BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
Dr Sue Mann, National Clinical Director in Women’s Health for NHS England Foreword England and a Consultant in Women’s Health I know how valuable access to post-pregnancy contraception (PPC) is for women. Most women who have recently experienced pregnancy do not wish to become pregnant again straight away, whether in maternity, early pregnancy or abortion settings. However, we know that a woman’s fertility returns within 21 days of birth and that almost half of women resume sexual activity within 8 weeks of birth. Furthermore, a study conducted in Scotland found almost 1 in 13 women presenting for an abortion or delivery had conceived within 1 year of a previous birth. This evidence, and this report, demonstrates a clear need for access to contraception in the post-pregnancy period, to facilitate choice and enable women to plan or prevent any further pregnancies as they wish. As women are already in frequent contact with the health system during pregnancy, there are several opportunities to have discussions with known, and often familiar, healthcare professionals about their options. This allows women to choose the contraception that’s right for them, at a time and place that suits them best after pregnancy. Crucially, PPC is also an effective public-health intervention – it takes an upstream approach to prevention and looks to avoid the harms which can come from an unintended or unwanted pregnancy. It reaches women who may typically struggle to engage with services outside of the pregnancy journey and therefore has the potential to greatly reduce reproductive health inequalities in a local area.
Dr Sue Mann FFPHM MRCOG MFSRH is the National Clinical Director in Women’s Health for NHS England. She has previously held national roles at Public Health England and Department of Health and Social Care and in all these roles she has consistently driven a population, integrated and outcome-based approach to delivery of women’s healthcare across the system. She currently leads a programme of work at NHS England to tackle
Gynaecology elective waiting lists through both improving efficiencies but also challenging current models of care to drive transformation. She is passionate about improving experience for women in healthcare and committed, following her appearance at the Women and Equalities Select Committee, to making this a priority for NHS England. She has also led the development of a Women’s Health Equity Framework to drive a reduction of inequalities in care received for menopause and heavy menstrual bleeding. She is a clinical Consultant in Women’s Health and Clinical Lead for Women’s Health in City and Hackney where she leads a specialist neighbourhood service for delivery of women’s healthcare. As part of this service she has pioneered the delivery of group consultations for delivering women’s healthcare particularly in menopause and seen more than 3,000 women in this way over the last 5 years. Working national to local, secondary to primary and integrating across specialties has enabled an integrated vision of how women’s healthcare in the future can be delivered. Alongside these significant benefits to the woman, there is compelling evidence which demonstrates PPC as a highly cost- effective intervention for the NHS and wider society. PPC has a return on investment of £32 to the public sector for every £1 invested. This is significant at a time of financial restraint in the NHS. Local authorities would also save costs on public health expenditure by avoiding unintended pregnancies and reduced costs of children in care. The savings are greatest for other wider government departments who do not invest in contraception directly but will make savings for example in education and welfare. This is why I welcome this report and applaud the best practice outlined within it – from South Tees, Bristol, London, and Derby – demonstrating how important this service is to women and the empowering impact it can have on their life. I want to sincerely thank all who continue to work hard to deliver PPC services for women across England and very much look forward to working with them on this crucial aspect of women’s reproductive care.
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