APPG SRH press release: Inquiry by Parliamentary cross-party group finds COVID-19 has impacted women’s access to contraception

An Inquiry by the All Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH), a group of cross-party MPs and Peers, has found that women in England are facing difficulty in accessing contraception, with many being bounced from service to service, which can result in more unplanned pregnancies and increased demand for maternity and abortion care. The national reorganisation of Public Health is an opportunity to tackle funding and commissioning challenges in Sexual and Reproductive Healthcare.

The Inquiry found that:

• 13% cuts to the contraceptive budget between 2015 and 2018 have likely obstructed and reduced access to services, resulting in long waiting times for women, leaving them at risk of unplanned pregnancies. Underfunding of Long-Acting Reversible Contraceptives (LARCs - intrauterine contraception and implants) in primary care has led to a reduction in GPs offering women the most effective methods to prevent pregnancy.

• The COVID-19 pandemic has exacerbated this provision gap, with a marked reduction in services offering contraception. As the NHS restores after lockdown, there are concerns that the cost of reinstating LARC services will prove a deterrent for many GP surgeries, leaving many women at risk of unplanned pregnancy.

• The Parliamentarians call on the Department of Health and Social Care to consider introducing an integrated commissioning model for Sexual and Reproductive Healthcare, with one body maintaining oversight and holding accountability for commissioning.

The Inquiry has gathered oral and written evidence from the Minister for Women’s Health, the Department of Health and Social Care, Public Health England, the Faculty of Sexual and Reproductive Healthcare (FSRH), the Royal College of Obstetricians and Gynaecologists (RCOG) and others.

Dame Diana Johnson DBE MP, Co-Chair of the All Party Parliamentary Group, said:

"The COVID-19 pandemic has highlighted the importance of easy access to contraception in the lives of women. At a time when many of us feel less certain about our futures, it’s more vital than ever that women can exercise choice over what happens in their lives.

"However, our Inquiry found that for many women, getting access to contraception is difficult and time-consuming. Due to the unnecessary complexity of the system, many women are being bounced from service to service, undergoing multiple, intimate consultations and spending months on waiting lists to access their preferred contraceptive method.

"The reorganisation of Public Health England is an opportunity to tackle some of these issues. We have recommended that the Department of Health and Social Care should consider introducing an integrated commissioning model for sexual and reproductive healthcare as it develops the new Sexual and Reproductive Health Strategy."

Baroness Barker, Co-Chair of the All Party Parliamentary Group, added:

"The report highlights exciting opportunities to improve contraceptive provision by centring it around women’s needs and lifestyles. The development of a digital contraceptive offer is the natural progression from the remote provision that has become necessary during the pandemic and would ease access for many women.

"Meanwhile, the report underscores the importance of better understanding the needs of marginalised and underserved groups. That’s why we’re calling for the collection of fit-for-purpose data on ethnicity, gender, age and socioeconomic status to ensure that essential healthcare is accessible to everyone."

Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare (FSRH), said:

"Funding and commissioning challenges have led to an overstretched and underfunded Sexual and Reproductive Healthcare service that was not sustainably supported to provide care to women and girls either before or during a pandemic. COVID-19 made a difficult situation worse.

"I see it in my clinic and hear from colleagues that capacity is a major concern as waiting lists increase. Many specialists and GPs feel unable to meet the needs of their patients due to obstacles such as insufficient funding, disjointed commissioning and training limitations. It is frustrating for me as a doctor and unfair for women, who have to navigate a complex system just to access basic healthcare.

"The Faculty of Sexual and Reproductive Healthcare strongly supports the report’s recommendation on an integrated commissioning model. We also support the call for sustained investment in Sexual and Reproductive Healthcare services."

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

"This report clearly illustrates that barriers exist for girls and women when accessing contraception, and these barriers are often due to the way the healthcare system has been designed and delivered.

"Instead of promoting choice, many women are denied access to the full range of options. Healthcare professionals have the skills, the opportunity and the desire to provide contraception, but they are inhibited by too much bureaucracy which has resulted in no real accountability for providing these services across different settings.

"The NHS Long Term Plan is centred around two key ideas. The first is that we, as a country, need to shift our focus towards prevention. And the second is that organisations responsible for providing healthcare services need to better coordinate the services they deliver together. Access to contraception is an example of where these two key pillars, which underpin the future of our healthcare system, need to be strengthened."

ENDS

For further information please contact Camila Azevedo at cazevedo@fsrh.org or 02037945309.

Notes to editors

The Executive Summary and full report, ‘Women’s Lives, Women’s Rights: Strengthening Access to Contraception Beyond the Pandemic’, is available here.

Key recommendations

• The forthcoming national Sexual and Reproductive Health Strategy from the Department of Health and Social Care (DHSC) should recognise and address the reduction in contraception funding across all areas of service provision, and the consequent impact on the most marginalised groups.
• The forthcoming national Sexual and Reproductive Health Strategy from DHSC should incorporate all aspects of women’s sexual and reproductive health needs and recognise the changing needs of women throughout their lives. This will provide a consistent, joined up vision around which providers can work to ensure that population contraceptive needs are met.
• Co-commissioning should be mandated to ensure that all women can access the full range of contraception via clear, streamlined and well-publicised pathways until DHSC’s engagement on future options for PHE, which presents an opportunity for a broader review of SRH commissioning responsibilities. In the context of the current review of PHE responsibilities, DHSC should consider introducing an integrated commissioning model for SRH, with one body maintaining oversight and holding accountability for all commissioning decisions.
• The forthcoming national Sexual and Reproductive Health Strategy from DHSC should prioritise the need for local streamlined women-centred contraceptive service provision for underserved populations, who are less likely to have frequent and easy access to contraceptive services.
• DHSC should consider the development of a national digital contraception service. At a minimum, commissioners should ensure there is a dedicated digital contraceptive offer to widen access, and to preserve access if face to face services are suspended. Commissioners should identify digitally excluded groups and ensure they are reached through outreach and other means.
• Health Education England and DHSC should collaborate to develop a workforce needs analysis and strategy based on population need for the future delivery of SRH services. They should plan and publish analysis of appropriate current and future skill mix and training needs of specialist and generalist contraceptive providers. Local areas should conduct workforce capacity assessment based on their population need. 

About the APPG SRH
The All Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG SRH) is a group of MPs and Peers seeking to raise awareness in Parliament of the needs of women seeking abortion and the importance of improving the sexual health of people in the UK.
The APPG brings together Parliamentarians, experts and campaigners to examine issues within sexual and reproductive healthcare in the UK, and to explore options to improve healthcare through policy and legislative change. The Group is chaired by Dame Diana Johnson DBE MP.