FSRH press statement: we respond to BPAS / Lancaster University / Decolonising Contraception and Shine Aloud UK report on access to LARC in the UK

Posted 2 June 2021

Date: 02 Jun 2021

Type: FSRH Press Releases and Statements

Today BPAS, researchers from Lancaster University, Decolonising Contraception and Shine Aloud UK published a report featuring experiences of users of long-acting reversible contraceptives (LARCs). The findings echo those of the recent Inquiry by the All-Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH) that people are facing barriers to access LARC. Our position on access to contraception is unequivocal: it is a fundamental right for individuals living in the UK to have confidential access to the full range of contraceptive methods.

The research has also found that providers are not being equipped with the resources necessary to provide an accessible, comprehensive contraceptive service inclusive of LARC.

In addition, potential users who are ambivalent about LARC, or who do not want to use LARC methods, have reported pressure to use or delay removal of LARC methods.

Dr Jane Dickson, Vice President of the Faculty of Sexual and Reproductive Healthcare, (FSRH), said:

Long-Acting Reversible Contraception (LARCs) - the subdermal implant, the intrauterine device (IUD), the intrauterine system (IUS) and the contraceptive injection - are the most effective contraceptive methods to avoid unplanned pregnancies. With typical use, fewer than one in a hundred women will get pregnant while using LARCs. This compares with 9 out 100 for the pill, and 24 out of 100 for fertility apps. LARCs also provide health benefits and can be used to treat heavy menstrual bleeding and endometriosis.

“We are not surprised that this new report corroborates the findings of the APPG SRH’s Parliamentary Inquiry into access to contraception in England. For years now, our members have been reporting that the system is failing to equip providers with the resources necessary to provide an accessible, comprehensive contraceptive service inclusive of LARC.

“The findings are also important to illustrate individual experiences of LARC access. Whilst the report is not representative of the experience of all women and vulnerable groups, because its results are not quantifiable, every single case matters. We care about every individual who has reported pressure to use or delay LARC removal. This is not best clinical practice, and one we do not support.

“We recommend healthcare professionals to provide women with evidence-based, non-judgemental information about all contraceptive methods available in the NHS. We want to support women to make the choice that suits them best.

“Our position on access to contraception is unequivocal: it is a fundamental right for individuals living in the UK to have confidential, non-judgemental access to the full range of contraceptive methods, so they can choose the best method that suits their needs. Our vision is a UK where a rights-based approach to contraceptive care is designed around the needs of the individual, and we hope this report will inspire action to realise this vision.

“Only 8 healthcare professionals were interviewed for this report, and none of them currently work in the NHS. We look forward to working with the authors and partners to bring in healthcare professionals’ perspectives into future recommendations.”

ENDS

For further information, please contact: Camila Azevedo, External Affairs Manager, at 07379408587 / cazevedo@fsrh.org

Notes to Editors

  • The BPAS / Lancaster University / Decolonising Contraception and Shine Aloud UK report can be found here
  • The report of the Parliamentary Inquiry into access to contraception in England by the APPG SRH can be found here 

Q&A

1) Does the BPAS/Lancaster University LARC report represent the views of NHS providers?

The findings do not represent the views of NHS doctors’ or nurses’ across the board, because only 8 healthcare professionals who provide LARC were interviewed, apart from social care providers, activists and academics “with an interest in or engagement with LARC”. Therefore, the data can provide a glimpse into the experiences of these professionals, but it is not representative of LARC providers in the NHS.

2) How does FSRH support choice and non-judgemental, person-centred contraceptive care?

We publish evidence-based quality Standards to guide how commissioners and service managers can design services that support patient choice. We work hard to disseminate these our Standards so that they are adopted by decision-makers.

Our Service Standards for Consultations in Sexual and Reproductive Health Services addresses the factors required to create an environment conducive to both the healthcare professional and patient to obtaining accurate, relevant, and concise information to facilitate the clinical decision. It recommends:

  • A patient centred approach should be adopted, i.e. care which is holistic, flexible and collaborative. Patients should be made to feel comfortable.
  • All healthcare professionals should have effective verbal communication skills and be conscious of their verbal communication throughout the consultation.
  • The healthcare professional should be aware of verbal and non-verbal communication and listen to the patient’s tone of voice and watch for signs that may indicate the patient does not understand or is not happy with the proposed management plan.
  • All healthcare professionals should use plain English language and avoid use of medical jargon and acronyms.
  • For an effective consultation, healthcare professionals should discuss, agree and develop/update the management plan, in partnership with the patient in a way which respects patient autonomy.
  • Additional time should be allocated for consultations for individuals with specific needs wherever possible.

We also educate healthcare professionals in the NHS and abroad on how to conduct a non-judgemental contraception consultation. As an example, we offer a free online course on contraceptive counselling, covering the difference between a non-judgemental approach that supports informed choice by the individual (“counselling”), and a top-down approach in which the provider directs the patient towards the decision the provider thinks is best (“giving advice”) - not an approach we advocate.

3) What is FSRH doing to raise awareness / improve access to contraceptive care for black people / vulnerable groups?

To raise awareness of contraception amongst Black communities, we have partnered with University College London (UCL) and Decolonizing Contraception, one of the supporters of the BPAS/Lancaster University LARC report, on the “Black Voices on Contraception Choice” project. This project aims to raise awareness on contraceptive choice, and will produce videos featuring Black men, women and gender-diverse people as well as Black clinicians addressing concerns about contraception and barriers to accessing services.

The videos will be informed by focus groups and interviews with participants from these communities and once complete will become part of the Contraceptive Choices website – a well-used and credible source of information on contraception for all.

UCL, FSRH and Decolonising Contraception will collaborate to disseminate the findings, including but not limited to blogs, podcasts, peer-reviewed papers with the aim of increasing confidence and satisfaction with contraception decisions among the target groups.

Currently we have recruited a researcher to run focus groups, film volunteers and produce the videos, which will be launched later in the year.

About FSRH
The Faculty of Sexual and Reproductive Healthcare (FSRH) is the largest UK professional membership organisation working at the heart of sexual and reproductive health (SRH), supporting healthcare professionals to deliver high quality care. It works with its 15,000 members, to shape sexual reproductive health for all. It produces evidence-based clinical guidance, standards, training, qualifications and research into SRH. It also delivers conferences and publishes the journal BMJ Sexual & Reproductive Health in partnership with the BMJ.