CONTRACEPTION
AND
SEXUAL HEALTH UPDATE
DR DEBBIE WISBY
NOVEMBER 6TH 2015
Background
• Registered Nurse and Midwife.
• Sexual Health Nurse / Practice Nurse
• Worked in academia since 1998.
• Principal Lecturer Midwifery, Neonatal and
Sexual Health / Lead Midwife for Education.
Hot Topics
Learning Outcomes
• Impact of change on sexual health service
modernisation.
• To update knowledge on contraceptive
methods /STI’s.
• Application to the latest statistics and
evidence based guidelines.
Sexual Health Modernisation
• National Strategy Sexual
Health and HIV (DH, 2001).
• A Framework for Sexual
Health Improvement in
England (DH, 2013)
• Public Health Outcomes
Framework (DH, 2013)
• Commissioning and new
ways of working.
• Service and role re-design as
part of structural reform.
Public Health Outcome Framework
Indicators S&RH
• Under 18 conceptions (Health
Improvement)
• Chlamydia Diagnoses 15-24 years old
(Health Protection)
• People presenting with HIV at a late stage
of infection (Health Protection)
• Population vaccine coverage – HPV
(Health Protection)
Perfect Storm
• Proposed £200 million
cuts to public health
budget announced by the
Treasury.
• Large cuts in SRH
services.
• Pressure on services
• Unacceptable delays
• Unsustainable pressure
on primary care.
Contraceptive Care
FSRH: 2015
• Contraceptive care has been calculated to
be one of the most cost effective
healthcare investments.
• For every £1 spent on SRH care saves
£11.
• Choice and access in contraception is at
the heart of women’s health and plays a
vital role in avoiding unplanned pregnancy.
State Of Maternity Services Report:
RCM: 2015
State Of Maternity Services Report:
RCM 2015
Contraceptive Methods
FPA: 2015
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No User Failure
Contraception
Injection
Implant
Intrauterine System
(IUS)
Intrauterine Device
(IUD)
Female sterilisation
Male Sterilisation
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User Failure
Contraceptive Vaginal Ring
Contraceptive Patch
Combined Oral
Contraceptive Pill (COC)
Progestogen-only Pill
(POP)
Male/Female condom
Diaphragm/Cap
Natural Family Planning
LARC: NICE (2005)
“LARC is defined as contraceptive methods
that require administration less than once
per cycle per month”.
• Copper intrauterine devices
• Progestogen-only intrauterine systems
• Progestogen-only injectable
contraceptives
• Progestogen-only subdermal implants
NHS Contraceptive Services:
2013/2014
• Oral contraceptives – most common form of
contraception for 47% women in all age groups.
• Male condom, 2nd most commonest method 18.2%
• The use of LARC methods have slowly increased
and account for 31% of all women, compared to
18% in 2003/4.
• Implant most common LARC method – 12.9% of
all methods.
• IU Devices – 9% over 35 years
• IU Systems – 17.5%
FSRH (CEU) Latest Guidance
• POP – March 2015
• IU Contraception- April
2015, updated June 2015.
• Fertility Awareness – June
2015
• Progestogen Only
Injectable ContraceptionDecember 2014, updated
June 2015
• Problematic Bleeding with
hormonal contraception July 2015.
• www.fsrh.org/
Sayana Press- Licence for
Self Adminstration (FSRH:2015)
• LARC contraceptive
depot injection (99%
effective)
• Available in UK since
2013.
• Subcutaneous
administration
• Administered every 13
weeks into upper anterior
thigh or anterior
abdomen.
• Licence extended to self
administration at home.
Sayana Press
• Training in the technique and
women must be supervised by
appropriately trained HCP
administering first dose.
• The study sites gave up to 3
injections to take home with a
review at one year.
• Need easy access to HCP if
problems arise.
• Written information given
• Pfizer offer a text service for
reminders when injection is
due.
• Systems in place for the
provision and disposal of
sharps.
www.sayanaanswers.co.uk
Ella One- Quick Starting
FSRH: 2015
• New data on quick starting
hormonal contraception after use
of ellaone (EC).
• Ulipristral acetate 30mg (UPA)
• A selective progesteronereceptor modulator.
• Effectiveness of progesteronecontaining contraceptive method
that is quick started might be
reduced due to competition at
the progesterone receptor site.
FSRH Statement
September 2015
Abortion Statistics
England and Wales: 2014
• Total number of abortions was 184,571
• 0.4% less than in 2013.
• Abortion rate was highest for women age
22.
• 98% of abortions were funded by NHS
• 67% took place in the independent sector
under NHS Contract, up from 64% in
2013.
• 92% carried out under 13 weeks gestation.
Abortion Statistics
England and Wales: 2014
• Medical abortions accounted for 51% of
the total.
• First year, there has been more medical
than surgical procedures.
• 3,099 abortions (2%) carried out under
ground E (risk that child could be born
handicapped).
• 37% of abortions in 2014 were to women
who had already had one or more
abortions.
STI Statistics
STI’s and Chlamydia
Screening in England : 2014
• In 2014, 440,000 diagnoses of STI’s made in England.
• Greatest impact in young heterosexuals under age 25 and
MSM.
• Most common STI was chlamydia (206,774 diagnoses in
2014).
• Largest proportional increase was reported for syphilis
(33%) and gonorrhoea (19%)
• MSM- 46% increase in syphilis, 32% gonorrhoea.
• High levels of condomless sex probably account for most of
the rise, although better detection of gonorrhoea may have
contributed.
HIV Statistics
HIV New Diagnoses, Treatment and Care
in the UK: 2015 Report (October)
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A total of 6,151 people were newly diagnosed with HIV during 2014.
85,489 people seen for HIV care by the end of 2014.
1:6 now aged over 55
MSM- new diagnosis HIV positive - 3,360 in 2014
Decline in HIV diagnoses through heterosexual sex, largely due to a
reduction in diagnoses among black African men and women.
Major challenge in the UK is timely diagnosis in order to start lifesaving
ART and prevent onward transmission of infection.
2 out of 5 in 2014, newly diagnosed with ‘late stage’ HIV.
Late diagnosis is associated with a tenfold increased risk of death with
one year of diagnosis.
In 2014, 613 people with HIV died, most were late diagnosis.
Urgent need to increase HIV testing opportunities in line with HIV testing
guidelines (2008)
http://www.bhiva.org/documents/guidelines/testing/glineshivtest08.pdf
Conclusion
Thank You For Listening
References
DH (2001) Better Prevention, Better Services, Better Sexual
Health, The National Strategy For Sexual Health & HIV, July
1st. London, HMSO.
DH (2013) A Framework For Sexual Health Improvement in
England, March, London.
DH (2013) Improving outcomes and supporting
transparency: Part1A: a public health outcomes framework
for England, 2013-2016.
DH (2014) Abortion Statistics, England and Wales:2014
www.dh.gov.uk June 2015
Health and Social Care Information Centre (2014) NHS
Contraceptive Services, Community Contraceptive Clinics,
Statistics for 2013/2014, October 30th 2014.
References
FSRH (2015) CEU Statement on Self-Administration of
Sayana Press, www.fsrh.org/ September.
FSRH (2015) CEU Statement on Quickstarting and ellaone,
www.fsrh.org/ September.
FSRH (2015) Statements on cuts to Sexual & Reproductive
Health Services, www.fsrh.org/ October.
RCM (2015) A State of Maternity Services Report, London,
RCM.
PHE(2015) Health Protection Report,Vol.9, No.22. June
23rd.
PHE(2015) HIV New Diagnoses, Treatment and Care in
the UK, 2015 Report, October.