BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
A separate and persistent challenge lies in the inconsistent commissioning of newer or higher-cost contraceptive methods. This contributes to geographic variation in access and restricts women’s ability to choose the method that best suits their needs. Without consistent funding, these inequities will continue. Service delivery pressures are particularly acute in the independent sector, where high-volume contracts often leave little capacity for extended counselling, provider training, or LARC skills development. Establishing dedicated post-abortion contraceptive clinics is also difficult due to workforce and cost constraints, limiting options for women who prefer to receive contraception separately from their abortion appointment. Training pathways present another layer of complexity. Current CoSRH training for intrauterine contraception is not well aligned with the needs and competencies of the abortion care workforce, particularly in the independent sector. Most abortion care is now delivered by nurses and midwives, many of whom are not independent prescribers. While national PGD templates support nurse-led provision, each ICB must authorise them individually, often requesting local modifications that create delays and variability across regions. Where prescribing falls to doctors, logistical issues, such as delays in obtaining pre-packed or appropriately labelled contraceptives, can further impede timely provision. Additionally, there appears to be a growing interest among abortion-seeking women and the wider population in fertility awareness-based methods (FABMs). Delivering FABMs well requires additional training, clinical time, and follow-up, which is not accounted for in current commissioning or service delivery models. There is also a need to improve access to sterilisation - both female and male – for individuals seeking abortion because their families are complete, or they do not ever wish to have children. The process for accessing sterilisation is often protracted, and
abortion policy documents rarely address vasectomy, despite its relevance to shared contraceptive responsibility.
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