Posted 27th Feb 2014
If anyone had asked me, six months ago, what sprang to mind when I thought about medical Royal Colleges the words ‘old fashioned’, ‘defending the role of doctors’, ‘male’ and ‘posh buildings’ would probably have featured strongly. I certainly hadn’t heard of the Faculties, despite 25 years of working in and with health charities. But a key motivation for taking on the (new) role of CEO at the Faculty of Sexual and Reproductive Healthcare, was the obvious passion and commitment displayed by the doctors (and nurses I discovered) involved. The Faculty has over 15,000 members – many are GPs, many are women and many have become involved in delivering sexual and reproductive healthcare because they saw the need for it – certainly not for the prestige or the money. I have worked in many organisations that rely on volunteers but I have been amazed at how much of the Faculty’s business is carried out by doctors and nurses working for free in their spare time. We work from small, rented offices (albeit in the RCOG building) to support healthcare professionals in sexual and reproductive healthcare to provide excellent standards of care to their patients. We have recently opened up our qualifications and membership to nurses and are now offering Letters of Competence in LARC methods as stand-alone qualifications to doctors and nurses. So a time of significant change and innovation for the Faculty under the leadership of Chris Wilkinson – reflecting the key role that nurses (and GPs) play in the delivery of sexual and reproductive healthcare in the UK.
So far, so good. Yet why is there a feeling that sexual and reproductive health (SRH) services are under threat? Everyone agrees, it seems, that contraceptive care is highly cost effective and enables women (and society) to avoid the sometimes serious consequences of an unwanted pregnancy. And yet in all the talk of the need to prioritise prevention, to promote public health and indeed to promote sexual health, I have been amazed by how often the ‘reproductive’ aspect of sexual health is being overlooked. Is this because we take access to free contraception and abortion as a given now? Is it because women (and men) find it easy to get the contraception they need? Is it because women using contraception are likely to be healthy and not highly visible as ‘users’? Years ago I worked in a poor part of Kenya, supporting the women there to access and understand contraceptive choices. I didn’t expect to have to lobby for this in the UK.
Despite progress in reducing teenage conception rates, our unwanted pregnancy rates (and abortion rates) remain high and yet this does not seem to translate into calls for action to ensure that the progress we have made in our sexual and reproductive health services in the last 10 years is maintained or developed. Recent surveys carried out by the Faculty of its members document a range of concerns about sexual and reproductive health services including the loss of senior SRH staff, clinics in the community being moved back into hospitals as a result of tendering and significant variation in prescribing of LARC - suggesting women are not being given a full choice of contraceptive methods in all services. A key ambition of the Government’s Sexual Health Improvement Framework (1) is for ‘high-quality, effective and accessible’ contraception to be available for ‘women of all ages’. Yet a report published by the Advisory Group on Contraception (AGC) in 2012 (2) found that nearly a third of women aged 15–44 do not have access to a fully comprehensive contraceptive service and research by the British Pregnancy Advisory Service (BPAS) found that nearly half of women with unplanned pregnancies were experiencing difficulties accessing contraception (3) . A whole range of studies have suggested that there is an urgent need to improve the quality of information about, and access to, the entire range of modern contraceptives (how many can women name?), especially LARCs.
So why are these issues not more visible? Why does Public Health England struggle to speak about reproduction, contraception and abortion care? Why is there not more leadership being shown by the various commissioning bodies now tasked (in England) with buying these services? Why is there not more urgency among policy makers/deliverers in tackling what could surely be an easy win both financially and morally?
There are, of course, examples of excellent ‘integrated’ sexual and reproductive health services which have been designed from the patient’s point of view. What strikes me as a common feature of these examples is the leadership role played by SRH consultants – working in conjunction with their GUM and other colleagues and pioneering the delivery of complex contraception in the community in particular. The specialty of Community Sexual and Reproductive Healthcare was established three years ago and is, the Faculty believes, key to ensuring that SRH services are led effectively now and in the future. It strikes me as an irony that a Specialty training programme allocated such a small number of spaces should face such a disproportionately large task. But herein lies the challenge – in an increasingly fragmented healthcare system, leadership in delivering accessible, open access SRH services will need to be shared by a whole range of people and institutions from elected councillors to patients. The FSRH will certainly want to play a part in this and we welcome opportunities to work with others to ensure women and men really do get the sexual and reproductive health services that they need, and indeed, are legally entitled to.
(1) A Framework for Sexual Health Improvement in England (2013)
(2) Sex, lives and commissioning: An audit by the Advisory Group on Contraception and the commissioning of contraception and abortion services in England (2012)
(3) bpas, 2012. ‘bpas finds nearly half of women with unplanned pregnancies experiencing difficulties accessing contraception’. http://www.bpas.org/bpasknowledge.php?year=2012&npage=0&page=81&news=488
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