A new report by a cross-party group of MPs and peers confirms that it’s not all in our heads: contraceptive services in England really aren’t good enough.
Last year, I wrote about how difficult I was finding it to access contraception. My experience was that contraceptive services in England could be woefully patchy, and chaotic in a way that often made trying to get hold of the pill intensely stressful and time-consuming. In the year since my investigation, I’ve received hundreds of messages from other women and people with wombs who’ve had similar experiences. These women want to have a stable form of contraception, one that suits their bodies and that they can reliably obtain. But they feel they are being thwarted by a system that is falling apart.
Now, a major political inquiry has confirmed that we’re not going mad: contraceptive services in England really are failing us. The report by the All Party Parliamentary Group on Sexual and Reproductive Health, a group of cross-party MPs and peers, has found that women in England are struggling to access contraception, with many having to travel long distances, being stuck on lengthy waiting lists or finding themselves sent back and forth between different services. Overall, it seems we shouldn’t be surprised that abortion rates in England and Wales are currently at record highs.
“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,” says Dame Diana Johnson, the Labour MP who chairs the All Party Parliamentary Group on Sexual and Reproductive Health.
“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.”
Unsurprisingly, the report also found that the Covid-19 pandemic has made it harder for many women and people with wombs to access contraception. Many GPs and clinics have been forced to limit their contraceptive services, and the fitting of long-acting reversible contraceptives (LARCs) such as the coil, implant or injection has been almost universally suspended. The number of young and Black, Asian, and Minority Ethnic (BAME) people requesting contraceptive care also dropped during the pandemic, suggesting these groups may be particularly affected by problems with contraceptive access.
At the same time, the pandemic has highlighted how contraceptive services in England could be transformed. Digital contraceptive services, remote consultations and telemedicine (medication delivered through the post) have become more widely available over the last six months, making it easier in some cases for women to access contraception.
That was certainly my experience: during lockdown, I was able to order a repeat pill prescription from my GP remotely, something I’d never been allowed to do before. MPs now say these elements should be incorporated permanently into England’s contraceptive services.
“The report highlights exciting opportunities to improve contraceptive provision by centring it around women’s needs and lifestyles,” says Baroness Barker, co-chair of the All Party Parliamentary Group. “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.”
Access to contraception is a human right, so why are contraceptive services in England struggling so much? Largely, the inquiry supports what I found last year in my investigation for Stylist, highlighting a toxic blend of massive funding cuts and splintered services that can be profoundly confusing to navigate. The budget for sexual and reproductive health services was slashed by £81.2 million between 2015 and 2018, while contraceptive budgets were cut by £25.9 million.
Responsibility for women’s sexual and reproductive healthcare services is also split between NHS England, local authorities and clinical commissioning groups (CCGs) – which is why you may have to go to completely different places to get hold of different forms of contraception.
“It is frustrating for me as a doctor and unfair for women, who have to navigate a complex system just to access basic healthcare,” says Dr Asha Kasliwal, president of the Faculty of Sexual and Reproductive Healthcare (FSRH). Ultimately, she says we are dealing with “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”.
Now, MPs and peers are calling on the government to implement serious changes to how contraceptive services are run in England. Health secretary Matt Hancock’s plans to abolish Public Health England are controversial, but MPs say they offer an opportunity for the government to radically rethink its approach to sexual and reproductive healthcare. They want to see the introduction of a simpler, streamlined system where one body is responsible for supporting women’s contraceptive, reproductive and gynaecological needs – as well a boost in funding for these services.
Whether the government will act on the inquiry’s recommendations remains to be seen. But one thing is clear: the system is broken, and we deserve more.