Prevention is a central pillar of the new vision for the NHS, as set out in the Department for Health and Social Care’s recent paper, Prevention is better than cure. Yet this vision does not mention contraceptive provision once. This is a clear oversight, given that contraception is all about the prevention of unplanned pregnancies – with all the personal, financial and societal costs that these can have. Being able to access contraception and protect against unplanned pregnancy is a fundamental aspect of women’s health and wellbeing, as well as an effective public health intervention.
If the Government wants to be serious about prevention it needs to get serious about contraception. Here’s why:
1. It is extremely cost-effective.
The most recent PHE statistics show (conservatively) that every £1 spent on contraception saves the whole public sector £9 over ten years, not to mention the wider societal impact and costs. This makes it a very cost-effective public health intervention and one that could reduce significant burden, both on the NHS and wider public services, down the line.
2. When contraceptive services are cut or under resourced, there is a significant impact on the ability of services to provide high-quality care.
This includes the provision of comprehensive contraception services, with consequences for individual women’s health and wellbeing. This is happening now – as highlighted in the recent report by the Advisory Group on Contraception (AGC). The AGC’s findings show that 66% of councils have reduced, or plan to reduce, their spending on sexual and reproductive health (SRH) services, of which contraception is a key service, in the three years to 2018/19. This means 8 million women are living in an area where budgets have been cut. The quality and accessibility of women’s care should not depend on their postcode. Later in this series, we will be further exploring the postcode lottery that women face in accessing care.
3. Cuts to contraception exacerbate health inequalities, as vulnerable women’s ability to access the care they need is restricted.
The reduction in the number of community services commissioned to provide contraceptive services seen in recent years may be stopping these women receive the more targeted outreach and support they may require. For example, while teenage pregnancy rates have fallen in England and Wales in recent years, research has shown that more vulnerable teenagers, who are in care or in the process of leaving care and for whom non-targeted outreach methods may not be as effective, are three times more likely to become pregnant than their peers. The reduction of health inequalities should underpin any effective strategy for public health and prevention, and while it is not a key feature of Hancock’s vision, it is an ambition of the long-term plan. Expanding access to contraception, and ensuring vulnerable women have the care they need, will contribute to narrowing the health inequalities gap.
If prevention is to be a central pillar of the health and care system, we need to stop overlooking contraception. The long-term plan should include measures and protections for women to have equitable access to comprehensive contraceptive services, both in primary care and community settings. This would deliver a double win for both women’s health and the public purse.