Women and people with wombs are being told to wait up to a year to have their contraceptive coil (IUD) removed in England and Northern Ireland, Refinery29 has learned. Waiting times for this procedure range from six months in London to one year in Northern Ireland.
The Faculty of Sexual and Reproductive Health (FSRH) – the body which provides clinical standards and guidance in the UK – has told Refinery29 that COVID has had an impact on services but that community sexual and reproductive healthcare services were "already understaffed and underfunded prior to the pandemic" due to government cuts.
Three women, all under 30, have told Refinery29 that they asked to have their coil removed soon after having it fitted due to "unbearable pain". One, named Alice, said she was told to wait six months in 2021. Another, 27-year-old Dani from London, was made to wait six months in 2021 despite having "problems" with her coil and being in "excruciating pain".
"I went for the coil because I was experiencing painful periods but it actually just made it worse," Dani explains. "With the coil I wasn’t just getting pain around my period but all the time so I decided to have it removed. I couldn’t get an appointment for two months."
Dani’s appointment was then rescheduled. "I had to wait another two months," she says. "The entire time I was in a lot of pain."
When Dani did eventually see a doctor she says she felt judged when they asked her why she wanted to have her coil removed. "I explained that I was in a lot of pain and the first thing he said to me was: 'So you’re ready to have an abortion then.' That really threw me, it was a very jarring question," she says.
"In total it took me about 10 months to get it sorted," Dani concludes. "I feel emotional even talking about it."
Last year, the FSRH surveyed its members (doctors, nurses and midwives) and of the 400 responses it received, more than half said that they were not able to offer appointments to all patients requesting long-acting reversible contraception (LARC: hormonal and non-hormonal IUDs, implants and injections).
The FSRH told Refinery29 in no uncertain terms: "It is clear that LARC services have been hardest hit compared to other sexual and reproductive healthcare."
However, when the FSRH conducted its survey in 2021, the longest waiting time was between three and four months. That means the waiting times reported by Refinery29 readers far exceed them.
Dr Anne Lashford is a GP and vice president of the FSRH. She told Refinery29 that these delays are, in part, down to the pandemic.
"During the worst of the pandemic, the redeployment of staff from sexual and reproductive healthcare community clinics and reduced access in GP practices have resulted in service closures and the build-up of a backlog, particularly for long-acting reversible contraception such as hormonal and non-hormonal IUDs and implants," she explained. "This backlog will take a very long time to clear, and we are concerned that some women are not able to access the sexual and reproductive healthcare that they need."
In reality however, the blame cannot be laid at the door of COVID alone. Cuts to services in recent years have diminished resources.
We are concerned that some women are not able to access the sexual and reproductive healthcare that they need.
Dr Anne Lashford
"In reality, community sexual and reproductive healthcare services were already understaffed and underfunded prior to the pandemic," Dr Lashford continued. "Government’s cuts to public health budgets from 2015 have left local authorities struggling to find the right level of funding for these services. It is estimated that more than 8 million women of reproductive age are now living in an area where the council has reduced funding for sexual and reproductive health services."
Thirty-six-year-old Katy, who lives in Enniskillen in Northern Ireland, may be one of those women. Her local women’s health clinic at the South West Acute Hospital recently told her that she will have to wait a year to have her coil – which she has now had for 10 years – removed.
"I had a non-hormonal copper coil, or intrauterine device (IUD), fitted in May 2012 when I was 26," Katy explains. "During the fitting I was told that it would need to be replaced in 10 years’ time and given an appointment card with the date of renewal: May 2022. I know plenty of people don’t get on well with IUDs but mine has never caused me any trouble and since I have no plans to have children I was keen for a straightforward replacement."
"I recently moved to Northern Ireland and as you might expect, sexual health services aren’t quite as easy to access here as they are in other parts of the UK. Knowing this, I brought up the subject of my IUD during a smear test at the end of February – I thought three months before the 'expiry date' would be enough time to schedule an appointment," she continues.
"The nurse told me to ring the women’s health clinic at the local hospital and to do it right away because there's a waiting list," Katy says. She rang the clinic and, straightaway, was told by a woman on the phone that "there was no need to panic because they (whoever 'they' are) have decided that 10-year IUDs are effective for 11 years."
"I was a bit surprised as I hadn’t heard about this – but then again, why would I?" Katy adds. "Turns out that this is rather convenient as the next thing she told me was that the waiting list for an appointment is currently one year and one month so she’d put my name down anyway and by the time my IUD actually expires I’ll be at the top of the list."
Refinery29 asked both NHS England and the National Institute for Health and Care Excellence (NICE) to comment on the safety and efficacy of leaving a contraceptive coil in place for longer than 10 years. The Department of health said this was a "clinical matter" and a spokesperson provided the following statement:
“We are committed to ensuring the public receive the best possible birth control and contraception services. We are aware of some challenges in the provision of Long-acting Reversable Contraception (LARC) services, including the removal of intrauterine devices (IUDs), due to restrictions on services put in place during the COVID-19 pandemic.”
“Local authorities are working closely with providers of long acting contraception to address backlogs in fitting and removal,” they added.
NICE did not respond.
Though Katy has no plans to have children, at age 36 she notes that waiting a year "could be the difference between being able to get pregnant and not being able to".
Katy and Dani are not alone. Dozens of women have been in touch with Refinery29 to tell of long waiting times. Some have even paid for private removals.
Thirty-five-year-old Hannah lives in West Yorkshire. She was told in early 2021 that she would have to wait months to have her coil removed even though she was planning to try and start a family in the near future.
"I was told there was a large backlog and they couldn’t confirm how long the wait list was at my local GP surgery," Hannah explains. "I joined the wait list and called back in May but they couldn’t confirm where I was in the queue and how long it was."
Hannah was anxious about losing time and didn’t want to delay family planning. She also didn’t want to wait for an indefinite amount of time so she took matters into her own hands.
"I called a local private hospital and got an appointment a week later at the start of June," she continues. "I had to pay for a private GP consultation which was £99 but they didn’t actually charge me for my coil removal. I’m aware that it is a privilege to be able to do that."
To date, Hannah says she has not received any update from her GP about her place in the queue.
Similarly, 35-year-old Samantha had a coil fitted in January 2015. She got married in June 2021 and wanted to have it removed in order to start trying to get pregnant. She contacted her local GP surgery in Shrewsbury, Shropshire in March 2021 and was told that it was not possible to remove her coil because of the coronavirus crisis.
"I eventually managed to get an appointment in June 2021," explains Samantha, who works for the NHS. "I saw the practice nurse but she was unable to reach the strings of my coil so a doctor came to try but, again, couldn't do it. I was referred for a scan of my uterus to ensure the coil was still in the correct place (it was)."
I felt that my choice over my body had been taken away. I had no say in what was happening.
Samantha, 35, Shropshire
Samantha was then told she needed a specialist referral to a gynaecologist but her GP could not tell her how long the wait for that would be. When she eventually got a letter, a few months later, she was upset, anxious and panicked to see it was merely scheduling a phone call. "I called the number on the letter and asked about the waiting list for removal again. I was told to expect it to be about 10 or 11 months long."
"I felt that my choice over my body had been taken away," Samantha says. "I had no say in what was happening. I wanted a baby, which is a huge decision anyway. It still makes me cross thinking back."
In the end, Samantha also went private at the end of 2021. "I waited less than two weeks for an appointment, the whole procedure took two minutes and it cost me £250."
Prolonged waits and private healthcare bills. This is the true cost of the COVID backlog and cuts to public health services.
Refinery29 has contacted NHS England and the National Institute for Health and Care Excellence (NICE) for comment.