Thanks to government budget cuts to local councils, sexual health services in the UK have come under increased pressure in recent years – and now professionals are warning that the situation is reaching breaking point. A prominent doctor has described contraceptive access in England as at a "crossroads" and linked the crisis to increased abortion rates.
"My concern is that the unmet need (for contraception) might get translated into unplanned pregnancies and possibly the increased abortion rates that we are seeing today," Dr Kasliwal, president of the Faculty of Sexual and Reproductive Healthcare (which represents 15,000 doctors and clinicians), is quoted by the BBC as having said.
Half of all councils in England have cut, or plan to cut, sexual health services, with long-acting reversible contraceptives (LARCs), including the coil and implant, bearing the brunt, reported the BBC. While condoms and the pill remain the most commonly used contraceptives, the coil and implant are becoming increasingly popular with women.
Three-quarters of English councils cut the number of long-acting reversible contraceptives fitted between 2014 and 2016, because there were fewer GPs with the time or training to put them in, according to data from the Advisory Group on Contraception reported by the BBC. Only doctors who have been trained can currently fit coils and implants.
Tilly Thorns, 23, was made to wait nine weeks to have a copper coil fitted at a sexual health clinic in Homerton, east London, two years ago. The long wait made her anxious and doubt her contraceptive choice, she told Refinery29. "Was I making the right decision? They kept pushing other forms of contraception on me, like the implant, other pills and the injection, and questioning my motive for wanting the coil, which was a big decision for me anyway that I'd heavily researched and thought a lot about.
"I had to take so much time off work that I had to start calling in sick just so I could go to appointments," Thorns added.
Laurene, 27, had a similarly difficult time when trying to have a coil fitted at Homerton Hospital. She had to wait six weeks for her appointment and received no explanation for the wait: "They just said it was the standard procedure. It was frustrating having to wait that long for something important like that.
"Thinking of other people who needed it more than me made me go mad – they shouldn't have to wait that long. Luckily I didn't have to put any urgent plans on hold – I was just thinking of those who needed it more urgently than me."
The stress of not being in control of my body in the way I'd like to be makes me quite panicky.
Even accessing the contraceptive pill, which is still celebrated for its ease and reliability (despite the recent backlash against it), can be difficult. Jazmin Kopotsha, 25, has been struggling to access the combined pill without issues in London since 2015. After a series of "notoriously long waits" to be seen at the GP practice where she was registered, she decided to visit a walk-in centre to pick up her contraception before a holiday two years ago.
"It's confusing because some [walk-in clinics] offer free contraception, while some give you a prescription – there's no clear rule on why, at least not from my asking around," she said. On top of that, "None of the [clinics] open after working hours were in my borough, so I had to travel for three hours to an obscure centre in west London."
Kopotsha has also tried using Lloyds online doctor, which has come with its own issues. "They charge about £20 after you do an online consultation but you still have to wait a week for them to dispense, because you have to be seen by a pharmacist who takes your blood pressure first and you may have to book an appointment. It's the same drama as seeing a GP."
The impact on her life has been inconvenient to say the least. "I've had to pause my sex life a few times, particularly when I've been with long-term boyfriends. The stress of not being in control of my body in the way I'd like to be makes me quite panicky. There are pros and cons to the pill, but having to reorientate your life, relationships, travel plans because you can't get medication doesn't help anyone."