Opinion  

In November 2004, the DoH made a remarkable announcement: to implement the Choosing Health white paper, £300 million would be dedicated to sexual health. Included was a £40 million rescue package for contraception (which had suffered years of under-funding) and an audit of the planning and provision of contraceptive services across England.

Choosing Health had everything: investment, strategy, planning. In 2004 we never expected that three years later contraceptive services would be in a worse state than ever before. So what went wrong?

Contraceptive services have disappeared
First, the money was not ring-fenced and allocation was left to the discretion of individual PCTs. This decision, coupled with financial pressures in the NHS, resulted in many trusts using the money for other purposes. fpa warned there would be serious consequences from this, which was confirmed when the DoH published the contraceptive audit last month (May).

Services have disappeared and contraceptive provision is generally neglected. There is little understanding of where services are being provided, how they are provided and who they are provided for. Some PCTs, the audit revealed, spend just 18p on each woman's contraceptive needs. The average spend on contraception for every woman in England is just £11.67.

Over 20 per cent of PCTs have restricted women's access to long-acting methods of reversible contraception. However, research from the University of Newcastle, on behalf of fpa, shows that improving the provision of these methods could save the NHS £500 million over 15 years.

Mapping exercises ensuring that patients and professionals benefit from joined-up services and care pathways aren't collected by 70 per cent of PCTs. Additionally 53 per cent of PCTs have no strategy in place to reduce repeat abortion.

Neglecting contraception provision is unacceptable
When community contraception clinics close, it does not just affect current services, it stores up problems for years to come. Clinics provide training for doctors and nurses in general practice. If there are fewer specialists, how will professionals obtain the expertise and support they need to provide services in the future? The UK has high teenage pregnancy rates and rising incidence of STIs. Neglecting contraception provision is not acceptable nor, in fact, sustainable. If we are to rescue contraceptive services from the bottom of the public health pile, we have to change our approach.

PCTs should recognise the value of contraceptive provision. Reconfiguring services so they respond to the needs of the local community must be a top priority. Investment must reach front-line services fast. New strategies and frameworks taking a holistic approach to reproductive healthcare should be put in place urgently, so that services can survive into the future.

We also need to expand nurse-led contraceptive services by providing robust training and professional development structures to ensure their expertise continues. Finally, patient choice should be paramount. Men and women should be able to access the same high quality of care whether they use community contraception clinics or general practice.

It is not too late to save contraceptive services. But PCTs and the DoH must take firm action and put contraception at the heart of public health.

Anne Weyman, OBE, has been chief executive of fpa UK since 1996. She is vice chair of the government's Independent Advisory Group on Sexual Health and HIV and a member of the Independent Advisory Group on Teenage Pregnancy. She is also a non-executive director of Islington PCT and a member of the board of trustees of the National Family and Parenting Institute.

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