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Call for equal access to contraception

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Greater provision of contraceptive services needed for women over 25.

An inquiry established to investigate how best to tackle the UK’s high level of unplanned pregnancy has recommended that  the government should overhaul existing contraceptive services, especially for the over 25s, and implement compulsory sex and relationship education from primary school on.

Labour’s National Teenage Pregnancy Strategy reduced the teenage pregnancy rate by 20 per cent from 1999-2010.

Nonetheless, the UK still has the highest rate of unplanned pregnancy in Western Europe.

The abortion rate in the UK has remained relatively static, although there has been a 10 per cent increase in 30-34 year-olds seeking abortions over the last ten years, and over the same time period the rate of repeat abortions has also risen from 31 per cent to 36 per cent.

And when a woman’s fundamental right to comprehensive information on the contraceptive choices available to her is either compromised or inadequate, then abortion does become a necessary last resort.

A key finding of the report is that nearly a third of women of reproductive age are without this fundamental right.

Long-acting reversible contraception (LARC), such as intra-uterine devices (IUDs), subdermal implants and injectables, offer diverse benefits. One major one is that they do not have to be taken daily like the pill.

They are, however, largely neglected as forms of contraception because women have concerns about efficacy and remain unaware of the benefits.

Such concerns, the report points out, should be being addressed by health professionals, so that women can retain bodily autonomy and assess the risks and benefits for themselves.

‘Full contraceptive advice,’ it says, ‘needs to ensure that the greatest number of women continue using contraception that they feel is best suited to them and that they have had the freedom to be able to make a well informed choice from a variety of contraceptive methods available to them.’

It continues, ‘the notion that there is an objective “perfect” contraceptive does not make sense; a contraceptive may only be perfect from the subjective point of view of the individual women concerned.’

Incredibly, there is no national register of healthcare professionals trained to fit each LARC, and commissioners are unable to assess whether local needs are being met.

Indeed, an investigation by the Advisory Group on Contraception found that two-thirds of Primary Care Trusts could not provide information about the number of trained practitioners able to fit IUDs or subdermal implants they employed.

If this is indicative of the healthcare resources, or lack thereof, available, is it any wonder that women are not using LARCs?

For this reason, a key recommendation by the inquiry is that new national guidelines must be issued to ensure that the provision of contraceptive services around the country is equally accessible and equally comprehensive.

While the MPs concluded that existing contraceptive services need improvement, the report also highlights that access to these meagre services is currently problematic for women over 25.

A key component of the National Teenage Pregnancy Strategy was for local areas to provide ‘a well-publicised contraceptive and sexual health advice service which is centred on young people.’

A consequence, however, of sexual health services targeted on under 25s, is that those in the older age bracket have found themselves excluded from locally operated services.

Indeed, for many women aged over 25, the only way to obtain contraception is to make an appointment with their GP, yet work commitments and childcare issues can often make it difficult to attend in regular surgery hours.

For this reason, the report calls for wider provision of contraceptive services, including making them available in the workplace.

It is also important not to forget that unplanned pregnancies are often interrelated with other issues, such mental health, addiction, and sexual violence.

A ‘combined approach’ is needed, the report suggests, bringing sexual health services together with facilities that come into contact with women experiencing these kinds of difficulties.

And an aspect that is often forgotten in inquiries of this nature, however, is the role that men have to play in unplanned pregnancy.

Perhaps because this cross-party inquiry was led by three female MPs, Amber Rudd, Sandra Osborne, and Lorely Burt, the report challenges the laissez faire attitude of some men and encourages the government to make them more ‘responsible actors’.

This particular recommendation may be easier said than done.

You can read the full report ‘The Morning After: A Cross Party Inquiry into Unplanned Pregnancy’ here.

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