BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
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receiving LARC in these facilities have reduced from its peak in 2019, prior to the COVID-19 pandemic (figure 2). Most of the abortion care in Wales is provided by local health boards. Data published found that there has been a 39% increase in abortion rates in Wales between 2016 and 2022, with the majority being delivered through early medical abortion. 132 Emergency Contraception is free of charge to women and girls over 13 years of age and has been available through pharmacists in Wales since 2011. On average there are 3000 emergency contraception consultations each month taking place in community pharmacies, with more than 90% taking place within 72 hours of unprotected sex. In April 2023 a new, expanded national Pharmacy Contraception Service was launched that allows all pharmacists in Wales to provide the Progestogen–only Pill immediately after emergency contraception. Access to contraception in the postnatal period is an important part of postnatal health and wellbeing. The need for timely engagement on PPC needs has been further emphasised in Maternity Care in Wales; A Five-Year Vision for the Future (2019-2024) which commits to providing both pre pregnancy counselling and postnatal contraception advice and administration. 133 Collecting data on this, however, is more challenging, as local health boards collect and record information in different ways currently. An action from the NHS Wales Women’s Health Plan is to create a national database of key measurables on women’s health, and provision of contraception including PPC. Efforts to improve access to education and training are also vitally important, with plans to review workforce capacity and competencies to ensure there are enough appropriately trained staff to deliver LARC across primary care, within specialist abortion services and in obstetrics and gynaecology departments. Plans are also being discussed for a ‘Once for Wales’ approach to training in postnatal contraception and how this might be delivered. This is a strategy focused on standardisation, coordination and shared learning across different areas of the health system. Summary Women’s health extends beyond clinical services, encompassing health promotion, prevention, research, and data-driven decision-making. There needs to be a whole system approach to creating a ‘left shift’, driving care back into the heart of our communities with a prevention-based focus. Contraception is one aspect of this. By benchmarking
offer emergency contraception, free of charge to all women in Wales, at any age with
bridging of contraception initiated at the same time • Continue to offer LARC for any indication by trained HCP in suitable facilities to support access close to home • Ensure a skilled workforce, competent to deliver contraception from community to secondary care • Develop research in contraception provision that makes a difference to women’s health • Collaborate across organisations and networks to create services which
are fully informed about the inequalities in women’s health in Wales and are invested in bringing change
against the Women’s Health Plan, Wales has an opportunity to reevaluate what we have, what is working well, where change is needed and where investment should be focused. The NHS in Wales will: • Provide a ‘Once for Wales’ approach that will ensure all women in Wales can access the contraception, they choose at the time that suits them
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