BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION THE CASE FOR CHANGE
Government analysis of the return of investment of contraception found that it could lead to savings of £32 over a 10 year period for the system as a whole, for every additional £1 invested. 39
“Contraception also has an important wider role in women’s lives – for example, managing symptoms of menstrual problems, gynaecological conditions and perimenopause. Through management of gynaecological conditions, contraception also supports women and girls to reach their full potential in education or the workplace.” 42 The better management of such conditions through PPC would undoubtedly help ease pressure on other primary and community services in the health service. This is particularly welcome as absenteeism from work due to heavy and painful periods, endometriosis, fibroids and ovarian cysts costs the UK economy nearly £11 billion every year. 43 Improving PPC access may help reduce health-related work absences and deliver savings in both healthcare costs and lost productivity. Improved PPC Provision Can Empower Women and Improve Their Health Literacy: Contributors were in consensus that in addition to reducing pressure on other healthcare services across contraception, sexual health and women’s health, PPC educates and empowers women and their partners to make informed decisions about their families – improving health literacy and maternal and child health outcomes: “Better public awareness of these issues would also help women make an informed choice as to when to have their next pregnancy and whether to access immediate post-natal contraception.” Dr Georgina Forbes, Specialist Doctor in SRH and the CoSRH Wales Committee Chair PPC is a Global Maternal Health Priority: This domestic progress echoes a growing global consensus from countries such as Australia and the US that PPC is not only a matter of women’s autonomy but a key strategic tool to address reproductive health inequalities. The UK has an opportunity to become a world leader in providing PPC, tackling reproductive health inequalities while also bringing financial savings to the NHS.
In relation to post-pregnancy contraception in particular, the cost savings are stark: “Over 10 years, based on an estimated 64% uptake of postnatal contraception on maternity wards, total cost savings to the NHS and wider system would amount to £150 million, comprising £59 million for the NHS, £9 million for local authorities, and £82 million for other government departments.” 40 These estimated savings compare highly favourably with other public health interventions such as childhood vaccinations or HIV Prevention (PrEP) which have been implemented. 41 This is critically important in the current financial context and the significant reductions facing Integrated Care Board (ICB) budgets. Importantly, in areas such as York and North Yorkshire, contributors for this report set out how improving PPC provision allowed them to optimise efficiency of their resources, and become more operationally cost-effective: “Allowing new mums the access to a safe and inexpensive contraception in their own home at a time when they were juggling a new baby [..] the POP [progestogen-only pill] six-month supply cost was £2.62 this is a cost-effective bridging method which allowed women an opportunity to consider their next contraception plan without having to rush a decision.” York and North Yorkshire PPC service Many contributors noted how providing contraception at this point, when women are already in contact with the health system, is resource efficient and eases pressure on other services in primary or community care where women would have had to make additional appointments to access contraception – which then become avoidable and unnecessary. It is crucial to note that PPC also provides valuable non- contraceptive uses to many women. For example, it can support the management of menstrual disorders or heavy menstrual bleeding, as acknowledged in the Women’s Health Strategy:
39 Public Health England. PHE Women’s Reproductive Health Programme 2020 to 2021. Cost effectiveness analysis has also demonstrated that immediate contraception provision at the time of a medical abortion is more cost-effective than delayed provision. 40 Public Health England, Extending Public Health England’s contraception return on investment tool, maternity and primary care settings. 41 Ong KJ, Desai S, Field N, Desai M, Nardone A, van Hoek AJ, Gill ON. Economic evaluation
of HIV pre-exposure prophylaxis among men-who-have-sex-with-men in England in 2016. Euro Surveill. 2017 Oct;22(42):17-00192. 42 Government UK. Women’s health strategy for England: Fertility, pregnancy, pregnancy loss, and postnatal support. 43 NHS Confederation. Women’s health economics, 2024.
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