Last week The Debrief learned anecdotally that many GPs in England have stopped providing some forms of contraception as a result of funding cuts. Emma*, 29 from South London told us what happened when she went for her routine contraception check up at the Hetherington Centre in Clapham North:
‘I went to see the nurse for my Yasmin check-up. She told me I had to move off it because it was being discontinued. When I pressed her she said it was ‘due to NHS cuts’ and told me that they were reviewing the costs of all contraceptive pills. I’ve been told that Yasmin is particularly expensive. She offered me a different pill which, she said, is basically the same. But I said to her “it must be slightly different or it would be the same price”.’
Emma then went on to tell us that when she further pressed her nurse she was ‘prescribed 6 months more of Yasmin’ but told she could not have any more after that because the NHS will no longer be able to prescribe it. When she went to the pharmacy to collect her prescription she says they tried to charge her for it as they would a normal prescription (contraception is supposed to be free), ‘the staff didn’t realise you could still get it as a contraceptive anymore. It was only when I pointed out that it was my contraceptive pill and not being prescribed for any other reason they refunded me.’
Similarly, Bex from Surrey told us that she was denied Yasmin due to cost. Her doctor told her that 'the surgery had to reduce its spending'. Christie from Greater London also says she was forced to change pill and given cost as an explanation: 'They told me that they had to put me on a different brand because Cilest was too expensive' she says.
Today new data and research from the Advisory Group on Contraceptionfinds that one in three councils has cut, or is considering cutting the number of GPs practices able to provide Long-Acting Reversible Contraception (also known as LARCs) such as coils and implants.
While the report doesn't discuss the affect of cuts on COCs (Combined Oral Contraceptives) the ACG's research finds that a quarter of councils have shut or may yet close some of their contraceptive services as a result of public health cuts. Following an FOI (Freedom of Information) audit of 152 local councils (of which 140 responded), the ACG found that more than one in six local NHS authorities (16 percent) had decreased their spend on contraceptive services during the financial year of 2015/2016 because of the unexpected £200m in-year cut to public health budgets which was announced by George Osborne in June 2015.
The report also says that, according to the ACG’s findings, around one in thirteen councils will now have fewer contracts in place with general practice to fit and remove hormonal and non-hormonal coils in 2016/2017 than they did the previous year. They also found that about 3.9 million women are living in an area where contraceptive services are restricted in some way.
The Debrief spoke to the British Pregnancy Advisory Service about the implications of these findings, they said:
‘We regularly speak with women who have experienced difficulties accessing contraception, and this report provides clear evidence that these aren’t isolated cases. One-third of women are living in areas where contraceptive services are restricted. It’s hard to imagine that this would be tolerated if this were any other aspect of healthcare. Nearly all women will need access to contraception at some point in their lives, and as the age of motherhood currently stands at a record high, women will need contraception for an even greater proportion of their reproductive lives.’
‘Services should be protected in a way that acknowledges the important role contraception plays in women’s lives and their health. Not only are services being shut down, but women who do manage to access a clinic are they are then being denied the full range of options on the basis of cost – including some of the most effective methods. Women should not have to “put up” with a method of contraception that does not work for them, and we should take women’s concerns about the side-effects of different methods seriously.’
However, a Department of Health spokesperson told The Debrief that it was down to local NHS authorities to decide how they spend their public health funding budget, confirming that while public health spending is ring-fenced, sexual and reproductive health services specifically are not:
‘Local areas are best placed to decide how to provide the sexual health services their communities need. Good progress is being made, for example teenage pregnancy is down 30 per cent in England since 2011—the lowest for 40 years.’
‘Over the next five years we will invest more than £16 billion in local government public health services, in addition to what the NHS will continue to spend on vaccinations, screening and other preventative interventions.’
How does Emma feel about being denied a method of contraception which has worked for her because of funding? ‘I’m worried they’re putting the cost of the pill above my health, but the sums they told me they’ll save don’t amount to that much at all, so I don’t understand the justification for this. My nurse told me, very specifically, that by phasing out Yasmin they would save about £4 per year for every woman who takes it.’
Today’s news is contrary to the NHS’s own guidelines on the cost of contraception. A briefing note published by the NHS Business Services Authority(who help the NHS with its prescribing purse strings) in 2010 explicitly states that ‘LARCs are more cost-effective than COCs (Combined Oral Contraceptives) even at 1 year of use…NICE (National Institute For Clinical Excellence) recommends that women requiring contraception should be offered information and advice on all methods of contraception, including LARCs. If LARCs are not offered as part of a contraceptive service, there should be a referral mechanism.’
Indeed, more than this surely the emotional cost of women being denied certain methods of contraception, having to try different things which may or may not work for them pot luck style and, potentially, having to deal with unwanted pregnancies as a result is far more significant.
The issue here is that what’s being taken away from women is choice. Whether that’s a contraceptive pill that has been working for a woman long-term or someone who is opting for a coil, choice is crucial when it comes to sexual and reproductive health; different women have different needs and will respond more positively to certain kinds of contraception than others. Women’s reproductive rights and contraceptive choices need to be taken seriously and changes to services ought to be communicated properly with the women who rely on them.
*some names have been changed
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This article originally appeared on The Debrief.