Why is it getting more difficult for women in the UK to access contraception?

Words by Lydia Smith.

It has been more than 40 years since the contraceptive pill was launched in the UK, transforming women’s lives and allowing them to take control their relationships and futures.

Fast-forward to 2018 and there are lots of different contraceptive options available, from the pill and the coil, to the implant and injection.

Despite this, though, it is getting increasingly difficult for women to access the contraceptive of their choice – because of budget cuts to sexual health services.

“Contraception and sexual health services are commissioned by local councils, who are struggling to cope with huge cuts made by the government to public health budgets,” Bekki Burbidge, deputy chief executive of sexual health charity FPA.

“Nearly half of all councils in England have reduced, or plan to reduce contraception services, between 2015 and 2019. The cuts have had a devastating impact on the availability of services. Many have either closed, or have reduced their staff or their opening hours. We’ve seen longer waiting times, especially for walk-in clinics, and fewer appointments available.”

More than 8 million women of reproductive age are now living in an area where the council has reduced funding for sexual health services, according to the Faculty of Sexual and Reproductive Healthcare.

“In some areas, specialist contraception services, including free emergency contraception schemes, are only available to younger women, with women over the age of 25 being directed back to their GP for contraception,” Burbidge adds.

Another study by FPA found a fifth of women have had to wait over two weeks for a contraception appointment – and more than a quarter of women surveyed said they felt they didn’t have enough time to go through all their options.

“The amount of evening drop-ins have reduced and I find it hard to get an appointment outside of working hours,” says Laura*, 32.

“Nearly all clinics are in work time. I now get my pill from my GP on repeat prescription but have been struggling to get an appointment for my smear.”

More women are turning to long-acting reversible contraceptives (LARCs), such as the hormonal or copper coil, the implant or the injection. According to figures from the NHS in England, the number of women choosing LARCs has nearly doubled since 2007.

Yet it is these types of contraceptives that are getting increasingly hard to access.

“The implant, IUD and IUS are the most effective methods of reversible contraception available – but they all have to be fitted by a trained healthcare professional,” explains Burbidge. “Unfortunately many GP surgeries and contraception clinics aren’t equipped to fit these methods, often due to the cost involved in training and fitting.”

This means women may be referred to specialist services – which can take time – or even more worryingly, they may not be offered these methods at all.

Yasmin Dick, 28, uses the hormonal coil (IUS) which lasts three to five years, but has recently had difficulty getting it replaced.

“Getting the coil put in was relatively straight forward, it was a bit annoying that my GP didn’t offer the service and couldn’t tell me anywhere locally that might but I found a sexual health clinic nearby that did do this and offered appointments,” she says.

“Unfortunately in the five years that have elapsed, it seems that the process and systems have changed. I wanted to go back to the original clinic, however they now only offer booking appointments online with time slots released the day before at midday. It’s essentially like trying to get festival tickets – the site crashes and then when you eventually get through everything is gone.”

Dick spent over an hour trying to book because of system issues, after which she was told there was no more availability. She was told to come in early the next morning and wait to see if a walk-in appointment was available. “Apparently they wouldn’t know the doctor rota and those who were qualified to carry out this procedure until this time,” she says.

She rang her GP who directed her to another clinic where she was able to get an appointment, but because of problems with her coil, she was forced to rebook yet again.

“The most frustrating part is that I am trying to be a responsible adult, making the right decisions for my sexual health and not getting pregnant and I don’t feel supported in this by the systems and processes in place,” she says.

If getting contraception means multiple visits, long waits for appointments or travelling to an awkward location, it creates more barriers to accessing contraception – which has a disastrous impact on women.

“When access to the most effective methods of contraception is limited, it leaves women at greater risk of unintended pregnancy,” Burbidge says. “The huge strain on sexual health services also puts people at risk of not getting testing and treatment for STIs, leaving them at risk of complications or passing on an infection to other people.”

It’s not just women who are affected, but men too. “Sterilisation has also been affected by funding cuts,” Burbidge says. “For example, some local areas no longer provide vasectomy operations on the NHS, which disproportionately affects those who can’t afford to pay for a private operation and takes away one of the few choices for men to take responsibility for contraception.”

Reversing cuts to sexual health services also makes financial sense, as research by Public Health England has shown that every £1 invested in publicly provided contraception saves £9 over ten years.

“It is a fundamental right for men and women living in the UK to have confidential access to the full range of contraceptive methods from services based in different settings,” says Dr Jane Dickson, Vice President of the Faculty of Sexual and Reproductive Healthcare.

“Doctors and nurses working at the frontline of contraception care who are desperately worried about the impact of continuous cuts on their patients,” she adds. “We are seeing the impact of the pressures faced by services and local authorities due to reduced funding and service fragmentation.”

Visit the NHS website to learn what your options are for access to contraception.

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