Access to progestogen-only contraceptive pills should be available over the counter, experts have said, as a report finds many women in England are struggling to access contraception as a result of underfunding and cuts to services.
An inquiry by the all-party parliamentary group on sexual and reproductive health (APPG SRH) heard that difficulties accessing contraception was leaving women at risk of unplanned pregnancies, a situation made worse by the Covid-19 outbreak. The inquiry said such problems also affected trans men and non-binary individuals.
Long waiting times for contraception and a lack of GPs trained to offer long-acting reversible contraceptives such as the implant or intrauterine device – the most effective reversible forms of contraception – are among the problems identified by the inquiry, with some women having to travel long distances to access the contraception they need.
“Women are facing increasing difficulty in accessing the contraception that best suits them and this has been made worse by the pandemic,” said Dame Diana Johnson MP, co-chair of the group.
The group says such problems are rooted in a problematic commissioning system and cuts, with sexual and reproductive health budgets reduced by £81.2m between 2015 and 2017-18, and contraceptive budgets down by £25.9m (13%) over the same period.
“In practical terms cuts have led to service closures, reduced opening hours, reduced service provision and cuts to staff numbers,” the report from the inquiry states.
“This inquiry heard that in some areas routine oral contraception is not being provided in SRH [sexual and reproductive health] contraceptive services to people over 25 years old. In other locations, free emergency contraception from pharmacies is unavailable for those over 25, 21 or 17 or is not commissioned at all. In other areas access to services is restricted by a patient’s address,” it adds.
While data on unmet contraceptive need is lacking, the team point out that abortion rates in England and Wales in 2019 were the highest since the Abortion Act 1967. England has the highest rate for teenage pregnancies in western Europe.
The scale of cuts to sexual health services has previously raised alarm, with experts warning they could also affect issues including the spread of STIs.
The report warns the effects of reduced access to contraception will hit marginalised groups the hardest, with young people potentially put off accessing services if they are aimed at all ages, and black, Asian and minority ethnic individuals less likely to go to a GP for contraception that white individuals.
Among the recommendations from the group, the report backs calls for the progestogen-only pill (POP) to be made available over the counter in pharmacies without a prescription, funding for postpartum contraception in all maternity settings, and the development of a national digital contraception service to help women get hold of the contraceptives they need.
“[The latter will] protect contraceptive provision in the event of another ‘lockdown’, even out inequalities in remote access to contraception, and streamline care pathways for women,” the report states.
Dr Asha Kasliwal, president of the Faculty of Sexual and Reproductive Healthcare, which gave evidence to the inquiry, said Covid-19 had made a difficult situation worse and called for sustained investment in sexual and reproductive healthcare services.
“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,” she said.
“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.”
Kasliwal said the progestogen-only pill, desogestrel, was very safe,adding that both the Faculty of Sexual and Reproductive Healthcare and the Royal College of Obstetricians and Gynaecologists had lobbied the Medicines and Healthcare products Regulatory Agency to approve over-the-counter availability. “I think they have been looking into it and I think they are hoping for a good outcome soon,” she said.
