Sexual and reproductive health (SRH) is integral to an individual’s overall health and wellbeing. Good SRH enables people to pursue their ambitions in education, work, and with their families; it supports strong and successful communities. Despite this, we continue to see women and girls experiencing poor reproductive health outcomes – with nearly half of all pregnancies in the UK being unplanned or ambivalent.
Latest statistics show that although demand for Long-Acting Reversible Contraception (LARC) – the most effective form of contraception – is increasing, provision has still not returned to pre-pandemic levels. SRH services are often poorly integrated into women’s healthcare pathways in the NHS. Following the implementation of the 2012 Health and Social Care Act, the responsibility for commissioning women’s reproductive health is split between local authorities, Integrated Care Systems (ICSs) and NHS England. This has severely fragmented SRH services, with no single body held accountable for ensuring women’s holistic needs are met, and opportunities for improving reproductive health outcomes are often missed due to different services being funded by different parts of the system. For example, maternity care is funded by the NHS and contraceptive services largely by local authorities, resulting in many women lacking access to postnatal contraception.
This has been exacerbated by cuts to public health funding, resulting in reduced local provision of SRH services. This is despite the fact that investment in SRH services is highly cost-saving, with Public Health England estimating in 2021 that for every £1 spent on LARC in primary care the NHS saves £48. The current situation also contributes to poorer health outcomes experienced by women and girls from marginalised groups, including women and girls living with disabilities, from low socio-economic backgrounds, and those from Black, Asian, or ethnic minority groups.
In light of these disparities and barriers in access to high-quality SRH services, the Faculty of Sexual and Reproductive Healthcare (FSRH) has developed the FSRH Hatfield Vision. FSRH are the leaders in the field of SRH, representing professionals working in this field including 2,000 nurses. As a multi-disciplinary professional membership organisation, we set clinical standards and guidance, provide training and lifelong education, and advocate for safe and effective SRH across the life course for all.
The FSRH Hatfield Vision is our framework setting out what needs to be achieved to improve the health of 51% of the UK’s population and tackle the inequalities that women and girls face across their lifetime. The Vision is designed to support system change, as well as leverage commitment and accountability for women’s SRH at a national level. Its main target is to significantly reduce health inequalities for women and girls by 2030, enabling them to live well and pursue their ambitions in all facets of their lives. The target can be reached, and the Vision’s success measured, by the achievement of the 16 goals and 10 actions in different areas of SRH which are set out in the document and should be implemented by the Government and healthcare bodies as a priority.
The Vision’s Goals serve to tackle the main issues in the SRH care landscape, such as Goal 3, calling for ICSs, local authorities, and providers to offer women and girls the full range of contraceptive methods in the location of their choosing, with quick access to Primary Care and specialist services when needed. Other goals include ensuring all women can access a practitioner in their local area who can provide menopause care and reaching the national NHS Cervical Screening Programme target of 80% coverage by 2025.
The Vision also outlines a number of actions necessary to achieving the 2030 target, and the expertise of highly skilled SRH Community nurses is essential to achieving these ambitions. For example, Action 2, calling for the primary care workforce, many of who are nurses, to be adequately resourced to provide LARC fittings, removals and training, with local contracts fully covering the costs of provision, training, and maintaining access to this essential service. Additionally, Action 3 calls for service specifications for specialist SRH services to be designed to include training requirements in their contracts.
Achieving the 2030 target of reducing SRH inequalities requires commitment and action from all governmental and healthcare bodies. The Vision is currently endorsed by over 40 organisations within the SRH sector, including the Royal College of Nursing, Academy of Medical Royal Colleges, British Medical Association, Local Government Association, and many others. The number of endorsements is steadily rising – demonstrating the weight of support behind the Vision’s overarching aim to address disparities in SRH outcomes between different groups of women.
You can read more about the Vision, and how to advocate for improved access to SRH health care, here.
Dr. Janet Barter
President of the Faculty of Sexual and Reproductive Health (FSRH)
Ruth Bailey, Queen’s Nurse