One-stop shops should open in the high street, where women can go to get contraception, screening services, menopause advice and help with other health needs, while the morning-after pill should be sold off the shelf without consultation, say leading UK experts.
The Royal College of Obstetricians and Gynaecologists, which has been working on a blueprint for women’s health services for more than a year in conjunction with other groups and government, says services for women need to be completely overhauled to give them far more control over their health.
Its report launched today in the House of Commons, called Better for Women, says women with busy lives struggle to get the healthcare and advice they need. It sets out a strategy for reshaping the present fragmented NHS systems that require women to see different nurses and doctors in a variety of specialised clinics, as well as their GP practice, for procedures that should be routine.
A survey of 3,000 women shows that large numbers find it hard to get advice and care near home. More than a third (37%) said they could not get contraception services locally and 60% could not easily access unplanned pregnancy services, including abortion care.
The all-time high level of abortions is connected to the unmet contraceptive needs of women, says the report. In 2018, there were 200,608 abortions across England and Wales – an increase of 4% on the previous year.
Over a third (34%) of women did not attend their last cervical cancer smear test, the survey shows. Only half had locally available sexually transmitted infection services, 56% struggled to get help for painful periods and 58% could not get menopause services locally.
It’s not just special pleading for women, said Lesley Regan, president of the college. Many are carers and mothers and they influence the healthcare behaviours of everyone else. “If you get it right for women, you get it right for lots of other people,” she said.
Many of the services women need are preventive, such as cancer screening and contraception. Many are paid for from the public health budget, through local authorities, and have been cut because of the 40% reduction in that budget, said Regan.
“Women are falling through the cracks of very basic services that should be very easy to prevent or access,” she said. “This is not rocket science. We are not suggesting an expensive new solution. We’re just saying we need to think about women across their life course because so many of the things that affect women, for which they need the NHS, are predictable.
“We’re not delivering what women need where they need it,” she said. A smear test, contraception and an STI check could all be done by the same person in 15 minutes, she said. “But at the moment, girls and women are being pushed around from pillar to post because a nurse or the health practitioner or the GP that they visit hasn’t got the commission to actually do the other things as well.”
Some 45% of pregnancies are now unplanned, she said. “What we do know is that when they’re not planned, they have much more complex outcomes often, and that means they are more expensive to deliver, and we see the abortion rate is not going up in girls – the teenage-pregnancy strategy has worked very well – it’s in the 40-year-olds who can’t access contraception.”
Women should not have to go back to the GP for a new prescription for the pill every three months when it has been heavily researched for the last 60 years. “It’s far more dangerous to get pregnant than it is to be on the pill,” she said. Girls and women should be able to get the very safe progestogen-only pill from a pharmacist or online, the report says. The morning-after pill should be sold straight off the shelf without the need to speak to a doctor or pharmacist.
The report says all young people should be educated from an early age about women’s health, and health issues such as the support during menopause should be embedded in workplace policies.
The college says the changes would save money by enabling women to stay in better health. Sexual health experts from the faculty of sexual and reproductive healthcare and the Royal College of Midwives (RCM) voiced support.
Gill Walton, chief executive of the RCM, backed its findings, including those on abortion, which she said should be regarded as just another medical procedure. “This is an important report that puts women at the centre of health improvement that needs governments and those running our health services to take notice. Our whole health service needs to focus much more on prevention of ill health, and to invest in our health and social services to support that,” she said.
