Holistic care: life-long reproductive health

Posted 20 Feb 2019

Date: 20 Feb 2019

Author: Dr Sue Mann

GPs and nurses should seize every opportunity to talk to women about their reproductive health says Dr Sue Mann speaking at last November's Current Choices conference.

Written by Dr Sue Mann and Kaye McIntosh

Visits for pill checks, cervical smears, post-natal checks and baby clinics are all chances to have holistic conversations about reproductive choice and factors that may affect it, said Dr Sue Mann, Consultant in Sexual and Reproductive Health (SRH) and Medical Expert in Reproductive Health at Public Health England.

An over-arching holistic approach - lifelong care

She called for ‘light touch interventions’ that focus on women who may find it hard to get where they need, such as those affected by obesity or mental ill-health. This should be part of an over-arching, holistic approach to care over a lifetime, from sex and relationships education through to menopause and beyond.

Public Health England (PHE) is working on action plan:

"...focusing on the core issues: being able to have children when, if, how you want, the hidden issues, e arly identification, how do we get people to have smears."

Supporting the 'unmet need'

Nearly half of the women who are coming through the door of a GP practice ‘have a maintenance need’, for ongoing provision such as contraception. Another 20% need pre-conception or post-natal care, while 12.5% have ‘an unmet need’.

They don’t come proactively but may be having heterosexual sex without birth control. But there’s an opportunity to offer support when they attend for other reasons.

One-third of births in this country are unplanned, or the mother is ‘ambivalent’. This is linked to higher rates of low birthweight, mental health problems for mother and baby and obstetric complications.

So PHE and health professionals must use every chance to bring the figure down, Dr Mann said.

"Whether women come in via a pregnancy or non-pregnancy route, it’s worth assessing what people’s plans are. Not just “what contraception you want” but “what do you want over the long term”.

Pre-conception health isn’t enough. Health professionals should be offering women who aren’t yet planning pregnancy early risk assessments for factors such as obesity or mental health problems that can affect them later on.

That gives an opportunity for targeted support, such as referral to a pre-conception specialist perinatal mental health team for women who have or had complex or severe problems.

Doctors and nurses also need support to have effective conversations, she added.

"Just training us as professionals to have these conversations is one thing, but encouraging people to change behaviour is something else."

The health coaching approach can help, using resources such as the Better Conversation model.

Dr Sue Mann spoke at our Current Choices conference which took place on 22-23 November 2018 in London. The event gathered 300+ sexual and reproductive healthcare professionals to debate the challenges of sexual and reproductive leadership, workforce and service provision.

For more details, visit www.fsrh.org/events.