Imagine it: your contraceptive implant is due to be replaced so you contact the sexual health clinic where you got it, only to be told there are no appointments for four months. You visit your GP – that is, if you can get an appointment – to discuss options, where you are told you can only get your implant replaced by the clinic who put it in. Sound familiar? Welcome to the UK's sexual health crisis.
If you ask women in their 20s and 30s about their experience with accessing services from contraception to abortion, you will hear the same trope: "I can’t get an appointment." This comes as no surprise. The government has made cuts to contraception spending power of nearly a fifth since 2015, despite the soaring demand for these services. The Advisory Group on Contraception (AGC) analysed the government’s contraception figures for 2018/19 and found that closures of services has continued to escalate from 9% in 2015/16 to 26% in three years. The AGC's audit also found that prescriptions for the most effective contraception in primary care have continued to fall, based on Public Health England's data.
A freedom of information request to every local council in England last year revealed that of the 151 councils that responded, 72 planned to cut sexual health funding in 2018/19 compared with 2017/18. Most said savings would be made through efficiencies, but 16 of them said services would be cut or reduced. These cuts included closures or reducing opening hours, opening days reduced and restricted free access to emergency contraception to women under the age of 25.
The lack of funding in these areas is directly impacting women seeking long-acting contraception, including the coil and implant, as well as the contraceptive pill and abortions. Last year, the number of abortions in England and Wales reached a record high of 200,608, an increase of 4% since 2017.
The cuts have also affected the availability of experienced GPs and nurses who can perform these procedures, forcing young women to travel hours to find a suitable appointment. A study conducted by sexual health charity FPA revealed that almost a fifth of women (16%) had to wait over two weeks for a contraception appointment, while a quarter of women (27%) said they felt they didn’t have enough time to discuss all contraceptive options during their consultation.
To gain a greater understanding of the impact young women have to face when trying to access sexual health services in the UK, we spoke to three women about their experiences. This is what they had to say...
Sophie is 24 and lives in Leicester. She had to wait four months to get her coil fitted.
What's your most recent experience with sexual health services in the UK?
In May 2019 I made the decision to have the coil fitted, as the combined contraceptive pill was no longer working for me. I initially organised an appointment with a practice nurse at my GP practice to discuss contraceptive options, but was actually provided with inaccurate information regarding the coil.
How long did you have to wait for an appointment?
I tried to book an appointment to have the coil fitted at my GP surgery as this is within walking distance of my house and is very convenient to get to. I was informed that the practice only runs one clinic for coil fittings per month, and that there was no appointment availability for three months. I rang my local sexual health clinic who informed me that the waiting time for a coil fitting was four weeks.
When you couldn't get an appointment, how did this make you feel?
I was left feeling incredibly frustrated; making the decision to try the coil was difficult in itself, but having to wait weeks to have it fitted made the whole experience ten times worse. It made me question whether it was all worth the hassle. When I couldn’t get an appointment at my GP practice, it made me feel like I was a burden on the system, and that I shouldn’t have chosen an option which wasn’t so readily available, in spite of the long-term benefits.
Individual GP practices and sexual health clinics simply don't have enough staff to cope with the demand, so it's often very difficult to get appointments.
When you were eventually seen, did you get all the information and advice you needed?
While I felt frustrated with having to wait even longer for an appointment, in the end I had a very positive experience. After waiting four weeks I had my coil fitted at my local sexual health clinic. The doctor who fitted it was very reassuring, and I felt that I was definitely in safe hands. I was given a lot of information about the two different types of coil, and was made to feel that my decision was supported. While the procedure itself isn’t that comfortable, it could have been made a lot worse if I hadn’t been made to feel so at ease by the health care professionals."
Jenny*, 26, is from south London and struggled with the cost of contraception.
What has your experience with sexual health services been like?
I remember not having to pay for my pill prescription while at university in south Wales, then moving back to London and being shocked by how much the cost of it added up. When I've been able to get to an appointment my experience has generally been pleasant enough, but it's never been a straightforward interaction.
How long have you had to wait for an appointment?
Probably about three weeks for an appointment to switch to a different contraceptive pill (from the mini pill back to the combined pill) and a similar amount of time when I had taken a break from the pill and wanted to go back on it. My GP surgery said it would be a three-week wait for an appointment or consultation so I looked on the NHS website for a walk-in clinic that was open after work (I wasn't able to take any time off work) and the only one that was open and offered free contraception was on the other side of London and a two-hour train/bus journey.
I might not have had to travel as far if I was able to pay for a prescription but I just couldn't afford it at the time so didn't have much of a choice. Thankfully the walk-in surgery was able to give me a six-month supply of pills then and there so I didn't need to worry about it for a while.
Knowing that there'll always be such a wait or effort involved has meant I've relied far too much on the emergency contraceptive when my pill has run out.
When you haven't been able to get an appointment, how has this made you feel?
Panicked and a bit at a loss. It's really not helped my attitude towards contraception which has historically been quite laissez-faire. Knowing that there'll always be such a wait or effort involved has meant I've relied far too much on the emergency contraceptive when my pill has run out.
Are there many clinics in your local area that offer these services?
I've moved around London a fair amount and found it different in each borough. I've gone to places that offer the free morning after pill, for example, and will then turn me away if my postcode isn't within their catchment area. Equally I've been to pharmacies near my office when I've been approaching the end of the recommended window for the emergency contraceptive and they've given me the free pill despite me living elsewhere.
When you did attend an appointment, did you get all the information and advice you needed?
Yes to be fair, never had a huge problem with information but I find it's not always offered, I tend to have to ask a lot of questions – especially when I'm handed a new brand (being switched from Microgynon to Rigevidon to something else, for example) and not being told why.
Rachael is 22 and lives in Scotland.
Tell us about your experiences with sexual health services.
The first time I got contraception was in Aberdeen. I made a GP appointment and got an appointment with the nurse in their clinic for an implant, it was very good service fast. When I went to get my implant out in the Renfrewshire area in Scotland I went to my GP in Renfrewshire who directed me to the sexual health clinic Sandyford in Paisley to book an appointment myself.
Were you able to go there?
Sandyford is awful! Their number is almost impossible to find, I waited on the phone for about half an hour. I booked in to have my implant removed and to have a contraceptive injection in its place while I decided what I wanted.
What was the appointment like?
The nurse had an assistant who took ages to get my implant out and has left a scar on my arm. I said to the nurse I wanted the pill and she refused, same when I expressed interest in the coil, just outright refusal. She also refused to give me my injection because "the clinic closes early on a Tuesday" and handed me about five condoms and told me to make another appointment. She told me to go to the reception to make one.
The nurse refused to give me my injection because 'the clinic closes early on a Tuesday' and handed me about five condoms and told me to make another appointment.
Did you get one?
When I got out there the reception was boarded up and closed. And then I couldn't get access back in and had to leave. I was really upset and angry. I know in the UK we have the NHS and I'm so thankful for free contraception, but I didn't have a lot of money at the time and she gave me the thinnest condoms ever, which broke. So I had to go out and buy my own and didn't have the reassurance of other contraception. I've ended up going to see my GP instead.