice, the NHS is also 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, clinical lead for sexual health in Bradford and Airedale, said:
“Across the country there are a number of examples of high-quality contraceptive care. But what this inquiry demonstrates is that these standards, and the level of funding available, are dependent on a person’s postcode.
“The current health reforms mean it is vital that, more than ever, PCTs, clinical commissioning groups and local authorities understand how they can commission effective contraceptive services for women of all ages.  The Department of Health should accept the recommendation made by this Inquiry and, without further delay, publish the sexual health document.”

Staff Writer