A report in a medical journal has found that a government scheme that gave doctors money for recommending long-term contraceptives like the implant, IUDs and the injection saw a decrease in abortion rates.
But, as the British Pregnant Advisory Service (BPAS) has noted today - what does that mean for women? Their day to day lives? The expectation they're getting the best advice about something which can impact them beyond recognition? Well for many, I think it means they were advised to go on contraception that wasn't right for them. And, actually, that can be devastating.
I was given the contraceptive implant (and a number of women I knew in the area who used the same GP had the same experience, or were advised to go on it) during that time. It was devastating for me. I bled for months on end - I wanted to curl up in agony with 'first day pain', but for weeks. I asked for it to be taken out repeatedly. I was ignored and told to 'give it more time'. I felt totally and completely loopy - whether it was from pain and bleeding, hormones or the feeling that I was being gaslighted by the medical profession and screaming into a black hole 'CAN SOMEONE SORT THIS OUT PLEASE I FEEL LIKE I'M LOSING IT', I'm not sure. I did actually lose it one day on the phone when told I couldn't get a GP appointment for weeks. I screamed and cried on the phone to the extent that the receptionist offered to call me an ambulance.
Before I was 'allowed' (because yes, it felt like I was weirdly being forced to stay with it, I remember thinking, 'This is bizarre, why are they so insistent on this?') to come off it, I was instead referred for invasive appointments to check there wasn't something else wrong. One memorable appointment involved the doctor saying that because I was then 30 I probably shouldn't be on the implant anyway because it 'means women like you put off getting pregnant later and later'. He ended the appointment snapping off his gloves, my legs still in the air laughing, 'Well if it was cancer you were worried about, you're fine there!'
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Eventually, about a year on, I happened to have an appointment with a locum who happened to be a sexual health specialist. 'This is horrible, I'm sorry this has happened to you,' she said kindly, booking me in for a removal. I think I cried. Again. There was a lot of crying that year.
The scheme was introduced in 2009 and gave GP surgeries money if they reached targets for offering women information about LARCs (long-acting reversible contraceptives) when they'd previously been on prescription contraception, including the morning after pill.
It's common practice to offer incentives for things like flu vaccines. For a surgery of 6,000 patients, it could've meant about £700 a year if 90% were given advice about LARCs. It was partly scrapped in 2014/15 and completely by 2019/20.
The report says the incentive scheme increased LARCs use and lowered abortion rates and should come back.
'Incentive or not, it is definitely good practice to give women more options about contraception,' said co-author Dr Richard Ma.
On that, I agree with Dr Ma. But, many women who responded to me and BPAS say they felt they were instead 'forced' onto contraceptive options that weren't quite right for them. Women are not getting the options. They're not getting the best advice. They're not getting a service when it comes to contraception.
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£700 isn't a lot of money. I don't think doctors are there, rubbing their hands gleefully, thinking of all the money baths they're going to take by knowingly causing women pain.
But I think it is a further indication of the lack of understanding in primary health care about contraception. Again, this is anecdotal (from my 25 years or so of being subject to these appointments and the numerous conversations I've had with family and friends) but it just doesn't feel like many GPs are clued up enough on the various types of contraception, or how to deal with issues women have before or after using them. I've been in more than one appointment where a doctor has googled in front of me. I've been in many more where I was told to 'give it a bit of time' - basically, try the booking system roulette and see what doctor you end up with next time.
Amy says she felt 'quite betrayed' when she found out there were cash incentives for suggesting LARCs, having gone through years of hell with her IUD.
'A nurse told me my best option was the progestin IUD,' said Amy. 'She said it gave out a local hormone which meant my acne would improve, that my periods would stop altogether and my pain would end. She was wrong.
'I continued to bleed non-stop for another year after that, and the pain was intense. I’m talking curl up in a ball, breathe like you’re giving birth pain for a few days every. single. week. I told sexual health nurses about the pain on multiple occasions, and was advised I should give any contraceptive "at least six months" to let my body get used to it. "Six months" became "nine months", and it started to feel as if they’d say anything to convince to stick with a contraceptive my body clearly hated. After three doctors visits I was prescribed a strong pain relief, the first two - as you’d expect being a woman complaining about period pain - essentially told me to get over it.
'The second year was much less intense, my periods calmed down as did the pains. Now, my periods are gone and I never (touch wood) have pain. But despite my relatively happy ending, the years of pain and bleeding I went through feel unnecessary. Knowing I dealt with all of that - and the disruptions to my job, relationship and body image - because of someone else’s cash incentive is quite frankly, appalling.'
Katie had a similar situation, feeling that she was being forced to continue with the injection that was causing her to bleed for up to eight weeks.
'To be honest felt like it was doing nothing as a contraceptive - I was bleeding for the majority of the time, so wasn't having sex,' she said. 'I felt like there was a big pressure to keep it up, with sexual health nurses telling me that my body just needed to get used to the hormones in the injection. I ended up having four injections in total before deciding that I needed to switch to the pill. I actually had very little luck with the pill too, with again, very long and painful periods. When I was 21, after three years of using contraception, I decided to come off of everything and just use condoms with my long-term boyfriend. We also use tracker apps, but honestly I cannot see myself using female contraception again. I'm just very put off by it now.'
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Melanie also bled for months on the injection after being encouraged to used it - and was scolded by a doctor for stopping. 'When it ran out, I took time off contraception because I wanted my body to rebalance itself and I wasn’t in a relationship anyway. When I returned to the clinic to discuss my options for a new type of contraception, I was scolded so harshly by the doctor about taking the break, that she actually reduced me to tears. I vowed not to return to that clinic, but my next nearest one was 1hr 40 mins away so I had to do a lot of travelling!'
A spokesperson from BPAS told Grazia: 'Long acting reversible contraceptives - which you can "fit and forget" can be a great option and all women should both know about them and have swift access to them. They provide extremely effective protection against pregnancy.
'But we do need to remember that efficacy is not the only issue women care about and there may be many reasons why a woman prefers condoms to a coil. Some women really want a method they are in charge of and can stop at any time.
'We are concerned that sometimes women feel LARCs are pushed upon them - and we know women can also have a hard time getting them removed if they are not working out. Equally there are women who struggle to get the implant or injection they want - particularly at the present time. Women’s choice is key - we need to respect it. Setting targets or giving incentives sometimes sits uneasily with providing woman-centred care - we need to get this balance right.'
Lots of women also replied - when I asked about whether they'd felt pressurised about using LARCs - that they felt they'd not received proper care when being put on various pills. And that they weren't listened to when they raised issues about those either. Whether or not you think there's a place for incentives in contraceptives, this points to a lack of understanding around women's bodies. And more concerning, an unwillingness to listen and see it as a real problem that is impacting women's lives.