Building back better: why this group of MPs and Peers is calling for improved access to contraception after the pandemic

Posted 14 Sep 2020

Date: 14 Sep 2020

Author: Dame Diana Johnson DBE MP

In this month’s eFeature, Dame Diana Johnson DBE, MP for Hull North and Co-Chair of the All-Party Parliamentary Group on Sexual and Reproductive Health, blogs about the APPG’s new report on access to contraception in England. She outlines some of the challenges to contraception provision before and during the pandemic, and discusses the opportunity to ‘build back better’ to ensure women have access to this essential form of healthcare.

This picture is of Diana Johnson, the Labour MP for Hull NorthAccess to contraception is a human right. When women can’t easily access contraception, it creates a ripple effect on their lives and families.
 
Since the passage of the 2012 Health and Social Care Act, the All-Party Parliamentary Group on Sexual and Reproductive Health (APPGSRH) has heard evidence of women being unable to access contraception in a way that meets their needs. The Inquiry into Access to Contraception was launched in response to these concerns, and re-launched to understand the impact of the Covid-19 pandemic on women’s access to contraception in the spring and summer of 2020.


Our findings

 
For many women, getting access to the contraception that suits them best is difficult and time-consuming.

Our Inquiry heard that funding cuts have placed additional strain on contraceptive services, with underfunding of Long-Acting Reversible Contraceptive (LARC) services in particular rendering provision financially inviable for many GP services. Meanwhile, the current commissioning system creates silos within sexual and reproductive healthcare, creating obstacles for healthcare commissioners to provide services which are shaped around women’s needs.

This can result in women being bounced from service to service, spending months on waiting lists, and having to undergo repeat consultations and sometimes repeat intimate examinations. The commissioning system also means that women who need multiple forms of care are often not able to access it in one place. Dr Asha Kasliwal, who is a consultant in Community Sexual and Reproductive Healthcare and President of the FSRH, told the Inquiry that she routinely fits coils for women who are also due cervical smear tests. However, because her area is not commissioned to perform smear tests, her patients have to join another waiting list, and undergo two invasive procedures instead of one.

If we want to improve access to contraception, there’s a pressing need to structure care around the needs and lifestyles of women. This is particularly true for groups which are currently underserved by contraception services, such as ethnic minority groups and lower socio-economic groups. One respondent to a survey, shared with us by Decolonising Contraception, said that she had been forced to make repeat visits to a sexual and reproductive health clinic, where she waited for hours to access contraception. “If you work a minimum wage job or shift work then you really can’t do that,” she said.

The ultimate consequence of these intersecting factors is that access to care is delayed and, in some cases, obstructed entirely.

During the pandemic, these obstacles to accessing care have become more entrenched as many services reduced, or totally ceased, provision of contraception. A patient-facing survey conducted by the Advisory Group on Contraception (AGC) found that 42% of respondents’ GPs or SRH clinics had closed during the pandemic. Concerningly, an FSRH survey found that 1 in 5 services had ended or severely limited outreach services for marginalised groups during the pandemic, with only 31% of healthcare professionals confident that women from marginalised groups could access contraception and other SRH care during this time.


How to strengthen contraceptive provision


The restoration of services after the Covid-19 pandemic, along with the reorganisation of Public Health England, provides a unique opportunity for national and local government to reshape contraceptive services according to the needs of women themselves. While there is much to fix, the pandemic has also highlighted areas of opportunity for contraceptive provision.

In our report Women’s Lives, Women’s Rights: Strengthening Access to Contraception Beyond the Covid-19 Pandemic, we call for renewed funding for contraceptive services to meet population need and for a re-evaluation of the current fragmented commissioning system. We also set out recommendations for the proper funding of LARC provision in Primary Care, the support of healthcare professionals in SRH training, and crucially the collection of data to understand women’s needs and experiences when they access contraception.

We call for the strengthening of systems to enable remote access to care, which will be especially vital in the instance of a second wave of Covid-19. The development of a national digital contraceptive offer is the natural progression from the remote provision that has become necessary during the pandemic, and would support ease of access for many women, though digital services must never be an absolute replacement for the vital role of face-to-face services, particularly to vulnerable populations.

As we start to rebuild services after the first wave of the pandemic, we are rebuilding them for a world in which many women’s futures are less certain, and their lives less stable than they were before. Contraception must be seen as a valuable, vital tool to support women’s sexual and reproductive health in these times, as well as their emotional and social wellbeing.

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Published in the September 2020 edition of the Sexual Health, Reproductive Health and HIV Policy eBulletin.